NUTRITIONAL ASSESSMENT

(Group 5)

TABLE OF CONTENTS

01 – NUTRITIONAL STATUS

02 – METHODS OF ASSESSING DIETARY INTAKE

03 – PREGNANCY

04 – LACTATION

Group Members:

Lareza, Melgie Lyne

Martinez, Kathleen

Peῆalosa, Khate

Belen, Alyssa

Balela, Jenn Antonette

Erestain, Alliah
 01 – NUTRITIONAL ASSESSMENY
RENI – RECOMMENDED ENERGY AND NUTRIENT INTAKES

Recommended Dietary Allowance and Diet adequate diet

Regional availability of foods, socio-economics 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 Allowance (RDA) to

Recommended Energy and Nutrient Intakes (RENI)

RENIs are levels of intakes of energy and nutrients which, on basis of current scientific knowledge,
are considered adequate for the maintenance if health and well-being of nearly all healthy
persons in the population. •Most nutrients are equal to the average physiologic requirements
(AR), corrected for incomplete utilization or dietary nutrient, bioavailability, plus two standard
deviation (SD), or twice an assumed coefficient of variation (CV), to cover the needs of almost all
individual in the population.

Essential of an adequate diet

The Milk groups

Is counted on to provide most of the calcium requirements. it provides riboflavin, high-quality
protein, other vitamins and minerals carbohydrates, and fats.
The meat groups
Provides generous amounts of high-quality protein, iron, thiamine, riboflavin, niacin,
phosphorus, and zinc are supplied At least once a week, liver, kidney, and saltwater fish such as
salmon, oysters, and mackerel should be included in the animal protein allowance.

The bread and cereal group

Furnishes thiamine, protein, iron, niacin, carbohydrates, and cellulose at a relatively low cost.
The Vegetable-Fruit group
Is an important supplier of fiber, nutrients, 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 involved 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.
All the following aspect are considered:
1. Dietary history and intake data
2. Biochemical data
3. Clinical examination
4. Anthropometric data
5. Psychosocial data

METHODS OF ASSESSING DIETARY INTAKE

1. 24-hour Recall
The individual completes a questionnaire or is interviewed by a dietitian/nutritionist or à
nurse experienced in dietary interviewing and is asked to recall everything that he/she
ate within the last 24 hours or the previous day.

a. 24-hour Recall Form and Food Group Evaluation

b. Food and intake from time off awakening until the next morning 24-hour recall
(table 44

2. Food Frequency Questionnaire

For frequency of food use, the following pattern of question, may be useful. Questions,
however, should be modified based on 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 you 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 note- as "occasionally" or "rarely."

3. Dietary History

The dietary history is more complete than either the 4-hour recall or food frequency
questionnaire, although it usually includes both sources. The dietary history
contains additional information about the following.
a. Economics
b. Physical activity
c. Ethnic and cultural background
d. Home life and meal patterns
e. Appetite
f. Allergies, intolerances, and food avoidances
g. Dental and oral health
h. Gastrointestinal concerns
i. Chronic diseases
j. medication

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
period. Three days, particularly two weekdays and one weekend da), have been found
to be a representative time period for most people.
 5. Observation of Food Intake

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

Evaluation of the food intake data

1. Evaluation of food group method
The simples, fastest, yet crudest way to evaluate food intake data
is to determine how many servings from each of the four-food group,
were consumed during the recorded day. The number of servings is
suggested in the basic four or seven food plans.
2. General Rules for Menu Planning
a. Use the whole day as a unit rather than the individual meal. Make breakfast
relatively simple and standardized, then plan dinner. Lastly, plan lunch and
snacks to supplement the other two meals.
b. Use some food from each of the food groups daily (energy-giving foods,
body-building foods, and body-regulating foods):
c. Use some raw fruits or vegetables at least once a day.
d. 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.
e. Combine or alternate foods of bland form with those of a more pronounced
flavor.
f. Combine and alternate soft and crisp foods.
g. Have a variety of color, food, and food arrangement.
h. When more foods are served at one meal, decrease the size of portions, and
use fewer rich foods.
3. Some Don't for Menu Planning
a. Avoid using the same kind of food twice a day without varying the form in which it
is served except staples like rice, bread, and milk.
b. Do not use the same food twice in the same meal even in different forms. Do not
use the same food too often from day to day.
4. Other Considerations
a. Meal Patterns, Meal or menu patterns are helpful in planning, but they must
consider the family's habits and needs. For example, the traditional pattern for
breakfast recommended by nutritionists is:
fruit egg or substitute
bread or rice hot beverage
The following is a good menu guide for lunch and dinner.
meat, fish, or vegetable
poultry rice fruit or dessert
b. 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.
1. Significance of Nutritional Assessment
a. It is the first essential in nutritional planning.
b. It provides data and information for planning and evaluation.
c. It helps define priorities and responsibilities of public health system at the
national, regional, provincial, city, municipal, and barangay levels.
2. Methods of Nutritional Assessment
A. Methods that provide direct information
➢ Clinical examination
➢ Biochemical examination
➢ Anthropometric measurement
➢ Biophysical technique
3. Factors Considered in the Selection of Nutritional Survey Method
4. Features of Methods and Reference Standards Used
a. Clinical Assessment
b. Biochemical assessment
c. Anthropometric Measurements
03 – Pregnancy

PREGNANCY
Or gestation is the period when the fertilized ovum implants itself in the uterus, undergoes
differentiation, and grows until it can support extra-uterine life.

Nutrition in Pregnancy

Calorie Allowance

- During the course of pregnancy, the total energy cost of storage plus maintenance amounts to
approximately 80,000 kcal. The energy cost of pregnancy then is about 300 kcal per day. The energy
intake should be 36 kcal per kg of pregnant weight per day.

WEIGHT GAIN
The weight of the blood volume and the enlargement of the reproductive organs are fairly constant. If
the weight gain is less than the weight of the maternal components in pregnancy, the growth of the
fetus calls on the reserve of the mother. A small weight gain is observed during the first trimester. A
more rapid weight gain happens in the second trimester, and a slower weight is recorded during the
third trimester.

MATERNAL WEIGHT
UNDERWEIGHT
• High risk of having lowbirth weight infants
• Higher rates of pre-term deaths and infant deaths
OVERWEIGHT AND OBESES
• High risk of complications like hypertension, gestational diabetes, and postpartum infections
 • Complications of labor and delivery
• Increased likelihood of a difficult labor and delivery, birth trauma, and cesarean section for
large babies.

PROTEIN ALLOWANCES

The additional allowance of protein during pregnancy takes into account the increased nitrogen content
of the fetus and its membranes, maternal tissues, and the added protection of the mother against
complications.

Reasons for additional protein:

To provide for the storage of nitrogen.
To protect the mother against many of the complications of pregnancy.
Foe the growth of the woman’s uterus, placenta, and associated tissues.
To meet the needs for the fetal growth and repair.
For the growth of the mammary tissues.
For the hormonal preparation for lactation.

CALCIUM ALLOWANCES

During the latter half of pregnancy, the intake and retention of calcium are considerably increased. The
quantity retained is more than what can be accounted for by the fetal utilization, and it perhaps
represents the establishment of a reserve supply which may be availed of during subsequent
emergencies.

IRON ALLOWANCES

At least 700 to 1,000 mg of iron must be absorbed and utilized by the mother throughout her
pregnancy. Of this total, about 240 mg is spared by the cessation of the menstrual flow.

IODINE ALLOWANCES

Iodine is especially important during pregnancy to meet the needs foe fetal development. An
inadequate intake of iodine may result in goiter in the mother or the child.

VITAMIN ALLOWANCES
• Thiamin and Niacin
• Riboflavin
• Vitamin D
• Ascorbic Acid
• Vitamin A
• Folic Acid and Vitamin B12
• Vitamin B6
• Vitamin K

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS

RAPID WEIGHT GAIN OR LOSS

Excessive weight gain during pregnancy is defined as an increase of three kilograms or more per month
in the second and third trimesters. On the other hand, a gain of less than 500 g per month during the
first trimester of pregnancy and 250 g during the second trimester is considered of a maternal risk
factor.

TOXEMIA
1. Acute toxemia of pregnancy: onset after the 24th week
a. Pre-eclampsia – hypertension w/ proteinuria and/or edema
b. Eclampsia - convulsions or coma
2. Chronic hypertensive (vascular) disease
a. Without superimposed acute toxemia
b. With superimposed acute toxemia

COMPLICATIONS OF PREGNANCY

ANEMIA

The classic macrocytic anemia of pregnancy represents a combine’s deficiency of iron and folic acid. It
produces anemia in babies and increases the chances of premature birth

DIABETES

A pregnant woman with diabetes is more prone to develop preeclampsia, pyelonephritis, and
polyhydramnios, and her baby has a higher risk of dying in utero or at birth

CONSTIPATION

Pressure exerted by the developing fetus on the digestive tract, lack of exercise, and insufficient bulk in
the diet cause constipation, which is chronic or habitual, gives rise to headaches and much discomfort

SOCIO-ECONOMIC AND CULTURAL FACTORS

Low-income groups tend to have big families, one reason for the decrease in kind and amount of food
available to the pregnant mother.

ALCOHOL, CAFFEINE, NICOTINE

1. NICOTINE Smoking during pregnancy lowers the mean birth weight and increases the risk of
perinatal mortality.
2. ALCOHOL Excessive maternal alcohol ingestion is linked to fetal alcohol syndrome (FAS).
3. CAFFEINE crosses the placenta to the fetus vary rapidly. The drug-metabolizing ability of a fetus
is extremely limited. The fetus can metabolize alcohol to a limited extent but not caffeine
MOTHER’S AGE AND ASSOCIATED HEALTH CONCERNS AND RISKS

PREGNANCY IN ADOLESCENTS

• Iron deficiency anemia

• Prolonged labor
• Higher rates of stillbirths, pre-term births, and low-birth weight infants
•
PREGNANCY IN OLDER WOMEN

• Hypertension and diabetes

• Higher rates of premature births and low birth weight
• Birth defects
• Fetal death

04 – Lactation

Is the process of producing and releasing milk from the mammary glands in the breast ("Lactation
(Human Milk Production): Causes & How It Works", 2022)
The preparation for assuring an adequate supply of good quality breast milk must begin at the onset of
pregnancy.
Most of the dietary essentials are increased over and above the requirements during pregnancy to meet
the demands of milk production.

1. Nutrition in Lactation

Calorie Allowances

The actual mechanism involved in the production of milk does not require a great expenditure of
energy. The chief concern during lactation is the loss of the food material in the milk and the storage of
a certain amount of food.
The extra energy required for lactation depends on the amount of milk produced. It is generally
suggested that the extra food calories should be about twice those secreted in the milk. The FNRI
recommends an increase by 1,000 calories above the normal requirement for an average production of
milk

Protein Allowances

An adequate protein intake of HBV foods during pregnancy is essential in preparation for lactation.

The food intake of a nursing mother must contain sufficient proteins to supply both the maternal needs
and the essential amino acids to be transferred through her breast for the baby's growth. Additional
protein in the diet tends to increase the yield of breast milk while a decrease of protein lowers the
amount of milk secreted.

The average protein allowance for the lactating mother is an additional 20.2 g protein to her normal
requirement. In such a case, a 20 g factor may be used

Calcium, Phosphorus, and Vitamin D Allowances

During lactation, the demand for calcium and phosphorus is increased above the requirement of the
pregnant woman.

The calcium allowance is 1.0 g daily for good milk production. If the protein requirement and other
essentials of the diet are fulfilled, the increased need for phosphorus will be met. The vitamin D
requirement of 400 IU remains the same as during pregnancy.

Iron Allowances
Some lactating women tend to be anemic unless the iron allowance in the diet is increased to the same
level as that during pregnancy.

The baby is born with a relatively large reserve of iron. Since milk is not a good source of iron, a good
allowance of iron in the mother's diet during lactation does not convey additional iron to the infant.
Nevertheless, iron-rich foods are essential for the mother's own health while supplements are included
early in the infant's diet

2. Food in lactation
NUTRITIONAL REQUIREMENTS

1. Calories 2. Protein 3. Calcium and Phosphorus

An addition of 1,000 calories An additional 20 g to the An increase of 0.5 mg to the

above the normal allowance normal allowance is needed normal allowance is needed
is needed. An approximate to compensate for the to prevent severe depletion
amount of 120 calories is protein lost in milk. The of maternal calcium reserve
required to produce 100 mL conversion of food into milk since this is used for milk
of milk. Thus, the daily protein is only about 50% production. Sources are milk
production of 850 mL of milk efficient; thus 2 g of food and milk products, eggs, etc.
will require an additional protein is required to
1,000 calories in the diet. produce 1 g of milk protein.
Energy giving foods are good Sources are milk, eggs,
sources of calories. animal proteins and legumes.
4. Iron 6. Vitamin B1 unpolished rice, legumes,
vegetables, milk, etc.
An additional intake is An additional allowance is
recommended for blood lost needed for thiamine 7. Riboflavin, Vitamin C, etc.
in parturition, for milk iron, secreted in milk. A mother
An additional allowance is
and basal losses. whose diet is very low in
needed for milk secretion.
thiamine may secrete a toxic
5. Vitamin A
substance called “glyoxaline” 8. Fluids
An additional 2,000 IU to the which accumulates in
thiamine deficiency. Its An intake of 8 glasses or
normal allowance is needed
presence with the low more is recommended to
to provide the amount of
thiamine content in milk is increase milk production.
vitamin A secreted is milk.
Sources are green leafy and associated with infantile
yellow vegetables, milk, eggs, beriberi. The sources of
etc. vitamin B1 include

3. Breast Misconception
1. A mother sick with tuberculosis cannot breastfeed.

2. Breast milk is not good if the mother has stayed long under the sun.

3. A mother cannot breastfeed during pregnancy.

4. A mother cannot breastfeed with only one breast if the breast is painful.

5. A mother cannot breastfeed if she has a cold, flu, or diarrhea.

6. Breast milk is not good if the mother has been caught in a sudden shower.

4. Advantages of breast feeding

Advantages of Breastfeeding
1. Breastmilk provides passive antibody transfer to the newborn. It simply means local immunity of the
baby to some children’s diseases.

2. Breast milk is higher in lactose than cow’s milk. The lactic acid converted from lactose limits the
growth of disease-producing germs in the GI tract.

3. Breastfed babies have no difficulty with the regulation of calcium phosphorus level than those that
are bottle-fed. Cow’s milk contains high level of phosphorus which lowers the calcium level due to the
inverse relationship of these two minerals. The decreased calcium level in an infant can cause tetany or
muscular spasm.

4. Bottle feeding affects the dental arch. The tongue thrusting in bottle feeding may cause
malformations of the dental arch.

5. Cow’s milk protein causes allergy

6. Breastfeeding also benefits the mothers:

a) Less incidence of breast cancer in women who breastfeed

b) Less incidence of thrombophlebitis or inflammation of a vein with formation of blood clot

c) Rapid return of the original size of the uterus

5. Factors Affecting Secretion

1. Diet

2. nutritional state of mothers

3. Emotional and physical

4. Sucking

5 Use of contraceptives and drugs