Introduction to Clinical Nutrition and the use of Nutritional Assessment and Nutrient Intake Guidelines
Nutritional assessment identifies individuals who are malnourished and/or at nutritional risk and it permits evaluation of the efficacy of nutritional support. Nutritional assessment must always be the starting point to provide meaningful and relevant recommendations to those seeking your advice.
Typically, there are 4 methods used to assess an individual’s nutrient status: anthropometric, biochemical, clinical, and dietary. This was discussed in your Basic Nutrition course in 5th quarter. In addition, there is a 5th assessment technique that is becoming popular in recent years- nutrigenomics. This involves identifying how nutrients will interact with specific genes. A review article on this new field is included in your
reading assignment for this week. This is located in the reading assignments folder.
Before our discussion of assessment techniques, we will first discuss the nutritional criteria we would like
our clients to meet. There are many dietary guidelines and recommendations put out by many different agencies. Which guidelines will you follow when assessing a particular person? In this first discussion, we will look at several guidelines that you may or may not use when you evaluate an individual. Is it possible that different guidelines may be optimal for different individuals?
RDA’s are levels of nutrient intake assumed to prevent deficiency disease in most healthy individuals. They were first developed in 1941 and the emphasis was on “adequate nutrition”. They were updated approximately every 5 years until the 10th and last RDA’s were published in 1989.
RDA’s have now been replaced with Dietary Reference Intakes (DRI’s) that are designed to provide quantitative estimates of nutrient intakes for “apparently healthy” people. They encompass current concepts about the roles of nutrient and food components in prevention of developmental abnormalities and reduction of the risk of chronic diseases. DRI’s when possible are stated in four categories: RDA (Recommended
Daily Allowance), EAR (Estimated Avg. Requirement), UL (Tolerable Upper Intake Level) and AI (Adequate Intake). The most recent DRI tables are available at the Food and Nutrition Information Center (Links to an external site.).
I believe Nutrient Density to be an extremely important concept when advising clients. Nutrient Density describes the nutrients a food provides relative to the energy it provides. The more nutrients and the fewer calories a food provides, the higher the nutrient density. Using this concept would encourage a higher intake of vegetables and discourage intake of empty calorie foods that so many Americans eat such as potato chips and soft drinks.
Dietary Guidelines for Americans are developed jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services to provide advice about food that promotes health and prevents disease. The most recent revision was issued in 2010. More detailed information can be found at Dietary Guidelines for Americans 2010. (Links to an external site.)
A variety of food guides have been proposed with the intent of translating scientific knowledge and recommendations into a practical form for the general public. These include the
MyPlate (Links to an external site.) developed by the USDA, as well as many alternative guides such as the one developed by the Harvard School of Public Health (Links to an external site.). The Food Exchange System is a method of planning meals that focuses exclusively on controlling energy consumption.
However, it does not address vitamin or mineral intake, nor food quality.
As we see from the assigned reading on “Nutritional Genomics” this week, any guidelines we use must also
be interpreted with the specific needs of the individual in mind. This paper describes several areas where guidelines may need to be adjusted to compensate for genetic variations.
There are 3 possible discussion topics for this week:
1. 1) Discuss the strengths and weaknesses of government nutrient recommendations, including DRIs, Dietary Guidelines for Americans, and MyPlate.
2. 2) Identify the guidelines you believe will be the most useful as you assess and support your clients
3. 3)Discuss how identification of genes and genetic expression can contribute to nutritional assessment
4. (from the assigned reading).
Each student is required to answer only one posted question.
Follow the guidelines in the grading rubric for appropriate discussions.
Assigned readings are attached to the assignment.
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