Clinical Assessment of Nutritional Status

Abstract

Nutritional assessment is an integral part of patient care since nutritional status affects a patient’s response to illness. Attention to nutritional status is especially important in pediatric patients as they are also undergoing the complex processes of growth and development, which are infl uenced by the genetic makeup of the individual and coexisting medical illness in addition to nutritional status. Thus, the assessment of nutritional and growth status is an essential part of clinical evaluation and care in the pediatric setting. The assessment should allow for the early detection of both nutrient deficiencies and excesses. There is no single nutrition measurement that is best; therefore, a combination of different measures is required. Growth is an important indicator of health and nutritional status of a child, and a variety of growth charts are currently available to help with the assessment of growth. These include the 2000 Centers for Disease Control and Prevention (CDC) growth charts that represent the US population and the 2006 World Health Organization (WHO) growth charts. Each growth measurement performed needs to be accurate and obtained at regular intervals. These longitudinal data will help identify at-risk patients and will allow the monitoring of a patient’s clinical response to nutritional therapy. During infancy, childhood, and adolescence, many changes in growth and body composition occur. Therefore, clinicians must understand normal growth to recognize abnormal patterns. Clinicians also need to recognize the nutritional changes that occur with acute and chronic disease. With the epidemic of pediatric obesity, the proper identifi cation of the overweight or obese patient is also important. A brief nutritional screening assessment may be used to identify patients in need of an in-depth assessment. A typical nutritional screening includes a brief medical and dietary history (including feeding ability), anthropometric measurements (eg, weight, stature), and possibly laboratory data. A full nutritional assessment includes more detailed medical and dietary histories (including a measure of dietary intake), a complete physical examination, further anthropometric and body composition measurements, sexual and skeletal maturation, laboratory data, and the estimation of nutritional requirements. A clinician’s global assessment of the child based on these objective data in addition to his or her clinical judgment is also important to consider in determining nutritional status. Most often, health care professionals work as a team in gathering the information for the assessment of nutritional status of children. (see Chapter 18, “Drug Therapy and Role of Nutrition” for details)