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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. Nutritional assessment in hospitalized patients. M. Safarian, MD PhD. Nutrition Care Process Steps. Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and Evaluation. Nutritional Assessment. Anthropometric assessment

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم

  2. Nutritional assessment in hospitalized patients M. Safarian, MD PhD.

  3. Nutrition Care Process Steps • Nutrition Assessment • Nutrition Diagnosis • Nutrition Intervention • Nutrition Monitoring and Evaluation

  4. Nutritional Assessment • Anthropometric assessment • Clinical evaluation • Biochemical, laboratory assessment • Dietary evaluation

  5. ESPEN guidelines Questions to be answered: • What is the condition now? • Is the condition stable? • Will the condition get worse? • Will the disease process accelerate nutritional deterioration?

  6. Anthropometric methods in ICU • Weight • Height estimation • Mid-arm circumference • Skin fold thickness • Head circumference

  7. Weight

  8. Ideal Body Weight (kg) • Men=48+ 2.3 for each inch over 152 m • Women=45.3+2.3 for each inch over 152 cm • Correction for skeletal size:

  9. Ideal Body Weight (kg) • Add 10% if SS is large • Subtract 10% if SS is small

  10. Adjusted body weight • Used when actual body weight is more than 120% of IBW: • ABW=IBW+ 25% of (actual body weight - IBW)

  11. Height in ICU patients

  12. Alternative measurementsEstimating Height from ulna length

  13. Estimations of height

  14. Body composition (BIA) Very popular Safe Noninvasive Portable Rapid

  15. Skin Fold Thickness • Represent an estimation of body fat percent • Best sites for measurement: • Triceps • Biceps • Sub scapular • Super iliac

  16. Practical problems: calliper measurements will be inaccurate, misleading and unreliable in many instances: Personal errors Practical problems Between individual variation population specific’ Low sensitivity Skin Fold Thickness

  17. Skin Fold Thickness

  18. Mid arm circumference • measured with a nonstretch measuring tape • midway between the acromion and olecranon of the nondominant arm • ≤ 15 cm: severe depletion of muscle mass • 16–19 cm: moderate depletion • 20–22 cm: mild depletion

  19. Mid arm circumference

  20. BMI estimation If MUAC is <23.5 cm, BMI is likely to be <20 kg/m2 If MUAC is >32.0 cm, BMI is likely to be >30 kg/m2

  21. Clinical assessment

  22. General: muscle wasting

  23. Wasting in the hands 32

  24. Wasting Clavicle 33

  25. The Legs showing muscle wasting 34

  26. Quadriceps and Knees 35

  27. Flaky paint dermatosis: protein deficiency

  28. Essential fatty acid deficiency syndromes (EFADs)

  29. Zinc deficiency

  30. Zinc deficiency

  31. Vitamin C deficiency Perifolicullar pitichea

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