Transcript Clinical methods

Nutritional Assessment of
Community Nutrition using
Clinical Parameters
Clinical Methods
• one of the most practical and important method
used in assessing the nutritional status of a
community.
• External examination of the body for changes in
superficial epithelial tissues especiallly skin, hair, &
buccal mucosa may be carried out.
• Similarly, organs close to the surface of the body
may be examined, e.g. the parotid & thyroid gland.
• When two or more signs charateristic of a deficiency
disease are present simultaneously, their diagnostic
significance is greatly enhanced.
CLINICAL ASSESMENT
Clinical signs & symptoms of
nutritional inadequacy
SITE
SIGN
DEFICIENCY
GENERAL
APPEARANCE
Loss of subcutaneous fat
Sunken or hollow cheeks
Calories
Calories, fluid
HAIR
Easily plucked hair, alopecia
Dry, brittle hair
Corkscrew hairs
Protein
Protein, biotin
Vitamin C
NAILS
Spooning
Transverse depigmentation
Iron
Protein
Skin
Dry and scaly flaky paint
Nasolabial seborrhea
Psoriasiform rash
Pallor
Follicular hyperkeratosis
Perifollecular hemoffhege
Easy bruising
Hyperpigmentation
Vitmin A, zinc
EFA, riboflavin
Vitamin A , zinc
Iron, vit. B12 , folate
Vit. A , EFA
Vitamin C
Vitamin K or C
Niacin
Eyes
Night blindness
Photophobia, xerosis
Conjuctival inflammation
Retinal field defect
Vitamin A, zinc
Vitamin A
Riboflavin, Vitamin A
Vitamin E
MOUTH
Glosssitis
Cheilosis
Decreased taste or smell
Tongue fissuring
Tongue atrpohy
Loss of tooth enamel
Riboflavin, Pyridoxin,
Niacin, Folic acid, Vit. B12,
Iron
Vitamin C, Riboflavin
Riboflavin, pyridoxine,
niacin
Riboflavin, pyridoxin
Zinc
Niacin
Riboflavin, niacin, iron
calcium
NECK
Goitre
Partid enlargement
Iodine
Protein
HEART
High output failure
thiamin
CHEST
Repiratory muscle
weakness
Protein, phophorus
Bleeding gums
Angular stomatitis
Abdomen
Ascites
hepatomegaly
Protein
Protein, fat
Extremeties
Edema
Bone tenderness
Bone/joint pain
Muscle pain
Joint swelling
Protein
Vitamin D
Vitamin A or C
Thiamin
Vitamin C
Muscles
Atrophic muscles
decreased grip strength
Protein
Protein
Neourological
Dementia
Acute disorientation
Nystagmus
Ophthalmoplegia
Wide-based gait
Perpheral neuropathy
Loss of vibratory sense
Loss of position sense
Tetany
Paresthesias
Wrist or foot drop
Diminished reflexes
Thiamin, vit. B12, folate,
niacin
phosphorus., niacin
Thiamin
Thiamin
Thiamin
Thiamine , pyridoxine,
vita.E
Vit. B12
Vit. B12
Ca, mg
Thiamine, vit. B12
thiamine
Iodine
• Early clinical symptoms &
signs of malnutrition are
rather vague & often include
weakness, lethargy,
irritability, & light
headedness.
• Many of the symptoms &
signs are non specific for a
single nutrient defict.
• And may be cause by
insufficiency of several
nutrients.
• E.g. flaking dermatitis may be
due to protein, riboflavin, or
linoleic acid deficiency
Advantages of Clinical Assessment
• Physical examinations should be an integral part of
most nutrition surveys for the following reasons:
• It is inexpensive.
• It does not require any laboratory equipment.
• Cooperation of the subject can be achieved easily.
• A physical examination may reveal evidence of certain
nutritional deficiencies which will not be detected by
dietary or laboratory methods.
• The identification of even a few cases of clear-cut
nutritional deficiency may be particularly revealing and
provide a clue of malnutrition in a community.
• The nutritional examination may reveal signs of a host
of other diseases which merit diagnosis and treatment.
DISADVANTAGES OF CLINICAL ASSESSMENT:
 The major problems encountered in the clinical
assessment of nutritional status are:
 These have a low general prevalence in developed
countries except in high risk groups.
 Some clinical signs are non-specific of nutritional
deficiency.
 One clinical sign overlaps for more than one
deficiency disorder.
 It does not reflect the magnitude of the problem.
 Skilled personel is required to carry out clinical
examinations.
THANK
YOU