PENILAIAN STATUS GIZI

(NUTRITIONAL ASSESSMENT)
Oleh
Astri Areka Dewi, S.Gz

Nutritional Assessment Definition

Nutritional Status
The health status of individuals or population as
influence by their intake and utilization of
nutrients
Can change throughout the life cycle as it
reflects the situation at a certain time point
Assessment
A process of gathering, analyzing and
interpreting information

NUTRITIONAL ASSESSMENT
Studies
Antrophometriy
Assessment =
aprocess of
gathering,
analyzing and
interpreting
information

Biochemical
Clinical
Dietary
Used to determine
nutritional status of
individual or population

Why is Nutritional Assessment

Important?
As tool used :
To identify persons at nutritional risk
To determine type of intervention to alter
nutritional status
To monitor affect of nutrition intervention

Methode of nutritional Assessment

Direct Methods :
Anthropometry
Biochemical (Laboratory)
Clinical assessment
Dietary assessment
Indirect Methods :
Health and vital statistic
Assessment of ecological factors

Methods of nutritional Assessment

ANTHROPOMETRY
Measurement of physical dimensions and
gross composition of the body
e.g height, weight, head circumference skinold thickness

BIOCHEMICAL
Measurement of a nutrient or its metabolite in
blood, eces,urine and other tissues
e.g : hemoglobin level, cholesterol level

Methods of nutritional Assessment

CLINICAL
Include physical examination and/or medical
history to detect signs and symptoms of
malnutrition
SYMPTOMS : disease manifestation patiensare aware of and complain
about (e.g : fatigue iron deficiency)
SIGN : observation made qualified examiner during physical
examination (e.g : enlarger thyroid gland iodine deficiency)

DIETARY
Measurement of quantity of the individual foods
consumed during one to several days OR
pattern of food use

Some Ecologial Factors to be

Considered

Socioeconomis factors
Food Conciderations
Availability (distribution)
Accessibility (food prices)
Preparation and pricessing methods
Consumption (Food habits/belief)
Utilization
Nutritional adequacy

.continued

Aspect of Health
Contributory Infection
Enviromental sanitation
Health-related services
Demographic issues
Polotical prioritis
Cultural factor
Geographical and climatic influences

Ecological Values
Beberapa informasi dapat
dikelompokkan menjadi variabel
ekologi, namun salahsatu yang dipilih
harus menyediakan informasi yang
relevan yang mudah dan ekonomis,
agar menjadi informasi yang berguna
dan spesifik untuk planning action

Measurement Vs Indices
Measurement :
A size or quantity measured by astandard such as :
Body weight of male adult
Recumben length of an infant
Hemoglobin concentration of a female adult
Intake of protein of a child
Indices (Singular = Index)
Contructed of two of more raw measurements on asingle
subject (e.g : BMI (Body mass Index)
Used to interpret and group measurement

Factor Affecting the choice of

Indices/measurement
1.
2.
3.
4.

Study Objectives
Sampling protocols and sampel size
Measurement Error
Validity

adequacy of measurement/index to reflect the nutritional parameter of

interest, e.g : acute malnutrition : WHZ

5. Precision
The degree to which repeated measurements of the same variable give te
same value

6. Accuracy
The extend to which the measurement/index is close to the
true value

ANTHROPOMETRIC
ASSESSMENT

Definition of Anthropometriy
Measurement of the body size , weight and
physical proportions (Lee and Nieman, 1996)
Measurement of the variation of the physical
dimensions and the gross composition of the
human body at different age levels and degree
of nutrition (Jellife, 1996 in : Gibson, 2005)
Measurement of the human body

ANTHROPOMETRY
Body Size

Height/length
Weight
Head Circumference
Others (Knee height in children and adult)

Body Composition
Fat mass (Skinfold thickness,Weist circumference)
Fat Free mass ( Midd-upper arm circumference/MUAC)

Factor Influencing anthropometric

measurements of the human body
Internal factor
Genetic, gender
External factor
Diet,drugs, environment, disease

GROWTH INDICES

Growth Indices

Weight-for-age (WA) : BB/U

Weight-for-Height (WH) : BB/TB, BB/PB
Z score
Height -for- age ( HA) : TB/U
Head Circumferene-for - age
Z- score merupakan indeks anthropometri yang digunakan
secara internasional untuk penentuan status gizi dan
pertumbuhan, yang diekspresikan sebagai satuan
standard deviasi(SD) populasi rujukan
Z score is indices for children of 0-59 month

 Pedoman : Tabel WHO antro 2005

Z-Skor = (nilai individu) (median populasi rujukan )

SD populasi rujukan
Interpretasi dari nilai tersebut
Gizi Kurang (Under-nutrition) didefinisikan sebagai
Z-skor <-2
Gizi lebih (Over-nutrition) didefinisikan sebagai
Z-skor > +2
Gizi Buruk ( Severe-Under-nutrition) didefinisikan
sebagai
Z-skor < -3

-3

-2

2
normal

BB/TB or BB/PB : Wasting (Kurus) : Gizi Kurang Akut

TB/U or PB/U : Stunting (Pendek) : Gizi Kurang Kronik
BB/U : Underweigth ( Rendah) : Gabungan Gizi Kurang
akut dan Kronik

Body Mass Indeks

Expressed in body weight (kg) =
Height (m)
WHO clasification of adult overweight
(risk of comorbidities)

Underweight : < 18.5 kg/m

Normal : 18.50-24.99 kg/m
Overwight : 25.00 kg/m
Pre obese : 25.00-29.00 kg/m
Obese I : 30.00- 34.99 kg/m
Obese II : 35.00-39.99 kg/m
Obese III : 40.00 kg/m

BIOCHEMICAL
ASSESSMENT

Dietary Deficiency
(Primary factor)
Nutritien reserve

Nutritional deficiency

Conditioning factot
(Secondary factor)

Tissue Depletion

Biochemical
lession
Functional
changes
Anatomic
Changes

Purpose
To detect subclinical or marginal
deficiencies or imbalances in
individuals

Biochemical test

Fluid :
Whole blood
Erytrocytes
Breast Milk
Tissue :
Adipose tissue
Liver
Bone
Urine :
Nutrient
Metabolit

Serum Albumin Level

Measures main protein in blood
Determines protein status
Serum Transferin Level
Indicates iron-carriying protein in blood
Indicates iron stores low
Indicates body lack protein

 BUN (Blood Urea Nitrogen)

May indicate renal failure, insufficient renal blood supply,
or blockage of the urinary tract

Serum Creatinin
Indicates amount of creatinin in blood
Used to evaluate renal function

Creatinin Excretion
Indicates amount of creatinin excreted in urine over-24
hour
Used in estimating body muscle mass
Muscle mass depleted, as in malnutrition, level will be
low

Albumin
Half Life 14-21 days
Normal value 3.5-5.0 g/dl
Most Widely used indicator of nutritional
status
Acute phase response : level decrease in
response to stress (infection,injury)
Affected by volume
Increases with dehidration, decrease with
edema and over hidration

The Others are :

Visceral Protein
C-Reactive Protein
Nitrogen balance
Hematological Indices ( trnsferrin,
Ferritin,Hb)
Creatinin

Identification Of Cut-Off Value

Is value of an indicator or test that used to
define a group or designate the presence
or absence of a condition
Cut-off values are not usually diagnostic,
they are often only Indicator / Risk

CLINICAL
ASSESSMENT

Clinical Assessment

Medical History (Riwayat Medis)

Pemeriksaan Fisik :
Sign
Symptom

Medical History
Mencatat Kejadian yang berhubungan dengan
gejala yang timbul & factor2 yang
mempengaruhinya
Meliputi
1. Identitas Penderita
2. Lingkungan Fisik & Sosial Budaya
3. Sejarah timbulnya gejala penyakit
4. Mis : Kpn BB mulai turun?
5.
Kpn ada gejala muntah ?,dll

4. Data Tambahan yang perlu diketahui

Menderita anemia?
Pernah operasi usus?
Pernah menderita penyakit Infeksi?
Apakah ada alergi makanan?
Apa macam diet yng sebelumnya dipakai?

Pemeriksaan Fisik
Yaitu Pengamatan terhadap
perubahan2 Klinis

Gejala Fisik yg diduga ada kaitannya dg malnutrisi

dibanding normal
Normal

malnutrisi

Rambut : Berkilat, tidak mudah Kehilangan sinarnya ,

lepas
kering,tipis, mudah lepas
Muka : Warna sama, halus,
tampak sehat, tidak bengkak

Depigmentasi, flek hitam di

bawah mata, bengkak
pembesaran kel. Parotis

Mata : bercahaya, bersih, tak

ada luka, tampak pembuluh
darah sklera

Konjunctiva pucat, bintik

bitot,keratomalasia

Bibir : halus, tak ada

pembengkakan

Jaringan parut di sekitar bibir,

Chelosis,Fisura angularis

Keterbatasan Pemeriksaan
Beberapa gejala klinis tidak mudah di
deteksi
Gejala klinis tidak bersifat spesifik
terutama pada KEP ringan dan sedang
Adanya variasi gejala klinis yang timbul

Dietary
Assessment

1. Metode Kualitatif
Untuk mengetahui frekuensi
makan,frekuensi konsumsi menurut jenis
bahan makan dan menggali informasi
tentang kebiasaan makan (food habit)
serta cara2 memperolehnya
Food Frequency
Dietary History
Telepon
Food List

2. Metode Kualntitatif
Bertujuan untuk mengetahui jumlah
makanan yang dikonsumsi sehingga
dapat dihitung konsumsi zat gizi dengan
menggunakan Daftar Komposisi Bahan
makanan (DKBM)
Recall 24 jam
Food Record
Food Weighing