Actually tomorrow is my psm exam and i dont know about Assessment of nutritional status . Please provide me answer is easy language and easy way i will write in exam without forgeting
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I now have enough comprehensive content from Park's PSM textbook. Let me now give you a thorough, exam-ready answer.
Assessment of Nutritional Status
(Park's PSM - Easy Exam Notes)
What is it? (Write this as your intro)
Nutritional status = result of many interrelated factors (food intake quantity + quality + physical health of the individual).
Purpose of nutritional assessment:
- Know prevalence and distribution of nutritional problems in a community
- Identify individuals/groups "at risk"
- Develop health care programmes
- Evaluate effectiveness of nutrition programmes
7 Methods of Assessment (CABFVEE - Memory Trick)
Remember: "C A B F V E E"
| # | Method | Memory Word |
|---|---|---|
| 1 | Clinical examination | C |
| 2 | Anthropometry | A |
| 3 | Biochemical evaluation | B |
| 4 | Functional assessment | F |
| 5 | Vital & health statistics | V |
| 6 | Ecological studies | E |
| 7 | Evaluation of dietary intake | E |
These methods are not mutually exclusive - they are complementary to each other.
1. Clinical Examination
- Simplest and most practical method
- Examine for physical signs of malnutrition
- Signs may be specific (e.g., Bitot's spots = Vit A deficiency) or non-specific
- When 2 or more signs of same deficiency appear together = diagnostic significance increases
WHO classified signs into 3 groups:
- Group 1 - Definite signs (strongly associated with malnutrition): e.g., Bitot's spots, corneal xerosis, follicular keratosis, angular stomatitis, scrotal/vulval dermatosis, oedema
- Group 2 - Possible signs (may or may not be due to malnutrition): e.g., moist and swollen lips (cheilosis), thyroid enlargement, conjunctival pallor, dental caries
- Group 3 - Non-specific signs (not reliably associated): e.g., nasal discharge, skin infections
2. Anthropometry
Measurement of body dimensions to assess nutritional status
Measurements used:
- Weight and Height (most common)
- MUAC - Mid-Upper Arm Circumference (very useful in children; no need for age)
- Skinfold thickness - measures fat stores (Triceps, Subscapular, Suprailiac)
- Head circumference - in children under 3 years
- Chest circumference
Key Indices:
| Index | What it measures | Used for |
|---|---|---|
| Weight for Age | Overall nutrition | Children; detects underweight |
| Height for Age | Chronic malnutrition | Detects stunting |
| Weight for Height | Acute malnutrition | Detects wasting |
| BMI = Wt(kg)/Ht²(m) | Obesity/thinness | Adults |
BMI Cut-offs (Adults):
- < 18.5 = Underweight (CED - Chronic Energy Deficiency)
- 18.5-24.9 = Normal
- 25-29.9 = Overweight
- ≥ 30 = Obese
MUAC Cut-offs:
- < 12.5 cm = Severe malnutrition (children 1-5 yrs)
- 12.5-13.5 cm = Moderate malnutrition
-
13.5 cm = Normal
Grading of PEM (Protein Energy Malnutrition) - Gomez Classification (Weight for Age):
- Grade I (Mild) = 75-90% of standard
- Grade II (Moderate) = 60-74% of standard
- Grade III (Severe) = < 60% of standard
3. Biochemical Evaluation
Detects subclinical deficiency before clinical signs appear = most sensitive method
Commonly used tests:
| Nutrient | Test |
|---|---|
| Protein status | Serum albumin, transferrin, prealbumin |
| Iron deficiency | Haemoglobin, serum ferritin, serum iron |
| Vitamin A | Serum retinol |
| Iodine | Urinary iodine excretion |
| Vitamin D | Serum 25-OH Vitamin D |
| Vitamin C | Serum/urine ascorbic acid |
Key Point: Biochemical tests detect subclinical (latent) deficiency - useful in early stages before symptoms appear.
4. Functional Assessment
Assesses functional consequences of malnutrition
- Immune function - delayed hypersensitivity (skin test)
- Muscle function - hand grip strength (dynamometer)
- Work capacity / Physical performance
- Cognitive function - mental development in children
- Dark adaptation test - for Vitamin A deficiency
5. Assessment of Dietary Intake
Measures what food the person actually eats
Methods:
| Method | Description |
|---|---|
| 24-hour recall | Ask person to recall everything eaten in last 24 hours (most commonly used) |
| Dietary history | Long-term usual diet pattern (3-day, 7-day recall) |
| Food frequency questionnaire | How often certain foods are eaten |
| Weighed food record | Actual weighing of food before eating |
| Food balance sheets | National food availability data |
Compare intake with RDA (Recommended Dietary Allowance) to identify deficiencies.
6. Vital and Health Statistics
Uses existing records - indirect method
- IMR (Infant Mortality Rate) - sensitive indicator of nutritional status
- Child mortality rate (especially 1-4 years = "toddler mortality")
- Birth weight - indicator of maternal nutrition
- Prevalence of low birth weight (< 2500 g)
- Morbidity data - frequency of infections
7. Ecological Studies
Studies the environment and factors affecting nutrition
- Food production data
- Food consumption at national/community level
- Socioeconomic factors (income, poverty, education)
- Agricultural statistics
- Food availability and distribution
Quick Summary Table (Write in Exam!)
| Method | Detects | Best For |
|---|---|---|
| Clinical | Frank/obvious deficiency | Quick field surveys |
| Anthropometry | Growth retardation, obesity | Children mainly |
| Biochemical | Subclinical deficiency | Early detection |
| Functional | Consequences of malnutrition | Functional capacity |
| Dietary | Inadequate intake | Cause finding |
| Vital statistics | Population-level trends | Community surveys |
| Ecological | Risk factors | Planning programmes |
Important Extra Points (Exam Favorites!)
Nutritional Surveillance = continuous monitoring of nutritional status of a population over time to detect changes and take action.
Indicators used for surveillance:
- Birth weight (maternal nutrition)
- Height for age, Weight for age (child nutrition)
- Arm circumference (when age unknown)
Difference between nutritional assessment vs nutritional surveillance:
- Assessment = done at one point in time (cross-sectional)
- Surveillance = done continuously over time (monitoring)
Memory Tips for Exam
- 7 methods = C-A-B-F-D-V-E (Clinical, Anthropometry, Biochemical, Functional, Dietary, Vital stats, Ecological)
- Most practical method = Clinical examination
- Most sensitive method = Biochemical (detects subclinical)
- Best for children when age unknown = MUAC or Weight for Height
- Wasting = low weight for height (acute)
- Stunting = low height for age (chronic)
- Underweight = low weight for age (composite)
Good luck in your exam tomorrow! You've got this. Focus especially on the 7 methods, anthropometric indices (wasting/stunting/underweight), and BMI cut-offs - these are the most commonly asked topics in PSM exams.
Create a quick reference PDF summary for this topic
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Your PDF is ready! Download it here:
Nutritional Status Assessment PSM
PDF Document · PDF
Here's what's packed inside:
- Color-coded sections for each of the 7 methods (Clinical, Anthropometry, Biochemical, Functional, Dietary, Vital Stats, Ecological)
- WHO classification table for clinical signs (3 groups)
- Anthropometric indices - Wasting / Stunting / Underweight explained clearly
- BMI + MUAC cut-off tables side by side
- Gomez Classification table for PEM grading
- Biochemical tests - nutrient by nutrient
- Dietary intake methods table
- Nutritional surveillance indicators (Assessment vs Surveillance difference)
- Exam Quick Recall table - 10 most commonly asked facts
- Memory aid at the bottom: "Can A Boy Find Directions Via Ecology?"
Print it, stick it somewhere visible, and revise tonight. All the best for your exam tomorrow!
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