Nutritional Assessment and

Techniques
LLL ESPEN
Nutritional Screening and Assessment


Assessment
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Assessment meliputi :



Body Composition


Changes in body composition in
starvation and disease/starvation

Measure Body Composition
Simple Method:
1. Anthropometry
2. Fuctional test
3. Creatinin Ecretion rate
4. Nitrogen Balance
5. Bioelectrical impedance (vector) analysis (BIA and BIVA)
Sophisticated Method :
1. Dual Energy X-ray Absorptiometry (DEXA)
2. Magnetic Resonance Imaging (MRI) and Computed
Tomography(CT)
3. Dilution Methods
4. Underwater Weighing (UWW) and Air Displacement
Plethysmography (ADP)
5. Total body Potassium
6. In vivo Neutron Activation Analysis (IVNAA)
Energy Expenditure
Total energy expenditure :
1. Resting energy expenditure
2. Diet induced energy expenditure
3. Activity Induced energy expenditure

Methods for Measurement of Energy
Expenditure
Direct Calorimetry
Indirect Calorimetry
Estimation of Energy Expenditure
Energy Intake and Energy Balance

Enteral Nutritional
One Form of the so-called artificial nutrition
and includes both feeding via nasogastric/enteral
or percutaneous (gastric or jejunal) tube and oral
nutritional supplementation.
Indication Enteral nutrition
To maintain or improve nutritional status
irrespective of the underlying disease or clinical
setting :
- Anticipated inadequate oral food intake for more
than days
- Present or imminent malnutrition


Contraindications EN



Gastrointestinal complications of EN:
- Diarrhoe
- Nausea and Vomiting
- Constipation
Other Complication
Aspiration
Tube related complications
Metabolic Complication

Monitoring Of EN

Routes Of Enteral Access


Short-term Enteral Feeding
Long-term enteral nutrition
Nasogastric Tube (NG)
Nasoenteral Tube (NET)

Indication Of Free amino acid formulae
Some forms Of congenital metabolic disease
Severe alergy to dietary protein
Nutritional treatment of Crohns Disease
Diabetes Formulae : High MUFA diabetes formulae
Formula for patients with liver disease :



Formulae for patients with renal
failure


Parenteral Nutrition
Indication :

Contraindications to parenteral
nutrition
If gastrointestinal tract fully fuctional with
adequate absorption of macro and
micronutrients
Inability to obtain venous access
Vascular access used for PN
1. Subclavian Vein Catheterization
2. Internal Jugular Vein Catheterization
3. Femoral vein Catheterization

Complications in relation to insertion
of CVC



Complication
Metabolic Complication
Technical Complication
Infectious Complication
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