NCM 105: Basic Nutrition and Diet Therapy

San Pablo
Colleges
College of Nursing

NCM 105: Basic Nutrition and

Diet Therapy
Module 6
Nutritional Assessment

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NCM 105: Basic Nutrition and Diet Therapy

Learning Objectives :
. At the end of the session, the students should be able to:

•1. Discuss the methods of assessing nutritional status; and

. .

•2. Explain the significance and purpose of nutritional assessment.

EXPLORATION

RECOMMENDED DIETARY ALLOWANCES

AND ADEQUATE DIET
An adequate diet is composed of various nutrients
which the body needs for maintenance, repair, living
processes, and growth or development. It is a diet which
meets in full all the nutritional needs of a person. There is no
ideal diet since it is a matter of individual requirement. The
purpose of daily meals is to supply the essential elements.
Regional availability of foods, socio-economic conditions,
taste preferences, food habits, age of family members, storage
and preparation
facilities, and cooking skills are factors to consider when nutritious meals are planned.

The dietary standard is changed from Recommended Dietary Allowances (RDA) to

Recommended Energy and Nutrient Intakes (RENI) to emphasize that the standard is in
terms of nutrients and not foods or diets. RENIs are levels of intakes of energy and nutrients
which, on the basis of current scientific knowledge, are considered adequate for the maintenance
of health and well-being of nearly all healthy persons in the population.

ESSENTIALS OF AN ADEQUATE DIET

Proteins, carbohydrates, fats, vitamins, minerals, cellulose, and water should be provided in
sufficient quantity through the daily meals to meet the needs of the body.

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NCM 105: Basic Nutrition and Diet Therapy
The milk group is counted on to provide most of the calcium
requirements. It provides riboflavin, high-quality protein, other
vitamins and minerals, carbohydrates, and fats. The milk allowance
is used in the form of fluid, whole or skim milk, buttermilk,
evaporated milk, dry milk, and cheese. A portion may be used in
cooking.
The meat group provides generous amounts of high-quality
protein. Iron, thiamine, riboflavin, niacin, phosphorus, and zinc are supplied. At least once a
week, liver, kidney, and salt water fish such as salmon, oysters, and
mackerel should be included in the animal protein allowance. There are
several non-meat alternatives that provide the same nutrients as animal
flesh. Vegetarians may combine plant sources such as grains and legumes,
grains and nuts/ seeds, and legumes and nuts/seeds to meet the complete or
high quality protein needs of the body.

The bread and cereal group furnishes thiamine, protein, oh niacin,

carbohydrate, and cellulose at a relatively low cost. The enrichment of
bread and cereals with iron, thiamine, rib and niacin substantially
contributes additional amounts o nutrients to the diet.
The vegetable-fruit group is an important supplier of fiber, minerals
and vitamins particularly vitamins A and C.

ASSESSMENT OF NUTRITIONAL STATUS

Nutritional status or nutriture is the degree to which the individual's psychological need for
nutrients is being met by the food the person eats. It is the state of balance in the individual
between the nutrient intake and the nutrient expenditure or need. The evaluation of the
nutritional status involves examination of the individual's physical condition, growth and
development, behavior, blood and tissue levels of nutrients, and the quality and the quantity of
the nutrient intake. In a thorough nutritional status assessment, all of the following aspects are
considered:
1. dietary history and intake data
2. biochemical data
3. clinical examination
4. anthropometric data
5. psychosocial data

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NCM 105: Basic Nutrition and Diet Therapy

METHODS OF ASSESSING DIETARY INTAKE

1. 24-hour Recall
The individual completes a questionnaire or is interviewed by a dietitian/nutritionist
or a nurse experienced in dietary interviewing and is asked to recall everything that he/she
ate within the last 24 hours or the previous day.
24-hour Recall Form and Food Group Evaluation
The following question pattern may be used for conducting the 24-hour recall. The
information should then be recorded in the chart at the end.

“In order to get a more complete picture of

your family's Health, I need to know more
about your eating habits. Would you please tell
me everything you ate or drank all day
yesterday? Let's begin with:”

1. What time did you go to bed the night before last? _______________________
- Was this the usual time? _______________________
2. What time did you get up yesterday? _______________________
- Was this the usual time? _______________________
3. When was the first time you had anything to eat or drink? _______________________
- What did you have and how much? _______________________
4. When did you eat again? _______________________
- Where? What and how much? _______________________
5. When did you eat next? _______________________
- What did you eat and how much? _______________________
6. Did you eat or drink anything else?
a. Anything from 1st to 2nd meal? 4
b. Anything from 2nd to 3rd meal?
c. Anything from 3rd meal to bed time?
7. Was this day's food intake different from usual? _______________________ - If so,
why? _______________________
8. Is weekend eating different? _______________________ - If so, why?
_______________________

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NCM 105: Basic Nutrition and Diet Therapy

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NCM 105: Basic Nutrition and Diet Therapy

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NCM 105: Basic Nutrition and Diet Therapy

2. Food Frequency Questionnaire

For frequency of food use, the following pattern of question may be useful.
Questions, however, should be modified based the information from the 24-hour recall. For
instance, if a patient said he/she had a glass of milk yesterday, he/she should not be asked,
“Do you drink milk?" but rather “How much milk do von drink?" Answers should be
recorded as 1/day, 1/wk, 3/mo, for example, or as accurately as possible. It may just have to
be noted as "occasionally" or "rarely."
1. Do you drink milk? If so, how much? _______________________
What kind? Whole ___________Skim____________
2. Do you use fat? If so, what kind? _______________________ How
much? _______________________
3. How many times do you eat meat? _______________________ Eggs
Cheese ________ Beans ________
4. Do you eat snack foods? If so, which ones? _______________________
How often? ____________ How much? ____________
5. What vegetables do you eat? (in each group)
_______________________
How often? ________________
a. Broccoli __________Green pepper____________
Cooked greens ____________Carrot_________
Sweet potato________________
b. Tomato _____________Raw cabbage____________
Asparagus__________ Beets _____________
Cauliflower __________Cooked cabbage ______ Celery
________Peas _________Lettuce_________
6. What fruits do you eat and how often?
a. Apples or apple sauce___________ Apricots _______
Banana Berries __________ Cherries __________
Grape or grape juice_________ Peaches ______________
Pears Pineapple __________ Plums ________Raisins _____
b. Oranges ___________ Orange juice ________
Grape fruit __________ Grape fruit juice ___________
7. Bread and Cereal Products
a. How much bread do you usually eat with each meal?_____
Between meals?______________
b. Do you eat cereal? (daily, weekly)
Cooked ____________ Dry ____________
c. How often do you eat foods such as macaroni, spaghetti, noodles, and the like?
__________
8. Do you use salt? ____________
Do you "crave” salts or salty foods? ______________
9. How may tsp of sugar do you use/day?
(1 packet - 1 tsp) __________________
10. Do you drink water? _________ How often during the day? ____________
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NCM 105: Basic Nutrition and Diet Therapy

How much each time?________ How much would you say you drink each day?_____
11. Do you drink alcohol? ___________ How often? ________How much?___ Beer,
wine, others?

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NCM 105: Basic Nutrition and Diet Therapy

3. Dietary History
The dietary history is more complete than either the hour recall or food frequency
questionnaire, although it ally includes both of these sources. The dietary history contains
additional information about the following:
1. Economics
a. Income
b. Amount of money for food each week or month and individual
perception of its adequacy for meeting food needs
2. Physical Activity
a. Occupation
b. Exercise
c. Sleep - hours/day
3. Ethnic and Cultural Background
a. Influence on eating habits
b. Religion
c. Education
4. Home Life and Meal Patterns
a. Number of household members
b. Person who does shopping
c. Person who does cooking and relationship with this person
d. Food storage and cooking facilities
e. Type of housing
f. Ability to shop and prepare food
5. Appetite
a. Good, poor, any changes
b. Factors that affect appetite
c. Taste and smell perception
6. Allergies, Intolerances, and Food Avoidances
a. Foods avoided and reason
b. Length of time of avoidance
7. Dental and Oral Health
a. Problems with eating
b. Foods that cannot be eaten
c. Problems with swallowing, salivation, and food sticking
8. Gastrointestinal Concerns
a. Problems with heartburn, bloating, gas, diarrhea, constipation, distention
b. Frequency of problems
c. Home remedies
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d. Antacid, laxative, and other drugs used

9. Chronic Diseases
a. Treatment
b. Length of time of treatment
c. Dietary modification
10. Medication
a. Vitamin and/or mineral supplement
b. Medications

4. Food Diary or Record

This method involves time, understanding, and motivation on the part of the patient or client.
The subject is asked to write down everything he/she eats or drinks for a certain time period
Three days, particularly two weekdays and one weekend day have been found to be a
representative time period for " people.

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5. Observation of Food Intake

Observation of food intake is the most accurate method of "y intake assessment but also the most
time-consuming, expensive, and difficult. It requires knowing the amount and kind a presented
to the person and the record of the amount actually eaten.

EVALUATION OF THE FOOD INTAKE DATA

Evaluation by Food Group Method
The simplest, fastest, yet crudest way to evaluate food in. is to determine how many servings
from each of the four foo were consumed during the recorded day. The number of se suggested
in the basic four or seven food plans.
General Rules for Menu Planning
1. Use the whole day as a unit rather than the individual meal,
breakfast relatively simple and standardized, then plan di
Lastly, plan lunch and snacks to supplement the other two
meal.
2. Use some food from each of the food groups daily
(energygive foods, body-building foods, and body-regulating
foods).
3. Use some raw fruits or vegetables at least once a day.
4. Plan to have for each meal at least one food with staying
power or high in satiety value, one which contains roughage, and generally some hot food or
drink.
5. Combine or alternate foods of bland form with those of a more pronounced flavor.
6. Combine and alternate soft and crisp foods.
7. Have a variety of color, food, and food arrangement.
8. When more foods are served at one meal, decrease the size of portions and use fewer rich
foods.
Some Don'ts for Menu Planning
1. Avoid using the same kind of food twice a day without vary the form in which it is served
except staples like rice, bread and milk.
2. Do not use the same food twice in the same meal even in different forms.
3. Do not use the same food too often from day to day.

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Other Consideration
1. Meal Patterns. Meal or menu patterns are helpful in planning but they must take into
account the family's habits and needs. For example, the traditional pattern for breakfast
recommended by nutritionists are:
fruit bread or
rice egg or
substitute hot
beverage
The following is a good menu guide for lunch and dinner:
meat, fish, or poultry
rice
vegetable
fruit or
dessert
2. Planning for the Week. It is best to have a weekly menu plan. In hospitals, the practice of
dietitians is to prepare a so-called “cycle menu.”

NUTRITION SURVEY
Nutrition survey is an epidemiological investigation of the nutritional status of the population by
various methods together with an evaluation of the ecological factors of the community.
Significance of Nutritional Assessment
1. It is the first essential in nutritional planning.
2. It provides data and information for planning and evaluation.
3. It helps define priorities and responsibilities of public health system at the national,
regional, provincial, city, municipal, and barangay levels.
Methods of Nutritional Assessment
A. Methods that provide direct information
1. Clinical examination
2. Biochemical examination
3. Anthropometric
4. Biophysical technique
B. Methods that provide indirect information
1. Studies on food consumption
2. Studies on health conditions and vital statistics
3. Studies on food supply situation.

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4. Studies on socio-economic conditions

5. Studies on cultural and anthropological influences

Factors Considered in the Selection of Nutrition Survey Method

1. Unit to be surveyed
Example: household, individual, at-risk group, etc.
2. Types of information required
Example: food intake, height and weight measurement, hemoglobin level, socio-economic
conditions, etc.
3. Degree of reliability and accuracy acquired
4. Facilities and equipment available
Example: reasonable number, type, practicality
5. Human resources
Example: nutritionist, medical technologist, medical nutritionist, biochemist, local extension
worker, auxiliary worker; training required
6. Time reference
Example: season of the year, day (weekend or weekday), number of days of food record
collection (1 day, 3 days, 1 week)
7. Funding or financial support

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