Nutritional assessment and Nutritional counseling

When you read more about nutrition, know how to modify your diet, what to eat and what to avoid and discover the best way to make your diet, you will need to know how to assess your nutrition. Our food is responsible for our shape and our health. If you eat well, you will be in good shape and healthy. If you don’t eat well, you will just be in bad shape and will suffer from the consequences of that; it is that simple. Counseling a nutritionist is the best way to achieve the maximum benefits of your diet. The long-term relationship between the person and the nutritionist will help both of them. The nutritionist will understand the case well and put the best plan for the person that will make him/her achieve her goals whatever these goals are. Whether you want to lose weight, gain weight or modify your diet for a certain disease, the nutritionist knows better. Here is how the nutritionist will assess your case and the information you need to know about nutritional counseling.

• Nutritional assessment:
The clinical nutritional assessment is based clinically on:
1. Medical and nutritional history:
A. Medical history like history of weight loss, weight gain and chronic illness.
B. Dietary history: a diet history can be obtained accurately by questioning food intake for specific meal within the past 24 hours or by asking specific questions about the patient’s consumption of individual food items such as bread, milk, egg and vegetable.
2. Physical examination:
Edema, hypertension and loss of subcutaneous fat and skeletal muscles wasting and weight changes are important signs in assessing the response for diet prescription.
3. Simple anthropometry:
A. The body mass index (BMI): The weight in kilograms divided by the height in meters squared (relatively independent of height, apply to males and females). Normal nutrition is defined as a body mass index of 18 to 25 while significant obesity as body mass index more than 28.
B. The arm muscle circumference: This is particularly valuable in edematous states in which weights are inaccurate and insensitive.
It is a little bit complicated to measure the arm muscle circumference but we will make it as easy as possible.
The arm muscle circumference (AMC) = Arm circumference – (TSF × 3.4/ 10).
TSF refers to triceps skin fold thickness. It is done perfectly by the nutritionist and it is perfect as anthropometry tool.
4. Laboratory investigations:
According to the condition like blood glucose, lipoprotein kidney function tests and liver function tests.

• Nutrition Counseling:
Nutrition counseling refers to individualized guidance on appropriate diets and nutrient intakes taking into consideration health, cultural, socioeconomic, functional and physiological factors.
Nutrition counseling includes:
A. An in-depth nutrition assessment.
B. Nutrition care pan:
1. Selection of food and its amounts.
2. Timing and composition of meals.
3. Food consistency: modified food textures.
4. Route of nutrition administration from oral to feeding tube or intravenous nutrition.

Choosing the right nutritionist will make your life easier and your health better. Building up a long-term relationship needs some time and making sure that the nutritionist is the best.

How to Improve the Nutritional Status of the Community?

In order to develop the nutritional status of our community, we need to fully understand the term of nutritional status. This is what will help us avoid getting diseases regarding malnutrition and make our communities healthier. Let’s go through the nutritional status of our communities and how to improve it.

• Nutritional status:
Nutritional status expresses the degree to which the physiological needs for nutrients are being met. A through assessment of nutritional status includes:
1) Dietary surveys: through food frequency questionnaire, 24-hour recall for qualitative or quantitative estimation of food consumption and compare it with individual needs.
National estimation of food consumption:
food balance sheet = food production + food imports – food exports. The result is divided by the mid-year population and days of the year to get the average supply of food/ capita/ day.
2) Anthropometric data: Anthropometric indices that include height and weigh are used to estimate growth especially in children.
3) History and physical examination: This is used for general built and manifestations of deficiency.
4) Laboratory investigations: Several lab investigations are done including blood hemoglobin, serum vitamin and minerals levels.
5) Statistical indices: There are a lot of important statics but the most important rates are infant mortality and prevalence of low birth weight.
6) Demographic and socio-economic data: These data are useful indirect indicators of nutritional risk in community.

• How to improve the nutritional status of the community?
These are the main points to make the nutritional status of the community better:
1. Assessing and monitoring of nutrition situations.
A. Identify the priority nutritional problems in the community and analyze their causes.
B. Strengthen growth monitoring within primary health care system.
2. Food sanitation: throughout the production, handling, Processing, packaging, distribution and preparation stages. This food should follow the international standards to be approved by the ministry of health in the states. The process of production should be done perfectly and the factories should be checked regularly.
3. Preventing and managing parasitic diseases as they are on the top list of diseases causing nutritional problems.
4. Food supplementation for the socio-economically deprived people.
5. Micronutrients can be added to certain foods in order to increase nutritive value as follow:
A. Enriched food: Flour and bread can be enriched by adding standard values of certain nutrients. Iron, thiamine, riboflavin and niacin are added to compensate amounts lost while milling white flour from the whole grain.
B. Food fortification: Fortification of food helps in adding certain nutrients originally lacking in the food. These are the most common two examples.
1) Fortification of salt is a long-range measure for correcting iodine deficiency.
2) Milk may be also fortified with Vitamin D, taking into consideration that food additions must be submitted to controlled limitation.
6. Nutrition education:
A. Face to face approach through home visits, lectures, group discussion demonstration and role play methods.
B. Mass Media through school curricula starting from primary school, posters, TV and booklets.

This is the ultimate guide to understand the nutritional status of the community. Following these points will help those who are seeking a better nutritional status to reach their goals.

Diet Modification in Diabetes Mellitus

patients with diabetes mellitus have a list of foods that they should eat and avoid other things. A single mistake can lead to terrible complications among diabetic patients regarding the way they eat.
The list of complications of Diabetes is so long and so serious. Let’s see the diet modification of diabetes and how to prevent the disease.

• Dietary modification in DM:
The dietary treatment aims to control the disease and permit normal growth and activity. The guidelines used to determine basic nutrition requirements include physical assessment, health and diet histories and laboratory report.

1. Nutrient balance in diabetic patients:
Carbohydrates provides 50 to 55% of the daily caloric requirement containing good amount of fiber and less refined sugar.
Protein provides 15 to 20% of the daily intake of calories.
Fat provides 30% of caloric intake from polyunsaturated fats and limited in cholesterol.

2. Caloric requirements:
Factors affecting caloric need include:
1) Basal metabolism.
2) Activity.
3) Physiological stress such as growth, spurt or pregnancy.
4) Weight (normal, overweight or thin).
5) Sex.
There are many ways to calculate daily caloric needs of diabetic patient:
A. If the patient is obese or elderly patient, the caloric need is calculated by multiplying desirable body weight by 15 kcal per kg.
B. If the patient is a sedentary patient, the caloric need is calculated by multiplying desirable body weight by 20 kcal per kg.
C. If the patient is of light activity, the caloric need is calculated by multiplying desirable body weight by 30 kcal per kg.
D. If the patient is hard activity, the caloric need is calculated by multiplying desirable body weight by 35 kcal per kg.

3. Nutrient distribution:
The physician will prescribe the percentage of the needed calories from carbohydrates, fat and protein and distribute them into three meals and three snacks to avoid fluctuations in blood glucose.

4. Nutrition counseling and patient compliance in diabetes:
A. Explanation of the disease and role of diet in controlling it.
B. The patient should be provided with as much information as possible including:
1) Food exchange lists that offer a variety of food choices.
2) Diet plans written or in picture form.
3) Scheduled meal times and frequency.
C. Special dietary measures to prevent or delay onset of atherosclerosis, reduced fat intake and increased fiber intake.
D. Why can exercise program is adjunct to diet therapy.
E. How to recognize symptoms of hypoglycemia or hyperglycemia and what to do about them.

5. Prevention:
A. Primary prevention:
1) Physical exercise.
2) Eating healthy balanced diet.
3) Avoidance of obesity.
4) Avoidance of stress.
5) Controlled use of drugs that may cause diabetes mellitus.
6) Vaccination against viral infection such as rubella.
B. Secondary prevention:
1) early case finding by applying screening tests (urine test of glucose) and confirmed by blood glucose level testing.
2) Proper control of diabetes.
3) Health education of diabetic patients on proper care of the skin, foot and diet instructions.
4) Annual screening for retinopathy (one of the most common complications of diabetes mellitus) is recommended because blindness can be prevented by early treatment.