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Chapter 072. Malnutrition and Nutritional Assessment (Part 5)

Nutritional History A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients. Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies. | Chapter 072. Malnutrition and Nutritional Assessment Part 5 Nutritional History A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake impaired absorption decreased utilization increased losses and increased requirements of nutrients. Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies. Table 72-3 The High-Risk Patient Underweight body mass index 18.5 and or recent loss of 10 of usual body weight Poor intake anorexia food avoidance e.g. psychiatric condition or NPO status for more than about 5 days Protracted nutrient losses malabsorption enteric fistulae draining abscesses or wounds renal dialysis Hypermetabolic states sepsis protracted fever extensive trauma or burns Alcohol abuse or use of drugs with antinutrient or catabolic properties steroids antimetabolites e.g. methotrexate immunosuppressants antitumor agents Impoverishment isolation advanced age Physical Examination Physical findings that suggest vitamin mineral and protein-energy deficiencies and excesses are outlined in Table 72-4. Most of the physical findings are not specific for individual nutrient deficiencies and they must be integrated with the historic anthropometric and laboratory findings. For example the finding of follicular hyperkeratosis on the back of the arms is a fairly common normal finding. On the other hand if it is widespread in a person who consumes little fruit and vegetables and smokes regularly increasing ascorbic acid requirements vitamin C deficiency is likely. Similarly easily pluckable hair may be a consequence of chemotherapy but in a hospitalized patient who has poorly healing surgical wounds and hypoalbuminemia it suggests kwashiorkor. Table 72-4 Physical Findings of Nutritional Deficiencies Clinical Findings Possible Deficiency0 Possible Excess Hair Nails Corkscrew hairs and unemerged coiled