waist/hip ratio
1. waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.
2. the subject stands erect with relaxed abdominal muscles,arms at the side,and feet together.
3. the measurement should be taken at the end of a normol expiration.
waist circumference
waist cicumference predicts mortality better than any other anthropometric measurement.
it has been proposed that waist measurement alone can be used to assess obesity,and two levels of risk have been identified.
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level1 is the maximum acceptable waist cicumference irrespective of the adult age and there should be no further weight gain.
level2 denotes obesity and requires weight management to reduce the risk of type 2 diabeter&CVS complications.
hip cicumference
1. is measured at the point of greatest cicumference around hips&buttocks to the nearest 0.5 cm.
2. the subject should be standing and the measurer should squat beside him.
3. both measurement should taken with a flexible,non-stretchable tape in close contact with the skin,but without indenting the soft tissue.
interpretation of WHR
1. high rick WHR = >0.80 for females&>0.95 for males i.e. waist measurement >80% of hip measurement for women and >95% for men indicates central obesity and is considered high risk for diabetes&CVS disorders.
2. a WHR below these cut-off levels is considered low risk.
advantages of anthropometry
1. objective with high specificity&sensitivity.
2. measures many variables of nutritional significance.
3. readings are numerical & gradable on standard growth charts.
4. readings are reproducible.
5. non-expensive & need minimal training.
limitations of anthropometry
1. inter-observers errors in measurement.
2. limited nutritional diagnosis.
3. problem with reference standards,i.e. local versus international standards.
4. arbitrary statistical cut-off levels for what considered as abnormal values
initial laboratory assessment
1. hemoglobin estimation is the most important test&useful index of the overall state of nutrition. beside anemia it also tells about protein&trace element nutrition.
2. stool examination for the presence of ova and or intestinal parasites.
3. urine dipstick & microscopy for albumin,sugar and blood.
specific lab tests
1. measurement of individual nutrient in body fluids
2. detection of abnormal amount of metabolites in the urine.
3. analysis of hair,nails & skin for micro-nutrients.
clinical assessment
1. it is an assential features of all nutritional surveys.
2. it is the simplest&most practical method of ascertaining the nutritional status of a group of individuals.
3. it utilizes a number of physical signs, that are known to be associated with malnutrition and deficiency of vitaminsµnutrients.
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1.good nutritional history should be obtained.
2.general clinical examination,with special attention to organs like hair,angles of the mouth,gums,nails,skin,eyes,tongue,mescles,bones&thyroid gland.
3.detection of relevant signs helps in establishing the nutritional diagnosis.
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1. advantages
*fast&easy to perform
*inexpensive
*non-invasive
2.limitation
*did not detect early cases.
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clinical signs of nutritional deficiency
thyroid gland
*in mountainous areas and far from sea places goiter is a reliable sign of iodine deficiency.
dietary assessment
*nutritional intake of humans is assessed by five different method. there are
1. 24 hours dietary recall
-a trained interviewer asks the subject to recall all food&drink taken in the previous 24 hours.
-it is quick,easy&depends on short-term memory,but may not be truly representative of the person's usual intake.
2. food frequency questionnaire
- in this method the subject is given a list of around 100 food items to indicate his or her intake per day,per week&per month.
- inexpensive,more representative&easy to use.
- limitation: *long questionnaire. *errors with estimating serving size. *needs updating with new commercial food products to keep pace with changing dietary habits.
3. dietary history
- it is an accurate method for assessing the nutritional status.
-the information should be collected by a trained interviewer.
- details about usual intake,types,amount,frequency&timing needs to be obtained.
- cross-checking to verify data is important.
4.food diary
- food intake should be recorded by the subject at the time of consumption.
- the length of the collection period range between 1-7 days.
-reliable but difficult to maintain.
5. observed food consumption
- the most unused method in clinical practice,but it is recommended for research purposes.
-the meal eaten by the individual is weighed and contents are exactly calculated.
-the methd is characterized by having a high degree of accuracy but expensive&needs time&efforts.
interpretation of dietary data
1.qualitative method
-using the food pyramid&the basic food groups method.
-different nutrients are classified into 5 groups.
-determine the number of serving from each group&compare it with minimum requirement.
2.quantitative method
-the amount of energy&specific nutrients in each food consumes can be calculated using food composition tables&then compare it with the recommended daily intake.
-evaluation by this method is expensive&time consuming,unless computing facilities are available.
advantages of biochemical method
1. it is useful in detecting early changes in body metabolism&nutrition before the appearance of overt clinical signs.
2.it is precise,accurate and reproducible.
3. useful to validate data obtained from dietary method e.g. comparing salt intake with 24-hour urinary excretion.
limitations of biochemical method
1.time consuming
2. expensive
3. they cannot be applied on large scale
4.need trained personnel&facilities