nutritional disorders
Nutrition in Clinical Medicine
Evaluation of Nutritional Status
Indications for nutritional evaluation include the following: Undesirable body weight or body composition Suspicion of specific deficiencies or toxicities of essential nutrients In infants and children, insufficient growth or development Nutritional status should be evaluated routinely as part of the clinical examination for Infants and children Older people People taking several drugs People with psychiatric disorders People with systemic disorders that last longer than several days Evaluating general nutritional status includes history, physical examination, and sometimes tests. If undernutrition is suspected, Testing (eg, History includes questions about dietary intake, weight change, and risk factors for nutritional deficiencies and a focused review of systems (see table). A dietitian can obtain a more detailed dietary history. It usually includes a list of foods eaten within the previous 24 hours and a food questionnaire. A food diary may be used to record all foods eaten. The weighed ad libitum diet, in which the patient weighs and writes down all foods consumed, is the most accurate record. ), is more accurate than height and weight tables. There are standards for growth and weight gain in infants, children, and adolescents (see Physical Growth of Infants and Children ). Distribution of body fat is important. Disproportionate truncal obesity (ie, waist/hip ratio>0.8) is associated with cardiovascular and cerebrovascular disorders, hypertension, and diabetes mellitus more often than fat located elsewhere. Measuring waist circumference in patients with a BMI of < 35 helps determine whether they have truncal obesity and helps predict risk of diabetes, hypertension, hypercholesterolemia, and cardiovascular disorders. Risk is increased if waist circumference is > 102 cm (> 40 in) in men or > 88 cm (> 35 in) in women. 