Background

An assessment of nutritional status in adults may include a comprehensive evaluation consisting of a tailored history and physical examination, laboratory assessment, anthropometrics, body composition, and functional data.^{[1, 2]}

No single variable accurately and reliably relays nutritional status of a subject in every situation. Validated screening tools are available for use in certain populations.

Poor nutritional status has been known to have unfavorable effects. Individuals with less than 80% expected total body protein levels have demonstrated increased morbidity, and 10% or greater unintentional weight loss has been associated with adverse outcomes and prolonged hospitalizations. In lean healthy subjects, weight loss over 35%, protein loss over 30%, and fat loss over 70% from baseline has been associated with death.^[3] A systematic review of 7 studies with 16 biomarkers showed that there was a significant association between the nutritional assessment score and albumin level.^[4]

A review article on management of nutrition in hospitalized patients highlighted the importance of individualizing nutrition plans and adequate support by nutritional risk screening for patients during the time of admission and subsequent detailed assessment of patients at risk of malnutrition for better outcome.^[5]

A systematic review of 29 studies with 6,298 free living adults and a mean of 107 participants was carried out to evaluate the validity of dietary assessment methods used to estimate the energy intake (EI) and total energy expenditure (TEE). The results showed under-reporting of EI (P < 0.05) when compared to TEE.^[6]Accurate quantification of EI is vital for interpreting the relationship between diet and chronic disease.

Next: Indications

Indications

Measurement of nutritional status in adults has no absolute indications. The importance of nutritional assessment becomes apparent during acute illness, in which malnutrition has been associated with increased morbidity and mortality. Identification of malnourishment and appropriate intervention may improve outcomes.

Next: Indications

Contraindications

Assessment of nutritional status in adults has no specific contraindications. However, owing to the cooperation required, hydrodensitometry may not be suitable for subjects who are physically challenged, children, or elderly persons. Additionally, bioelectrical impedance analysis (BIA) should not be performed in subjects with pacemakers.

Periprocedure

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Burrows TL, Ho YY, Rollo ME, Collins CE. Validity of Dietary Assessment Methods When Compared to the Method of Doubly Labeled Water: A Systematic Review in Adults. Front Endocrinol (Lausanne). 2019. 10:850. [QxMD MEDLINE Link].
Jensen GL, Hsiao PY, Wheeler D. Adult nutrition assessment tutorial. JParenter Enteral Nutr. May/2012. 36:267-74. [QxMD MEDLINE Link].
Cornier MA, Després JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. November/2011. 124:1996-2019. [QxMD MEDLINE Link].
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Heyward V. ASEP Methods Recommendation: Body Composition Assessment. JEPonline. 2001. 4:1-12.
Leahy S, O'Neill C, Sohun R, et al. Generalised equations for the prediction of percentage body fat by anthropometry in adult men and women aged 18-81 years. Br J Nutr. May/2012. 29:1-8. [QxMD MEDLINE Link].
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Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. November/1981. 34:2540-5. [QxMD MEDLINE Link].
Miller MD, Crotty M, Giles LC, et al. Corrected arm muscle area: an independent predictor of long-term mortality in community-dwelling older adults?. J Am Geriatr Soc. July/2002. 50:1272-7. [QxMD MEDLINE Link].
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Massy-Westropp NM, Gill TK, Taylor AW, et al. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. April/2011. 14:127. [QxMD MEDLINE Link].
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Biaggi RR, Vollman MW, Nies MA, et al. Comparison of air-displacement plethysmography with hydrostatic weighing and bioelectrical impedance analysis for the assessment of body composition in healthy adults. Am J Clin Nutr. May/1999. 69:898-903. [QxMD MEDLINE Link].
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Media Gallery

Stadiometer. Courtesy of the Scottish Health Survey 2010 - Volume 2: Technical Report published by the Scottish Government, available at https://www.scotland.gov.uk/Publications/2011/09/27124046/0.
Tricep skinfold thickness measurement with plastic calipers. Courtesy of the CDC.
Subscapular skinfold thickness measurement with plastic calipers. Courtesy of the CDC.
Upper arm length measurement and mid-arm mark. Courtesy of the CDC.
Scale. Courtesy of Detecto Scale (www.Detecto.com).
Metal Harpenden calipers. Courtesy of Baty International Ltd.
Plastic calipers. Courtesy of Wikipedia.
Hydrodensitometer. Courtesy of Human Performance Lab, University of Wisconsin-La Crosse.
Air displacement plethysmograph. Courtesy of Wikipedia.
Fist-grip (hand) dynamometer. Courtesy of Lafayette Instrument Company, Inc.
BMI graph. Courtesy of Wikipedia.
Subjective Global Assessment (SGA) form.
MNA®-Short Form. Courtesy of Nestlé Nutrition Institute (https://www.mna-elderly.com/).
MNA®-Long Form. Courtesy of Nestlé Nutrition Institute (https://www.mna-elderly.com/).
DEXA scanner. Courtesy of CDC.

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Table 1. Symptoms and Signs of Nutritional Deficiency (from the Merck Manual of Diagnosis and Therapy, edited by Robert Porter. Copyright 2012 by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co, Inc, Whitehouse Station, NJ. Available at https://www.merckmanuals.com/professional/. Accessed 11/18/2013)

Area/System	Symptom or Sign	Deficiency
General appearance	Wasting	Energy
Skin	Rash	Many vitamins, zinc, essential fatty acids
	Rash in sun-exposed areas	Niacin (pellagra)
	Easy bruising	Vitamin C or K
Hair and nails	Thinning or loss of hair	Protein
	Premature whitening of hair	Selenium
	Spooning (upcurling) of nails	Iron
Eyes	Impaired night vision	Vitamin A
Eyes	Corneal keratomalacia (corneal drying and clouding)	Vitamin A
Mouth	Cheilosis and glossitis	Riboflavin, niacin, pyridoxine, iron
Mouth	Bleeding gums	Vitamin C, riboflavin
Extremities	Edema	Protein
Neurologic	Paresthesias or numbness in a stocking-glove distribution	Thiamin (beriberi)
	Tetany	Ca, Mg
	Cognitive and sensory deficits	Thiamin, niacin, pyridoxine, vitamin B₁₂
	Dementia	Thiamin, niacin, vitamin B₁₂
Musculoskeletal	Wasting of muscle	Protein
	Bone deformities (e.g., bowlegs, knocked knees, curved spine)	Vitamin D, Ca
	Bone tenderness	Vitamin D
	Joint pain or swelling	Vitamin C
GI	Diarrhea	Protein, niacin, folate, vitamin B₁₂
	Diarrhea and dysgeusia	Zinc
	Dysphagia or odynophagia (due to Plummer-Vinson syndrome)	Iron
Endocrine	Thyromegaly	Iodine

Table 2: Standards for Upper Arm Muscle Area in Adults (From the Merck Manual of Diagnosis and Therapy, edited by Robert Porter. Copyright 2012 by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co, Inc, Whitehouse Station, NJ. Available at https://www.merckmanuals.com/professional/. Accessed 11/18/2013).

Percentage of Standard (%)	Men (cm²)	Women (cm²)	Muscle Mass
100 ± 20*	54 ± 11	30 ± 7	Adequate
75	40	22	Marginal
60	32	18	Depleted
50	27	15	Wasted
*Mean mid upper arm muscle mass ± 1 standard deviation. From the National Health and Nutrition Examination Surveys I and II.

Table 3: Serum Proteins Used for Assessment of Nutritional Status^{[3, 33, 34]}

Protein	Half-life, days	Function	Comment
Albumin	14-20	Maintenance of plasma oncotic pressure; carrier protein	levels increase with dehydration, blood and albumin transfusion, and anabolic steroids levels decrease in liver failure, inflammation, volume overload states (cirrhosis, congestive heart failure, renal failure), zinc deficiency, protein-losing states (nephrotic syndrome, enteropathy), corticosteroid use, and bedrest
Transferrin	8-9	Iron transport	levels increase during dehydration, iron deficiency, pregnancy, estrogen therapy, and acute hepatitis levels decrease in liver and renal failure, inflammation, anemia due to chronic disease and vitamin B12 and folate deficiency, corticosteroids, zinc deficiency, and protein-losing states (nephrotic syndrome, enteropathy) Often measured indirectly as total iron-binding capacity (TIBC)
Prealbumin (transthyretin)	2-3	Binds thyroxine; carrier for retinol-binding protein	levels increase in renal failure (degraded by the kidney) and corticosteroid and oral contraceptive use levels decrease in liver failure, inflammation, and hyperthyroidism
Retinol-binding protein (RBP)	12-24	Vitamin A transport; binds to prealbumin	levels increase in renal failure (degraded by the kidney) levels decrease in cirrhosis, inflammation, vitamin A and zinc deficiency, and hyperthyroidism

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Sections Nutritional Status Assessment in Adults
Overview
Periprocedural Care
Technique
Laboratory Medicine
Media Gallery
Tables
References

Nutritional Status Assessment in Adults

Background

Indications

Contraindications

References

Tables

Contributor Information and Disclosures

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