Nutrition

Nutritional deficiencies can often aggravate certain health conditions (with or without pathology), and certain conditions (e.g. malabsorption) can lead to nutritional deficiencies. In addition, many patients (e.g. the elderly during prolonged hospitalization) have unsuspected nutritional deficiencies that need to be treated.

The usual indications for a nutritional assessment are as follows:

• undesirable body weight or inadequate proportions of body composition;

• a suspicion of deficiency or intoxication by specific essential nutrients;

• in infants and children, insufficient growth or development.

Assessment of general nutritional status includes history-taking, clinical examination and, occasionally, further investigations. If undernutrition is suspected, additional tests (e.g., albumin levels) or delayed hypersensitivity skin tests may be performed. Body composition analysis (e.g., skinfold measurement, bioelectrical impedance analysis) is used to estimate body fat percentage and to assess obesity.

The history includes questions about food intake, weight changes, risk factors for nutritional deficiencies and a review of systems. A dietician can carry out a more detailed dietary survey. This usually includes a list of foods ingested in the previous 24 hours.

A complete clinical examination, including measurement of height and weight and body fat distribution, should be carried out. Body mass index (BMI), weight (kg)/height(m)², which corrects weight for height, is a more accurate index than height and weight tables. There are standards for growth and weight gain in infants, children and adolescents.

The distribution of body fat is an important factor. Disproportionate abdominal obesity (i.e. waist-to-hip ratio > 0.8) is more often associated with cardiovascular and cerebrovascular disorders, hypertension and diabetes mellitus than when fat is localized in other parts of the body. Measuring waist circumference in patients with a BMI < 35 helps determine whether they have abdominal obesity, and contributes to estimating the risk of diabetes, hypertension, hypercholesterolemia and cardiovascular disorders. The risk is increased if waist circumference is > 102 cm in men or > 88 cm in women.

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