Biochemical assessment of nutritional status
Biochemical assessment uses laboratory
measurements of blood parameters to assess
general nutritional status and to identify
specific nutritional deficiencies.
Initial Laboratory Assessment
Hemoglobin estimation is the most
important test, & useful index of the overall
state of nutrition. Beside anemia it also tells
about protein & trace element nutrition.
Stool examination for the presence of ova
and/or intestinal parasites
Urine dipstick & microscopy for albumin,
sugar and blood
Specific Lab Tests
Measurement of individual nutrient in body fluids
(e.g. serum retinol, serum iron, total iron-binding
capacity, urinary iodine, vitamin D)
Detection of abnormal amount of metabolites in the
urine (e.g. urinary creatinine/hydroxyproline ratio)
Analysis of hair, nails & skin for micro-nutrients.
Measurements of serum cholesterol, triglycerides,
fasting glucose, CD4 and CD8.
Measurement of virus load of HIV, renal function,
and liver enzyme levels.
Advantages of Biochemical Method
It is useful in detecting early changes in body metabolism &
nutrition before the appearance of evident clinical signs.
It is precise, accurate and reproducible.
Useful to validate data obtained from dietary methods e.g.
comparing salt intake with 24-hour urinary excretion.
Disadvantages of Biochemical Method
Time consuming
Expensive
They cannot be applied on large scale
Needs trained personnel & facilities
Protein Energy Malnutrition (PEM)
PEM is referred to as protein-calorie malnutrition.
It is considered as the primary nutritional problem in Bangladesh
The term PEM applied to a group of related disorders that
include marusmus, kwashiorkor or an intermediate status of
marasmic- kwashiorkor.
PEM is due to “food gap” between the intake and requirement.
Causes of PEM in children
Social and economic factors
Biological factors
Environmental factors
Role of free radicals and aflatoxin
Age of the host
Kwashiorkor
Kwashiorkor is a disease marked by severe protein
malnutrition and bilateral extremity swelling. It usually
affects infants and children, most often around the age of
weaning through age 5. It causes fluid retension (edema), dry,
peeling skin, and hair discoloration. The disease is seen in very
severe cases of starvation and poverty-stricken regions
worldwide.
Victims of Kwashiorkor fail to produce antibodies following
vaccination against diseases, including diptheria and
typhoid.
This disease can be threated by adding food energy and
protein to the diet.
Symptoms of kwashiorkor
Change in skin and hair color (to a rust color) and texture.
Fatigue.
Diarrhea.
Loss of muscle mass.
Failure to grow or gain weight.
Edema (swelling) of the ankles, feet, and belly.
Damaged immune system, which can lead to more frequent
and severe infections.
Irritability.
Marasmus
Marasmus is severe undernutrition — a deficiency in all
the macronutrients that the body requires to function,
including carbohydrates, protein and fats. Marasmus causes
visible wasting of fat and muscle under the skin, giving
bodies an emaciated appearance.
Marasmus usually develops between the ages of six months
and one year in children who have been weaned from breast
milk or who suffer from weakening conditions like chronic
diarrhea.
Signs and symptoms of marasmus
Visible wasting of fat and muscle.
Prominent skeleton.
Head appears large for the body.
Face may appear old and wizened.
Dry, loose skin (skin atrophy).
Dry, brittle hair or hair loss.
Lethargy, apathy and weakness.
Weight loss of more than 40%.
BMI below 16.
Dehydration.
Electrolyte imbalances.
Low blood pressure.
Slow heart rate.
Low body temperature.
Gastrointestinal malabsorption.
Stunted growth.
Developmental delays.
Anemia.
Osteomalacia or rickets.
Micronutrient malnutrition
People who do not have enough vitamins and minerals
develop micronutrient malnutrition, which can be devastating.
Consequences include serious birth defects, undeveloped
cognitive ability, and reduced productivity.
Iron, vitamin A and iodine are the most common around the
world, particularly in children and pregnant women. Low- and
middle-income counties
bear the disproportionate burden of micronutrient deficiencies.
Micronutrient deficiencies can be caused by either insufficient
intake or impaired absorption, which ca be due to infections
or chronic inflammation. In infants, micronutrient deficiencies
are caused by maternal micronutrient deficiencies in utero or
due to rapid postnatal growth
Public Health concern of micronutriment
malnutrition
Micronutrient deficiencies (MD) are one of the greatest
public health concerns that affect more than 2 billion
people worldwide (WHO,2016)
-Globally, one in three children suffers from a
micronutrient deficiency. (WHO,2018
At least 50% of the under 5-children suffer from more -
that one micronutrient deficiency (WHO,2018)
Ref. National Micronutriment Survey, Bangladesh 2019-2020
