nutritional assessment

Indications

• within 48 hours of admission to the pediatric ICU
• assessment of undernutrition in the elderly

Laboratory

• serum albumin & serum prealbumin
  • serum prealbumin may be more responsive to nutrient intake than serum albumin
  • lack sensitivity & specificity as markers of nutritional status in older adults
  • does not substitute for calorie count in assessing nutrient intake in elderly patient recovering from an acute illness
    • Mini Nutritional Assessment better than calorie count
• hemoglobin A1c
• Chem 7
• lipid panel

Procedure

• Mini Nutritional Assessment allegedly determines how well the patient is eating
  • now first line (GRS11)
• calorie count for 3 days (formerly first line)
  • seems like more direct objective measure than Mini Nutritional Assessment
  • may miss other unspecified factors contributing to nutritional risk
• body weight trends more useful than calorie counts in screening for undernutrition in elderly (calorie counts allegedly not cost effective)

Management

• risk criteria that should trigger a nutrition consult:
  • unplanned body weight change of > 10% in last 6 months
  • suboptimal PO intake
  • problems chewing or swallowing
  • nausea, vomiting or diarrhea
  • visibly malnourished
  • morbidly obese
  • 70 years of older scheduled for surgery
  • diagnosis which may alter nutritional needs
  • severe tolerance problems during external feeding
  • religious, cultural or ethnic practices affecting diet
  • pregnant or nursing
  • patient needs nutritional information to guide eating at home

More specific terms

• mini nutritional assessment short-form (MNA-SF)