What is Nutrition? The Assessment of Nutritional Status in a Health and Nutrition Survey

 

I had wanted this morning to write a good, lengthy and detailed article on the assessment of nutritional status. This is one of my areas of specializations besides science, medicine, food quality control, astronomy, toxicology, forensic science, and evolutionary biology.

Then I found a paper published by Aditi Kesari and Julia Y. Noel. They have already briefly done this in the link below:

https://www.ncbi.nlm.nih.gov/books/NBK580496/#:~:text=Nutritional%20assessment%20allows%20healthcare%20providers,malnutrition%2C%20and%20plan%20necessary%20interventions.

Nevertheless, to summarize in note and point form, the assessment of nutritional status is not merely conducting some clinical examinations followed by some lab tests, and radiological imaging on a person or in a population as doctors normally do. It is not so easy as that as most malnutrition is sub-clinical, and they don’t show up on any clinical examination.

Neither is nutrition all about what food is good or bad for health, nor it is about what food is rich in carbohydrates, proteins, fats, vitamins, minerals, carbohydrates, cholesterol or sugars or salt. Neither is nutrition all about which food is high in cholesterol, causes diabetes, cancer or heart disease, stroke or various kinds of diseases, or about which food to avoid or to take, or which food is toxic, others are ‘healthy’.  I am afraid nutrition is far, far, far more than what most people are interested in and talk about most.

Nor is nutrition all about chemistry and the chemical composition of foods, or about diseases related to nutrition, diet and eating. Nor is it all about slimming programme and how to reduce weight. Those are what most people in the public talk about. 

Nutrition is far, far, more elaborate and complex than these questions people ask all the time.  Furthermore, as nutritionists and clinicians, we are fully qualified through our years postgraduate training up to master’s and doctorate degree levels that there is no way to find out if an individual or a population suffers from malnutrition since most of malnutrition are sub-clinical and does not show any kind of signs or symptoms by mere clinical examination no matter how elaborate, extensive or advanced our clinical examinations.

The diagnosis of subclinical malnutrition is far, far beyond the skills, training and experience of any single doctor. It requires a team of medical and scientific experts working together in coordination using their best expertise to make an assessment, unless an individual suffers from very severe nutritional diseases where some of the signs, symptoms and other presentations show up clearly. I have very briefly written some of these clinical signs and syndromes of nutritional deficiency diseases. It was merely casual side notes under the title:

The Diagnosis for Diabetes Mellitus: New vs Old Methods in Real Life or Hospitalized Situations below this link:

https://scientificlogic.blogspot.com/2023/05/the-diagnosis-for-diabetes-mellitus-new_29.html

To summarize what nutritionists do when they conduct a nutritional assessment in a population (rather than on any individual), here are some of the criteria they examine, very briefly written in point form below:

1.       Clinical examination

2.       Anthropometric measurements like heights, weight, skin-fold thickness, skull, abdomen, hip sizes.

3.       Radiological examination for bone densities if necessary

4.       Laboratory examinations including saturation or loading tests for vitamin deficiencies.

5.       Food consumption studies

6.       Chemical analysis of food consumed from randomized food samples taken

7.       Food taboos studies

8.       Socio-economic factors, religious or other taboos influencing food intake.

9.       Agricultural and food production including soil science.

10.   Epidemiological studies on disease patterns within a community

11.   Re-evaluation as follow-up studies within 5 years of study

We would not go into the details of the above as we ourselves have to undergo an additional and intensive 5 more years of postgraduate training meant for doctors, biomedical scientists or nutritionists after graduation. Just a very, very brief point-form summary above for awareness will do.

The above are professional training and the job of a nutritionist or a clinician specializing in nutrition. It takes about 10 years to become a qualified and licensed nutritionist before he / she can practise nutrition in Malaysia.  It is a licensed profession like dietetics. 

Lim ju boo