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Alternative Nutrition Diagnostics/Assessments

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Meghan O'Hearn

public health nutritionist

Normal user

14 Jan 2016, 11:23

Weight-for-height z-score and MUAC are the evidence-based norm for identifying, categorizing and treating wasting/acute malnutrition and height-for-age z-score is the standard indicator for stunting. We occasionally see blood tests for screening of micronutrient deficiencies (iron mainly), but this is rarely done at a population level--except for large scale research. We continue to measure proxy indicators of our nutrition, yet technology is advancing faster than we can even comprehend.

With all the laboratory research into finger prick and non-invasive techniques (mass spectrometry, plasma ionization) for understating micronutrient and protein profiles as well as alternative proxy nutrition indicators like handgrip strength tests, I am curious to know what the public health nutrition community's thoughts are on the future of nutrition diagnostics?

SOME DISCUSSION QUESTIONS:
What information do we ideally need to know to understand a person's nutrition and be able to act upon it?

Is it necessary to have comprehensive understanding of nutrition status in order to address it effectively?

How relevant are all these individualized assessments/diagnoses at the population level?

Should we be looking at the factors affecting nutrition (dietary intake, gut microbiota, environment, genetics) or focus more on measuring an individuals full nutrition profile?

What are your thoughts on handgrip strength (HGS) compared to MUAC or WHZ in measuring malnutrition? I haven't been able to find much literature on this matter.

I look forward to your thoughts and a critical discussion :)

André BRIEND

Frequent user

14 Jan 2016, 13:37

Dear Meghan,

You raise an important but difficult question, on how to define malnutrition. A short answer to that is that there is no generally accepted “gold standard” to assess nutritional status. For this reason, in many programmes, MUAC is used as it is best to identify children with a high risk of dying, a clear indication that these children need intensive care, independently of their “true” nutritional status which we don’t know how to define.

The problem with this “risk approach”, is that it is not applicable to older children (> 5 y) as the association between MUAC and risk of death in absence of treatment has not been investigated beyond this age. To determine which children should receive treatment, another criterion should be used. The best approach would be to use a functional outcome, such as hand grip strength, rather than a biochemical indicator with an unclear meaning. Comparing the ability of WFH and MUAC to predict this functional outcome, after adjusting for age, would be an interesting research project.

Measuring body compartments, especially muscle and fat, with a clear function as nutritional reserve would be an interesting approach as well, but this is not easy. There is no simple reliable method as far as I know for instance to measure muscle mass in young children.

I hope this helps,

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