Clinical Signs Of Nutritional Deficiency

CLINICAL SIGNS OF NUTRITIONAL DEFICIENCY

DISORDERS

Clinical examination is an important practical method for assessing the nutritional status of a community. Essentially, the method is based on examination for changes, believed to be related to inadequate nutrition that can be seen or felt in the superficial epithelial tissues especially the skin, eyes, hair and buccal mucosa or in organs near the surface of the body such as the parotid and thyroid glands.

Clinical assessment must always be carried out by individuals with adequate training. The following simple guide is employed to interpret the following deficiencies.

Guide for the interpretation of deficiencies and identifying the clinical signs.

Condition Clinical Signs

(i) Protein Energy : Odema, depigmentation, Malnutrition sparseness and easy pluckability of hair, moon face, enlarged liver, muscle wasting.

(ii) Vitamin A : Night blindness, Bitot' s spots deficiency in the eye, Xerosis of skin.

(iii) Riboflavin deficiency : Angular stomatitis, cheilosis.

(iv) Thiamine deficiency : Oedema, sensory loss, calf muscle tenderness.

(v) Niacin deficiency: Raw tongue, pigmentation of the skin.

(vi) Vitamin C deficiency : Spongy and bleeding gum.

(vii) Vitamin D deficiency : Rickets, beading of ribs, Knock - knees, bowed legs.

(viii) Iron deficiency: Pale conjunctiva, spoon - shaped nails.

(ix) Iodine deficiency : Enlargement of thyroid gland.

Source: Jelliffe, D.B., 1989, The Assessment of Nutritional Status of the community WHO Monograph Series, Geneva

Biophysical Methods:

The biophysical methods are used to assess the alterations in functions associated with inadequate nutrition. For (eg) Dark adaptation test is used to evaluate the ability to see in the dim light.

Biochemical test:

Biochemical tests can be used to detect the deficiencies by analyzing blood, urine, stools and phlem. For (eg) Estimation of hemoglobin in blood to detect iron deficiency.

Indirect Methods:

Vital Statistics:

Malnutrition influences morbidity, mortality, life expectancy and other health statistics. Hence vital statistics may therefore be considered as indirect indication of the nutritional status of the community.

Infant mortality rate, maternal mortality rate and morbidity rate are the vital statistics that can be used to assess the nutritional status of the community.

Assessment of socio - economic status: -

Low food availability, increased family size, unsanitary living conditions, inadequate knowledge of nutritional needs, inappropriate weaning practices are powerful social cultural and economic factors, which influence nutritional status.

Diet surveys:

Diet surveys are helpful in studying the quality and quantity of food consumed by the family and the community. The techniques of collecting information on family food consumption include:

Food Inventory Method: This method is usually employed in Institutions where homogenous group of people take their meals in a common kitchen eg. Hostels, orphanages. In this method the amount of food stuff issued to the kitchen as per the issue register is taken into consideration. No direct measurement or weighing is done. A study period of one week is desirable.

2)     Food expenditure pattern method

In this method information on the amount spent on food and non-food items during the previous month or week is collected using a questionnaire. This method avoids actual weighing of foods.

3)     24 hour recall

In this method a set of standardized cups suited to local conditions are used. The standard cups help the respondent to recall the quantities of the food prepared and fed to individual members on the previous day. This is usually done for three consecutive days. The advantage of this method is that the intake of each food item by the specific individual in the family such as pre-school child, adolescent, pregnant women can be assessed using the cups.

4) Diet History:

This method is useful for obtaining qualitative details of diet and studying patterns of food consumption at household and industrial level. The procedure includes assessment of the frequency of consumption, different foods, daily or number of times in a week or fortnight or occasionally. This method is used to study meal pattern, dietary habits, food preferences, and avoidances during sickness.

5) Weighment method:

In this method, the food either raw or cooked is actually weighed using an accurate balance. It is ideal to conduct the survey for seven consecutive days. Every day food is weighed in the morning and evening before actual cooking. The age, sex, physiological status of the family members should be noted down. Nutrient intake is then calculated using the ICMR food composition tables. Though this method is accurate as the foods are directly weighed, it requires extreme co-operation of the house wives.

The information on food and nutrient consumption is compared with the recommended allowances of the ICMR and the adequacy is determined. A combination of dietary, clinical and biochemical assessment is desirable for assessment of nutrition status of individuals or communities.