Nutritional Assessment Focusing on Office Anthropometrics.
-
Upload
christopher-henderson -
Category
Documents
-
view
219 -
download
2
Transcript of Nutritional Assessment Focusing on Office Anthropometrics.
![Page 1: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/1.jpg)
Nutritional Assessment
Focusing on Office Anthropometrics
![Page 2: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/2.jpg)
Joan Temmerman, MD, MS, FAAFP, CNS
Medical Bariatrician, Clarian BariatricsAssistant Professor of Clinical Medicine, Dept. of Medicine, Indiana University School of MedicineDiplomate, American Board of Bariatric MedicineDiplomate, American Board of Family MedicineFellow, American Academy of Family PhysiciansCertified Nutrition Specialist
![Page 3: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/3.jpg)
Objectives
• Review specific issues in providing respectful care for bariatric patients
• Apply nutritional assessment to bariatric patients
• Define anthropometrics• Discuss importance• Review techniques and methods• Review equipment used
![Page 4: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/4.jpg)
Everyone on the Healthcare Team is important!
![Page 5: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/5.jpg)
Beauty comes in all shapes and sizes
![Page 6: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/6.jpg)
Empathetic encounters
• Patient-centered interactions• Respect and sensitivity• Communication
– establishing rapport– attentive listening– exploration of concerns
• Avoid criticizing patients Partnership
![Page 7: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/7.jpg)
Empathetic encounters user-friendly office
• Accessibility to office• Office comfortable• Sturdy armless chairs• Adequate restrooms• Large gowns• Step stool for exam tables• Adequate equipment
![Page 8: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/8.jpg)
Nutritional Assessment
• Dietary assessment• Anthropometrics• Biochemical tests• Clinical evaluation
![Page 9: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/9.jpg)
Dietary Assessment Tools
1. weight history 2. dieting history 3. dietary patterns
• food diary or daily food record (3 day diet record) • food frequency questionnaire • 24 hour recall • diet history interview
![Page 10: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/10.jpg)
What are Anthropometrics?
• The physical dimensions and composition of the body
• Anthropometry is the measurement of body size, weight, and
proportions
• Valuable for assessing nutritional status
Lee RD, Nieman DC. Nutritional Assessment, 5th edition, 2010.
![Page 11: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/11.jpg)
Anthropometrics
• Height (stature)• Weight• BMI• Body composition• Circumferences
![Page 12: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/12.jpg)
• Important clinical decisions based on weight and stature
• Measurements must be as accurate and precise as possible
![Page 13: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/13.jpg)
Measuring Height (stature)
• Do not just ask!• No shoes!!
• Head positioned in Frankfort horizontal plane
![Page 14: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/14.jpg)
Frankfort horizontal plane
![Page 15: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/15.jpg)
Stadiometer • Beam perpendicular• Eyes looking straight ahead• Heels together; toes pointed
slightly outward• Weight evenly distributed• Contact points: -both heels
-buttocks-shoulder blades-back of head
• Deep breath; stand as tall as possible
![Page 16: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/16.jpg)
Weight
• One of the most important measurements
• Private setting• Scale that can weigh all
patients• Record weight silently• Avoid making
comments (focus on non-weight
outcomes)
![Page 17: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/17.jpg)
Limitations of weight
• Does not give information about how much fat, muscle or bone (body composition)
• Muscular person may have “abnormal” weight
• “Normal” weight may mask excess fat
• Obesity= excess body fat (not excess weight)
![Page 18: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/18.jpg)
Body Mass Index (BMI)
• Height and weight must be accurate to calculate BMI correctly
• BMI most widely used measurement to assess weight status
![Page 19: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/19.jpg)
BMI
![Page 20: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/20.jpg)
![Page 21: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/21.jpg)
Limitations of BMI
• Does not directly measure body fat• Does not provide information on body
composition• May be abnormal for muscular person• Doesn’t predict fat distribution• Doesn’t take into account age or
gender
![Page 22: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/22.jpg)
13% body fat 26% body fat
Limitations of BMI
![Page 23: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/23.jpg)
Body Composition
The quality of weight (i.e. fat and lean tissue) is more important
than weight quantity
![Page 24: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/24.jpg)
Body Composition
weight
% fat free mass(lean body mass)
% fat mass
![Page 25: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/25.jpg)
What is normal range of body fat?
• Guidelines vary• As people age, they tend to
lose muscle mass and gain fat
• Sarcopenic obesity: BMI < 27; body fat > 30%
![Page 26: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/26.jpg)
Healthy body fat women: 20-35%
![Page 27: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/27.jpg)
Healthy body fat men: 8-22%
![Page 28: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/28.jpg)
Methods to measure body composition
• Hydrostatic (underwater) weighing • Skinfold measurements • Bioelectrical Impedance Analysis
(BIA) • Air displacement (Bod Pod)• Dual energy x-ray absorptiometry
(DEXA)
![Page 29: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/29.jpg)
Hydrostatic (underwater) Weighing
• The volume of submerged object = volume of displaced water
• Standard laboratory (research) technique
• 2-4% error rate• Not practical for
testing large nos.
![Page 30: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/30.jpg)
• Patient submerged• All air expelled from
lungs• 3-4 measurements
averaged• Takes about 20 min• Uncomfortable &
difficult for some• Requires specialized
equipment & training
![Page 31: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/31.jpg)
Skinfold measurements
calipers
![Page 32: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/32.jpg)
Skinfold measurements
![Page 33: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/33.jpg)
Skinfold limitations
• Error rate 5-10%• May be difficult in obese patients• Hard to locate proper site• Skinfold may be too large for caliper• Reliability of measurements in obese
unknown; not accurate in extremely obese
Blackburn,G. Ed., 1994. Obesity Pathophysiology Psychology and Treatment
![Page 34: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/34.jpg)
Bioelectrical Impedance Analysis (BIA)
• Painless electrical current; instrument measures resistance
• The more water, the easier the current passes through
• Muscle holds more water (greater conductivity)
• More fat, higher resistance
• Calculates body water, fat-free mass and body fat %
![Page 35: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/35.jpg)
Bioelectrical Impedance Analysis (BIA)
• More accurate than skinfold measurements: error rate 4%
• Affected by hydration: -Dehydration increases resistance,
overestimates body fat, -Pedal edema may decrease resistance,
underestimate body fat.
• Contraindicated for pacemakers and defibrillators
![Page 36: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/36.jpg)
BIA
Tanita
![Page 37: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/37.jpg)
BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) SEGMENTAL SCALE
![Page 38: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/38.jpg)
![Page 39: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/39.jpg)
Air Displacement Plethysmography: Bod Pod
![Page 40: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/40.jpg)
Bod Pod
• Similar to water displacement except air displaced
• Rapid, accurate analysis (3-5% error)• Easy for special populations (elderly,
disabled, children)• Provides resting metabolic rate (RMR)
and total energy expenditure (TEE)• Costly (machine ~ $40,000)
![Page 41: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/41.jpg)
Dual energy x-ray absorptiometry (DEXA)
![Page 42: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/42.jpg)
DEXA
• Originally developed to assess bones
• Widely used for body composition
• Quick (3 minutes), safe
• Measurements may be affected by thickness and bone
![Page 43: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/43.jpg)
Circumferencesmeasurements of specific areas
-Waist -Hips -Chest-Neck -Arm -Thighs
![Page 44: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/44.jpg)
Waist Circumference (WC)
• Distribution of fat very important
• Apple shape high risk• Abnormal WC linked to
cardiometabolic disease (≥35 inches F; ≥40
M)
• Superior to BMI in predicting health risks
![Page 45: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/45.jpg)
Fat distribution critical
• Energy is stored in adipose tissue
• Largest organ in body• Extensive blood
supply
• Excess intra- abdominal fat (apple shape) is high-risk
![Page 46: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/46.jpg)
Increased abdominal fat
• Independent risk factor, even when BMI is not markedly increased
• WC better predictor of total abdominal fat than waist-to-hip ratio (WHR)
![Page 47: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/47.jpg)
Measure waist to detect abdominal obesity
Landmarks: top of iliac crest (hip bone)
![Page 48: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/48.jpg)
Measuring waist with pannus
![Page 49: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/49.jpg)
Hips largest circumference below umbilicus
hips
thigh
![Page 50: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/50.jpg)
Measurements
Thigh: just below gluteal fold
neck
![Page 51: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/51.jpg)
Other office measurements
• Vital signs• Include BMI and waist circumference
as vital signs
• Blood pressure
![Page 52: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/52.jpg)
Measuring Blood Pressure
• Correct cuff size critical
• Use larger BP cuffs when appropriate
• Large adult cuff: mild to moderate obesity
• Thigh cuff: severe obesity (arm>16 inches)
• Patient sitting; arm relaxed; elbow heart level
![Page 53: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/53.jpg)
Anthropometrics• Simple, safe, non-invasive• Inexpensive, portable equipment• Produce accurate and precise data when
obtained by trained personnel
• Assess long-term nutritional status• Disadvantages:
– Don’t assess short-term nutritional status– Unable to assess nutritional deficiencies
Boyle MA, Holben DH. Community Nutrition in Action, 5th edition, 2010.
![Page 54: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/54.jpg)
Summary
• Accurate anthropometric measurements
are cornerstone of nutritional assessment
• BMI screens for degree of obesity• Body composition (weight quality)
key measurement• Fat distribution predicts health risks
![Page 55: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/55.jpg)
Additional Resources
• follow this link to view the process for obtaining an accurate height: http://www.youtube.com/watch?v=0LNCuP24MSc.
• follow the following link to view proper technique for obtaining an arm circumference, waist circumference, buttocks circumference and thigh circumference:http://www.youtube.com/watch?v=KacU_TW50Zo.
![Page 56: Nutritional Assessment Focusing on Office Anthropometrics.](https://reader037.fdocuments.net/reader037/viewer/2022110401/56649ddc5503460f94ad40dc/html5/thumbnails/56.jpg)
Additional Resources
• To view the techniques for conducting a subscapular measurement, suprailiac skinfold measurement, and biocromial breadth follow this video link: http://www.youtube.com/watch?v=SXFSvTCHPXo
• Follow this video link to see how a Bod Pod is used to measure body composition: http://www.youtube.com/watch?v=elobnbT33yo