Introduction DPG Clinical/Dietary Assessment and Nutritional Requirements for health and disease
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Introduction DPG
Clinical/Dietary
Assessment and
Nutritional Requirements
for health and disease
Rosan Meyer (RD, PhD)
And Luise Marino, Hinke Kruizenga, Nicolette
Wierdsma
2020
Conflict of Interest • Academic lectures for: • Danone/Nutricia • Mead Johnson • Nestle • Research grant holder: Danone/Nutricia • Board member: CoMISS Nestle
Who are we?
Who are we?
How does the Pocket Guide work? • Guides nutritional management using the following principles: A – Anthropometry: when and how to perform measurements and how to interpret these. Covers also advanced anthropometrical measurements including DEXA, BodPod. B – Biochemistry: nutritional blood markers with normative values C – Clinical assessment: how to assess a child clinically D – Dietary intake assessment: different techniques are covered D – Dietary requirements: Macro and micronutrients are covered in general and one chapter focuses on requirements for specific diseases E – Evaluation: GI digestion, absorption and losses are described including drug nutrient interactions. Nutritional outcome markers are also provided
Interpretation of Growth Parameters
Biochemical Assessment
• Low albumin
• Low phosphate
• Low potassium
• Normal magnesium
• Protocol followed for tight glucose control
• ? Risk of refeeding syndrome
■ Weight-for-height < 3 SD, MUAC < 11.5 cm (6-59 months) with/without
any sign of bilateral oedema and/or visibly wasting.
■ Very low weight or increased rates of
weight loss (recent loss of weight of 1 kg or more/wk for 2 consecutive
weeks or loss of weight of 500-999 g/wk for 2 consecutive weeks.
■ Minimal or no feeding prior to admission, or before commencing re-
feeding,defined as acute food refusal or estimated energy intake 400-600
kcal/d or severe restriction (less than 50 % of required intake).
Clinical Assessment – Essential part of
Nutritional Assessment
Diet History also Important in Critically Ill
ChildrenDifferences in Requirements in Children
Disease: Unwell child on
ward and poor growth
Health
Activity
Disease: PICU
Thermic Effect of Food
Activity
Growth
Thermic Effect of Food Activity
Growth
Growth
d
REE REE
REE
In acute disease conditions TEE is not increased because of the reduction in PAL – SACN 2011Calculations • Website: http://www.dieteticpocketguide.com/
Interpretation of Growth Parameters
Assessing Feeding Difficulties
Pediatr Allergy Immunol. 2018;29:689–704.
Differences in Requirements in Children
Disease: Unwell child + poor
height growth
Health
Activity
Disease: PICU
Thermic Effect of Food
Activity
Growth
Thermic Effect of Food Activity
Growth
Growth
d
REE REE
REE
In acute disease conditions TEE is not increased because of the reduction in PAL – SACN 2011Requirements for Health and Disease
• EAR/DRV developed for groups and not individuals
• “It is important to note that DRVs should be used to assess the energy
requirements for large groups of people and populations, but should not be applied
to individuals due to the large variation in physical activity and energy expenditure
observed between people. “
• EAR/DRV does not account for impact of disease:
• “Standard reference tables or equations for estimating BMR (from weight, height
and age) were established for use in healthy subjects without malnutrition and
disease, and without dehydration and oedema, all of which can have substantial
effects on body weight.”
• EAR/DRV does not account weight loss
• Important to use requirements that are evidence based
Scientific Opinion on Dietary Reference Values for energy. EFSA Journal SACN. Dietary Reference Values for Energy
2013;11(1):3005. [112 pp.] doi:10.2903/j.efsa.2013.3005. Available online 2011; ISBN: 9780108511370.Establishing Requirements
Requirements for Vitamins and Minerals for
Catch-up Growth
Type I Nutrients: Type II Nutrients:
Biochemical functions Growth nutrients
Deficiencies- less healthy and Deficiencies of these nutrients
Susceptible to stress and - Energy (fat/carbohydrates)
- AA
Infections
- Water
-Vitamins and mineral
- Sodium
Trace Elements - Chloride
Not malnourished with - Zinc
Just type 1 nutrient Will lead to malnutrition:
deficiency Wasting and stunting
Golden MH. Food and Nutrition Bulletin, vol. 30, no. 3 2009Conclusion • Nutritional assessment includes • Anthropometrics • Biochemistry • Clinical assessment • Dietary assessment • A complete nutritional assessment informs nutritional requirements • Important to understand differences in requirements between health and disease • Use evidence based requirements
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