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ASSESSMENT OF NUTRITIONAL STATUS
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Information gathering, growth assessment, estimation of needs, determination of risk factors, identification of goals and provide recommendations and education
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Nutrition-focused medical history
✓ Usual intake including types and portion sizes of foods consumed
✓ Fluid intake: Juice, milk, water over 24-hour period
✓ For Breast-fed children, assess minutes on each breast and frequency of feeding
✓ Formula: Type, changes, and response
✓ Oral supplements or tube feedings (delivery method, tolerance, formula, length of time)
✓ Herbal, vitamin, or mineral supplements
✓ Food aversions, allergies, appetite, and religious/ethnic restrictions
✓ Access to food: Food insecurity, Women, Infants and Children (WIC), food stamps
✓ Note specific conditions that may affect absorption, metabolism, and digestion or increase the caloric needs of the patient (fever, increased respiratory rate and effort, cardiac disease, etc.)
✓ Deficiencies from inadequate intake or comorbidities: Vitamin D, iron deficiency anemia, zinc
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Gastrointestinal history including defecation patterns, nausea, vomiting, gastroesophageal reflux treatment, abdominal surgeries
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Medications and potential food/drug interactions:
✓ Note side effects of drugs that may cause electrolyte wasting, change in stool patterns or malabsorption
✓ Note whether the drug’s efficacy is reduced by food or food interferes with absorption or mechanism of action
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Family history: Food allergies/atopic disease, celiac disease, diabetes, obesity, heart disease, stroke
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Birth history: Prematurity, intrauterine growth retardation, small for gestational age, necrotizing enterocolitis
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Laboratory values:
✓ Consider evaluating electrolytes, albumin, prealbumin, CBC, and hepatic function and lipid panels if indicated (e.g., in the setting of emesis, diarrhea, poor growth, obesity, supplemental nutrition or when otherwise warranted based on clinical evaluation)
✓ Deficiencies (if diet history indicates): 25-OH vitamin D, zinc, iron profile
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Growth parameters:
✓ Unintentional weight loss: 5–10% loss is moderate, >10% is severe
✓ Length/height, weight, head circumference (if younger than 3 years) percentiles
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▪ Up to 2 years of age—Use 2006 World Health Organization (WHO) growth chart for weight, supine length, and head circumference
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▪ 2–20 years of age—Plot weight and standing height on the Center for Disease Control (CDC) 2000 growth charts and calculate BMI and plot
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▪ Plot on CDC growth chart or specialty chart (prematurity, disease specific, etc.) until 20 years of age
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▪ Correct for prematurity until 3 years of age
✓ Optional: Obtain triceps skinfold and mid-arm circumference to calculate muscle and fat stores. Measure lower leg length, knee height, or arm span (when unable to obtain accurate height)
✓ Typical growth velocity presented in Table 20-1
✓ Use z score to express individual anthropometrics in relation to population standard (i.e., 25th percentile weight-for-age= z score of 1 indicates that weight-for-age is 1 standard deviation from the mean)
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