Assessment of nutritional status: objectives, importance and methods
Assessment of nutritional status tells us who is malnourished, how badly and why. Direct methods (ABCD) examine people; indirect methods use community data such as vital statistics.
Objectives
- To find the extent, severity and distribution of malnutrition in a community: how many, how badly, where.
- To identify high-risk groups: infants, preschool children, adolescent girls, pregnant and lactating women, the elderly, the poor.
- To find the causes (ecological factors) so that the right action is chosen.
- To plan and target intervention programmes and set priorities for scarce resources.
- To monitor and evaluate programmes such as ICDS and PM POSHAN over time (nutritional surveillance).
- To provide baseline data for research and policy.
Importance
Without assessment, programmes are planned blind. A survey may show that a block has many stunted children but that its adults are mostly well fed, so resources go to the anganwadis, not to adult feeding. Repeated surveys such as the National Family Health Survey (NFHS) and those of the National Nutrition Monitoring Bureau (NNMB) show whether things are improving. For one person, assessment guides diet counselling and treatment; in a programme it helps pick children for supplementary feeding or referral.
Methods at a glance
| Group | Method | What it shows | Example |
|---|---|---|---|
| Direct | Anthropometry | Body size and composition | Weight, height, MUAC, skinfolds, BMI |
| Direct | Biochemical tests | Nutrient levels in blood and urine | Haemoglobin, serum retinol, urinary iodine |
| Direct | Clinical examination | Visible signs of deficiency | Bitot's spots, goitre, oedema, pallor |
| Direct | Diet surveys | Food and nutrient intake | 24-hour recall, weighment, food frequency |
| Direct | Biophysical or radiological | Changes in tissue function or structure | Dark adaptation test, X-ray of the wrist in rickets |
| Direct | Functional assessment | How well the body works | Grip strength, work capacity, immune response |
| Indirect | Vital statistics | Deaths and illness linked to nutrition | Infant, under-five and 1-4 year mortality; low birth weight rate |
| Indirect | Ecological factors | Conditions that cause malnutrition | Food production, prices, income, water, sanitation, customs |
| Indirect | Food balance sheet | Food available per person in a country | National per capita availability of cereals and pulses |
Direct vs indirect methods
Which method picks up a deficiency first
A diet survey shows the risk before the body changes at all. Clinical signs come last, so a community where many people show signs already has a serious problem.
Before a nutrition programme starts in a block, a quick baseline survey (weights, heights, haemoglobin and a 24-hour recall in a sample of homes) shows the main problem. The same survey a year later shows whether the programme worked.
2 marks: “What are the ABCD methods of nutritional assessment?” Anthropometry, Biochemical tests, Clinical examination and Dietary surveys: the four main direct methods.
5 marks: “State the objectives of assessment of nutritional status.” Extent and severity of malnutrition, high-risk groups, causes, planning programmes, monitoring and evaluation, baseline data; one line and one example each.
10 marks: “Classify the methods of assessment of nutritional status and explain the importance of assessment.” Define; objectives and importance; classification chart of direct (ABCD, biophysical, functional) and indirect (vital statistics, ecology, food balance sheet) methods with one example each; direct versus indirect; the order in which a deficiency shows up.
Direct = ABCD + B + F (Anthropometry, Biochemical, Clinical, Diet, plus Biophysical and Functional). Indirect = V-E-F (Vital statistics, Ecology, Food balance sheet).