PENILAIAN STATUS GIZI(NUTRITIONAL ASSESSMENT)OlehAstri Areka Dewi, S.Gz

Nutritional Assessment DefinitionNutritional StatusThe health status of individuals or population as influence by their intake and utilization of nutrientsCan change throughout the life cycle as it reflects the situation at a certain time pointAssessmentA process of gathering, analyzing and interpreting information

NUTRITIONAL ASSESSMENT

StudiesAssessment = aprocess of gathering, analyzing and interpreting informationUsed to determine nutritional status of individual or populationAntrophometriy

Biochemical

Clinical

Dietary

Why is Nutritional Assessment Important?As tool used :To identify persons at nutritional riskTo determine type of intervention to alter nutritional statusTo monitor affect of nutrition intervention

Methode of nutritional AssessmentDirect Methods :AnthropometryBiochemical (Laboratory)Clinical assessmentDietary assessmentIndirect Methods :Health and vital statisticAssessment of ecological factors

Methods of nutritional AssessmentANTHROPOMETRYMeasurement of physical dimensions and gross composition of the bodye.g height, weight, head circumference skinold thickness

BIOCHEMICALMeasurement of a nutrient or its metabolite in blood, eces,urine and other tissuese.g : hemoglobin level, cholesterol level

Methods of nutritional AssessmentCLINICALInclude physical examination and/or medical history to detect signs and symptoms of malnutritionSYMPTOMS : disease manifestation patiensare aware of and complain about (e.g : fatigue iron deficiency)SIGN : observation made qualified examiner during physical examination (e.g : enlarger thyroid gland iodine deficiency)DIETARYMeasurement of quantity of the individual foods consumed during one to several days OR pattern of food use

Some Ecologial Factors to be ConsideredSocioeconomis factorsFood ConciderationsAvailability (distribution)Accessibility (food prices)Preparation and pricessing methodsConsumption (Food habits/belief)UtilizationNutritional adequacy

.continuedAspect of HealthContributory InfectionEnviromental sanitationHealth-related servicesDemographic issuesPolotical prioritis Cultural factorGeographical and climatic influences

Ecological ValuesBeberapa informasi dapat dikelompokkan menjadi variabel ekologi, namun salahsatu yang dipilih harus menyediakan informasi yang relevan yang mudah dan ekonomis, agar menjadi informasi yang berguna dan spesifik untuk planning action

Measurement Vs IndicesMeasurement :A size or quantity measured by astandard such as :Body weight of male adultRecumben length of an infantHemoglobin concentration of a female adultIntake of protein of a childIndices (Singular = Index)Contructed of two of more raw measurements on asingle subject (e.g : BMI (Body mass Index)Used to interpret and group measurement

Factor Affecting the choice of Indices/measurementStudy ObjectivesSampling protocols and sampel sizeMeasurement ErrorValidityadequacy of measurement/index to reflect the nutritional parameter of interest, e.g : acute malnutrition : WHZ5. PrecisionThe degree to which repeated measurements of the same variable give te same value6. AccuracyThe extend to which the measurement/index is close to the true value

ANTHROPOMETRICASSESSMENT

Definition of AnthropometriyMeasurement of the body size , weight and physical proportions (Lee and Nieman, 1996)Measurement of the variation of the physical dimensions and the gross composition of the human body at different age levels and degree of nutrition (Jellife, 1996 in : Gibson, 2005) Measurement of the human body

ANTHROPOMETRYBody SizeHeight/lengthWeightHead CircumferenceOthers (Knee height in children and adult)Body CompositionFat mass (Skinfold thickness,Weist circumference)Fat Free mass ( Midd-upper arm circumference/MUAC)

Factor Influencing anthropometric measurements of the human bodyInternal factorGenetic, gender

External factorDiet,drugs, environment, disease

GROWTH INDICES

Growth IndicesWeight-for-age (WA) : BB/UWeight-for-Height (WH) : BB/TB, BB/PB Z scoreHeight -for- age ( HA) : TB/UHead Circumferene-for - age Z- score merupakan indeks anthropometri yang digunakan secara internasional untuk penentuan status gizi dan pertumbuhan, yang diekspresikan sebagai satuan standard deviasi(SD) populasi rujukanZ score is indices for children of 0-59 month

Pedoman : Tabel WHO antro 2005 Z-Skor = (nilai individu) (median populasi rujukan ) SD populasi rujukanInterpretasi dari nilai tersebutGizi Kurang (Under-nutrition) didefinisikan sebagai Z-skor +2Gizi Buruk ( Severe-Under-nutrition) didefinisikan sebagai Z-skor < -3

-3 -2 2 normal BB/TB or BB/PB : Wasting (Kurus) : Gizi Kurang AkutTB/U or PB/U : Stunting (Pendek) : Gizi Kurang KronikBB/U : Underweigth ( Rendah) : Gabungan Gizi Kurang akut dan Kronik

Body Mass IndeksExpressed in body weight (kg) = Height (m)WHO clasification of adult overweight (risk of comorbidities)Underweight : < 18.5 kg/mNormal : 18.50-24.99 kg/mOverwight : 25.00 kg/mPre obese : 25.00-29.00 kg/mObese I : 30.00- 34.99 kg/mObese II : 35.00-39.99 kg/mObese III : 40.00 kg/m

BIOCHEMICALASSESSMENT

Nutritien reserve

Dietary Deficiency(Primary factor)Nutritional deficiencyConditioning factot (Secondary factor)Anatomic ChangesFunctional changesBiochemical lessionTissue Depletion

PurposeTo detect subclinical or marginal deficiencies or imbalances in individuals

Biochemical testFluid : Whole bloodErytrocytesBreast MilkTissue :Adipose tissueLiverBoneUrine :NutrientMetabolit

Serum Albumin LevelMeasures main protein in bloodDetermines protein statusSerum Transferin LevelIndicates iron-carriying protein in bloodIndicates iron stores lowIndicates body lack protein

BUN (Blood Urea Nitrogen)May indicate renal failure, insufficient renal blood supply, or blockage of the urinary tractSerum CreatininIndicates amount of creatinin in bloodUsed to evaluate renal functionCreatinin ExcretionIndicates amount of creatinin excreted in urine over-24 hourUsed in estimating body muscle massMuscle mass depleted, as in malnutrition, level will be low

AlbuminHalf Life 14-21 daysNormal value 3.5-5.0 g/dlMost Widely used indicator of nutritional statusAcute phase response : level decrease in response to stress (infection,injury)Affected by volumeIncreases with dehidration, decrease with edema and over hidration

The Others are :Visceral ProteinC-Reactive ProteinNitrogen balanceHematological Indices ( trnsferrin, Ferritin,Hb)Creatinin

Identification Of Cut-Off ValueIs value of an indicator or test that used to define a group or designate the presence or absence of a conditionCut-off values are not usually diagnostic, they are often only Indicator / Risk

CLINICALASSESSMENT

Clinical AssessmentMedical History (Riwayat Medis)Pemeriksaan Fisik : SignSymptom

Medical HistoryMencatat Kejadian yang berhubungan dengan gejala yang timbul & factor2 yang mempengaruhinyaMeliputiIdentitas PenderitaLingkungan Fisik & Sosial BudayaSejarah timbulnya gejala penyakitMis : Kpn BB mulai turun? Kpn ada gejala muntah ?,dll

4. Data Tambahan yang perlu diketahuiMenderita anemia?Pernah operasi usus?Pernah menderita penyakit Infeksi?Apakah ada alergi makanan?Apa macam diet yng sebelumnya dipakai?

Pemeriksaan FisikYaitu Pengamatan terhadap perubahan2 Klinis

Gejala Fisik yg diduga ada kaitannya dg malnutrisi dibanding normal

NormalmalnutrisiRambut : Berkilat, tidak mudah lepasKehilangan sinarnya , kering,tipis, mudah lepasMuka : Warna sama, halus, tampak sehat, tidak bengkakDepigmentasi, flek hitam di bawah mata, bengkak pembesaran kel. ParotisMata : bercahaya, bersih, tak ada luka, tampak pembuluh darah skleraKonjunctiva pucat, bintik bitot,keratomalasiaBibir : halus, tak ada pembengkakanJaringan parut di sekitar bibir, Chelosis,Fisura angularis

Keterbatasan PemeriksaanBeberapa gejala klinis tidak mudah di deteksiGejala klinis tidak bersifat spesifik terutama pada KEP ringan dan sedangAdanya variasi gejala klinis yang timbul

Dietary Assessment

Metode Kualitatif Untuk mengetahui frekuensi makan,frekuensi konsumsi menurut jenis bahan makan dan menggali informasi tentang kebiasaan makan (food habit) serta cara2 memperolehnyaFood FrequencyDietary HistoryTeleponFood List

2. Metode KualntitatifBertujuan untuk mengetahui jumlah makanan yang dikonsumsi sehingga dapat dihitung konsumsi zat gizi dengan menggunakan Daftar Komposisi Bahan makanan (DKBM)Recall 24 jamFood RecordFood Weighing