Nutritional assessment tools

Nutritional Assessment - The ABCD Basics

📌 Mnemonic: ABCD

• Anthropometry:
  • Weight-for-height (wasting), height-for-age (stunting), weight-for-age (underweight).
  • Mid-Upper Arm Circumference (MUAC): Severe Acute Malnutrition (SAM) if < 11.5 cm.
• Biochemical:
  • Serum albumin (< 3.5 g/dL), prealbumin, transferrin.
• Clinical Signs:
  • Edema, hair changes (flag sign), skin changes (flaky paint dermatosis).
• Dietary History:
  • 24-hour recall, food frequency questionnaire.

⭐ Weight-for-height is the best indicator for diagnosing acute malnutrition (wasting).

Anthropometry - Sizing Up Growth

Key indices to assess nutritional status and identify malnutrition.

• Weight-for-Height (Wt/Ht): Measures wasting (acute malnutrition).
• Height-for-Age (Ht/A): Measures stunting (chronic malnutrition).
• Weight-for-Age (Wt/A): Composite index; useful for screening.
• Mid-Upper Arm Circumference (MUAC): Age-independent (6 mo - 5 yrs).
  • SAM: < 11.5 cm
  • MAM: 11.5 - 12.5 cm
• Z-Score: Most reliable method for assessment.
  • SAM is defined as a Z-score < -3 SD.
  • $Z-score = (Observed Value - Median Value) / SD$

⭐ For children with nutritional edema (Kwashiorkor), MUAC is the preferred anthropometric measure as weight-based indices are unreliable.

📌 Mnemonic: For Waterlow classification, remember Wasting comes before Stunting alphabetically, so Wt-for-Ht comes before Ht-for-Age.

Clinical Clues - Reading the Body

• Hair:
  • Kwashiorkor: Sparse, thin, easily pluckable. Dyspigmentation (lightening).
  • 📌 FLAG sign: Alternating bands of light/dark hair reflect periods of poor/good nutrition.
• Eyes:
  • Bitot's spots: Foamy plaques on conjunctiva (Vit A def).
  • Pale conjunctiva: Anemia (Iron def).
• Skin:
  • Flaky paint dermatosis: Peeling, hyperpigmented skin in Kwashiorkor.
  • Follicular hyperkeratosis (Phrynoderma): Gooseflesh-like bumps (Vit A def).
• Mouth & Nails:
  • Angular stomatitis/cheilosis: Cracks at mouth corners (Riboflavin def).
  • Bleeding gums: (Vit C def).
  • Koilonychia: Spoon-shaped nails (Iron def).

⭐ In Kwashiorkor, skin lesions often appear after edema starts to subside, typically in areas of friction like the groin, buttocks, and behind the knees.

MUAC - The Magic Tape

• What: Mid-Upper Arm Circumference, a simple tool for assessing nutritional status in children (6 months to 59 months).
• Why: Strong predictor of mortality, largely age-independent in this range, and requires minimal training. Uses a color-coded "Shakir tape".
• How: Measured at the midpoint of the non-dominant (usually left) upper arm.
• Cut-offs (WHO):
  • < 11.5 cm: Severe Acute Malnutrition (SAM) [Red]
  • 11.5 cm - < 12.5 cm: Moderate Acute Malnutrition (MAM) [Yellow]
  • ≥ 12.5 cm: Normal [Green]

⭐ Exam Favourite: MUAC is a better predictor of mortality risk associated with malnutrition than the weight-for-height (W/H) z-score.

High-Yield Points - ⚡ Biggest Takeaways

• Mid-Arm Circumference (MAC) is key for community screening; <11.5 cm indicates Severe Acute Malnutrition (SAM).
• Weight-for-height is the best indicator of acute malnutrition (wasting); a Z-score <-3 SD is SAM.
• Height-for-age is the best indicator for chronic malnutrition (stunting).
• Weight-for-age is a composite index and the first to fall in malnutrition, but can't differentiate wasting vs. stunting.
• The Shakir tape uses a simple tri-color system for rapid MAC assessment.