This chapter focuses on the whole area of nutritional assessment and may involve a wide spectrum of testing to determine the health of an individual. This process typically entails in-depth evaluation of both subjective data and objective evaluations of an individual’s food and associated nutrient intake, components of lifestyle, and medical history. It is essentially an overview of nutritional status focusing on nutrient intake analysis of diet, blood tests, and physical examination.
PRINCIPLES OF NUTRITIONAL ASSESSMENT
There are a number of instruments and questionnaires that can help to identify potential areas of concern regarding caloric intake and perhaps a lack of essential nutrients for health. Currently there are very extensive validated diet history questionnaires available from the National Cancer Institute, but they are long and burdensome. Shorter dietary questionnaires focused on targeted intakes (fruits, vegetables, dietary fats) are less burdensome.
Body Composition Analyses
Dual X-ray absorptiometry (DXA) has replaced underwater weighing as the gold standard for determining body fat and lean body mass. DXA’s advantages are that it is safe, easy to use, and very accurate with the use of appropriate standards. The disadvantages are the generally high cost and the need for regular cross-standardization of the instrument, as well as the weight limits of the table.
Elderly individuals often have poor dietary intakes; major causes include inadequate finances, ill-fitting dental appliances, or the inability or lack of desire to prepare healthful foods and a loss of sense of smell, which makes food seem tasteless. Older people often find that their tastes have changed, and sweet, easy-to-eat foods rich in refined carbohydrates (breads, cereals, sweet rolls) are favored over more healthful items.
The physician plays a crucial role in assessing the nutritional status of the patient. Using the instruments available to evaluate dietary intake along with appropriate biological testing and physical evaluation, the physician will receive insight to assess the diet and environmental factors that weigh in on the health status of the patient. The evaluation of weight status is, by far, the most pressing of diagnoses to aid in the prevention of obesity
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