UNIT 6

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Assessment of nutritional
status
6.1 The importance of nutritional assessment
6.2 Anthropometry
6.3 Body mass index (BMI) and body fat
percentage
6.4 Biochemical methods
6.5 Clinical methods
6.6 Dietary methods
6.7 Environmental factors
 Introduction
Assessment of nutritional status can be carried out using a lot of different techniques. The
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

techniques used allow healthcare professionals to assess the state of a person’s health
based on their diet. Nutritional assessment can be carried out at any stage of a person’s
life. For example, measuring the height of a child could be carried out to check that they
are growing at the correct rate for their age, or measuring the weight of an adult to
calculate their BMI which will tell if they are a healthy weight for their height. It can also be
used to check for deficiencies of nutrients, as well as malnutrition or undernutrition.
In this unit, you will learn about the different assessment techniques, also known as the
ABCD’s of nutritional assessment. This includes anthropometry (including calculating
and understanding both BMI and body fat percentage), biochemical, chemical and
dietary methods of assessment. You will learn how to carry out some of these techniques
by yourself, and even have the chance to practise the correct methods on yourself or your
classmates.
 Learning outcomes
Standard HSC.4.4.01: Perform basic nutritional assessment techniques.

Learning outcomes:

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
HSC.[Link] Explain the need for nutritional assessment.
HSC.[Link] Demonstrate anthropometric measurements to assess nutritional status.
HSC.[Link] Analyse simple nutritional indices such as body mass index (BMI) and
body fat percentage.
HSC.[Link] Describe the biochemical methods of assessing nutritional status.
HSC.[Link] Describe the clinical methods of assessing nutritional status.
HSC.[Link] Describe the dietary methods of assessing nutritional status.
HSC.[Link] Evaluate individual dietary intake to assess nutritional status

48 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Keywords
Word Form Definition
analysis noun detailed examination of something
anthropometry noun the study of measurements of the human body
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

assessment noun evaluating or examining something

biochemistry noun the branch of science that explores living things
body mass
noun the measurement of a person’s weight for their height
index
body fat the percentage of the body that is made up of fatty
noun
percentage tissue
circumference noun the distance around something
relates to medical work done and treatment of
clinical adjective
patients
when something continues to happen in the same
consistent adjective
way
not having enough of something that is important or
deficient adjective
necessary
diet noun the foods and drinks regularly consumed by a person
interpret verb to understand something in a particular way
to get the size or amount of something using a device
measure verb
which gives standardised units
to watch or observe something over a period of time
monitor verb
for a special purpose
the process of eating or drinking the right type of
nutrition noun
foods to maintain health
allows people to answer in a way which is not limited
open-ended adjective
or controlled
a point that shows the relationship between two
plot noun
things on a graph
technique noun a way of carrying out a task
underweight noun a person who has a BMI below 18.5

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 49

 6.1 The importance of nutritional assessment

6.1 The importance of nutritional

assessment
Nutritional assessment
Nutritional assessment methods allow medical professionals to assess a person’s nutritional
status.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Keyword
nutritional status
the state of a person’s health depending on his or her diet

Medical professionals, such as a dietitian, will often measure the nutritional status of a
patient. They interpret the results to understand the patients health status and advise them
on how to improve their diet and overall nutritional status.

An ideal nutritional status happens when the intake of nutrients matches the nutritional
requirements or needs of a person.

50 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Malnutrition
The term malnutrition is used to describe someone who has a poor nutritional status.
A malnourished person may be underweight, overweight or obese. They could also be a
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

‘healthy’ weight but have a deficiency of nutrients such as vitamins or minerals.

Keyword
deficiency
a lack of, or shortage of something (such as nutrients)

The term undernutrition is used when a person does not eat enough food or get enough
nutrients from the foods that they consume.
Malnutrition and undernutrition are often confused. It is important to remember that a
person who is malnourished is not always undernourished, they may be overweight or
obese.

Malnutrition

Overnutrition Undernutrition

Overweight

Micronutrient
Stunting Underweight

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 51

 6.1 The importance of nutritional
assessment
Further information
There are four main types of undernutrition: wasting, stunting, underweight,
and deficiencies. Long term undernutrition can have many negative effects

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
on health, especially for children. It increases someone’s risk of disease and
even death.

Wasting is when someone is a low weight for their height. This is usually due
to severe weight loss, through lack of food or they have had an infectious
disease, such as diarrhoea, which has caused them to lose weight. A young
child who is wasted has an increased risk of death.
Stunting is when a child is a low height for their age. It is the result of
undernutrition over time and is more common in low-income countries. It
is also linked to poor nutrition of the mother during pregnancy and poor
feeding during infancy.
Underweight is when a child is a low weight for their age. A child who is
underweight may also be stunted or wasted, or both.

Remember
Micronutrients are vitamins and minerals. They are needed for the body to
produce enzymes, hormones, and other substances that are essential for
proper growth and development.

Micronutrient deficiency is when someone is not getting enough of certain

vitamins or minerals. Deficiencies in Iodine, vitamin A, and iron are common
and can be very dangerous, particularly for children and pregnant women
in low-income countries.

52 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Measuring nutritional status
The purpose of nutritional assessment
There are many reasons why nutritional assessment is useful.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

It can:
identify people who are malnourished or at risk of
malnourishment.
identify issues or diseases which may be present.
develop healthcare programmes to meet the needs of a
community.
Measure how effective nutritional programs and
interventions were once they have been completed.

Nutritional assessment techniques

Many different techniques are used by medical professionals to assess nutritional status.
We will look at some of these techniques throughout this unit.
There are five main categories of nutritional assessment. These are known as ABCDE
methods of assessing nutritional status.

Anthropometric methods

Biochemical methods (laboratory)

Clinical methods

Dietary assessment

Environmental factors

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 53

 6.2 Anthropometry

6.2 Anthropometry
Anthropometric measurements
Anthropo means ‘human’ and metry means ‘measurement’. Anthropometry, therefore, is
the physical measurements of the body. Anthropometric measurements include measuring
height and weight. It can also include measuring proportions of the hips, waist, legs, arms

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
and skinfolds. Medical professionals analyse the results to find out the physical status of a
person.

Anthropometric measures are particularly useful in children as it can show if they are growing
and developing at the correct rate and highlight any problems with their nutritional status.
These measurements will provide a quick indication of malnutrition such as obesity, stunting
and wasting.

Waist circumference
Waist circumference is the total distance around the waist. A larger waist circumference
shows there is more abdominal fat (fat around the middle of the body).
High levels of abdominal fat are linked with non-communicable diseases such as
cardiovascular disease, cancer and diabetes.
Age, gender and ethnicity will affect the measurement.

54 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Waist circumference - Waist circumference -
Classification
Males Females
Less than 94cm Less than 80cm Desirable
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

94-102cm 80-88cm High risk

More than 102cm More than 88cm Very high risk

How to measure waist circumference

Follow these steps to accurately to measure waist circumference.
Place the tape at the mid-point between the top of the hip bone and the lower
ribs. It can be measured over thin clothes.
The tape should not be too tight or too loose.
Abdominal muscles should be relaxed.
The measurement should be taken after breathing out.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 55

 6.2 Anthropometry
Measuring weight
Make sure the weighing scale is accurate.
The person should remove heavy items from pockets such as mobile phones.
The person should stand still with their arms by their sides.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Measure weight in kilograms (kg).

Measuring height
Remove shoes as they can add extra height.
Make sure the person is standing straight with their back
against the measure.
Make sure the measure is straight.
The heels, back and head should be touching the
measure.
Look straight ahead.
Lower the reading bar to the top of the head so a
measurement can be taken.
Measure the height in centimetres (cm).

56 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Growth charts
The WHO provide growth charts for all children up to nineteen years of age. These charts
are used to compare height and weight against people of the same age and gender. They
are also used to follow a child’s growth and can identify some medical problems at an early
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

age.
Lines or curves on the growth chart show the height of many other children at each age.
The WHO growth charts are divided up into age groups. There are charts for babies aged
0-2 years, 2-5 years, and 5-19 years. In general, people do not grow after nineteen years of
age.

What you will need

To figure out where someone fits on the growth chart there are a few things you need to
know.
The person’s gender (male or female)
The person’s age (usually in years)
The person’s height (in centimetres)

How the chart works

The bottom of the chart shows the age of the person. Once you find the age of the person,
you then look for their height on the chart. Make a mark on the chart where the age meets
the height. The red, yellow, and green lines on the chart are called percentiles.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 57

 All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

Health Sciences
G12 – Term 2 – Unit 6: Assessment of nutritional status
6.2 Anthropometry

58
 59
G12 – Term 2 – Unit 6: Assessment of nutritional status
Health Sciences
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
 6.2 Anthropometry
Interpreting the results
As you know, the red, yellow and green lines on growth charts are called percentiles.
Percentiles show how many other people (of the same age as the person being measured)
are taller, shorter and the same height.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Example
The height for sixteen-year-old males on the 50th percentile is 173cm. This
means that the average height for sixteen-year-old males is 173cm tall. The
height on the 97th percentile is 187.5cm. This means that only 3% of sixteen-
year-old males are this height or taller.
The height for sixteen-year-old females on the 50th percentile 162.5cm. This
means that the average height for sixteen-year-old females is 162.5cm tall.
The height on the 3rd percentile is 150cm. This means that 97% of sixteen-
year-old females are this height or taller.

Did you know?

The data on the growth charts provided by the WHO are based on the
American population. When you plot the age and height for someone, you
are comparing them to the average height of children in the USA.

Research: Average height in UAE

Research the average height of adult men and women in the UAE. Choose
two other countries and investigate how their average height compares to
the UAE.

Healthcare professionals use growth charts to compare the growth of individuals of the
same age. They also help to monitor and track the development of boys and girls over time.
Growth charts can be used to identify if there is a growth problem that could be related to
malnutrition.

60 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 61
G12 – Term 2 – Unit 6: Assessment of nutritional status
Health Sciences
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
 6.3 Body mass index (BMI) and body fat percentage

6.3 Body mass index (BMI) and body

fat percentage
Body mass index (BMI)
Body mass index (BMI) is a measurement of a person’s weight for their height which is used
to identify weight status. So, to calculate BMI, you need to know the person’s weight and
height.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Remember
Think back to the lesson when you learned how to measure weight and
height.

Calculating BMI
BMI is calculated using the following equation:

BMI = weight (kg) ÷ height2 (m2)

62 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Example
Sara weighs 58kg and her height is 1.61m.
To calculate Sara’s BMI, first, we must work out her height2.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

1.61 x 1.61 = 2.592 (height2)

Then we can calculate her BMI.
58 ÷ 2.592 = 22.4
Sara’s BMI is 22.4

After calculating BMI, the next step is to understand the results. The BMI number will fall
into one of four categories; underweight, normal weight, overweight or obese (there are
different classes of obesity).

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 63

 6.3 Body mass index (BMI) and body
fat percentage
You can see from the information on the previous page, people with higher BMIs are
overweight or obese. People who have a high BMI are more likely to develop non-
communicable diseases like diabetes and heart disease.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Underweight
A BMI result lower than 18.5 is a sign that the person is underweight. In this case, the person
should speak to a healthcare professional about gaining weight in a healthy way.

Healthy weight
A BMI between 18.5 and 24.9 is a sign that the person is a healthy weight. They should aim
to maintain this weight by eating a healthy, balanced diet.

Overweight
A BMI result between 25 and 29.9 is a sign that the person is overweight. They should consider
talking to a healthcare professional about losing some weight in a healthy way.

Obese
There are different levels of obesity, but any BMI above 30 is classed as being obese. A
person with a BMI of more than 30 should seek professional help as they need to reduce
their weight.

Remember
BMI is a measure of weight for height. It does not consider fat mass or muscle
mass. A person could have a lot of muscle which would add to their weight
and increase their BMI even though they have a healthy amount of fat.

64 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Body fat percentage
Sometimes it is useful to use BMI with body fat percentage to assess health. A person could
be overweight or obese according to their BMI, but their body fat percentage could be quite
low. This happens a lot with sports players and athletes who have a lot of muscle.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

BMI = 32 BMI = 32
Everyone has fat on their body. We need fat to protect our organs, provide energy, and help
our bodies stay warm. Too much fat on the body can increase the risk of developing non-
communicable diseases such as heart disease and cancer.

Measuring body fat

Before you can calculate body fat percentage, you must first measure the amount of fat on
the body.
The most accurate way to measure body fat is by using a DEXA scanner. This is an X-ray
that shows an exact breakdown of fat mass, bone density and muscle mass.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 65

 6.3 Body mass index (BMI) and body
fat percentage
Another method for calculating body fat is to measure skinfold thickness. Skinfolds are
areas of skin that can fold when pinched. Skinfolds are measured using a tool called
callipers which grip the fat through the skin and can be used at different parts of the body.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Bioelectrical impedance analysis (BIA) is another method of measuring body fat. It sends
a weak electrical current through the body. The person does not feel the electrical current.
The machine can tell when the electrical current is travelling through fat as opposed to
muscle.

66 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Calculating body fat percentage
After you have measured body fat, you can then calculate the body fat percentage. You
need three things for this:
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

Total body weight (TBW) in kilograms (kg)

Body fat in kilograms (kg)
Age

The formula for calculating body fat percentage:

Body fat
X100
TBW

Example
Hamad’s body fat is 30kg and his TBW (total body weight) is 100kg. He is 30
years old.

30 ÷ 100 = 0.3
0.3 x100 = 30%
Hamad’s body fat percentage is 30%.

Maha’s body fat is 14kg and her total body weight (TBW) is 58kg. She is 22
years old.

14 ÷ 58 = 0.24
0.24 x 100 = 24%
Maha’s body fat percentage is 24%.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 67

 6.3 Body mass index (BMI) and body
fat percentage
Understand the results
After you calculate the body fat percentage, you need to interpret the results. Body fat
percentages change as people get older. This is why it is important to know the person’s
age, so you can accurately identify which category they are in.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
There are four possible category that a person can be in:
Blue
This category shows that the person has too little body fat for their age.
Green
This category shows that the person has a healthy amount of body fat for their age.
Amber
This category shows that the person has gone above the healthy body fat for their age and
they should try to reduce it.
Red
This category shows that the person has so much body fat for their age that it could have a
negative impact on their health by putting them at a higher risk of certain conditions. They
need to reduce it.

68 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 69
G12 – Term 2 – Unit 6: Assessment of nutritional status
Health Sciences
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
 6.4 Biochemical methods

6.4 Biochemical methods

Biochemical methods
As you have learned, the B in ABCDE of nutritional assessment stands for biochemical
methods. These can also be called laboratory measurements of nutritional assessment.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Keyword
biochemistry
a part of science that explores the chemistry of living things

Biochemical methods of assessment involve testing samples of blood and urine. Samples
are taken and tested in a lab facility. When your body digests the food you eat, chemicals
and nutrients are released into your bloodstream. These travel around your body and are
either stored, used up as energy or exit through your urine. Therefore, blood and urine are
good ways find out the nutrients that are present in someone’s body.

70 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

The results
To have accurate results of biochemical measurements, the laboratory specialist who
interprets the results needs to know certain things about the patient who is being tested.
The information they need to know includes:
previous medical history.
current medications.
a clinical examination report.

Biochemical methods of assessing nutritional status are the most accurate as they show
exactly how much of a certain nutrient or enzyme is present in the body. It is easy to see if
someone is deficient in any nutrients by looking at their biochemical markers. Sometimes
deficiencies and nutrient-related diseases are itentified before symptoms develop.
Biochemical methods do not require the patient to remember what foods they have eaten,
or how much of a certain food they have eaten.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 71

 6.5 Clinical methods

6.5 Clinical methods

Clinical methods
The letter C in ABCDE stands for clinical methods of nutritional assessment.
Clinical methods are a physical examination. Medical professionals look for physical clues

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
of nutrition-related health problems on the body. These clues may be seen or felt in different
parts of the body. Tissues of the body that can show nutrient deficiencies include the
following:
Skin
Eyes
Gums
Hair
Nails
Mouth

Example
If a person has a sore mouth and bleeding gums, it could suggest they are
deficient in some vitamins and minerals.
If a person’s hair can be pulled out very easily, it could mean they are low in
protein, iron of vitamin D.
If a person’s nails are thin and indented, it could suggest they have an iron
deficiency.

72 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Normal Rickets

Rickets is a disease that causes

the bones of children to become
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

soft. Their bones do not grow or

develop properly.
The development of rickets is
usually due to a deficiency in
vitamin D and calcium.

What is checked in a physical exam?

Medical professionals need to know the patient's medical history when completing a
physical exam.
The following will be checked:
Diarrhoea and other digestive issues
Medications
Previous or current medical conditions
Physical appearance
Signs of infection
Nutritional supplement use

Other factors including the person’s ability to prepare meals, financial resources, and social
resources are considered. You will learn more about these in the 'environmental factors'
lesson.

Further information
Completing out a physical examination and taking a medical history can
help a doctor to identify malnutrition. If a doctor thinks there is some form
of malnutrition, they may send the patient for biochemical testing to check
which exact nutrients are causing problems.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 73

 6.6 Dietary methods

6.6 Dietary methods

Dietary intakes
The letter D in ABCDE stands for dietary intakes.
This is where the patient must record their eating patterns or the !"#$

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
food and drinks that they consumed in a given period of time.
Nutritional assessment is completed by healthcare professionals
who consider the foods eaten, and patterns of consumption. This
method of dietary assessment relies on the honesty of the patient to
accurately record the correct foods, the correct cooking methods
and amounts eaten.

Recording dietary intakes

Three of the most common ways to measure dietary intake are:
Twenty-four-hour dietary recall
Three-day food diary
Food frequency questionnaire

Twenty-four-hour dietary recall

This is done over a period of twenty-four hours. Patients must remember what they ate
within a twenty-four-hour period (usually from midnight on one day until midnight the next
day).

74 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 A medical professional will interview the patient and ask questions such as “Did you eat
anything after breakfast?” The patient should give as much information as they can about
the foods and drinks they consumed. It is an open-ended method of nutritional assessment.
This means the questions are open for the patient to answer in as much detail as they want
to, compared to closed 'yes' or 'no' responses.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

The patient needs to recall:

the ingredients used.
the cooking method used.
the time of day they had it.
the amount of food eaten.
if they had any leftovers.

Advantages
The information is easy to collect.
Most patients can remember what they ate on
the previous day.
Recalls do not take a large amount of time to
complete and can be done over the phone or
in person.
The information provided can estimate regular
food and nutrient intake.

Disadvantages
This method depends on memory only. Some people may
have difficulties recalling the portion size of their food, or
how much they had leftover.
If a patient ate in a restaurant, they may not know the
cooking methods or ingredients used.
It only gives an overview of one day’s eating pattern. This
may not show that patient’s regular eating habits.
Some patients will not give honest responses because of
fear of being judged by the medical professional that is
interviewing them.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 75

 6.6 Dietary methods
Three-day food diary
The three-day food diary is similar to the twenty-four-hour dietary recall as it is an open-
ended method of nutritional assessment. However, patients must record food intake for
three days: two weekdays and one weekend day. They should record the same information

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
as on a twenty-four-hour diet recall.

However, this is a diary that they must complete, rather than a recall. Information should
be recorded in real-time and not from memory. Weights of foods should be measured
using scales. Because of this, it is expected to be more accurate than a 24-hour recall where
portion sizes are not expected to be as accurate.

Advantages:
The level of detail provided (three days of food intake, mealtimes, and weights of
portions) will allow for accurate estimates of regular dietary intake.
Diary entries are done in real-time, so it does not depend on memory.

Disadvantages:
It requires a high level of commitment to weigh and record every item of food
eaten.
People may change their normal eating habits because they know they must
record all their food. They may also become lazy and not record some smaller
items of food or ingredients added to meals for example, salt or butter.

76 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Food frequency questionnaire
A food frequency questionnaire (FFQ) has a set number of
questions with multiple-choice answers. It is not an open-ended
method of nutritional assessment. It includes questions about
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

portion size and how often food is eaten. FFQs may ask how
often a portion of food is eaten over the course of a week, a
month, several months or a year.
FFQs have an interviewer who is trained in how to ask the questions to the patient, so there
is no impact on the result. They are useful when medical professionals want to analyse the
intake of a small number of foods or one single food group.

Advantages:
It can be used on large groups of people.
It is quick and easy to complete.

Disadvantages:
Specific foods are listed. Sometimes a food could be forgotten or missed out.
Some people’s eating patterns of certain food items are not consistent.
It requires a good level of memory, especially for longer timeframes.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 77

 6.7 Environmental factors

6.7 Environmental factors

How can environmental factors effect nutritional status?
Different environmental factors can have a significant impact on a person's nutritional
status. This includes a person’s access to healthy food, ability to cook healthy meals and
cultural factors that may affect their food choice.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
food
availability
Culture Money

Education
about Time to
nutrition cook

Environmental
factors
Access to affecting food
suitable Choice in
place to
choice shops
cook

Work Family
patterns traditions

Cooking
skills Religion

78 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 Socioeconomic status
Keyword
socioeconomic
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

relating to people’s background or social status and income

A person's socioeconomic status can impact their eating habits and food choice. If someone
has limited income, they may not be able to spend much money food. Healthier foods are
generally more expensive than unhealthy foods. Where someone lives can impact their
ability to cook healthy meals, for example if their home does not have suitable cooking
facilities or if there is no access to healthy affordable food near their home.

Research: Social factors

Research some other social factors that contribute to health and explain
how these can impact nutritional status.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 79

 6.7 Environmental factors
Although unhealthy eating may be cheaper in the short-term, the consequences of lack
of healthy food long-term can have severe effects on health and result in obesity, type 2
diabetes, cardiovascular disease and other non-communicable diseases.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
Nutrients available
When assessing nutritional status it’s important to consider the food options available for
people. In certain countries food availability will depend on weather and seasons. There
could be other reasons that good food is not able to get to certain areas, such as war or
natural disasters.

Further information
Food deserts
Food deserts are areas where people don’t have easy access to affordable,
healthy food options. This is usually because there is no grocery store within
convenient traveling distance.

80 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences

 This is more common in low-income areas, where people do not have access
to a car to travel easily for food shopping. The nearest hypermarket may be
a long way away and not easy to access via public transport.
All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

Did you know?

Studies have found that wealthy areas have three times as many grocery
stores as poor ones.

People’s choice about what they eat is therefore limited by the options
available to them and what they can afford. Food deserts may not have
a grocery store to buy healthy options but could have a large number of
fast-food restaurants and convenience stores selling unhealthy processed
foods.

Other dietary restrictions should also be considered, such as allergies and intolerances like
lactose intolerance and gluten allergies as this will limit food choice, especially of those who
do not have access to larger hypermarkets that have more selection.

Health Sciences G12 – Term 2 – Unit 6: Assessment of nutritional status 81

 6.7 Environmental factors
Cultural factors
People from different background and cultures consume different types of food. This is
sometimes due to tradition and sometimes due to religion. Traditional foods from certain
cultures may not be very healthy, so it is important consider the types of foods that people

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.

All rights reserved. No part of this bage may be reproduced, stored in a retieval system or transmitted in any form or by any means without prior permission in writing of the publisher.
may be eating when assessing nutritional status.

Religious practises may have certain food rules or restrict certain foods, this should also
be considered, especially if someone lives in an areas where it is not easy to access certain
foods.

Example
If you are Muslim and move to a non-Islamic country you may find it hard to
find healthy Halal food options. This will result in you having to change your
diet based on the Halal options available, which may be very limited.

Research: Different cultures

Research a different culture or religion to find out common foods that
people eat and foods that are restricted.

82 G12 – Term 2 – Unit 6: Assessment of nutritional status Health Sciences