ABCD of dietary assessment

When collecting a patient’s health history, it can be crucial to evaluate and document the dietary status. Nutrition is vital to maintaining a healthy weight and stopping conditions equivalent to heart problems and diabetes. Additionally, adequate nutrition is crucial for healing and recovery from illness and injury (Hinkle, 2021). A whole dietary assessment helps clinicians assess overall dietary status and discover malnutrition and its causes. Malnutrition can mean each insufficient and excessive nutrient intake and may be divided into the next categories (Kesari and Noel, 2022):

• Malnutrition (low weight for height, short height for age and low weight for age)
• Deficiency or excess of trace elements (vitamins and minerals).
• Overnutrition (chubby, obesity, type 2 diabetes, circulatory system diseases)

There is a mnemonic you should use to recollect the several elements of a whole nutrition assessment:

Nthropomorphic measurements

Anthropomorphic measurements are characteristics of the human body, including size and shape.

• Height, weight and BMI
• Circumference measurements (upper arm, abdomen and thigh) are indicators of protein stores
• The thickness of the skin fold (biceps, triceps, subscapularis and supralateral) is an indicator of energy (fat) storage.

Iochemical measurements

Diagnostic tests are sometimes performed to envision the patient’s clinical picture.

• Routine laboratory tests equivalent to serum electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose, lipid profile, liver enzymes, complete blood count, and cholesterol can detect malnutrition.
• Proteins equivalent to albumin, prealbumin, transferrin and retinol-binding protein will help assess dietary status but shouldn’t be used alone.
• If deficiencies are suspected, the extent of trace elements of B vitamins (thiamin, riboflavin, niacin, pyridoxine, folic acid, B12), vitamins A, C, D, E and K, iron, zinc, selenium may be determined.

Linear signs

A patient’s dietary status is usually evident in a head-to-toe physical assessment.
Carefully examine the patient for the next physical symptoms that will indicate malnutrition (Chu and Delmore, 2020; Cleveland Clinic, 2022):

• Low body weight, distinguished bones
• Muscular dystrophy
• Poor skin integrity, dry, inelastic skin, rashes and lesions
• Loss of subcutaneous fat tissue
• Low body temperature
• Low heart rate and blood pressure
• Thin legs and arms with swelling of the abdomen and face
• Decreased handgrip strength, weakness, fatigue
• Irritability, apathy or lack of attention
• Poor dental health
• Brittle hair, hair loss or lack of hair color

On the opposite hand, these physical symptoms may indicate overnutrition (Chu and Delmore, 2020; Cleveland Clinic, 2022):

• Obesity
  • Is the fat tissue distributed evenly, concentrated within the upper torso or across the hips?
• High blood pressure
• Insulin resistance and hyperglycemia

ietary

Complete a comprehensive dietary assessment by asking questions that allow the patient to offer subjective answers related to their each day eating habits (Bickley, 2021).

• Have you experienced lack of appetite?
• Can you describe your eating habits?
  • Do you eat fruit and vegetables day by day?
  • What do you eat on a typical day?
• Do you maintain the identical weight or has it fluctuated?
• How do you’re feeling about your current weight?
• Do you prepare meals at home?
  • How many meals do you eat every day and what are your portions?
  • How often do you eat out?
  • Do you follow any restrictive diets (i.e. vegan, vegetarian)?
• Do you exercise and in that case, how often?
• Have you experienced nausea or vomiting?
• Have you noticed any changes in your menstrual cycle?

I hope this easy mnemonic helps you the following time you evaluate a patient. For more resources on physical assessments, click here.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.

Chu, A. S., and Delmore, B. (2020). Nutrition assessment parameters. (5), 232-232.

Cleveland Clinic. (2022, May 4). Malnutrition. https://my.clevelandclinic.org/health/diseases/22987-malnutrition

Hinkle, J. (2021). Brunner and Suddarth’s textbook of medical-surgical nursing (fifteenth edition)^vol ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975161057

Kesari, A., and Noel, J. Y. (2022). Nutritional assessment.. https://www.ncbi.nlm.nih.gov/books/NBK580496/