Center for Human Nutrition

Medical Nutrition Syllabus

Guide to Healthy Diet and Lifestyle

Exercise Guidelines

Managing Obesity

Exercise Prescription

Medicine and Surgery Nutrition Assessment Checklist

Pediatric Nutrition Assessment Checklist

Adolescent Nutrition Assessment Checklist
Syllabus Menu: | Dietary Assessment | Weight Assessment | Dietary Recommendations | Nutritional Deficiencies | Nutrition During Lifecyle | Nutrition in Pathological Conditions | Vegetarianism | [Popular Diets | References |

 
Dietary Assessment

A patientís nutritional status can be evaluated by using and integrating information obtained from a past medical history, family history and a social history. It is worthwhile to assess the nutritional status of every patient. Many complaints such as fatigue, headaches, and digestive disturbances can be improved by simple changes in diet. Nutrition also plays a pivotal role in prevention. Nutritional assessment becomes especially important when the patient has certain nutritional "red flags", such as:

  • Elderly
  • No regular exercise regime and/or sedentary lifestyle
  • Recent loss of 10% or more of usual body weight
  • Alcoholism
  • Taking drugs such as steroids, immunosuppressants
  • Infection, protracted fever, trauma
  • Malabsorption syndromes, draining abscesses, renal dialysis
  • Receiving simple intravenous solutions without oral intake for >10 days

Past Medical History

  • Immunizations, hospitalizations, operations, major injuries, chronic illnesses, and significant acute illnesses
  • Current or recent prescription medications, vitamins and minerals, laxatives, topical medications, OTC medications, and nutritional supplements
  • Potential drug-nutrient interactions, such as those caused by potassium-wasting diuretics
  • Food allergies or lactose intolerance

Family History

  • Family history of cancer, diabetes, heart disease, hypertension, obesity, and osteoporosis
  • Parents, siblings, children, spouse: include ages, current health status, and cause of death if deceased

Social History

  • Occupation, daily exercise pattern, marital and family status
  • Economic status, educational level, residence, emotional response to illness and coping skills
  • Duration and frequency of use of substances, including tobacco, alcohol, illegal drugs, and caffeine

Assessing Your Patientís Dietary Intake

There are several methods for obtaining a dietary history. Each has its advantages and disadvantages.

24-hour Recall

  • An informal, qualitative method in which you ask the patient to recall all of the foods and beverages that were consumed in the last 24 hours, including the quantities and methods of preparation.
  • An advantage of this method is that dietary information is easily obtained. It is also good during a first encounter with a new patient in which there is no other nutritional data. Patients should be able to recall all that they have consumed in the last 24 hours.
  • A disadvantage of this method is that it is very limited and may not represent an adequate food intake for the patient. Data achieved using this method may not represent the long-term dietary habits of the patient. Estimating food quantities and food ingredients may be difficult especially if the patient ate in restaurants.

Usual Intake/Diet History

  • This method asks the patient to recall a typical daily intake pattern, including amount, frequencies and methods of preparation. This intake history should include all meals, beverages and snacks.
  • Advantages of this method are that it evaluates long-term dietary habits and is quick and easy to do. Based on the information acquired, you may identify patients who would benefit from meeting with a registered dietitian.
  • A disadvantage of this method is that a limited amount of information on the actual quantities of food and beverages is obtained. Also, this method only works if a patient can actually describe a "typical" daily intake, which is difficult for those who vary their food intake greatly. In these patients it is would be advisable to use the 24-hour recall method. Another disadvantage is that patients may not include foods that they know are unhealthy.
  • An excellent method to better understand a patientís nutritional status is to use a usual intake and lifestyle recall. This consists of asking the patient to run through a typical day in chronological order, describing all food consumption as well as activities. This method is very helpful because it may reveal other factors that can affect the patientís nutritional and overall health. [For example: (1) the patient sits in traffic for a 3-hour round trip each day; (2) the patient comes home from work late and eat dinner just before bedtime; or (3) the most exercise the patient gets is walking to and from the parking lot at work.]

Food Frequency Questionnaire

  • This method makes use of a standardized written checklist where patients check off the particular foods or type of foods they consume. It is used to determine trends in patientsí consumption of certain foods. The checklist puts together foods with similar nutrient content, and frequencies are listed to identify daily, weekly, or monthly consumption.
  • An advantage of this method is that it makes it possible to identify inadequate intake of any food group, so that dietary and nutrient deficiencies may be identified. The questionnaire can be geared to a patientís pre-existing medical conditions.
  • Disadvantages include patient error in filling out the questionnaire and no way to find out how foods are prepared. Patients may over- or under-estimate food quantities.

Dietary Food Log

  • This method asks the patient to record all food, beverage and snack consumption for a one- week period. Specific foods and quantities should be recorded. The data from the food log may later be entered into a computer program, which will analyze the nutrient components of the foods eaten according to specific name brands or food types. Patients are asked to enter data into the food log immediately after food is consumed so they do not forget.
  • The most important advantage of this method is that a computer can objectively analyze data obtained. Data on calorie, fat, protein and carbohydrate consumption can be obtained. Also, since patients are asked to enter data immediately after eating, the data is more accurate than other methods.
  • Disadvantages include patient error in entering accurate food quantities. In addition, it is possible that the week long food log does not accurately represent a patientís normal eating habits since they know the foods they eat will be analyzed and therefore may eat healthier.

Generic Nutrition Questionnaire

Do not be daunted by the following list. Reading through the sample questions will simply give you an idea of probing questions you might use to ascertain your patientís nutritional status.

  1. Would you describe you appetite as hearty, moderate, or poor?
  2. Are you on a special diet? Specify the type of diet. Who recommended the diet? If you have been on a special diet in the past, define it.
  3. Have you ever had any problems with weight? Underweight or overweight?
  4. Do you eat at approximately the same time every day?
  5. Do you skip meals? If so, when?
  6. Do you usually eat between meals? What do you snack on most often?
  7. Are there any foods you do not eat because you donít think they are good for you? If yes, what?
  8. Are there any foods you do eat regularly because you think they are good for you? If yes, what?
  9. Are there any foods you cannot eat? What happens when you eat this food?
  10. Are there foods you avoid because you donít like them?
  11. How is your food usually prepared, e.g. baked, broiled, fried?
  12. Are you on a diet now to lose or gain weight? If yes, what kind? Who recommended it?
  13. How do you feel about your weight?
  14. Are you taking any vitamin or mineral supplements? What and how often?
  15. Do you smoke? How many cigarettes (cigars or chewing tobacco) per day?
  16. Do you drink any alcohol? How much per day and when?
  17. How often do you exercise? What types of exercise do you do?
  18. Who in the house plans the meals? Buys the food? Prepares the food?
  19. Are there times in the month when there isnít enough money for food or you run out of food?
  20. How many of your meals are eaten at home? School? Work? Restaurants?
  21. How many hot meals do you eat per week?
  22. What condiments do you use? Examples include butter on bread, sugar on cereal, salad dressing, gravy, etc.