Clinical Assessment of Nutritional Status : Clinical Assessment of Nutritional Status

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
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
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
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
Thyroid not visible, palpable in midline Thyroid enlarge, may be grossly visible Iodine
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
Tympanic membrane: pliable Calcified (hearing loss) Excess vitamin D
Smooth, intact nasal angle Irritation and cracks at nasal angle Riboflavin

Excess vitamin A

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
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

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


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