Clinical Nutritional Assessment
Dietitians have traditionally been involved in the care of hospitalized
patients. Nutritional assessment in hospitalized patients incorporates all
areas of nutritional assessment--dietary, anthropometric, and biochemical. It
has been noted that up to 50% of hospitalized patients are malnourished.
Malnutrition in the hospital setting is defined as an unintentional weight loss
of greater than 10% and serum albumin levels of less than 3.2 g/dL. Hospital
malnutrition can contribute to high rates of infection, impaired wound healing,
less than optimal surgical outcome, postoperative complications, longer hospital
stays, and a higher risk of death.
Nutritional assessment begins with a detailed nutritional history that includes
clinical, dietary, socioeconomic, and family issues. Areas of interest include
present and past illnesses, family illness history, food allergies or
intolerance, medications, nutritional supplements, over-the-counter medications,
alcohol use, work environment, and education level.
Clinicians sometimes use standardized protocols in their assessments. One such
protocol is the Likelihood of Malnutrition Score (LMS). This includes the
parameters: serum folate, serum vitamin C, triceps skinfold thickness, serum
albumin, absolute lymphocyte count, hematocrit, mid-arm muscle circumference,
and body weight. The LMS has been shown to correlate with length of hospital
stay. The Prognostic Nutritional Index (PNI) incorporates serum albumin, serum
transferrin, delayed skin hypersensitivity, and triceps skinfold thickness.
The PNI has been shown to correlate with postoperative complications and
mortality.
Functional assessment can also be used to help assess nutritional status. One
can test physiologic function by examining overall activity, exercise tolerance,
grip strength, respiratory function, wound healing, and plasma albumin
concentration.
