Complete Nutritional Assessment

The purpose of a nutrition assessment is to obtain, verify, and interpret data needed to identify nutrition-related problems, their causes, and significance. It is an ongoing, nonlinear and dynamic process that involves data collection and continual analysis of the patient/client’s status compared to specified criteria. A complete nutrition assessment includes the following parameters:

• Food/Nutrition-Related History
• Anthropometric Measurements
• Biochemical Data
• Medical Tests, and Procedures 
• Nutrition-Focused Physical Findings
• Client History

More information on nutrition assessment can be found at: https://www.ncpro.org/nutrition-care-process?set_ga_opt_in_cookie=1&set_ga_opt_in=Save+Settings.

Other Anthropometric Measures

Other anthropometric measures may be added when completing a full nutrition assessment. 

Proxy measures for height:

Knee height: Knee height is correlated with stature and can be used to estimate height in bedridden patients or those that cannot stand. Knee height is measured using a sliding broad-blade caliper. Knee height is the distance from the top of the patella to the bottom of the foot. Equations for estimating stature from knee height have been published for children over 6 years of age (Chumlea, Stevenson). These measurements can be plotted on growth charts, and trends can be monitored. In general, growth should follow the general pattern of the growth chart.  When an accurate measure of height is needed to calculate body mass index  caution is warranted as there is only fair to poor agreement between actual height and estimated height.

Knee Height Equations

Click to expand

References Knee height:

1.Chumlea WC. Prediction of Stature from Knee Height for Black and White Adults and Children with Application to Mobility-Impaired or Handicapped Persons. J Am Diet Assoc. 1994;94:1385–90.

2.Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Archives of Pediatric and Adolescent Medicine. 1995; 149(6): 658-62.

3.Lamounier JA, Marteletto NM, Calixto CA, Andrade MR, Tibúrcio JD. Stature estimates of children with cerebral palsy through segmental measures: A systematic review. Rev Paul Pediatr. 2020 Jan 13;38:e2018185.

Mid Upper arm circumference (MUAC):

Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow (acromion and olecranon process).  It is a simple measurement to assess nutritional status. Specifically, it can be used as a proxy measure of body composition. MUAC is part of the World Health Organization’s set of measures to diagnose childhood malnutrition. Additional information including z-score cut-offs can be found at: https://www.who.int/tools/child-growth-standards/standards/arm-circumference-for-age

Skinfold measurements: 

The measurement of the skinfolds is used to estimate the percentage of body fat. More information can be found at: https://nutritionalassessment.mumc.nl/en/skinfold-measurements

Functional Measures:

Grip strength: Handgrip strength (HGS), a measurement of muscle function, and is a reliable indicator of undernutrition. Becker et al (²) recommended using handgrip strength (HGS) to measure functional status. HGS was associated with height, weight, age, and sex in healthy populations in several studies. HGS detected changes in muscle mass sooner than other anthropometric and biochemical measurements in children >6 years.(³) HGS is easy to measure, non-invasive, and inexpensive, and it may identify acute nutrition status changes earlier in hospitalized patients. In general, reliable measurements can be obtained in children aged 6 years and over.

References: Handgrip Strength (HGS)

1.Praveen Sharma, Abdul Rauf, Abdul Matin, Rachit Agarwal, Pankaj Tyagi, Anil Arora, Handgrip Strength as an Important Bed Side Tool to Assess Malnutrition in Patient with Liver Disease, Journal of Clinical and Experimental Hepatology,Volume 7, Issue 1,2017,Pages 16-22,ISSN 0973-6883, https://doi.org/10.1016/j.jceh.2016.10.005.

2.P Becker, LN Carney, MR Corkins. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015; 30 1: 147–161

3. J Saunders, T. Smith. Malnutrition: causes and consequences. Clinical Medicine. 2010; 10 6: 624–627.

4. Marrodán Serrano MD, Romero Collazos JF, Moreno Romero S, et al. [Handgrip strength in children and teenagers aged from 6 to 18 years: reference values and relationship with size and body composition]. Anales de Pediatria (Barcelona, Spain : 2003). 2009 Apr;70(4):340-348. DOI: 10.1016/j.anpedi.2008.11.025.