Clinical Assessment of Nutritional Status
| Evidence of Adequate Nutrition | Evidence of Deficient or Excessive Nutrition | Deficiency or Excess |
| General Growth | ||
| Normal weight gain, growth velocity, and head growth for age and gender | Weight loss or poor weight | Protein, calories, fats, and other
essential nutrients, especially vitamin A, pyridoxine, niacin, calcium, iodine, manganese, zinc |
| Excess weight gain | Excess calories | |
| Sexual development appropriate for age | Delayed sexual development | Excess vitamins A, D |
| Skin | ||
| Smooth, slightly dry to touch
Elastic and firm Absence of lesions Color appropriate to genetic background |
Hardening and scaling | Vitamin A |
| Seborrheic dermatitis | Excess niacin | |
| Dry, rough, petechiae | Riboflavin | |
| Delayed wound healing | Vitamin C | |
| Scaly dermatitis on exposed surfaces | Riboflavin, Vitamin C, Zinc | |
| Wrinkled, flabby | Niacin | |
| Crusted lesions around orificies, especially nares | Protein, calories, zinc | |
| Pruritus | Excess vitamin A, riboflavin, niacin | |
| Poor turgor | Water, sodium | |
| Edema | Protein, thiamine
Excess sodium |
|
| Yellow tinge (jaundice) | Vitamin B12
Excess vitamin A, niacin |
|
| Depigmentation | Protein, calories | |
| Pallor (anemia) | Pyridoxine, folic acid, vitamin B12, C, E (in premature infants), iron
Excess vitamin C, Zinc |
|
| Paresthesia | Excess riboflavin | |
| Hair | ||
| Lustrous, silky, strong, elastic | Stringy, friable, dull, dry, thin | Protein, calories |
| Alopecia | Protein, calories, zinc | |
| Depigmentation | Protein, calories, copper | |
| Raised areas around hair follicles | Vitamin C | |
| Head | ||
| Even molding, occipital prominence, symmetric facial features
Fused sutures after 18 months |
Softening of cranial bones, prominence of frontal bones, skull flat and depressed toward middle | Vitamin D |
| Delayed fusion of sutures | Vitamin D | |
| Hard, tender lumps in occiput | Excess vitamin A | |
| Headache | Excess thiamine | |
| Neck | ||
| Thyroid not visible, palpable in midline | Thyroid enlarge, may be grossly visible | Iodine |
| Eyes | ||
| Clear, bright | Hardening and scaling of cornea and conjunctiva | Vitamin A |
| Good night vision | Night blindness | Vitamin A |
| Conjunctiva: pink, glossy | Burning, itching, photophobia, cataracts, corneal vascularization | Riboflavin |
| Ears | ||
| Tympanic membrane: pliable | Calcified (hearing loss) | Excess vitamin D |
| Nose | ||
| Smooth, intact nasal angle | Irritation and cracks at nasal angle | Riboflavin
Excess vitamin A |
| Mouth | ||
| Lips: smooth, moist, darker color than skin | Fissures and inflammation at corners | Riboflavin
Excess vitamin A |
| Gums: firm, coral pink, stippled | Spongy, friable, swollen bluish red or black, bleed easily | Vitamin C |
| Mucous membranes: bright pink, smooth, moist | Stomatitis | Niacin |
| Tongue: rough texture, no lesion, taste sensation | Glossitis | Niacin, riboflavin, folic acid |
| Diminished taste sensation | Zinc | |
| Teeth: uniform white color, smooth, intact | Brown mottling, pits, fissures | Excess fluoride |
| Defective enamel | Vitamins A, C, D, calcium, phosphorus | |
| Caries | Excess carbohydrates | |
| Chest | ||
| In infants, shape almost circular | Depressed lower portion of rib cage | Vitamin D |
| In children, lateral diameter increased in proportion to anteroposterior diameter | Sharp protrusion of sternum | Vitamin D |
| Smooth costochondral junctions | Enlarged costochondral junction | Vitamin C, D |
| Breast development: normal of age | Delayed development | Zinc |
| Cardiovascular System | ||
| Pulse and BP within normal limits | Palpitations | Thiamine |
| Rapid pulse | Potassium
Excess thiamine |
|
| Arrhythmias | Magnesium, potassium
Excess niacin, potassium |
|
| Increased BP | Excess sodium | |
| Decreased BP | Thiamine
Excess niacin |
|
| Abdomen | ||
| In young children, cylindric and prominent | Distended, flabby, poor musculature | Protein, calories |
| Prominent, large | Excess calories | |
| In older children, flat | Potbelly, constipation | Vitamin D |
| Normal bowel habits | Diarrhea | Niacin
Excess vitamin C |
| Constipation | Excess calcium, potassium | |
| Musculoskeletal System | ||
| Muscles: firm, well-developed, equal strength bilaterally | Flabby, weak, generalized wasting | Protein, calories |
| Weakness, pain, cramps | Thiamine, sodium, chloride, potassium, phosphorus, magnesium
Excess thiamine |
|
| Muscle twitching, tremors | Magnesium | |
| Muscular paralysis | Excess potassium | |
| Spine: cervical and lumbar curves (double S curve) | Kyphosis, lordosis, scoliosis | Vitamin D |
| Extremities: symmetric; legs straight with minimum bowing | Bowing of extremities, knock knees | Vitamin D, calcium, phosphorus |
| Epiphyseal enlargement | Vitamin A, D | |
| Bleeding into joints and muscles, joint swelling, pain | Vitamin C | |
| Joints: flexible, full range of motion, no pain or stiffness | Thickening of cortex of long bones with pain and fragility, hard tender lumps in extremities | Excess vitamin A |
| Osteoporosis of long bones | Calcium
Excess vitamin D |
|
| Neurologic System | ||
| Behavior: alert, responsive, emotionally stable | Listless, irritable, lethargic, apathetic (sometimes apprehensive, anxious, drowsy, mentally slow, confused) | Thiamine, niacin, pyridoxine, vitamin C, potassium, magnesium, iron, protein, calories
Excess vitamins A, D, thiamine, folic acid, calcium |
| Absence of tetany, convulsions | Masklike facial expression, blurred speech, involuntary laughing | Excess manganese |
| Convulsions | Thiamine, pyridoxine, vitamin D, calcium, magnesium
Excess phosphorus (in relation to calcium) |
|
| Intact peripheral nervous system | Peripheral nervous system toxicity (unsteady gait, numb feet and hands, fine motor clumsiness) | Excess pyridoxine |
| Intact reflexes | Diminished or absent tendon reflexes | Thiamine, vitamin E |
