Malnutrition Syndrome and Nutrition Assessment Methods - Case Study

Patient Background and Diagnosis

Dawna, a 26-year-old woman, was admitted to the hospital with a diagnosis of anorexia nervosa and long-standing history of restrictive-eating behavior with purging. She had lost one-third of her body weight over 6 months. On admission, Dawna was 5'61tall and weighed 82 lbs, with a BMI of 13.2. Her resting heart rate was 50 beats per minute. She was afebrile. Laboratory values included C-reactive protein (0.7 mg/dL), white blood cell count (6,200 mm''), prealbumin (25 mg/dL), and fasting blood glucose (75 mg/dL). Dawna exhibited generalized loss of muscle and subcutaneous fat. Other findings included lanugo hairs. Markedly underweight status was evident, with weight loss of 42 lbs over 6 months. Midarm muscle circumference measurement was below the fifth percentile. 

Questions:

1. What malnutrition syndrome would you anticipate in a patient who presents with anorexia nervosa? How would you confirm this? a. Severe malnutrition in the context of chronic illness b. Severe malnutrition in the context of environmental or social circumstances c. Severe malnutrition in the context of acute injury d. Mild or moderate malnutrition in the context of chronic illness 2. What factors indicate the type of malnutrition diagnosed?

3. Consider Dawna's history and clinical diagnosis, clinical signs and results from a physical examination, anthropometric data, laboratory indicators, dietary intake, and functional outcomes. Would you suspect reduced handgrip? Why? Use TABLES A and B, which describe the clinical characteristics to be used to identify, document, and support a diagnosis of malnutrition. 

1.    As you go through the information in this chapter, determine which nutrition assessment methods you would incorporate in your procedure.To measure the prevalence of diabetes. These preventable chronic diseases are related to poor-quality eating patterns and physical inactivity. Nutritional assessment is the first step to identify nutrition-related problems that arise from nutrient deficiency and lead to chronic disease or result in malnutrition.

Conducting nutritional assessment in the community setting is important when identifying early risks for chronic disease. Novel approaches such as evaluating the genetic profile of individuals to identify genetic determinates that lead to chronic disease are being researched as a potential added “tool”.

Diabetes can be treated and managed when someone adopts a healthy eating pattern, engages in regular physical activity, and takes prescribed medications to lower blood glucose levels. Another critical part of diabetes management is reducing cardiovascular disease risk factors such as high blood pressure, high lipid levels, and the use of tobacco. Patient education and self-care practices also are important aspects of disease management that help people with diabetes stay healthy.Nutrition assessment of patients with diabetes is challenging, as conventional food recalls are vulnerable to underreporting especially in obese individuals. One of the most frequently used methods of determining habitual dietary intake is the food frequency questionnaire (FFQ).

2.    What drives your assessment-method selection? 
1.    What type of nutrient-assessment methods will be used in your methodology? 24-hour recall method 
2.    What validation or reproducibility issues may arise in your selected nutrient-assessment methods?
In comparison with FFQ, 24-hour recall method is more reliable for short time periods. And also, it has more validity compared with FFQ. 

The 24-hour recalls reported higher nutrient intakes in all food groups when compared to the FFQ 
3.    In addition to nutrient assessment, will you need to use biomarkers?
It will be difficult for students and nutritionist to get blood samples and get approval from students.
 
Questions:
1.    Based on the information addressed in this chapter, identify which method of nutrition assessment would be most appropriate for collecting this type of data, and explain the reasoning behind your answer.
-    To explore diet quality among low-income pregnant women throughout the city, Dr. Ellen Ramirez is collecting data in order to quantify two things: 
-    1) fresh fruit and vegetable consumption; and 
-    2) pregnant women’s access to fresh, unprocessed foods during the second and third trimesters.

Dietary recall method is best to use Computerized Food and Nutrition Analysis System.