Holistic Nutritional Assessment TableAssessment CriteriaAssessment Findings / DataInterpretation of
Holistic Nutritional Assessment Table
Assessment CriteriaAssessment Findings / DataInterpretation of Data for Nutritional NeedsAge and growth/development stage16 year old male. Developmental stage- AdolescentA 16 year old falls within the late adolescence bracket of 15-19 years (Das et al., 2017). The age is characterized by rapid growth hence high nutritional demands.
Anthropometric: Height, Weight, BMI, Recent weight changesHeight: 161cm; Weight: 44Kgs; BMI: 16.97Kg/m2
3 Kg weight loss in the past 6 months
Normal BMI, according to World Health Organization falls between 18.5 and 24.9 Kg/m2 (WHO, 2021). Values below 18.5 are regarded as underweight while values above 25.0 can be overweight (25.0-29.9), obesity (30.0-39.9) and morbid obesity (>40). This patient is underweight with a BMI of 16.97 Kg/m2
Biochemical and Medications: (list any laboratory information available) No tests are required, but if available include. Include both prescription and over-the-counter drugs.
Laboratory testsComplete blood count-WBC-12, 476×109/L
Hemoglobin-9.7g/dl
ESR-31mm/hr
CRP-13mg/L
Blood culture positive for Staphylococcus aureus
Medications
Ferrous Sulfate 600mg PO divided q12hr
Tylenol 500mg PO BD
Vancomycin 1g IV every 12 hours
Leukocytosis, anemia, elevated ESR and CRP, and a positive blood culture for Staph. aureus are the laboratory findings. These findings are consistent with the patients’ condition, chronic osteomyelitis, which was diagnosed at the age of ten. His malnutrition is caused by the chronic infection (increased metabolic demands), as well as reduced feeding and a financial inability to obtain enough, safe, and appropriate nutrition. Tylenol relieves his pain, Vancomycin is prescribed for Staph. Aureus, and ferrous sulfate replenishes the iron stores in hemoglobin.
Clinical: Physical signs and symptoms of malnutrition observed in the patientWrinkled and lose skin; loss of buccal fats, angular cheilitis, koilonychias, muscle wasting, lethargic and apatheticAngular cheilitis and koilonychias are signs of iron deficiency anemia (Roberts, 2017), which justifies the administration of Ferrous sulfate. Otherwise, all of the symptoms point to a diagnosis of protein energy malnutrition (PEM), which is defined by a low intake of proteins and calories. In this case, the causes of PEM include high metabolic demand due to the chronic infection and improper and inadequate food intake due to poverty
Dietary Data: Question present diet (see page 9 of text)
– How do an individual’s genes determine how the body handles specific nutrients?
Congenital differences in enzymatic activity cause variations in nutritional requirement. Differences in genetics also cause like and dislike of certain foodsExample: Other people find synthetic phenylthiocarbamide quite bitter while a different group of people cannot taste the chemical (Roberts, 2017)– What role does a person’s microbiota have in an individual’s response to diet and food components? What is its role in disease prevention and progression?Microbiota help in digestion of food. In terms of disease prevention, they produce chemicals that kill bacteria, viruses and fungiLactobacillus acidophilus and Bifidobacterium bifidum are two major beneficial flora that help in digestion and maintaining a healthy gut (Roberts, 2017)– How does food intake affect a person’s microbiota?Food intake impacts the gut’s microbiome.A study shows that abundance of specific microbiota can be determined by food changes. For example, plenty of plant-based diet causes a healthy diversity of the gut flora (Valdes et al., 2018)– How does an individuals’ genome affect responses to diet and food?Genetic variation can modify nutrient utilization and subsequently dietary requirementA polymorphism in MTHFR gene has been evidenced to alter folate metabolism increasing the risk for neural tube defects (Meddens et al., 2020). Abundant folate supplements are therefore required to ameliorate the risk (Meddens et al., 2020)– How does diet during critical periods of development “program” long-term health and well-being? For instance, how does undernutrition during fetal life increase the risk of diabetes in adulthood?Reduced insulin levelsMalnutrition has multi systemic effects including endocrine system. Insulin levels are reduced and the child has glucose intolerance. Individuals with impaired glucose intolerance have 50% chance of developing diabetes in 10 years’ time (Goyal et al., 2020)– How can obesity be prevented? Can obesity be cured?Lifestyle interventions such as dietary modifications and physical activityIt is recommended that individuals cease consumption of junk food and integrate plenty of fruits and vegetables in their diet. Other benefits that comes alongside prevention of obesity include reduction of risks of diabetes– How does nutrition influence the initiation of disease and its progression?Malnutrition affects the immune system which protects the body from diseasesCell mediated immunity is depressed, secretions of IgA reduces, production of complement components are low, lymph glands, tonsils and thymus are atrophied (Roberts, 2017). Malnutrition effects on immune systems. Resulting effect is increased risk for infections.– What are the nutritional needs of aging adults?Calcium and vitamin D, Vitamin B12, Dietary fiber, PotassiumCalcium and vitamin D helps maintain a healthy bone. Vitamin B12 supplements are useful in those who are unable to absorb the vitamin.– What are the biochemical and behavior bases for food choices? How can we most effectively measure, monitor, and evaluate dietary change?Three main biochemical constituents of food are proteins, carbohydrates and fatsDietary intake can be evaluated by observation and recording of food consumption. A duplicate diet approach can be used to record and individual’s diet, and to analyze the dietary exposures (Roberts, 2017)–
– How can we get people to change their eating behaviors?
Make a strict diet scheduleHelp the individuals to adhere to their diet plan which must consist of more vegetables, fruits, low-fat foodstuffs, and whole grains
Medical-Psychosocial History: (see below)24 hour diet recall2 meals. Breakfast-coffee, supper-rice and cabbagesThe 16 year old have high caloric demands that the 2 meals a day cannot satisfy. This contributes to his diagnosis of PEM.AllergiesNo known food and drug allergiesSupplements (vitamins, minerals, herbal, or other)Folic acid 1mg/day; Zinc 32mg/day, Potassium and Magnesium supplementsPatients with malnutrition have electrolyte imbalance (K, Mg) and micronutrient deficiencies (Folic acid). Supplementation of the electrolytes and micronutrients is key to their managementPatient’s concerns about food or nutritionThe patient has penchant for beef which they cannot afford regularlyHe therefore have a low intake of proteins, a cause for PEMPerson preparing meals and food safety practices related to food preparationHis mother prepares all the food. Practices include washing hands, washing all vegetables and fruits before eating and cookingThe food practices are safe and are the reason for low foodborne illnesses (gastroenteritis) in his familyAlcohol consumptionPatient does not take alcohol. Zero alcohol intake in his nuclear familyMalnutrition related to alcoholism is not an issue in this caseEconomics related to food intakeLow socioeconomic status, cannot easily acquire all the nutrientsThis causes improper and inadequate food intake leading to PEMPsychological factors affecting nutritionPatient has chronic osteomyelitis, express symptoms of psychological distress such as fatigue and anxietyLoss of appetite is a neurovegetative symptom and leads to loss of weigh as evidenced in the patientMedical factors affecting nutritionHis diagnosis, chronic osteomyelitis affects nutritionInfections cause high metabolism and the reason for high nutritional demands in the patient. High metabolic status in addition to low intake for proteins and calories causes PEM.Social factors related to nutrition (culture, religion, barriers, knowledge base)In this patient, lack of knowledge on nutrition among the parents can result in poor nutritionParents are casual laborers and laymen with little comprehension of nutritional demands of an adolescent son.Nutritional Outcome or Goal #1The patient will develop a daily food plan menuInterventions for outcome or goal #1Educate the parents about importance of appropriate nutrition; advise them to include more proteins and carbohydrates to prevent PEM. Help the patients create a 3 meal menu with integration of the food constituentsNutritional Outcome or Goal #2The patient will take the micronutrients and electrolyte supplements as scheduledInterventions for outcome or goal #2Administer the prescribed medications to the patient. Teach the patient and the parents on the importance of the micronutrient supplements.
References
Das, J. K., Salam, R. A., Thornburg, K. L., Prentice, A. M., Campisi, S., Lassi, Z. S., Koletzko, B., & Bhutta, Z. A. (2017). Nutrition in adolescents: physiology, metabolism, and nutritional needs: Adolescents: physiology, metabolism, and nutrition. Annals of the New York Academy of Sciences, 1393(1), 21–33. https://doi.org/10.1111/nyas.13330
Goyal, R., Nguyen, M., & Jialal, I. (2020). Glucose Intolerance. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499910/
Meddens, S. F. W., de Vlaming, R., Bowers, P., Burik, C. A. P., Linnér, R. K., Lee, C., Okbay, A., Turley, P., Rietveld, C. A., Fontana, M. A., Ghanbari, M., Imamura, F., McMahon, G., van der Most, P. J., Voortman, T., Wade, K. H., Anderson, E. L., Braun, K. V. E., Emmett, P. M., … Koellinger, P. D. (2020). Genomic analysis of diet composition finds novel loci and associations with health and lifestyle. Molecular Psychiatry. https://doi.org/10.1038/s41380-020-0697-5
Roberts, I. (2017). Nelson’s textbook of pediatrics (20th edn.), by R. Kliegman, B. Stanton, J. St. Geme, N. Schor (eds): Elsevier, Philadelphia, 2016, Hardcover (2 volumes) 3,888 pp., English, ISBN 978-1-4557-7566-8 (International edition also available) includes access to the e-book version, U.S. $221, U.K. £108.99. Pediatric Radiology, 47(10), 1364–1365. https://doi.org/10.1007/s00247-017-3907-9
Valdes, A. M., Walter, J., Segal, E., & Spector, T. D. (2018). Role of the gut microbiota in nutrition and health. BMJ (Clinical Research Ed.), 361, k2179. https://doi.org/10.1136/bmj.k2179
World Health Organization. (2021). Obesity and overweight. Who.Int. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
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