nutritional analysis report essay

Nutritional Analysis and Recommendations

The current report contains the analysis of the food intake for one week, from June 2 till June 9, and the recommendations on how to improve the diet and make it more nutritious and balanced. It should be noted that the average caloric intake during the indicated period equals 1798 calories. This means that the number of consumed calories was higher than the basal metabolic rate, which equals 1711.5 kcal a day. The intake of saturated fat is normal, whereas sodium consumption is 76 percent higher than the required 2652 mg. Besides, the diet is marked by the deficit of protein, omega 3 and omega 6, vitamins D, E, K, B12, B5, iron, potassium, and zinc. The rate of consumption of vitamins B1, B2, and magnesium is also slightly less than needed; however, the deficit is less than 10 percent. The diet is marked by a 95 percent paucity of vitamin D.

The first thing that should be addressed is the lack of protein. On average, the intake of protein during the week was equal to 50 – 80 percent. From this, it could be inferred that the diet could be improved by adding products rich in protein. For example, eggs and chicken breasts that are rich in protein were taken only in two days out of seven. Therefore, it is suggested to make eggs, boiled or scrambled, boiled, steamed, or baked chicken, turkey, and fish, as well as broccoli, oats, and almonds as a part of the daily ration. More precisely, the diet could include two fried eggs for breakfast and 200 grams of meat for lunch.

Most of the examined days, the acceptable amount of fat was exceeded. Thus, it is recommended to exclude chips and butter ratiohe ration. Since the diet is high in sodium, it could be advised to eat less canned, frozen, and salty products. In the case of the given ration, one could use less salt while cooking vegetables, pasta, or rice. Additionally, one should remove products that were salted in advance. Such products include salted butter, chips, canned corn, potato fries. Chips could be substituted for fresh fruits and vegetables high in vitamins and microelements and do not contain added salt. Instead of canned corn and fried potato, it is advised to eat boiled or backed one. In the process of cooking, it is essential not to add too much salt and do not add salty souses afterward to decrease the consumption of high-sodium foodnutrientstrients’ analysis reveals that the diet is slightly low in unsaturated fatty acids omega 3 and omega 6. The products rich in these fats are eggs, fish, nuts, soybeans, and flax seeds. Thus, the inclusion of eggs and fish in daily consumption would dissolve the problem of lack of protein. What is more, it would facilitate the normal intake of omega 3 and 6.

The ration is also poor in vitamins D, E, K, B12, and B5. It is essential to notice that the presence of vitamin D in natural foods is very low, and thus it is impossible to get all the necessary amounts of this vitamin with food. Therefore, it could be suggested to add to the ration dietary supplement that would help to reduce the deficit. Apart from biologically active additives, one could include salmon, trout, cod, sardines, and mushrooms. For example, one could eat 100 grams of one of the listed kinds of fish to get more vitamin D from food. Besides, trout and salmon are also rich in vitamin B12 and, this way, address the issue of vitamin B12 deficit in the diet. The shortage of vitamin B5 could be reduced through the consumption of chicken breasts, salmon, and avocado. Therefore, it is advised to eat half of the avocado a day to cover a 32 percent deficit of vitamin B5.

Vitamin E plays an essential role in metabolism in body tissues and affects the fragility of capillaries. The products high in this vitamin include vegetable oils, seeds, and nuts. Therefore, it would be beneficial to include in the nutrition at about 25 grams of walnuts, or hazelnuts, or almonds, or sunflower seeds. Vitamin K helps to maintain healthy bones and blood vessels. To minimize the deficit of Vitamin K, and, by the way, the shortage of iron and zinc, it is suggested to eat a cup of raw kale, spinach, rocket salad, or collards. Such a salad is an excellent addition to the previously mentioned fish or meat dishes. As it has already been mentioned, the diet lacks potassium. This issue could be resolved through the inclusion in the nutrition of fresh fruits such as bananas, grapefruit, oranges, and apricots. Thus, a cup of grapefruit would address the issue of potassium’s shortage.

To sum up, the previously discussed diet changes reveal that more fresh fruits and vegetables, nuts and seeds, fish and meat should be eaten a day to make a diet more balanced and healthier. It seems fair to conclude that the menu should include less canned or restaurant foods and chips. Additionally, more water should be drunk a day since it was calculated that the diet lacks 30 percent of water. The indicated changes are supposed to improve the ration and allow to cover the shortage of vitamins, minerals, and other nutrients.

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How to write a nutritional assessment: A Complete Guide

Knowing how to write a nutritional assessment is tough. Especially when every RD does it a little differently.  So how do you know what to write and how to write it?  This is your complete guide to organizing and writing nutritional assessments.

How to Write a Nutritional Assessment: A Complete Beginners Guide

Writing a nutritional assessment note as a new dietitian, can be tricky.

Every RD seems to write them differently. Which means getting a straight answer on how to get them done can feel almost impossible.

While each facility will have it’s own assessment template built in to their EMR, writing the summary at the end of a nutritional assessment is one of the most important skills you can have as a new RD.

To make writing these notes as easy as possible for you, use this complete guide on writing clear and simple nutrition notes.

It’s divided into 2 parts.

Part 1: Structure of a nutritional assessment Part 2: Phrasing in a nutritional assessment

In this post you’ll:

• See what a real-life nutrition note example can look like
• Learn exactly how to break that down and do it for your patients
• Get a cheat sheet with easy phrases that will keep your notes clear, concise, and well written

Let’s get started with maybe the most common questions about writing nutrition notes.

PART 1: STRUCTURE OF A NUTRITIONAL ASSESSMENT

Why do nutrition notes always look different.

Before you look over an example, let’s be clear about this one very important fact: Every nutritional assessment will look different. 

There are two reasons for this.

First, each facility will have a template posted in their EMR that’s special to that facility. 

This means the information you’re asked to focus on might vary between each place you work.

Part of this is the difference between acute care, long-term care, and writing personal notes for your private practice.

But it’s also a matter of style. 

And this brings us to the second reason nutritional assessment notes can look wildly different.

When writing their final free-form summary, every RD will use a slightly different structure and set of phrases they prefer.

The content might be robust or minimal. The sentences might be long and complete, or short and abbreviated.

Finding your style is part of becoming a great dietitian.

How to summarize a nutritional assessment note?

Let’s be clear before we dive in.

The purpose of this post is not to instruct you on the only way to write a note.

The point is to give you an easy-to-follow starting place that will always work when you’re feeling overwhelmed by all the possibilities.

Because there is nothing more frustrating than sifting through a medical note you KNOW has the information you need but is buried on a single line that’s taken you seven minutes to find.

No one has time for that, least of all dietitians.

Instead, let’s build nutrition notes that are quick to write and easier to read.

Writing strong nutrition assessments comes down to doing each of these things, in all your notes:

• Identify all the topics you consider important to successfully caring for your patient or resident. 
• Outlined what’s happening with them or the reason you were tasked to see them.
• State clearly what you are prioritizing for them.

What do clear and concise notes look like?

Before we dive in, I want you to remember this one thing.

No matter how a preceptor or a professor tells you they want you to write a note, there’s no wrong way to do this.

Every dietitian has a writing style special to just them.

And as you write more notes, you’ll start to develop your own voice and cadence in your notes. 

You’ll decide what to focus on and have phrasing you’ll use over and over again to illustrate that point.

Let’s take a look at what a free-form admission note can look like once you’ve assembled all the information you need to complete an assessment.

NOTE: This was written for long-term care. But the components will stay the same in acute care, even if the content and phrasing vary a bit.

EXAMPLE NUTRITIONAL ASSESSMENT NOTE:

Pt is an 80 yo woman recently D/C from hospital s/p UTI leading to sepsis. PMH of lymphedema, spinal fx, PVD, Afib, HTN, R+L leg cellulitis, osteoarthritis, Fe def, MLD, B12 def, constipation, mitral valve insufficiency, heart disease, zinc def, Ca def, GERD, cirrhosis, hiatal hernia, h/o gastric bypass.

Stage 3 R+L buttock PIs, improving per RN 1/27 note. Cellulitis with infected L-leg stasis wounds noted per chart review. 2+ B/L LE edema noted. 

Abx for wound infection continues, diuretic started for fluid retention. No new labs avail.

Continues on a cardiac diet with variable intake of 25-75% intake per caregiver doc. 

CBW on admit: 245.2 lb. Last avail wt on 10/4/22: 222.7 lb, 22.5 lb / 9.2% wt gain x 3 months, significant. Pt reports UBW of ~200 lb x 1 year, significant and insidious wt gain noted. 

NFPE indicates decreased lean muscle mass in calves, upper arms. High risk for malnutrition noted.

Add Prostat 20 ml TID + Juven BID to aid in continued wound healing. Recommend providing additional 240 ml fluids q shift and encouragement during meals to support adequate intake. 

Food preferences discussed. Will include Ensure TID, and daily tuna sandwich with lunch to support improved intake and decrease current malnutrition risk.

Goals: no significant wt gain x 90 days, no s/s dehydration, improved skin integrity, intake 75%< of all meals/ONS.

Continue with weekly wts x 4 weeks, will adjust dietary interventions PRN. Will follow skin integrity, intake, wt status, labs as avail. Care plan updated.

What are the parts of this nutrition note summary?

You’ve probably seen something like this a million times already. 

Let’s break this down so you can start to replicate it.

Although a standard assessment has a few distinct parts to it, each facility will have a different format they’ll ask you to follow.

PRO TIP: Don’t feel like just because you aren’t familiar with that specific way of writing that you don’t know what you’re doing. 

It’s going to be an adjustment wherever you go. And that’s ok.

Just remember these basic parts and follow the assessment template they give you. 

The structure of all nutrition notes will have each of these parts, mixed and matched as necessary.

Let’s go through each part of the above assessment and look at what’s included.

1. Who and what (M/F, age, admitting diagnosis, PMH)

This is where you’re introducing the person you’re talking about and providing an overview of everything they’re going through. It can look like this:

You’ll see this sort of header in almost all formal medical assessments, most of the time cut and pasted by whichever doctor wrote it first. 

It’s usually only for reference but when you’re rushing to remember who has what, it’s handy when you know it’s ALWAYS at the top of your full notes.

2. Pertinent medications, skin integrity, notable lab values

Here you’re building a bridge between what’s happening medically and the nutritional issues you’ll be talking about. 

Stage 3 R+L buttock PIs, improving per RN 1/27 note. Cellulitis with infected L-leg stasis wounds noted per chart review. 2+ B/L LE edema noted. Abx for wound infection continues, diuretic started for fluid retention. No new labs avail.

Some people list every medication and lab value provided. Others include only the ones they’re going to address in their interventions. 

But when it comes to wounds, you MUST be clear if their skin is intact and how you know this (ex: skin intact per 1/14 wound care note ) or exactly what kind of breakdown they have and where you got that information.

3. Weight status, current diet order, ONS, or additional supplements

Now you’re starting to outline the nutritional concerns and interventions that you’ve touched on in the last couple of sections. 

CBW on admit: 245.2 lb. Last avail wt on 10/4/22: 222.7 lb, 22.5 lb / 9.2% wt gain x 3 months, significant. Pt reports UBW of ~200 lb x 1 year, significant and insidious wt gain noted. NFPE indicates decreased lean muscle mass in calves, upper arms. High risk for malnutrition noted.

Even though you might not be making a change or highlighting a recommendation until the next couple of sentences, you’re still setting the stage for them. 

If anyone has questions about why you’re making the nutritional recommendations you’re making, they’ll likely find the justification for those in this section.

4. Recommendations and interventions

This is where you’re being firm about what your patient or resident needs and how you’re going to support them.

If they need an ONS, say what it’s going to be and why they need it. Or if they have food preferences, put them here. If the diet order is inappropriate and it needs to be changed, make a note of that adjustment (ex: Cardiac diet in place. DM with elevated glu levels noted. Diet changed to CCD, low Na )

5. Goals, follow-up plan

And finally, state your follow-up plan. Make sure to note why you’re doing something if it’s at all unclear.

This will look different in acute care. But the basic information remains the same. You want to be clear about what needs to happen (your nutritional goals for them) and when they’re expected to be completed (a follow-up statement).

This is by no means the only way to write a nutritional assessment.

Some dietitians ONLY write their goals and interventions in the final comment box at the end of a full note.

However, a complete note like this makes sure you’ll never lose track of important information. And any other RD coming behind you to treat this person will know exactly what you did and why you did it.

Without having to sift through a seven-page nutrition note just to figure out a diet order or why someone’s getting extra protein.

The benefits of summarizing your note in this way include:

• A consistent place where anyone reading your note can find all relevant information.
• A single area to read pertinent nutrition information, rather than scrolling through a sometimes very lengthy assessment template.
• Information that’s easy to copy and paste or reference when you need to use that information in another place, like going from an admission note to a progress note.

What isn’t in this summary nutrition note?

You might notice that PES statements weren’t included in this free-form nutrition note. 

There’s no special reason for this.

If you want PES statements in your nutrition note, go for it.

Everything in your PES statements should also be written in your free-form note.

What you include in this final note is completely up to you as a registered dietitian and health care professional. 

And as long as you have all the relevant information in the full assessment, you can format this last summary note in any way you want.

You have a voice specific to you. You’ll develop a style that’s yours alone. It might take time but remember there are no wrong answers.

But what can help is remembering this structure.

And then use some simple phrases to help keep your notes short, to the point, and easy to understand.

Let’s get into a cheat sheet to get you started writing clear and concise notes you can be proud of.

PART 2: PHRASING IN A NUTRITIONAL ASSESSMENT

How can you keep your nutrition note concise.

When becoming a dietitian, you spend a lot of time reading scientific studies. 

Writing expertly written papers. 

Ensuring your grammar is in proper form.

But writing nutritional assessments and summarizing your notes is when you’re going to forget all of that.

Instead of full sentences and precise grammar, opt for word abbreviations and short sentences.

And although you can write your notes in any way you see, these are the kinds of shortcuts you’ll find yourself using over and over. 

Let’s take a look at some common phrasing that can help you write simpler notes, faster.

COMMON PHRASES

Let’s start with taking the personal out of your notes. 

Skip the complete sentences that begin with My patient has… or I noticed that…

Instead, start your sentences with what’s happening with your patient as in Pt notes… or Pt reports.

Providing context:

These can go at either the beginning or end of a sentence. They’re used to indicate where you got specific information from, so you’ll never have to search for it again.

• Per WHO + date note (ex: place at the start or end of a sentence, per 1/8 RN note)
• WHO reports (ex: RN reports poor intake over last week / Pt reports poor appetite x 1 week)
• As discussed with (ex: Recommend decreasing Ensure from 4x/day to BID, as discussed with RN)

Writing out weight status:

A lot of writing about weights comes down to abbreviations and stylistic choices. Here are some ideas.

• Wt status ( Instead of : weight status)
• Wt change x LENGTH OF TIME ( Too long : My patient reports noticing a weight loss of 5 lbs since his last doctor’s appointment on 1/14. Better : Pt reports 5 lb wt loss x 1 month)
• Therapeutic wt change (To be specific about a loss or gain that is MD recommended)
• Intentional wt change (To be clear about a loss or gain being patient-driven)
• Beneficial or Favorable ( Can also be used as : wt gain is not beneficial or further wt loss is not favorable)
• Significant and Nonsignificant (For clarity about a weight change)

Identifying important items:

There are times you just need to identify that something is a fact. These make those statements easy.

• Noted ( ex : Noted h/o weight loss or Recent non-significant h/o weight loss noted)
• In place ( ex : Multiple diuretics in place)
• Continues with ( ex : Continues with wound vac, abx in place for ongoing wound infection)
• Fluctuations
• Currently on or remains on

Making your recommendations:

The phrasing for your recommendations and interventions will likely depend on the facility you work in. Some places encourage dietitians to add their own orders, other places require outreach to RNs or MDs for approval before you can see an order in place.

Choose your words based on what is appropriate for the facility you work in. Here are some common ones to pick from.

• Current dietary interventions remain appropriate.
• Remains with 
• Will follow as avail
• Will update as avail

And That’s It!

We covered how to structure a nutritional assessment as well as phrases to use to write it quickly and simply.

Feel like you need more than just a blog post? Check out:

• Clinical Bootcamp for a full rundown on doing clinical nutrition in the real world
• Clinical Text Support to get immediate answers to your clinical questions while you’re at work and short on time
• Private Coaching for tutoring in MNT, interview prep and career counseling

Want even more to help in clinical? Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.

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Nutritional Assessment

Aditi Kesari ; Julia Y. Noel .

Affiliations

Last Update: April 10, 2023 .

• Continuing Education Activity

Evaluation of nutritional status is critical, either to identify if an individual has nutritional imbalance due to an underlying condition or to assess if an individual is likely to develop a pathological condition due to nutritional imbalance. A detailed, systematic evaluation of a patient's nutritional status conducted by healthcare providers in a team-based setting to diagnose malnutrition and identify underlying pathologies to plan intervention constitutes nutritional assessment. This article provides an overview of nutritional evaluation, including components of nutritional assessment, factors that affect nutritional status, and the role of interprofessional teams involved in managing patients at nutritional risks.

• Explain the significance of nutritional assessment and summarize its components.
• Identify factors that affect the nutritional status of individuals.
• Describe challenges involved in nutritional assessment.
• Summarize the role of interprofessional collaboration in performing the nutritional assessment of patients.
• Introduction

Food and nutrition are basic indispensable needs of humans. Nutrition plays a critical role in maintaining the health and well-being of individuals and is also an essential component of the healthcare delivery system. The nutritional status of individuals affects the clinical outcomes. Essential nutrients are classified into six groups, namely carbohydrates, proteins, lipids, minerals, vitamins, and water.

Nutritional requirements of healthy individuals depend on various factors, such as age, sex, and activity. Hence, recommended values of dietary intakes vary for each group of individuals. In the United States, the Food and Nutrition Board of the Institutes of Medicine (IOM) under the National Academy of Sciences issues nutrition recommendations for populations throughout the life span called Dietary Reference Intakes (DRIs). [1]

An imbalance in nutritional intake leads to malnutrition. The word ‘malnutrition’ is defined in multiple ways, and there is still no consensus. [2]  Traditionally, the term malnutrition has been used in the context of lack of energy intake or deficiencies of nutrients, under which two main conditions, namely marasmus, and kwashiorkor, are discussed. Marasmus primarily refers to energy or calorie deficiency, whereas kwashiorkor refers to protein deficiency characterized by peripheral edema. [3] [4]  

However, the term malnutrition now includes conditions caused by both insufficient as well as excess intake of macronutrients and micronutrients. [5]  As per WHO guidelines, malnutrition encompasses three categories, namely,

• Undernutrition (low weight-for-height, low height-for-age, and low weight-for-age),
• Micronutrient (vitamins and minerals) deficiency or excess, and
• Overnutrition (overweight, obesity, and other diet-related health conditions such as type 2 diabetes mellitus, cardiovascular disorders, etc.).

The presentation of malnutrition can be acute, sub-acute, or chronic and may or may not be associated with underlying inflammation. Furthermore, the double burden of malnutrition has also been emphasized in various studies. This involves the dual manifestation of overnutrition and undernutrition, which makes the diagnosis of malnutrition a challenge. [6] [7]  

Hence, a comprehensive, multi-faceted evaluation of a patient's nutritional status is warranted. A comprehensive nutritional assessment, however, should be differentiated from nutritional screening. Nutritional screening is done to quickly identify individuals at risk of developing malnutrition. [8]  

For example, the mini nutritional assessment (MNA) is used in the geriatric patient population to screen for individuals at risk of malnutrition. This screening tool consists of a questionnaire and has a scoring system that helps identify at-risk individuals. On the other hand, a comprehensive nutritional assessment is performed to evaluate the nutritional status of patients already identified at nutritional risk. Nutritional assessment allows healthcare providers to systematically assess the overall nutritional status of patients, diagnose malnutrition, identify underlying pathologies that lead to malnutrition, and plan necessary interventions.

While performing nutritional assessment, it is important to understand that there is no single best test to evaluate nutritional status. Information should be collected systematically, and an evaluation of nutritional status should be done based on the overall data collected. As per the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines, a comprehensive nutritional assessment involves a thorough clinical examination (history and physical examination), anthropometric measurements, diagnostic tests, and dietary assessments. [5]  

Additional clinical examinations or diagnostic tests may be necessary for different groups of populations and individuals with specific underlying pathology. As per the International Consensus guidelines committee, the diagnosis of malnutrition in adults can be categorized as (i) starvation-related malnutrition (chronic, non-inflammatory), (ii) acute disease or injury-related malnutrition (mild to severe inflammation), or (iii) chronic disease-related malnutrition (chronic mild to moderate inflammation). [9]  

Given below are the components of a comprehensive nutritional assessment that need to be performed while evaluating the nutritional status of individuals.

Clinical History:  Patients' clinical history is a crucial component of nutritional assessment. Clinical history aims to look for indications of malnutrition and identify underlying factors that may lead to malnutrition or increase the risk of malnutrition.

• Once patient identification markers (name, age, sex) are noted, take a detailed history of chief complaints.
• If not mentioned in chief complaints, ask for other constitutional symptoms, such as fever, fatigue, malaise, loss of appetite, or sleep disturbances. The presence of these symptoms can be an indication of underlying pathologies. For example, fever suggests active infection or inflammation.
• Inquire about the patient’s usual weight and ask if there have been any weight changes. Weight loss of >10% of body weight can signify underlying pathology. Weight gain can be suggestive of various underlying endocrine pathologies. Weight gain can also lead to insulin resistance contributing to metabolic syndrome.
• Ask if there are any symptoms suggestive of malnutrition other than weight changes, such as rashes, sores in the mouth, dryness of skin and eyes, loss of night vision, hair loss, bleeding gums, poor healing of wounds, swelling of extremities, tingling, or numbness.
• Ask about eating habits and dietary preferences. For example, ask about the number of meals eaten in a day, approximate portion sizes, whether they are following any restrictive diets, whether they are vegan or vegetarian, or if they are allergic to any food items. This can help in diagnosing a possible nutritional deficiency. For example, a vegan diet may be associated with vitamin B12 (cobalamin) deficiency. [10]  A detailed dietary assessment is also warranted and is discussed below. If patients are on parenteral or enteral diets, they should be interviewed accordingly.
• Ask about any factors affecting food intake, like poor dentition, ulceration in the oral cavity, difficulty in swallowing, loss of appetite, heartburn, nausea, and/or vomiting. Further, inquire about bowel habits, which help assess the general functioning of the gastrointestinal system. Also, ask if there is any abdominal pain, abdominal distention, diarrhea, flatulence, or constipation, which can indicate underlying gastrointestinal pathologies that affect nutritional status.
• Ask about any current major clinical or surgical illnesses, including mental illnesses. Also, ask if they are taking any medications, either prescribed or over the counter. Ask if there is any history of chronic illnesses, hospitalization, trauma, or malignancies. The impact of current or past illnesses on nutritional status is discussed below.
• In female patients, detailed menstrual history should be taken. Amenorrhea in child-bearing aged women can indicate pregnancy, chronic infection, chronic illness, eating disorder, etc., which can affect the nutritional status of patients. History suggestive of menorrhagia can reveal the presence of anemia. Also, a history of contraceptive use is essential. Women on oral contraceptive pills have different nutritional requirements. Oral contraceptive pills have been shown to deplete B vitamins, vitamin C, and some minerals, such as magnesium, selenium, and zinc. [11]
• Next, ask questions related to lifestyle habits (active vs. sedentary), daily physical activities, and exercise routine.
• History about social habits such as drinking, smoking, tobacco consumption, or other non-prescription drugs should also be taken.
• Since socioeconomic conditions can affect nutritional status, request information related to this as well.
• Finally, family history can also be useful for the early diagnosis of conditions that can affect a patient's nutritional status or help identify underlying predisposing conditions.

Dietary Assessment:  Dietary assessment is necessary to ensure adequate nutrition and hydration intake. It is advised to consult a qualified registered dietitian-nutritionist (RDN), if available, to obtain a thorough dietary assessment.

• The information can be collected from various sources such as the patients themselves, family members, caregivers, or medical records.
• History about dietary habits, frequency of meals, and serving sizes needs to be collected. As mentioned earlier, details about food preferences, restrictive diets, and allergies should be noted.
• Current nutrient and fluid intake should be recorded. Methods such as the 24-hour recall method, food frequency questionnaire (FFQ), diet charts, observation, etc., can be used. Wearable monitoring devices, phone apps, or nutrition analysis software can be used as aids. [8]
• If patients are on any nutritional supplements, care must be taken to record the frequency and dosage to limit the risk of nutrient insufficiency and toxicity.
• If patients are on parenteral or enteral diets, information on feeding regimens (quantity and frequency) should be noted. Factors affecting these feedings, such as displacement of feeding tubes, site irritation, or infections, should be considered.

Physical examination: The next component of the nutritional assessment is physical examination. The physical examination aims to identify signs of malnutrition and factors affecting nutritional status.

• General condition: General condition and appearance of the patient should be observed. Look for any signs of emaciation. Note whether the patient is conscious, alert, and ambulatory. Make a note of whether a patient is being examined in a hospital or outpatient setting. An initial observation of the patient's cognitive, mental, and emotional status should be noted. Also, note any parenteral or enteral feeding devices being used. A patient's general condition can help determine whether a patient can meet their nutritional needs and/or whether their condition is causing their malnutrition or putting them at a higher risk of nutrition deficiencies.
• Vital signs: Vital signs (body temperature, pulse, blood pressure, and respiratory rate) should be checked. Temperature > 100.4 degrees Fahrenheit or 38 degrees Celsius can signify active inflammation/infection. Hypothermia (temperature < 95 degrees Fahrenheit or 35 degrees Celsius) can be associated with conditions causing impaired nutritional status, such as sepsis, trauma, burns, stroke, alcohol intoxication, and metabolic disorders like hypothyroidism, adrenal insufficiency, and Wernicke encephalopathy. [12]  High pulse rates, apart from cardiac conditions, can indicate hyperdynamic circulation. Some causes of hyperdynamic circulation that are associated with altered nutritional status are fever, anemia, pregnancy, hyperthyroidism, septic shock, Beriberi, and anxiety. High blood pressure or hypertension is one of the risk criteria for metabolic syndrome. Abnormal rate and patterns of respiration can be indicative of various pathologies. For example, Kussmaul's breathing is associated with diabetic ketoacidosis (DKA).
• Height and Weight: Measure the height and weight of the patient. Body mass index (BMI) calculated from these variables can help determine whether an individual is undernourished or overnourished. Details about BMI and other anthropometric measurements are discussed later.
• Eyes: Look for pallor, which may be indicative of various nutrient deficiencies (iron, vitamin B12, folic acid, vitamin B6, vitamin C, or protein deficiency), as well as various chronic illnesses. Look for icterus, suggesting metabolic disturbances associated with the hepatobiliary system. The presence of Bitot spots and xerosis is indicative of vitamin A deficiency. Xanthelasmas, yellow-colored plaques on eyelids, can suggest obesity, hypercholesterolemia, or diabetes mellitus.
• Oral cavity and perioral region: Assess the general health of the oral cavity and look for pathologies that can affect the adequate intake of nutrients. Also, look for glossitis, angular stomatitis, and cheilosis, which can indicate vitamin B complex deficiency. Bleeding gums and gingivitis are suggestive of vitamin C deficiency. Again, look for pallor. If an eating disorder is suspected, look for vomiting-related oral damage, for example, discoloration of teeth, loss of enamel, cavities, and enlarged salivary glands. [13]  A consultation with a dentist may be helpful. Look for loss of buccal fat pads or sunken facial appearance. This can be associated with various conditions such as eating disorders, marasmus, tuberculosis (TB), or HIV/AIDS.
• Skin: Assess the general health of the skin. Xeroderma (extremely dry skin) can signify vitamin A and/or essential fatty acid deficiencies. Petechia, purpura, and ecchymosis may be associated with vitamin C and vitamin K deficiencies. Vitamin C deficiency can also present with perifollicular hemorrhage. Poorly healed wounds indicate vitamin C, protein, and/or zinc deficiencies. Pigmentation and rashes in sun-exposed areas (around the neck and on extremities in glove and stocking patterns) can be due to niacin deficiency. [14]  The yellow-orange discoloration of the skin can be detected in cases of excessive consumption of carotenoids (pigments found in carrots, pumpkin, tomatoes, etc.). Xanthomas, which are localized lipid deposits, can be seen in individuals with obesity, hypercholesterolemia, or diabetes mellitus. Look for loss of subcutaneous adipose tissue in axillary folds, buttocks, and extremities. This can be associated with energy-deficient states like marasmus, TB, HIV, and eating disorders.
• Hair: Various nutrients are required to maintain the health of hair and hair follicles. Dry hair can be a sign of vitamin A or vitamin E deficiency. Biotin deficiency can make hair brittle. Severe undernutrition, especially protein deficiency, can lead to discolored and easily pluckable hair, eventually resulting in hair loss. Rapid hair loss can also be indicative of underlying systemic illnesses.
• Nails: Assess the general health of nails and nailbeds. Dry and brittle nails can be associated with various nutritional deficiencies, such as deficiencies in biotin, zinc, and proteins. Discoloration of nails is another sign of poor nutrition. [15]  Koilonychia can be a sign of iron deficiency anemia. While clubbing is associated with many pathologies, it may also be observed with malnutrition, chronic alcohol use disorder, and chronic laxative use, often seen in individuals with eating disorders.
• Extremities: Examine all extremities carefully. Protein or thiamine deficiency can lead to edema. Vitamin B12, thiamine, vitamin E, and vitamin B6 deficiencies can present with paresthesia and muscle weakness. Loss of vibration and position sensation can also be observed in individuals with vitamin B12 and/or vitamin E deficiencies. Patients with diabetes mellitus may also show signs of peripheral neuropathy, foot ulceration, or gangrene. Severe undernutrition, as well as chronic illnesses, can lead to muscle atrophy and wasting. Bowing of lower limbs can be seen in children with vitamin D deficiency rickets.
• Odors: Certain odors can be suggestive of specific disorders or substance use. Detection of fruity acetone odor in patients with ketoacidosis, musty odor in patients with phenylketonuria, sweet burnt sugary odor in patients with Maple syrup disorder, or the smell of alcohol can also be helpful during the examination of patients.
• Functional assessment: It is essential to do a functional assessment of patients. Observe whether patients are ambulatory and whether they can eat and drink with or without assistance. Examine the strength of extremities to determine whether they can perform activities of daily living (ADLs) or other physical activities. Mental assessment is also crucial, along with physical assessment. For example, elderly patients with severe malnutrition may be physically (due to weakness) and mentally (due to dementia) incapable of maintaining healthy nutritional status. Similarly, patients with thiamine deficiency may develop Wernicke encephalopathy and Korsakoff psychosis and may become incapable of meeting their own dietary needs.
• Systemic evaluation: An appropriate systemic examination should be performed based on the history and general examination findings.

Anthropometric Measurements

• Height, weight, and BMI: Measure the weight and height of the patient, as mentioned above. Patients should be advised to avoid wearing heavy garments or shoes while these measurements are taken. Bed or chair scales may be needed if patients are not ambulatory or cannot stand. In pediatric age groups, these parameters are plotted on growth charts to assess growth and nutritional status. BMI (weight in kilograms divided by height in meters squared) is also calculated using these parameters, and the state of nutrition can be assessed. In adults, BMI < 18.5 kg/m^2: underweight; BMI = 18.5 to 24.9 kg/m^2: within normal range; BMI > 24.9 to 29.9 kg/m^2: overweight; and BMI ≥ 30 kg/m^2: obesity. [16]  
• Factors such as edema and hydration should be considered while making these determinations, as they can affect the weight and BMI values. BMI cannot differentiate between muscle mass and adipose tissue/fat mass. And finally, BMI does not take into account micronutrient deficiencies. 
• Other anthropometric measurements: Circumference (arm, abdomen, and thigh) measurements and skinfold (biceps skinfold, triceps skinfold, subscapular skinfold, and suprailiac skinfold) thickness measurements can also help with the evaluation of nutritional status. Skinfold thickness measurements are considered indicators of energy stores (mainly lipid stores). Circumference measurement, namely midarm circumference (MAC), can be used to derive midarm muscle circumference (MAMC=MAC-3.1414 X triceps skinfold thickness), which is an indicator of protein stores. While these tests can quickly be done at the bedside without additional cost, subjectivity in terms of measurements and the applicability of results across various populations can make these tests less reliable.
• A complete anthropometric assessment may also involve body composition measurements, which are discussed in diagnostic tests.

Diagnostic tests: The next component of the nutritional assessment is diagnostic tests, which are done to validate the results of the clinical presentation.

Laboratory Tests

• Routine clinical tests: Routine clinical tests can help evaluate the patient's overall status (as well as nutritional status). [17]  These include serum electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose levels, lipid profile, liver enzymes, and complete blood count. Serum electrolytes and hydration status may be deranged in malnourished individuals. BUN and serum creatinine are also predictors of nitrogen balance along with being indicators of renal function, and lower levels of these can be seen in malnourished patients. Low levels of serum creatinine can be indicative of lower muscle mass. Both BUN and creatinine levels, however, can be affected by hydration levels and kidney function. Elevated blood glucose levels and lipid profile (triglycerides and cholesterol) levels are indicators of metabolic syndrome. Hyperglycemia can also be a nonspecific indicator of the inflammatory response. [18]  
• Low cholesterol levels can be seen in undernourished individuals. Low hemoglobin is suggestive of anemia. Lymphocyte functioning and proliferation are affected in chronic malnutrition and may manifest as decreased lymphocyte count. [19]  Undernutrition and protein deficiency, in general, lead to impaired immune response. Taken together, an impaired, delayed hypersensitivity response (anergic or no reaction) may be seen in undernourished individuals. For example, malnourished individuals with TB may show an anergic tuberculin skin test. [20]
• Visceral proteins: [21]  Levels of visceral proteins such as albumin, prealbumin, transferrin, and retinol-binding protein can help evaluate nutritional status. However, none of these tests alone are specific for detecting malnutrition, and their levels can be affected by multiple factors. For example, low serum albumin levels suggest protein deficiency due to malnutrition and other pathologies that affect the protein status, such as liver cirrhosis or nephrotic syndrome. High levels of serum albumin could be associated with dehydration. Albumin has a long half-life (up to 20 days) and, hence, cannot be used for monitoring frequent changes in nutritional status during refeeding. Prealbumin (or transthyretin), a thyroid hormone carrier, is preferred in such cases as it has a shorter half-life (2 to 3 days), which allows for the detection of acute alterations in nutritional status. Retinol-binding protein is another protein with a very short half-life (12 hours) and can be used for monitoring changes in nutritional status. However, its levels are affected by vitamin A levels. Transferrin, an iron transport protein, is another nutritional indicator as well as an acute phase reactant. It has a half-life of approximately ten days, and its levels are affected by serum iron levels.
• Micronutrient levels: If specific micronutrient deficiencies are suspected, individual micronutrient levels can be measured. For example, levels of B vitamins (thiamine, riboflavin, niacin, pyridoxine, folic acid, B12), vitamins A, C, D, E, and K, iron, zinc, selenium, homocysteine, etc., can be measured. More specific tests such as the Schilling test for B12 deficiency or iron panel to differentiate between different types of anemia can also be performed based on clinical presentation.
• Other non-nutrition-specific markers can also be used; for example, C-reactive protein (CRP) can be used to indicate inflammation. [21]

Body Composition Studies

Apart from laboratory tests, body composition studies can be performed to estimate the body's composition in terms of water, air, muscle, bones, and fat mass.

• Bioelectrical impedance analysis (BIA): This helps analyze the body composition based on the ability of different body tissues to conduct electricity. Conductance is higher in tissues with more water and electrolytes (for example, blood) and less in adipose and bone tissues. This is an easy, non-invasive test that can be done at the bedside using low-cost equipment. However, in patients with extremely high BMI or fluid overload, the results may be less accurate.
• Dual-Energy X-ray absorptiometry (DEXA or DXA): This is a standard method used to determine body composition and is also used as a reference to compare other body composition tests. However, it is expensive, requires a specialized machine, and involves exposure to X-rays. It is more commonly used in clinical research than in routine clinical practice. [22]
• Other tests, such as computed tomography (CT) scan and magnetic resonance imaging (MRI), can also be used to determine body composition but are expensive options for routine nutritional assessment. Body composition, however, can be determined when imaging is done for other diagnostic purposes.
• Issues of Concern

Despite multiple studies on malnutrition and the knowledge that malnutrition affects clinical outcomes, the term malnutrition still has different interpretations and usages. In the consensus statement focusing on undernutrition by the Academy of Nutrition and Dietetics and ASPEN, adult malnutrition was used interchangeably with adult undernutrition for discussion. [23]  

Also, there is no single best test that can give a complete picture of an individual's nutritional status. Additionally, various factors may affect the interpretation of individual tests or examinations, or the tests may have some shortcomings. Furthermore, the nutritional status of individuals itself is affected by multiple interdependent factors discussed below. Hence a holistic, team-based approach that takes into consideration overall data from clinical examination, dietary assessment, and diagnostic tests is necessary to determine the comprehensive nutritional status of a patient. At the same time, different nutritional screening or assessment tools may be required for different types of patient populations (i.e., children vs. elderly) or settings (i.e., hospital vs. outpatient).

Specialized tests may also be required in any patient, based on the underlying pathology. Another challenge with nutrition evaluation is dual manifestations of malnutrition, in which overnutrition and undernutrition can coexist. This further complicates the diagnostic process. The entire team of healthcare providers should be aware of these concerns to enhance the outcomes of nutritional screening and assessment.

Factors Affecting Nutritional Status

It is important to consider the following factors affecting the nutritional status of individuals while performing a comprehensive nutritional assessment. It is also crucial to remember that these factors can be interdependent. The factors can be classified as physiological, pathological, and psychosocial factors. 

Physiological factors:  Physiological factors such as age, sex, growth, pregnancy, and lactation can influence nutritional needs and should be considered while performing a nutritional assessment. For example, as a child grows, its nutritional requirements will increase. The recommended nutritional requirements for male and female children of the same age are equal early in life, but as they approach adolescence, males require additional nutritional intake. On reaching adulthood, the rise in nutritional requirements of individuals plateaus off in their respective ranges. However, the caloric and nutritional needs of females increase during pregnancy and lactation. Hence, along with a balanced diet, a pregnant or lactating mother may also require additional supplementation of micronutrients, such as iron, folic acid, calcium, and vitamin D. [24]  Maternal age at the time of pregnancy can further affect these requirements. For example, the calcium requirements of pregnant teens are higher than those of pregnant adults. [25]  Physical activity also determines the recommended macronutrient (carbohydrate, protein, and/or fat) nutritional requirements. Individuals with an active lifestyle require higher nutritional needs than individuals with a sedentary lifestyle. Failure to meet the additional nutritional needs in any of the situations mentioned above increases the risk of malnutrition, especially if other health conditions coexist. On the other hand, as age advances, the energy needs of elderly individuals decrease due to less mobility and loss of lean tissue leading to decreased appetite. Factors such as poor dentition, increased prevalence of chronic conditions, and adverse effects of polypharmacy combined with psychosocial factors, like poor socioeconomic conditions or dementia, can further decrease intake of nutritious food, thus leading to impairment of nutritional status. [26]

Pathological factors:  While performing nutritional assessment, it is important to understand how underlying pathologies can affect nutritional status. Some of these factors are discussed below.

• Genetics: Genetics play a significant role in maintaining an individual's nutritional status. Genetic predisposition combined with lack of physical activity and a high-energy diet can lead to obesity and metabolic syndrome, thus putting individuals at higher risk of developing cardiometabolic diseases. In various genetic disorders, multiple factors could be responsible for the pathogenesis of malnutrition. For example, in cystic fibrosis, malabsorption of nutrients results from decreased uptake by the intestines and reduced secretion of pancreatic enzymes. This, coupled with increased energy needs, can contribute to malnutrition in these patients. [27]  Similarly, many other genetic disorders, such as phenylketonuria, Prader-Willi syndrome, maple syrup urine disease, abetalipoproteinemia, and lysosomal storage disorders, significantly affect the nutritional status of individuals.
• Infections: Malnourished individuals are more susceptible to infections and related complications. Interestingly, both acute and chronic infections adversely affect the nutritional status of individuals and can precipitate malnutrition. For example, in measles, an acute viral infection, severe deterioration of the nutritional status of children is observed due to acute inflammatory response, increased energy needs, and decreased intake of nutrients due to sore throat or oral lesions. The coexistence of malnutrition increases the severity of measles infection, susceptibility to secondary infections, and mortality rate. Measles is also associated with vitamin A deficiency, which can lead to xerosis, keratomalacia, and corneal ulceration, contributing to ophthalmological complications. [28]  Chronic infections, such as tuberculosis (TB) and human immunodeficiency virus (HIV) infection, are associated with anorexia and cachexia. The underlying proinflammatory cytokine response and metabolic alterations are mainly responsible for this. [29]  Other factors, like the adverse effects of drugs, can also contribute to this, thus aggravating malnutrition. Malnutrition, on the other hand, increases the severity of the infection, leading to a bidirectional relationship between infection and malnutrition. Parasitic infestations also severely affect the nutritional status of individuals. [30]  For example, intestinal parasite infestation, such as ascariasis, leads to a deficiency of macronutrients and micronutrients.
• Medical and surgical illnesses: Various medical and surgical illnesses affect the nutritional status of individuals through multiple mechanisms and may lead to malnutrition. An important mechanism that leads to malnutrition in patients with systemic disorders is the underlying inflammatory response. Many conditions like cardiovascular diseases, chronic obstructive pulmonary disorders, rheumatoid arthritis, chronic pancreatitis, neuromuscular disorders, etc., have some underlying chronic inflammatory response, which leads to an altered metabolic state. Another mechanism that could lead to nutritional disturbances is malabsorption. Many gastrointestinal pathologies such as inflammatory bowel disease, pernicious anemia, celiac disease, gastrointestinal obstruction, pancreatitis, and liver cirrhosis can lead to malnutrition through this mechanism. Malabsorption can also occur because of conditions affecting other organ systems. For example, right-sided congestive cardiac failure may be associated with intestinal edema, resulting in malabsorption and malnutrition in these patients. The next mechanism is metabolic disturbances observed in conditions characterized by dysfunction of the liver, gallbladder, and pancreas and endocrine disorders like diabetes mellitus, Cushing syndrome, and hyperthyroidism. Malnutrition also occurs due to decreased nutrient intake or loss of nutrients. Poor intake of nutrients can be seen in local pathologies affecting ingestion of food, as well as diseases that have dementia as one of the clinical features, such as Parkinson and Alzheimer diseases. [31]  Recurrent nausea or vomiting, which leads to either decrease in the nutrient intake or loss of nutrients, can be seen in gastrointestinal pathologies, cyclic vomiting syndrome, brain tumors, Meniere disease, allergies, migraines, and motion sickness. Similarly, conditions characterized by recurrent diarrhea or steatorrhea can also be associated with malnutrition due to loss of nutrients. Mental illnesses (also discussed in psychosocial factors) affect nutritional status too. The mental status of these patients, adverse reactions to prescription drugs, loss of appetite as part of the disease process, etc., can all lead to malnutrition in these individuals. [32]
• Surgery: Malnutrition before surgery can increase the risk of complications, including increased need for ICU admission, longer recovery time, infections, and higher rates of morbidity and mortality. Hence, a nutritional assessment before surgery is crucial. Surgery alone can be a risk factor for malnutrition due to various factors, such as pre- and post-operative fasting, hypermetabolism, adverse effects due to drugs, pain, and other factors specific to the type of surgery. [33] [34] [33]
• Trauma: Severe trauma cases, including head injuries, burns, and multiple fractures, can put patients at high risk of malnutrition. The initial acute inflammatory response and increased energy needs following trauma lead to a hypermetabolic phase. [35]  This, followed by a prolonged period of immobility, leads to muscle atrophy and protein breakdown, causing additional metabolic disturbances. The severe condition of these patients also affects food intake. Altogether, these factors often lead to malnutrition. Furthermore, malnutrition can adversely affect the recovery phase and increase the risk of complications, thus worsening clinical outcomes. [36]
• Malignancies: Malnutrition in malignancies is multi-factorial. Inflammatory mediators, increased energy needs, adverse effects of drugs/therapy (like mouth ulceration, nausea, and vomiting), mental stress, anxiety, and depression can lead to deterioration of nutritional status. Furthermore, malnutrition can inhibit the effectiveness of therapy and worsen the prognosis of the disease. [37]
• Medications: Adverse effects of various drugs, such as nausea, gastric irritation, or loss of appetite, can contribute to decreased food/nutrient intake. Commonly taken over-the-counter (OTC) drugs, such as NSAIDs, can lead to gastrointestinal irritation. Similarly, iron tablets can also cause gastrointestinal irritation and constipation as side effects. Some medications can lead to specific deficiencies, such as the drug isoniazid, which can lead to vitamin B6 (pyridoxine) deficiency. Hence, detailed drug-related history is needed as some drugs can cause drug-nutrient interactions.

Psychosocial factors:  Often, the above-mentioned physiological and pathological factors may coexist with psychosocial elements, resulting in further deterioration of nutritional status and eventually leading to malnutrition.

• Factors such as socioeconomic conditions, natural and man-made calamities, cultural norms, religious beliefs, etc., can affect nutritional intake. Undernutrition is the major concern in impoverished areas, famine-stricken, war zones, or refugee camps. Though it may seem obvious that overnutrition is mainly observed in affluent groups due to access to resources, the relationship between obesity and socioeconomic status is complicated. While undernutrition is one of the outcomes of lower socioeconomic status, paradoxically, individuals from these groups are also susceptible to developing obesity. This is due to limited access to fresh, nutrient-dense, and relatively more expensive food on the one hand and easy availability of less expensive, energy-dense food on the other hand. Malnutrition with dual manifestation may especially be seen in these groups of individuals.
• Other factors such as eating disorders, mental illnesses, and unhealthy diet trends can also drastically affect nutritional status and increase the risk of malnutrition.
• Alcohol and substance use are other major factors that need to be considered. Excessive alcohol consumption affects macronutrient and micronutrient metabolism, leading to nutritional deficiencies. [38]  Excessive alcohol consumption is associated with multi-organ tissue injury, which leads to inflammation. Alcohol consumption can also affect fluid balance. Furthermore, patients' food habits with chronic alcohol use disorder may further contribute to malnutrition. Similarly, illicit drugs affect the metabolism of nutrients as well. Substance use also affects patients' food habits and emotional and mental status, potentially contributing to malnutrition.
• Clinical Significance

Imbalanced nutritional status adversely affects the health and wellness of individuals. By evaluating the nutritional status of individuals early on, nutritional screening and assessment allow for timely intervention and thus help maintain the health and wellness of individuals and improve quality of life. Timely interventions, especially in specific groups of individuals, such as infants, growing children, pregnant and lactating mothers, etc., help prevent long-term complications.

Nutritional assessment and intervention together break the vicious cycle between malnutrition and various diseases or conditions, in which malnutrition aggravates a disease/condition, and the disease/condition, in turn, precipitates malnutrition. Breaking this cycle helps in improving clinical outcomes. Nutritional and clinical management based on comprehensive nutritional assessment results in positive healthcare outcomes by reducing the recovery period, hospital length of stay, risk of complications, susceptibility to infections, and mortality associated with clinical and surgical illnesses. The use of standardized, systematic nutrition risk screening and assessment in the clinical setting also helps in reducing overall healthcare costs.

• Enhancing Healthcare Team Outcomes

Malnutrition adversely affects the health status of individuals, clinical outcomes, and overall healthcare costs. Since malnutrition is a public health concern, it should be addressed accordingly. To prevent this condition, efforts should be made at multiple system levels (public health, community, and individual). Establishing sustainable food systems, educating individuals about healthy diets and lifestyles, maintaining governmental and local food assistance programs, and arranging nutritional screening programs at schools, housing shelters, nursing facilities, and retirement homes, are just a few ways to improve nutritional status and reduce the burden of malnutrition on the healthcare system.

From a clinical standpoint, a systematic team-based nutritional evaluation helps detect malnutrition or factors causing it early, which allows for early intervention and better clinical outcomes. This requires the involvement of physicians (generalists and specialty care physicians), nurses, dietitians, nutrition specialists/technicians, pharmacists, dentists, and laboratory personnel. The primary attending physician is responsible for overall patient care. Since nutritional status is an important predictor of healthcare outcomes, the primary attending physician’s involvement in nutritional assessment and intervention is critical. 

Nutrition specialists/technicians and dietitians also play vital roles in nutritional assessment. For example, dietetic technicians, registered (DTRs) are qualified to assist with general nutrition screenings and may also assist dietitians and other members of the healthcare team with identifying patients at risk for malnutrition in the clinical setting. Clinical dietitians or RDNs are trained to perform medical nutrition therapy (MNT) using the Nutrition Care Process (NCP), which includes nutrition assessment as the first step in identifying potential nutrition problems in patients, such as the risk factors of malnutrition mentioned throughout this article. Many of the components of nutritional assessment in the NCP are synonymous with those mentioned above.

The five domains of nutrition assessment outlined in the NCP include 1) food or nutrition-related history, 2) biochemical data, medical tests, and procedures, 3) anthropometric measurements, 4) nutrition-focused physical findings, and 5) client history. [39]  By being involved in the diagnostic process and contributing to the planning and monitoring of steps of the intervention, nutrition specialists/technicians and dietitians help enhance overall healthcare outcomes.

Nurses also help with early nutritional screening to identify nutrition risk factors and monitor the patient's condition to maintain timely documentation records of clinical status. Pharmacists may also provide information about potential drug side effects or conditions that may impact the risk of malnutrition. They may also provide suggestions to help prevent drug-nutrient interactions that could influence a patient's nutrition status (i.e., antiepileptic drugs and potential impact on vitamin D levels).

Dental professionals can also play a unique role in identifying malnutrition risk factors in patients. For example, a child or adult with multiple dental caries and poor dentition will likely be at higher risk for malnutrition due to limitations with oral intake; a dental professional can assist with alleviating these concerns, thus promoting better overall nutrition. Consultations with specialty physicians may be required not only for the management of underlying conditions but also for the improvement of the nutritional status of patients. Other healthcare team members' services and expert opinions are also essential based on a patient's clinical presentation.

Overall, effective collaboration between each healthcare team member is essential to provide a thorough, comprehensive nutritional assessment. While each collaborating member may not function within the same healthcare system, modern technology and dynamic electronic medical records allow clinicians to communicate remotely to provide better overall care, which can manifest into more detailed nutritional assessment data collection and utilization.

As this article highlights, there are many different components of nutritional assessment, and it would be an overwhelming task for one member of the healthcare team to assume responsibility for performing all of these components alone. Therefore, it is to the benefit of the physicians, nursing staff, and allied health professionals to coordinate the facilitation of obtaining appropriate nutrition assessment data that can be used to enhance healthcare outcomes for patients' health and safety.

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Disclosure: Aditi Kesari declares no relevant financial relationships with ineligible companies.

Disclosure: Julia Noel declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Kesari A, Noel JY. Nutritional Assessment. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Nutritional Analysis

After I logged my food intake and physical activity for two weekdays and one day of the weekend, I could make conclusions about my overall nutrition. Out of the main food groups, including whole grains, vegetables, whole fruits, protein, and dairy, my data showed that I was under 70% intake percentage in two food groups and not over 150% for any food groups. The two food groups where my intake lacked a healthy amount overall included vegetables and proteins. This means I do not eat enough of these two food groups in my everyday diet. However, no food groups were above 150 percent, meaning I am not eating too much of any certain food group, which is healthy. I reached 100% for whole fruit intake, 90% for whole grains, and 85% for milk and yogurt in dairy. My protein and vegetable intake was under 70%, with 68% protein intake, and vegetables fell the shortest with only 50% consumption (Choose MyPlate). I, therefore, do not meet the recommended amounts for vegetables and proteins; however, I do reach the recommended amount of the other food groups.

My recommended number of calories to intake per day based on my weight, height, physical activity, and age is 2,000 calories per day. Each day, I fell a little short of the calorie count. Wednesday, I consumed about 1,789 calories; on Thursday, I consumed about 1,606; and on Friday, I consumed about 1,879 calories. This is a good reflection of my calorie intake because the recommended weight for my group is between 122 pounds and 164 pounds (Choose MyPlate). Therefore, it makes sense that I eat a little under my recommended calorie count and weigh in the low end of the range. My BMI is in the healthy weight range of 20. This is found by taking the body weight divided by the height squared. Weighing a little over 120 pounds and having a height of around 5’8 brings me very close to a BMI of 20. The average BMI for a healthy weight is in the range of 18.5 to 24.9 kilograms/meters squared (Wardlaw).

I believe since my preferred method of physical activity contains mostly cardio with some weight training, the most important dietary element that I should maintain is whole grains. My regular physical activity includes going to the gym 4 or 5 days out of the week and running between one and two miles, followed by a couple of reps of a weight machine working various parts of my body. It is important that my body maintains a healthy number of carbohydrates, which are the main components making up whole grains, because they provide a powerful energy source. Carbohydrates can be simple sugars called monosaccharides, for example, fructose, glucose, and galactose. Carbohydrates can also be disaccharides, meaning two monosaccharides or polysaccharides, pertaining to starches, fibers, and glycogen. Carbohydrates, when ingested, are broken down by amylase, which mixes with the starchy products to break it down to further be digested (Wardlaw). Carbohydrates are important because certain tissues, such as red blood cells, can only receive energy from simple carbohydrates. When running, as physical activity, versus weight lifting, it is important to have more carbohydrates than protein because of how the body will then use the energy to fuel your actions and store the access food intake. Excess of one food intake will then turn into fat, or adipose tissue, which is then much harder for your body to burn off.

One thing that I need to do to enhance my diet would be to start eating more vegetables. I do not like many vegetables, which makes this hard to do, but to enhance my diet, I need to find ways to incorporate more vegetables. One way to do this would be to take a vegetable I like, such as broccoli, and incorporate it into more foods, such as making pasta with broccoli. I also enjoy smoothies, so adding kale or other nutrient-rich vegetables into smoothies with other fruit or dairy products would be a good way to eat more vegetables. I also need to eat more protein. This has only become a recent deficiency in college, where I make all of my own meals. I need to eat more meat in my meals to increase my protein intake, which is an essential source of amino acids, which are the building blocks of many body functions and processes. I need to eat more meat in my meals because I do not like eggs and beans, which are other great sources of protein.

Proteins give our bodies amino acids, which are used in the process of translation to make polypeptide chains, which then will become a cell protein (Wardlaw). Every cell contains proteins, and proteins are essential for body functions such as maintaining fluid balance, contributing to the immune system, and promoting healthy growth and development. While I didn’t have a super low protein percentage, it is still important that my average protein percentage is above 70 to give my body and cells adequate fuel.

I have reached the proper percentage of fruits because fruits are my favorite food group, which makes It easy to consume enough. I enjoy fruit smoothies often as well as raw apples, bananas, and berries that I eat either plan for breakfast or snacks as well as incorporated in different foods. Fruits do, however, contain a lot of sugar, which leads me to be close to the 50g of sugar a day limit. Each day, I consumed about 40g of sugar, which is just under enough to be healthy. My recommended amount of saturated fat intake was 22 grams; I also came close to that limit by consuming 17g, 19g, and 20g during my three-day food track. Saturated fats “can drive up total cholesterol and tip the balance toward more harmful LDL cholesterol, which prompts blockages to form in arteries in the heart and elsewhere in the body” (Harvard Medical School). This explains why it is important to limit saturated fats. In addition to limiting saturated fats and sugars, it is important to limit sodium. My recommended sodium intake was 2300mg of sodium. Wednesday and Thursday, I was very close to this limit, consuming 2064mg and 2100mg of sodium, and on Friday, I exceeded the limit (Choose MyPlate). Sodium is in tons of American’s everyday food in larger quantities than necessary, making it very easy to consume more sodium than needed. Sodium can increase blood pressure and, in extreme cases, cause heart disease.

The last food group I have not talked about would be milk and yogurt or the dairy category, which I had a healthy percentage of 85%. I consume enough dairy by eating lots of yogurt, drinking milk, and eating cheese in a variety of my meals and snacks. Too much dairy can lead to gastrointestinal problems, but the healthy amounts ensure probiotics and other healthy bacteria the body needs.

I am lucky to have grown up in Madison, Wisconsin, with a family that was able to provide me with proper nutrition to grow and develop. In many places in the world, with their physical location or socioeconomic status, families can’t give their children proper nutrition. Money becomes an issue in providing all the healthy food groups and quantities for many people across America, arguably leading to many cases of obesity. I am fortunate enough not to have economic factors interfere with my ability to buy, make, and consume nutritious meals. Without having any economic barriers, it leaves only responsible for my nutritional intake and the quality of my meals for my body.

During this three-day track of my nutritional intake and physical activity, I was able to learn a lot about my food consumption and restate some important knowledge. I am glad I am on track with the BMI and physical activity guidelines, as well as meeting the proper percent of intake for most of the food groups. I will continue to work on my vegetable and protein intake, as well as watching my sodium and saturated fat levels in the near future.

Wardlaw, G. M., Smith, A. M., & Collene, A. (2015). Contemporary nutrition: a functional approach. New York, NY: McGraw-Hill Education. Text.

Choose MyPlate. (n.d.). Retrieved October 02, 2017, Website from http://www.choosemyplate.gov/

Harvard Medical School. The truth about fats: the good, the bad, and the in-between. Retrieved October 02, 2017, Website from https:// www.health.harvard.edu/staying- healthy/the-truth-about-fats-bad-and-good

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Part 1: Healthy Body WeightExamining your energy balance and factors that affect your appetite.

Part 2: Breaking Bad HabitsExamining your unhealthy eating behaviors and developing a plan to break them.

Part 3: Physical ActivityExamining your level of fitness and developing a plan to increase it.

SummarySummarizing your plan for gaining or maintaining a healthy lifestyle.

To receive full credit all answers must be typed and in complete sentences to receive full credit. You will be graded for detail and specific information. Provide details that demonstrate your knowledge of nutrition and a healthy lifestyle. Listing, bulleting, or short answers are not acceptable.

Remember to use full sentences and paragraphs when answering all parts. A well-formed paragraph consists of at least three proper sentences. A proper sentence is a complete idea and consists of at least one noun and one verb.

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Home — Essay Samples — Nursing & Health — Nutrition & Dieting — Nutrition

Nutrition Essays

The best nutrition essay prompts to kickstart your writing.

Embarking on the journey of writing a nutrition essay begins with understanding the prompt. A well-chosen prompt can illuminate the path to a compelling narrative, enriched with insightful analyses and groundbreaking conclusions. Here are examples to ignite your creativity:

• Explore the impact of vegan diets on athletic performance.
• Analyze the role of micronutrients in preventing chronic diseases.
• Discuss the socio-economic barriers to healthy eating in urban areas.

Strategies to Brainstorm and Select a Captivating Nutrition Essay Topic

Choosing the right topic is crucial for your essay's success. Consider these points to spark a brainstorming session that leads to the selection of a compelling topic:

• Relevance: Choose a topic that is relevant to current trends and research in nutrition.
• Interest: Pick a subject you are passionate about to maintain motivation throughout your writing process.
• Originality: Aim for a unique angle or perspective to stand out from commonly discussed topics.
• Resources: Ensure there are enough resources and research available to support your essay.

Exploring Unique Nutrition Essay Topics for an Engaging Read

To captivate your audience, veer away from the beaten path and explore these thought-provoking topics:

• The effects of gut microbiota diversity on mental health.
• Nutritional strategies for managing autoimmune diseases.
• The influence of cultural practices on dietary habits across the globe.
• Future trends in nutrition: The rise of personalized diets.

Inspiring Examples of Paragraphs and Phrases for Your Nutrition Essay

Let these samples inspire your writing, enhancing the flow and depth of your essay:

"As we delve into the intricate relationship between diet and mental health, it becomes evident that the gut-brain axis serves as a critical communication pathway. This symbiotic relationship underscores the importance of nutritional choices in maintaining mental well-being."

"The concept of personalized nutrition, tailored to an individual’s genetic makeup, lifestyle, and environment, heralds a new era in dietary science. This bespoke approach promises to revolutionize our understanding and management of nutrition-related health outcomes."

Strawberry Infused Water Research Paper

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The Importance of Proper Nutrition and Healthy Diet

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Nutritional Influences of Carbohydrates and Proteins on Depressive Symptoms

The importance of nutrition education in school, nutrition concept for the football players, nutrition rules that will fuel your workout, the importance of nutrition management in respiratory diseases and mechanically ventilated patients , assessment of my nutrition and dietary routine, importance of proper nutrition in bodybuilding, a study of the relationship between nutrition and brain function, parenteral nutrition in cancer chemotherapy, how identification of genes and genetic expression can contribute to nutritional assessment, all about fats: why you need them in your diet, vegan lifestyle: why veganism is more than a diet, the importance of eating organic food, the differences between nutrient-dense foods and empty-calorie foods and their effects on health, evolution as one of the major determinants in the obesity setting, veganism - the best solution to nowadays' problems, why palm oil is bad for your health, should chocolate milk be served in schools, the process of canning and history of canned food, advantages and disadvantages of different fruits.

Nutrition is the biochemical and physiological process by which an organism uses food to support its life.

Nutrition process includes ingestion, absorption, assimilation, biosynthesis, catabolism and excretion.

Human nutrition deals with the provision of essential nutrients from food that are necessary to support human life and good health. In humans, poor nutrition can cause deficiency-related diseases such as blindness, anemia, scurvy, preterm birth, stillbirth and cretinism, or nutrient excess health-threatening conditions such as obesity and metabolic syndrome. Undernutrition can lead to wasting in acute cases, and stunting of marasmus in chronic cases of malnutrition.

Supplements can never fully replace real foods. Unprocessed food is healthiest. Omega-3 fats are crucial and most people don’t get enough. There is no perfect diet for everyone.

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• Eating Disorders
• Mental Health
• Drug Addiction

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Best Food Essay Examples

Diet analysis essay.

1917 words | 6 page(s)

Introduction The aim of the paper is to evaluate my dietary consumption in order to gain an awareness of the food that I consume and to determine whether it is healthy and contributing positively to my overall health and nutrition. The paper will focus on my 7-day dietary food-log for the purpose of analysis in order to determine the kinds of food that are providing me with the required nutrients and how my dietary consumption can be altered to facilitate a healthier nutritional intake.

Personal profile I have comparatively healthy eating habits because all my meals are balanced, containing enough fresh fruit, and vegetables. But, my calorie consumption is insufficient for an individual of my age and activity level. According to the Calorie Calculator, I need 2361 kcla every day to maintain a healthy weight, but my average calorie intake over seven days was 1307kcal. This is a difference of 1054 calories. I am currently at a healthy weight with a BMI of 19.7 according to the BMI calculator. If I continue with the bad eating habits of skipping breakfast and lunch on some days, I will experience energy deprivation, unhealthy bingeing due to intermittent fasting, and I may become underweight. As such, I need to eat heavier snacks, more calorie-packed lunches and lighter dinners. I am working to get sixty percent of my calories from carbohydrates, thirty percent from fats and proteins. I am glad that my fiber intake is healthy with plenty of whole grain bread and rice, having consumed seventy-nine percent fiber in the one week period. However, this can always be increased by replacing the white rice with brown rice.

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Skipping Meals I have a bad habit of skipping breakfast because of getting up late in the morning and having no time to eat. On the days that I have skipped breakfast, I have struggled with very low energy levels even though I am accustomed to going on an empty stomach in the morning hours for two to three times per week. Considering that I am a college student, I understand that my brain and body need glucose in the morning so that I can function effectively.

Eating breakfast is an effective factor in a weight maintenance program. If I don’t make a habit of eating breakfast every day, I will become underweight. It is also true that people who do not eat breakfast are most likely going to snack on high-fat food or overeat at dinner. I can observe from my food chart that I had a heavy snack after my morning classes when I went without breakfast. I am glad, however, that the snack consisted of healthy wholemeal bread.

I also find that I have a more anxious and moody temperament on the mornings that I go without breakfast which is bad for my concentration and interaction with people. Additionally, not eating breakfast increases my chances of being hypoglycemic, or having low blood sugar. Hypoglycemia can cause physical symptoms such as headaches, weakness, shakiness, and a rapid heart rate, some of which I have experienced, especially the headaches and dizziness in extreme cases when I have skipped both breakfast and mid-morning snack.

Dietary changes After gaining a better understanding of my diet and food consumption, I will most certainly change my diet intake to a higher amount of carbohydrates and proteins, and increase the healthy fruit and vegetables. I will start and maintain a habit of going to bed early so that I can wake up early to allow enough time for a healthy breakfast to set me on a healthy and energized start to the day. To prevent losing too much weight, I will be accompanying my one fruit snack with nuts or a light sandwich that will also boost my caloric intake. I will substitute my Vegetarian Chili and Vegetarian Fajita with Meat Chili and Fajitas. I will instead eat my vegetables in the form of healthy salads during dinner or lunch, or both whenever possible.

To increase my carbohydrate intake, I will need to include more healthy starch in my diet such as yam, potatoes and a variety of breads such as seeded or granary bread. I will also increase my portions by one-third to increase my energy levels. This will be supplemented with an active lifestyle. As it is now, I am fairly active, living the typical college life. In my free time, I swim and take long walks. But on the weekends, I mostly sleep in to repay the week-long sleep debt. I will take more time away from my bed to increase movement, heart rate, and ultimately to spike up my energy levels.

My fluid intake is fairly good. I get most of my water from milk, and breakfast beverages, with the occasional glass of water when I get very thirsty. But I believe that I need to hydrate more, by increasing my fruit intake and plain water intake so as to aid in digestion and overall health. I need to cut out Coca Cola and replace it with fresh juice or succulent fruit such as grapefruit, oranges, mangoes, and tangerines. Coca Cola contains too much sugar, and although I am not trying to lose any weight, it is not a healthy food choice. Coffee is also a beverage that I can perhaps do without even though it contributes to my daily fluid requirement. But, coffee is a diuretic, meaning that it will make me urinate often, hence increasing my risk for dehydration. While it does not acutely affect my health and hydration considering that I take it occasionally, it may not be a significant issue in my dietary intake. All in all, water is my best option to keep hydrated. It is cheap and caffeine free! Instead of coffee in the morning, I will take fruit juice. On the mornings when I am in a hurry, I will have a quick cereal with whole milk.

My breakfast could use more whole grains, such as whole bran cereal, oats, and muesli, and less of black sweetened coffee, bagels, sweeteners, and bread. I could also do more with soft boiled eggs and meats once in a while, for example, one to two times per week. I could also incorporate an afternoon snack to my diet plan in order to maintain a healthy body weight. In addition to the afternoon snacks, I could use some dessert with my lunch or dinner a few times a week. The afternoon snacks may consist of nuts, smoothies, or light sandwiches made from thinly sliced whole bread, vegetables, and sauces such as mustard and tomato sauce. An afternoon snack would contribute to a higher calorie intake, which would prevent me from eating too much at night. A lighter meal at night would allow for more comfortable sleep and digestion.

Behavioral changes I need to regulate my meals by eating at the same time every day. To achieve this, I need to give structure to my eating habits so as to make eating an important and regular part of my daily living. Having a structured eating schedule will enable me to eat enough of the right foods. Once the habit of eating meals and snacks is firmly in place, I can then adjust the food content and sizes accordingly as opposed to simply eating impassively because it is time to eat or because I am really hungry. A regular food schedule will help me to combat skipped meals, irregular, or delayed eating. As such, it will help me to prevent binge eating because I will avoid the intense hunger that causes me to binge eat. Regular meals will keep my blood-sugar level stable to reduce the feeling of irritability and tiredness. Also, my metabolism will be steady. I understand that if I go for more than four to five hours without eating in the course of the day, my body will go into ‘starvation’, and it will go into stress mode to prepare for a lack of food. ‘Starvation’ lowers the metabolic rate to preserve energy. For that reason, the next meal consumed will be metabolized for the purpose of storing up energy which leads to weight gain.

After I have set s regular structure, I will be able to plan my meals in advance. I will know when my next meal or snack will be and I will have a plan as to what to eat at that time. I tend to blame a lack of time as my reason to skip breakfast or lunch. However, time is made for important things so I must make time to eat. To practice this, I need to consider my meals and my snacks as an important part of my day and to prioritize eating over doing other things such as reading, watching television, or sleeping. When I prioritize accordingly, I will not leave a space of more than four hours in between meals and snacks. Since my college schedule will not allow me to shorten the gaps between my eating because of some extremely tight schedules, I will make sure to increase my portions instead to supply me with the energy to run around during the day. I need to be sufficiently prepared for the frequent meals in the day. I will start to carry an easy-to-eat snack in my backpack or my car, for example, a bag of dried fruit or nuts, fruit, or a muesli bar.

Conclusion The outcome of my dietary evaluation indicates that my nutrient consumption is good but it could be better. Just because I eat a lot of whole grain does not necessarily mean that my diet is healthy overall. I need to increase fruit and vegetables and to eat regularly so that my digestive system is not always in shock, which could lead to issues such as constipation or calorie retention. Not having time for breakfast is not an excuse to skip breakfast altogether. I can always create time for breakfast by going to bed early enough so that that I have had enough sleep by morning.

A dietary analysis is a practice that should be carried out on a more regular basis because it is only by writing down our food habits that one can see clearly how they are treating their bodies by what they eat. Having awareness will make one think twice next time they reach for fast food or unhealthy beverages such as soda.

Based on my food intake, I am not consuming enough calories to fit my daily requirements. I need to increase my calories by one-third by including more variety to my snacks and by eating regular sizeable portions of foods rich in healthy starch. In the two days that I skipped breakfast and the one day that I skipped lunch too, my calorie intake was too low which translated into low energy levels and nutrient deprivation.

I must make these changes very soon so that I will not plunge into underweight and compromise my nutrient consumption. While the changes that I need to make are negligible, it will take discipline. I need to do is add on to what is already there, include more variety in my diet, increase my portions, maintain a regular eating schedule, avoid skipping meals, and add an afternoon snack and occasional dessert after lunch or dinner. This analysis has helped me to see that although I may be at a healthy weight with a good BMI, I may not be as healthy as I want to be.

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