Physical Examination: Certain risk factors and signs of nutrient deficiency or excess can be identified during the physical examination. Any one sign is rarely diagnostic; the more signs present the more likely they reflect a malnourished individual.
Hair: dull, dry, sparse, shedding
Eyes: cloudy, pale, dry, red, dull
Lips: swollen, red, cracks at sides
Gums: bleeding, abnormally red, swollen
Teeth: dental enamel erosion in bulimia due to induced vomiting
Tongue: swollen, red, fissured, glossitis, atrophic lingual papillae due to deficiency of riboflavin, niacin, folate, vitamin B-12, protein or iron
Skin: dry, flaky, hyperpigmented, decubiti present, decreased skin turgor, poor wound healing due to deficiency of protein, vitamin C, zinc; xanthomas due to increased serum lipids
Nails: spoon-shaped, brittle, and ridged
Face: dark skin, scaling skin, pallor
Hands: smooth areas on backs of fingers and nails in bulimia from inducing vomiting
Lower extremities: edematous
Muscular: wasted, weak, tender, xanthomas (tendon, planar, palmar) in hyperlipidemia
Neurologic: apathy, lethargy, disoriented, memory loss, and paresthesia
Laboratory Tests: Many lab tests can provide useful information on patientsí nutritional status along with information on their medical status.
- Red Blood Cell Parameters: hematocrit and hemoglobin (low values indicate anemia), low mean corpuscular volume (MCV) or microcytosis-- iron, copper, pyridoxine deficiency, high MCV or macrocytosis - folate, vitamin B12 deficiency.
- White Blood Cell Count: neutropenia is often seen in deficiency states.
- Serum Lipid Levels: total cholesterol >200 mg/dl, HDL <35 mg/dl, LDL >130 mg/dl.
- Vitamin levels: folate and vitamin B12 can be helpful.
- Creatinine-height index (estimate skeletal muscle mass).
- Visceral proteins: serum albumin, serum transferrin etc.
- Blood Urea Nitrogen (BUN).
- Urinary Urea Nitrogen (UNN).