STUDY - Technical - New Dacian's Medicine
Assessment
of Nutritional Status (1)
Translation Draft
Nutritional deficiency is rarely found among the healthy population living in industrialized
areas. High-quality proteins in the diet and other foods are abundant in these areas, thus eliminating the possibility of the occurrence of kwashirkor (a form of malnutrition caused by protein deficiency in the diet) and marasm.
Improving food preservation, packaging and distribution have reduced seasonal variations in the ingestion of different nutritional factors. Improving the content of foods with essential vitamins and minerals, such as iodine in salt, vitamin D in milk and iron and b complex vitamins in flour, has led to the elimination of some common gaps, such as goiter through iodine deficiency, rickets or folic acid deficiency. However, in the population of industrialised areas, the most common nutritional disorder is obesity.
The success of public health programs in preventing food deficiencies has been given, to some extent, by a routine assessment of the state of nutrition, but nutrition diagnoses rarely appear in tables and in evolutionary data. However, malnutrition has an important contribution to morbidity and mortality. Such deficiencies are rarely attributed to underlying diseases, but in many cases, the compromise of nutrition precedes the development of diseases, contributes to mortality and decreases the ability to recover.
Routine assessment of nutrition status is necessary to identify these situations where nutritional intervention is essential for recovery. Nutritional evaluation is intended to track three aspects of global nutrition - energy, protein and micro-component balance, and has three components: nutrition history, careful physical examination with simple anthropometric measurements and laboratory data.
Let's move on now to a few things about nutrition history! The assessment of nutritional status should be started with a chronological notation of body weight and changes in body weight. Questions about an individual's body weight, especially at key moments in his or her life, such as finishing high school, college or marriage, may make this assessment easier. Significant weight changes should be carefully investigated.
Were the changes in weight followed by changes in physical activity, ingestion or health status? Hip fracture is often preceded by weight loss, while hypertension, hyperlipemia and insulin resistance are often associated with weight gain. It should be noted that changes in weight can sometimes be ambiguous, especially in the presence of edema. Moreover, a person who was initially obese may lose up to 15 kg due to a consuming condition and have a normal body weight, despite decreased body mass. Under these conditions, the estimation of muscle mass should be made by a technique described below.
A healthy person with a varied diet is very unlikely to have deficiencies in the diet, but not all individuals have a varied diet. To assess the nutritional intake of the diet, the patient is asked to write down everything he has eaten in the last 24 hours (morning, noon, evening and between meals), and all this information will be used to determine whether the food consumed is sufficiently varied and appropriate. Does the patient consume, on a typical day, several types of vegetables and fruits, as well as foods containing calcium? Which food is missing? Is the amount of food adequate, neither too high nor too low? Are meals prepared by the patient or someone else? Are there social, medical, dental problems that restrict food choice? For this purpose, the following "formula" for nutrition evaluation can be used...
1. For patients in the ambulatory: a. Energy requirement: Body weight and weight relative to height are indicators of the energy balance. The imbalance between intake and energy consumption causes weight loss or gain. The evolution of body weight is also made in relation to key events in the life of the individual (graduation from high school, college, marriage, marriage, etc.). Are changes in body weight voluntary or involuntary? b. Protein requirement: Most patients provide their protein needs through a combination of foods and not from one. For example, protein accounts for 0.5% of cooked vegetables, 4% of milk, 23% of meat and 10% of uncooked pasta. 40g of protein (sufficient for a person of 50 kg) are contained in any of the following foods: 200 g fish, poultry, red meat; 150g walnuts; 130g peanuts or peanut butter; 200g cheese, 7 eggs or 12 egg whites; 400g cooked rice plus 470g cooked beans; 500g tofu (soy cheese), 1000g milk. The daily protein requirement is 0.8-1g/kg. c. Microelements requirement: The assessment of different types of nutrition can also assess the risk of vitamin deficiency. This assessment is mainly important in patients with a fixed income or in those who live alone. Vitamin A: meat, milk, eggs, vegetables intensely colored in yellow and with green leaves. Thiamine: meat, milk, eggs, enriched flour. Riboflavin: meat, milk, eggs. Niacin: meat, vegetables and cereals rich in starch. Vitamin B: meat, starch-rich vegetables. Vitamin B12: milk, meat, eggs. Folic acid and pantothenic acid: ubicuitari. Vitamin C: vegetables, fruits, milk. Vitamin D: fortified milk, meat. Vitamin E: intensely colored vegetables in yellow with green leaves, meat, eggs, fruits, milk. Iron: meat, spinach, raisins, enriched flour, lentils. Calcium: dairy products.
2. For patients with acute conditions: a. Energy requirement: Acute diseases disrupt the two components of energy balance. The disease decreases appetite and energy intake and increases energy consumption due to fever, infection or trauma or decreases energy consumption by reducing physical activity. b. Protein Requirement: Diseases can increase protein requirement through i. Increased rate of metabolism, ii. Protein loss through the skin (burns, exfoliation), gastrointestinal tract (protein loss enteropathy) or kidney (proteinuria). The daily protein requirement is i. In the case of moderate stress of 1-2 g/kg (infections, fractures, surgery), ii. In a severe stress of 2-2.5 g/kg (burns, multiple fractures). c. Microelements need: acute conditions are self-limiting (the microelements most likely to be affected are B complex vitamins, which have a fast turn-over).
3. For patients with chronic conditions: a. Energy requirement: Chronic diseases require a long-term adaptation of changes in energy balance. The duration of compromised attempts to correct the energy balance can in itself achieve an energy imbalance. b. Protein Requirement: Chronic diseases can increase the protein requirement in the diet. Nephrotic syndrome attracts increased daily protein intake to compensate for protein loss and prevent protein delet. Chronic infections increase protein catabolism for energy production, with protein requirement doubling to maintain the amount of amino acids needed for the synthesis of new proteins. Hyperthyroidism increases the rate of metabolism, leading to a high rate of protein catabolism, for energy production (protein requirement may double). Psoriasis increases protein loss in the skin, with protein requirements increasing in proportion to the losses. c. Microelements need: Chronic conditions may affect the absorption of microelements. Gastric resection: decreases the absorption of calcium and iron if the duodenum is bypass-at.
Proximal resection of the small intestine: decreases the absorption of vitamin B12 and bile salts. Medications can affect the intake of microelements: chloroquine, levadopa, theophylline can decrease appetite, propyltiouracil and rifampicin can alter taste. Hydroxyzine, imipramine increase appetite. Excess ethanol can lead to malabsorption of thiamine, vitamin B12 and folate. Phenytoin, phenobarbital, pyridamine may lower levels of folate, vitamin B6, vitamin B12 and may increase the requirement of vitamin D. Methotrexate lowers folate levels by increasing folate excretion. Antimalariars (primetamin and sulfadiazine) and antibiotics (penicillin, sulfonamide) lower folate levels.
Sodium bicarbonate reduces folate absorption by lowering jejunal pH. Salicilates increase vitamin C and folate excretion and cause iron deficiency if gastrointestinal bleeding occurs. H2 receptor blockers decrease vitamin B12 absorption, probably by decreasing the formation of hydrochloric acid and pepsin. Nonsteroidal anti-inflammatory drugs can cause iron deficiency through gastrointestinal bleeding. Glucocorticoids increase calcium loss in the vessels.
Diseases can act on body weight through several mechanisms, including decreased food intake through anorexia or a situation where energy intake is not high enough in relation to increased needs from fever, infection or trauma. Specifying the diagnosis itself can contribute to weight loss as a result of the dietary test required for various laboratory tests or diagnostic procedures.
Drug therapy can affect taste or reduce appetite, leading to weight loss. Not all conditions cause weight loss (when the main effect on the energy balance consists of a reduction in physical activity, if the energy intake remains unchanged or increases, excess weight may occur). Acute or chronic diseases increase the need for energy, proteins and microelements.
The protein requirement can be triple in severe conditions. Patients whose ingestion is restricted by various factors are at increased risk of nutritional deficiency. When the initial assessment suggests an inadequate diet, a closer assessment of the diet is indicated. In chronic conditions, the duration, severity and manner in which weight gain or loss occurred (constant, progressive worsening, rapidly installed gain or weight loss) may provide a chronological assessment of the evolution of the conditions and the concomitant change in appetite and physical activity. The history of nutrition status should include attempts to improve body weight, as well as an assessment of the causes of the success or failure of these tests.
Right now, I'm going to stop here. Next time I will continue with the presentation of the elements related to the nutritional process.
Nutritional deficiency is rarely found among the healthy population living in industrialized
areas. High-quality proteins in the diet and other foods are abundant in these areas, thus eliminating the possibility of the occurrence of kwashirkor (a form of malnutrition caused by protein deficiency in the diet) and marasm.
Improving food preservation, packaging and distribution have reduced seasonal variations in the ingestion of different nutritional factors. Improving the content of foods with essential vitamins and minerals, such as iodine in salt, vitamin D in milk and iron and b complex vitamins in flour, has led to the elimination of some common gaps, such as goiter through iodine deficiency, rickets or folic acid deficiency. However, in the population of industrialised areas, the most common nutritional disorder is obesity.
The success of public health programs in preventing food deficiencies has been given, to some extent, by a routine assessment of the state of nutrition, but nutrition diagnoses rarely appear in tables and in evolutionary data. However, malnutrition has an important contribution to morbidity and mortality. Such deficiencies are rarely attributed to underlying diseases, but in many cases, the compromise of nutrition precedes the development of diseases, contributes to mortality and decreases the ability to recover.
Routine assessment of nutrition status is necessary to identify these situations where nutritional intervention is essential for recovery. Nutritional evaluation is intended to track three aspects of global nutrition - energy, protein and micro-component balance, and has three components: nutrition history, careful physical examination with simple anthropometric measurements and laboratory data.
Let's move on now to a few things about nutrition history! The assessment of nutritional status should be started with a chronological notation of body weight and changes in body weight. Questions about an individual's body weight, especially at key moments in his or her life, such as finishing high school, college or marriage, may make this assessment easier. Significant weight changes should be carefully investigated.
Were the changes in weight followed by changes in physical activity, ingestion or health status? Hip fracture is often preceded by weight loss, while hypertension, hyperlipemia and insulin resistance are often associated with weight gain. It should be noted that changes in weight can sometimes be ambiguous, especially in the presence of edema. Moreover, a person who was initially obese may lose up to 15 kg due to a consuming condition and have a normal body weight, despite decreased body mass. Under these conditions, the estimation of muscle mass should be made by a technique described below.
A healthy person with a varied diet is very unlikely to have deficiencies in the diet, but not all individuals have a varied diet. To assess the nutritional intake of the diet, the patient is asked to write down everything he has eaten in the last 24 hours (morning, noon, evening and between meals), and all this information will be used to determine whether the food consumed is sufficiently varied and appropriate. Does the patient consume, on a typical day, several types of vegetables and fruits, as well as foods containing calcium? Which food is missing? Is the amount of food adequate, neither too high nor too low? Are meals prepared by the patient or someone else? Are there social, medical, dental problems that restrict food choice? For this purpose, the following "formula" for nutrition evaluation can be used...
1. For patients in the ambulatory: a. Energy requirement: Body weight and weight relative to height are indicators of the energy balance. The imbalance between intake and energy consumption causes weight loss or gain. The evolution of body weight is also made in relation to key events in the life of the individual (graduation from high school, college, marriage, marriage, etc.). Are changes in body weight voluntary or involuntary? b. Protein requirement: Most patients provide their protein needs through a combination of foods and not from one. For example, protein accounts for 0.5% of cooked vegetables, 4% of milk, 23% of meat and 10% of uncooked pasta. 40g of protein (sufficient for a person of 50 kg) are contained in any of the following foods: 200 g fish, poultry, red meat; 150g walnuts; 130g peanuts or peanut butter; 200g cheese, 7 eggs or 12 egg whites; 400g cooked rice plus 470g cooked beans; 500g tofu (soy cheese), 1000g milk. The daily protein requirement is 0.8-1g/kg. c. Microelements requirement: The assessment of different types of nutrition can also assess the risk of vitamin deficiency. This assessment is mainly important in patients with a fixed income or in those who live alone. Vitamin A: meat, milk, eggs, vegetables intensely colored in yellow and with green leaves. Thiamine: meat, milk, eggs, enriched flour. Riboflavin: meat, milk, eggs. Niacin: meat, vegetables and cereals rich in starch. Vitamin B: meat, starch-rich vegetables. Vitamin B12: milk, meat, eggs. Folic acid and pantothenic acid: ubicuitari. Vitamin C: vegetables, fruits, milk. Vitamin D: fortified milk, meat. Vitamin E: intensely colored vegetables in yellow with green leaves, meat, eggs, fruits, milk. Iron: meat, spinach, raisins, enriched flour, lentils. Calcium: dairy products.
2. For patients with acute conditions: a. Energy requirement: Acute diseases disrupt the two components of energy balance. The disease decreases appetite and energy intake and increases energy consumption due to fever, infection or trauma or decreases energy consumption by reducing physical activity. b. Protein Requirement: Diseases can increase protein requirement through i. Increased rate of metabolism, ii. Protein loss through the skin (burns, exfoliation), gastrointestinal tract (protein loss enteropathy) or kidney (proteinuria). The daily protein requirement is i. In the case of moderate stress of 1-2 g/kg (infections, fractures, surgery), ii. In a severe stress of 2-2.5 g/kg (burns, multiple fractures). c. Microelements need: acute conditions are self-limiting (the microelements most likely to be affected are B complex vitamins, which have a fast turn-over).
3. For patients with chronic conditions: a. Energy requirement: Chronic diseases require a long-term adaptation of changes in energy balance. The duration of compromised attempts to correct the energy balance can in itself achieve an energy imbalance. b. Protein Requirement: Chronic diseases can increase the protein requirement in the diet. Nephrotic syndrome attracts increased daily protein intake to compensate for protein loss and prevent protein delet. Chronic infections increase protein catabolism for energy production, with protein requirement doubling to maintain the amount of amino acids needed for the synthesis of new proteins. Hyperthyroidism increases the rate of metabolism, leading to a high rate of protein catabolism, for energy production (protein requirement may double). Psoriasis increases protein loss in the skin, with protein requirements increasing in proportion to the losses. c. Microelements need: Chronic conditions may affect the absorption of microelements. Gastric resection: decreases the absorption of calcium and iron if the duodenum is bypass-at.
Proximal resection of the small intestine: decreases the absorption of vitamin B12 and bile salts. Medications can affect the intake of microelements: chloroquine, levadopa, theophylline can decrease appetite, propyltiouracil and rifampicin can alter taste. Hydroxyzine, imipramine increase appetite. Excess ethanol can lead to malabsorption of thiamine, vitamin B12 and folate. Phenytoin, phenobarbital, pyridamine may lower levels of folate, vitamin B6, vitamin B12 and may increase the requirement of vitamin D. Methotrexate lowers folate levels by increasing folate excretion. Antimalariars (primetamin and sulfadiazine) and antibiotics (penicillin, sulfonamide) lower folate levels.
Sodium bicarbonate reduces folate absorption by lowering jejunal pH. Salicilates increase vitamin C and folate excretion and cause iron deficiency if gastrointestinal bleeding occurs. H2 receptor blockers decrease vitamin B12 absorption, probably by decreasing the formation of hydrochloric acid and pepsin. Nonsteroidal anti-inflammatory drugs can cause iron deficiency through gastrointestinal bleeding. Glucocorticoids increase calcium loss in the vessels.
Diseases can act on body weight through several mechanisms, including decreased food intake through anorexia or a situation where energy intake is not high enough in relation to increased needs from fever, infection or trauma. Specifying the diagnosis itself can contribute to weight loss as a result of the dietary test required for various laboratory tests or diagnostic procedures.
Drug therapy can affect taste or reduce appetite, leading to weight loss. Not all conditions cause weight loss (when the main effect on the energy balance consists of a reduction in physical activity, if the energy intake remains unchanged or increases, excess weight may occur). Acute or chronic diseases increase the need for energy, proteins and microelements.
The protein requirement can be triple in severe conditions. Patients whose ingestion is restricted by various factors are at increased risk of nutritional deficiency. When the initial assessment suggests an inadequate diet, a closer assessment of the diet is indicated. In chronic conditions, the duration, severity and manner in which weight gain or loss occurred (constant, progressive worsening, rapidly installed gain or weight loss) may provide a chronological assessment of the evolution of the conditions and the concomitant change in appetite and physical activity. The history of nutrition status should include attempts to improve body weight, as well as an assessment of the causes of the success or failure of these tests.
Right now, I'm going to stop here. Next time I will continue with the presentation of the elements related to the nutritional process.
Have understanding, love
and gratitude!
Dorin, Merticaru