Principles Of Nutritional Assessment

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ISBN: 9780195171693 | 0195171691
Cover: Hardcover
Copyright: 3/31/2005

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This is a comprehensive text on the methods - dietary, anthropometric, laboratory and clinical - of assessing the nutritional status of populations and of individuals in the hospital or the community. This Second Edition incorporates recent data from national nutritional surveys in the US andEurope; the flood of new information about iron, vitamin A and iodine; the role of folate in preventing neural tube defects; the use of HPLC techniques and enzyme assays; improvements in data handling; and many other developments. A paperback edition of this book is available to readers living outside of North America and Europe. Interested parties should contact the author at: rsgibson@nutrition.earthlight.co.nz http: //nutrition.earthlight.co.nz

1 INTRODUCTION,

(26)

1.1 Nutritional assessment systems,

(3)

1.1.1 Nutrition surveys,

(1)

1.1.2 Nutrition surveillance,

(1)

1.1.3 Nutrition screening,

(1)

1.1.4 Nutrition interventions,

(2)

1.1.5 Assessment systems in the clinical setting,

(1)

1.2 Nutritional assessment methods,

(2)

1.2.1 Dietary methods,

(1)

1.2.2 Laboratory methods,

(1)

1.2.3 Anthropometric methods,

(1)

1.2.4 Clinical methods,

(1)

1.2.5 Ecological factors,

(1)

1.3 Nutritional assessment indices and indicators,

(2)

1.4 The design of nutritional assessment systems,

(11)

1.4.1 Study objectives,

(1)

1.4.2 Sampling protocols,

(2)

1.4.3 Calculating sample size,

(1)

1.4.4 Validity,

(1)

1.4.5 Reproducibility or precision,

(1)

1.4.6 Accuracy,

(1)

1.4.7 Random errors,

(1)

1.4.8 Systematic errors or bias,

(1)

1.4.9 Confounding,

(1)

1.4.10 Sensitivity,

(1)

1.4.11 Specificity,

(1)

1.4.12 Prevalence,

(1)

1.4.13 Predictive value,

(1)

1.4.14 Ethical issues,

(1)

1.4.15 Additional factors,

(1)

1.5 Evaluation of nutritional assessment indices,

(7)

1.5.1 Reference distribution,

(1)

1.5.2 Reference limits,

(1)

1.5.3 Cutoff points,

(2)

1.5.4 Trigger levels,

(4)

2 FOOD CONSUMPTION AT THE NATIONAL AND HOUSEHOLD LEVELS,

(14)

2.1 Measuring food consumption at the national level,

(6)

2.1.1 Food balance sheets,

(3)

2.1.2 Total diet studies,

(2)

2.1.3 Universal product codes and electronic scanning devices,

(1)

2.2 Measuring food consumption at the household level,

(3)

2.2.1 Food account method,

(1)

2.2.2 Household food record method,

(1)

2.2.3 Household 24-h recall method,

(1)

2.3 National food consumption surveys: household methods,

(1)

2.4 Summary,

(4)

3 MEASURING FOOD CONSUMPTION OF INDIVIDUALS,

(24)

3.1 Methods for measuring food consumption of individuals,

(9)

3.1.1 Twenty-four-hour recall method,

(3)

3.1.2 Repeated 24-h recalls,

(1)

3.1.3 Estimated food records,

(1)

3.1.4 Weighed food records,

(1)

3.1.5 Dietary history,

(1)

3.1.6 Food frequency questionnaire,

(4)

3.2 Technical improvements in food consumption measurements,

(4)

3.2.1 Telephone,

(1)

3.2.2 Photographs,

(1)

3.2.3 Graduated food models,

(1)

3.2.4 Tape recorders,

(1)

3.2.5 Microcomputers,

(1)

3.3 Selecting an appropriate method,

(5)

3.3.1 Determining the mean nutrient intake of a group: level one,

(1)

3.3.2 Calculating the population percentage "at risk": level two,

(1)

3.3.3 Ranking individuals by food or nutrient intake: level three,

(1)

3.3.4 Determining usual intakes of nutrients of individuals: level four,

(1)

3.4 Summary,

(6)

4 ASSESSMENT OF NUTRIENT INTAKES FROM FOOD CONSUMPTION DATA,

(40)

4.1 Compiling or augmenting food composition data,

(4)

4.1.1 Direct chemical analysis,

(1)

4.1.2 Using food composition data from other sources,

(1)

4.1.3 Calculating representative values,

(1)

4.1.4 Estimating missing food composition values,

(1)

4.1.5 Calculating nutrient values of recipes from ingredient data,

(1)

4.2 Food composition databases,

(4)

4.2.1 United States Nutrient Databases,

(1)

4.2.2 Canadian Nutrient File,

(1)

4.2.3 United Kingdom National Nutritional Database,

(1)

4.2.4 European food composition databases,

(1)

4.2.5 International Minilist Nutrient Database,

(1)

4.3 Food composition tables,

(1)

4.3.1 U.S. and Canadian food composition tables,

(1)

4.3.2 U.K. food composition tables,

(1)

4.3.3 European food composition tables,

(1)

4.4 Sources of error in food composition values,

(14)

4.4.1 Inadequate sampling protocols,

(1)

4.4.2 Inappropriate analytical methods,

(4)

4.4.3 Analytical errors,

(1)

4.4.4 Uncertainties associated with energy and protein values,

(2)

4.4.5 Inconsistencies in terminology,

(3)

4.4.6 Incorrect description of individual foods,

(1)

4.4.7 Genetic, environmental, preparation, and processing factors,

(1)

4.5 International Network of Food Data Systems,

(1)

4.6 Verifying nutrient values in a food composition database,

(1)

4.7 Analysis of foods or diets,

(2)

4.8 Assessment of available nutrient intakes,

(8)

4.8.1 Monsen's algorithms for available iron,

(1)

4.8.2 FAO/WHO algorithm,

(1)

4.8.3 Algorithm of Murphy and co-workers,

(1)

4.8.4 Other algorithms for available iron,

(1)

4.8.5 WHO algorithm for available zinc,

(2)

4.8.6 Algorithm of Murphy and co-workers for available zinc,

(1)

4.8.7 IZiNCG algorithm,

(1)

4.8.8 Development of algorithms for other nutrients,

(2)

4.9 Summary,

(6)

5 MEASUREMENT ERRORS IN DIETARY ASSESSMENT,

105

(24)

5.1 Sources of measurement error,

105

(1)

5.2 Assessment and control of measurement errors,

106

(15)

5.2.1 Nonresponse bias,

106

(1)

5.2.2 Respondent biases,

106

(4)

5.2.3 Interviewer biases,

110

(1)

5.2.4 Respondent memory lapses,

111

(2)

5.2.5 Incorrect estimation of portion size consumed,

113

(1)

5.2.6 Measurement aids to quantify portion sizes,

113

(4)

5.2.7 Omission of information on nutrient supplement usage,

117

(2)

5.2.8 Coding errors,

119

(1)

5.2.9 Errors in the handling of mixed dishes,

120

(1)

5.3 Implications of measurement errors in dietary assessment,

121

(1)

5.4 Summary,

122

(7)

6 REPRODUCIBILITY IN DIETARY ASSESSMENT,

129

(20)

6.1 Assessment of reproducibility in dietary methods,

129

(7)

6.1.1 Twenty-four-hour recalls,

130

(1)

6.1.2 Food records,

131

(1)

6.1.3 Dietary histories,

132

(2)

6.1.4 Food frequency questionnaires,

134

(2)

6.2 Sources of true variability in nutrient intakes,

136

(5)

6.2.1 Between-subject variation,

136

(1)

6.2.2 Age and sex effects,

137

(1)

6.2.3 Within-subject variation,

137

(3)

6.2.4 Day-of-the-week effects,

140

(1)

6.2.5 Seasonal and other effects,

140

(1)

6.2.6 Sequence effect,

141

(1)

6.3 Statistical assessment of reproducibility,

141

(4)

6.3.1 Analysis of variance,

141

(1)

6.3.2 Paired tests on the mean or median intake,

142

(1)

6.3.3 Degree of misclassification,

142

(1)

6.3.4 Mean and standard deviation of the difference,

143

(1)

6.3.5 Correlation analysis,

144

(1)

6.4 Summary,

145

(4)

7 VALIDITY IN DIETARY ASSESSMENT METHODS,

149

(48)

7.1 Design of relative validity studies,

149

(3)

7.1.1 Selection of subjects for a validation study,

150

(1)

7.1.2 Study objective and time frame,

150

(1)

7.1.3 Sequence and spacing of test and reference methods,

150

(1)

7.1.4 Independent errors,

151

(1)

7.1.5 Sex and age,

151

(1)

7.1.6 Socioeconomic status, ethnicity, and health status,

151

(1)

7.1.7 Other factors,

152

(1)

7.2 Relative validity in dietary studies,

152

(9)

7.2.1 Relative validity of 24-h recalls,

152

(3)

7.2.2 Relative validity of food records,

155

(1)

7.2.3 Relative validity of dietary histories,

156

(2)

7.2.4 Relative validity of food frequency questionnaires,

158

(3)

7.3 Use of biomarkers to validate dietary intakes,

161

(21)

7.3.1 Use of doubly labeled water to validate reported energy intake,

164

(3)

7.3.2 Basal metabolic rate as a biomarker for energy intakes,

167

(2)

7.3.3 Cutoffs based on predicted total energy expenditure,

169

(1)

7.3.4 Twenty-four-hour urinary nitrogen excretion to validate protein intake,

170

(1)

7.3.5 Other uses of 24-h urine nitrogen in validation studies,

171

(2)

7.3.6 Excretion of nutrients in urine,

173

(1)

7.3.7 Fatty acids in adipose tissue,

174

(6)

7.3.8 Fatty acids in blood fractions,

180

(2)

7.4 Statistical assessment of validity,

182

(5)

7.4.1 Tests on the means or medians,

182

(1)

7.4.2 Pearson correlation coefficients,

183

(2)

7.4.3 Other measures of correlation,

185

(1)

7.4.4 Regression analysis,

185

(1)

7.4.5 Cross-classification,

186

(1)

7.4.6 Mean and standard deviation of the difference,

186

(1)

7.4.7 Analysis of surrogate categories,

187

(1)

7.4.8 New approaches,

187

(1)

7.5 Summary,

187

(10)

8 EVALUATION OF NUTRIENT INTAKES AND DIETS,

197

(36)

8.1 Nutrient reference levels,

197

(15)

8.1.1 Underlying principles,

198

(5)

8.1.2 U.K. Dietary Reference Values,

203

(1)

8.1.3 U.S. and Canadian Dietary Reference Intakes,

204

(4)

8.1.4 European reference values,

208

(1)

8.1.5 FAO/WHO nutrient requirements,

208

(2)

8.1.6 WHO Safe Range of Population Intakes for Trace Elements,

210

(1)

8.1.7 WHO Recommendations for prevention of diet-related chronic diseases,

211

(1)

8.2 Evaluating the nutrient intakes of individuals,

212

(2)

8.2.1 Using the EAR,

212

(1)

8.2.2 Using the AI,

213

(1)

8.2.3 Using the UL,

213

(1)

8.3 Evaluating the nutrient intakes of population groups,

214

(6)

8.3.1 Probability approach,

215

(2)

8.3.2 EAR cutpoint method,

217

(1)

8.3.3 Using 77% percent of the RDA as a cutoff value,

218

(1)

8.3.4 Use of AI for groups,

218

(1)

8.3.5 Use of UL for groups,

219

(1)

8.3.6 WHO lower limits of safe ranges of population mean intakes,

219

(1)

8.4 Food-based dietary guidelines,

220

(7)

8.4.1 Characteristics of food-based dietary guidelines,

221

(1)

8.4.2 Evaluating intakes using food-based dietary guidelines,

222

(5)

8.5 Summary,

227

(6)

9 ANTHROPOMETRIC ASSESSMENT,

233

(12)

9.1 Advantages and limitations of anthropometric assessment,

234

(1)

9.2 Errors in anthropometry,

234

(6)

9.2.1 Random measurement errors and precision,

235

(2)

9.2.2 Systematic measurement errors and accuracy,

237

(2)

9.2.3 Errors from changes in tissue composition and properties,

239

(1)

9.2.4 Invalid models and errors in body composition,

239

(1)

9.3 Interpretation and evaluation of anthropometric data,

240

(5)

9.3.1 Conditioning factors,

240

(1)

9.3.2 Appropriate reference data,

241

(1)

9.3.3 Classification systems,

242

(3)

10 ANTHROPOMETRIC ASSESSMENT OF BODY SIZE,

245

(28)

10.1 Measurements of body size,

245

(8)

10.1.1 Head circumference,

245

(1)

10.1.2 Gestational age,

246

(1)

10.1.3 Recumbent length,

246

(1)

10.1.4 Height,

247

(1)

10.1.5 Knee height in children,

248

(2)

10.1.6 Lower leg length in infants,

250

(1)

10.1.7 Knee height in adults,

251

(1)

10.1.8 Arm span,

251

(1)

10.1.9 Weight in infants and children,

252

(1)

10.1.10 Weight in older children and adults,

252

(1)

10.1.11 Elbow breadth,

253

(1)

10.2 Growth indices,

253

(6)

10.2.1 Head circumference-for-age,

254

(1)

10.2.2 Weight-for-age,

254

(1)

10.2.3 Weight-for-height,

255

(1)

10.2.4 Height-for-age,

256

(1)

10.2.5 Selecting the appropriate growth indices,

256

(1)

10.2.6 Weight changes,

257

(2)

10.3 Body mass index in adults,

259

(5)

10.3.1 BMI and measures of body fat and disease risk,

260

(1)

10.3.2 WHO classification of overweight and obesity in adults,

261

(1)

10.3.3 Canadian classification of overweight and obesity in adults,

262

(1)

10.3.4 U.S. classification of overweight and obesity in adults,

263

(1)

10.3.5 BMI and chronic energy deficiency in adults,

263

(1)

10.4 BMI in children and adolescents,

264

(4)

10.4.1 WHO classification of overweight and obesity in children,

266

(1)

10.4.2 U.S. classification of overweight and obesity in children,

266

(1)

10.4.3 Comparisons of overweight and obesity among countries,

267

(1)

10.5 Summary,

268

(5)

11 ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION,

273

(26)

11.1 Assessment of body fat,

273

(17)

11.1.1 Skinfold thickness measurements,

274

(5)

11.1.2 Waist-hip circumference ratio,

279

(3)

11.1.3 Waist circumference,

282

(3)

11.1.4 Limb fat area,

285

(1)

11.1.5 Calculation of body fat from skinfolds via body density,

286

(4)

11.2 Assessment of the fat-free mass,

290

(3)

11.2.1 Mid-upper-arm circumference,

290

(1)

11.2.2 Mid-upper-arm muscle circumference,

291

(1)

11.2.3 Mid-upper-arm muscle area,

292

(1)

11.3 Summary,

293

(6)

12 ANTHROPOMETRIC REFERENCE DATA,

299

(36)

12.1 Fetal growth reference data,

300

(1)

12.2 Growth reference data for preterm infants,

301

(2)

12.3 Head circumference reference data,

303

(1)

12.4 Distance growth reference data for infants and children,

304

(7)

12.4.1 NCHS/WHO growth reference data,

304

(1)

12.4.2 WHO multicenter growth reference data for infants and children,

305

(1)

12.4.3 European growth reference data,

306

(1)

12.4.4 U.S. CDC 2000 growth reference data,

307

(3)

12.4.5 U.K. 1990 growth reference data,

310

(1)

12.4.6 Growth reference data for children with special needs,

311

(1)

12.5 Parent-allowed-for growth reference data,

311

(1)

12.5.1 U.S. parent-allowed-for growth reference data,

311

(1)

12.5.2 U.K. familial height chart,

312

(1)

12.6 Tempo-conditional growth charts,

312

(2)

12.6.1 U.S. tempo-conditional growth charts,

313

(1)

12.6.2 U.K. tempo-conditional growth charts,

313

(1)

12.7 Growth velocity reference data,

314

(3)

12.7.1 U.S. growth velocity reference data,

315

(1)

12.7.2 U.K. growth velocity reference data,

316

(1)

12.8 Adult height and weight reference data,

317

(1)

12.8.1 U.S. adult height and weight reference data,

317

(1)

12.8.2 U.K. adult height and weight reference data,

318

(1)

12.9 Body mass index reference data,

318

(4)

12.9.1 U.S. BMI reference data for children,

319

(1)

12.9.2 U.K. BMI reference data for children,

319

(1)

12.9.3 International BMI cutoffs for children for obesity,

320

(1)

12.9.4 Other BMI reference data for children,

321

(1)

12.10 Waist circumference reference data,

322

(2)

12.10.1 U.S. waist circumference reference data,

323

(1)

12.10.2 U.K. waist circumference reference data for children,

323

(1)

12.11 Triceps and subscapular skinfold reference data,

324

(2)

12.11.1 U.S. triceps and subscapular skinfold reference data,

324

(1)

12.11.2 U.K. triceps and subscapular skinfold reference data,

325

(1)

12.12 Mid-upper-arm circumference reference data,

326

(1)

12.12.1 WHO MUAC reference data by age or height,

326

(1)

12.12.2 U.S. mid-upper-arm circumference reference data,

327

(1)

12.13 Mid-upper-arm fat area reference data,

327

(1)

12.13.1 U.S. mid-upper-arm fat area reference data,

328

(1)

12.14 Mid-upper-arm muscle-circumference and muscle-area reference data,

328

(1)

12.14.1 U.S. mid-upper-arm muscle circumference and mid-upper-arm muscle area reference data,

328

(1)

12.15 Summary,

329

(6)

13 EVALUATION OF ANTHROPOMETRIC INDICES,

335

(18)

13.1 Modes of expression of anthropometric indices,

335

(4)

13.1.1 Percentiles,

336

(1)

13.1.2 Z-scores,

337

(2)

13.1.3 Percent-of-median,

339

(1)

13.2 Use of anthropometric indices in clinical settings,

339

(2)

13.2.1 Screening to identify abnormal changes in growth,

340

(1)

13.2.2 Assessing response to therapy,

341

(1)

13.3 Use of anthropometric indices in public health,

341

(6)

13.3.1 Use of MUAC for children,

342

(1)

13.3.2 Use of MUAC for adults,

343

(1)

13.3.3 MUAC-for-height: QUAC stick,

343

(1)

13.3.4 Weight-for-height wall chart,

344

(1)

13.3.5 Using combinations of indices for studies of individuals,

345

(2)

13.4 Use of anthropometric indices in population studies,

347

(3)

13.4.1 Targeting interventions,

347

(2)

13.4.2 Assessing response to an intervention,

349

(1)

13.4.3 Identifying the determinants and consequences of malnutrition,

349

(1)

13.4.4 Nutritional surveillance,

350

(1)

13.5 Summary,

350

(3)

14 LABORATORY ASSESSMENT OF BODY COMPOSITION,

353

(20)

14.1 Chemical analysis of cadavers,

354

(1)

14.2 Total body potassium using 40K,

354

(1)

14.3 Total body water using isotope dilution,

355

(2)

14.4 Other body fluid compartments and isotope dilution,

357

(1)

14.5 In vivo activation analysis,

358

(1)

14.5.1 Total body nitrogen by in vivo NAA,

358

(1)

14.5.2 Total body calcium by in vivo NAA,

359

(1)

14.6 Densitometry,

359

(3)

14.6.1 Hydrostatic weighing,

360

(1)

14.6.2 Water-displacement plethysmography,

361

(1)

14.6.3 Air-displacement plethysmography,

361

(1)

14.6.4 Calculation of body fat from body density,

362

(1)

14.7 Total body electrical conductivity,

362

(1)

14.8 Bioelectrical impedance,

363

(2)

14.9 Computerized tomography,

365

(1)

14.10 Magnetic resonance imaging,

366

(1)

14.11 Dual-energy X-ray absorptiometry,

366

(2)

14.12 Ultrasound, 368 14.13 Summary,

368

(5)

15 LABORATORY ASSESSMENT,

373

(30)

15.1 Nutrients in biological fluids and tissues,

374

(10)

15.1.1 Blood,

374

(1)

15.1.2 Erythrocytes,

375

(2)

15.1.3 Leukocytes,

377

(1)

15.1.4 Breast milk,

377

(2)

15.1.5 Saliva,

379

(1)

15.1.6 Sweat,

379

(1)

15.1.7 Adipose tissue,

380

(1)

15.1.8 Liver and bone,

380

(1)

15.1.9 Hair,

380

(2)

15.1.10 Fingernails and toenails,

382

(1)

15.1.11 Buccal mucosal cells,

382

(1)

15.1.12 Urinary excretion rate of the nutrient or its metabolite,

383

(1)

15.2 Functional tests,

384

(6)

15.2.1 Abnormal metabolic products in blood or urine,

386

(1)

15.2.2 Reduction in activity of enzymes,

386

(1)

15.2.3 Changes in blood components,

387

(1)

15.2.4 In vitro tests of in vivo functions,

387

(1)

15.2.5 Induced responses, load and tolerance tests in vivo,

387

(1)

15.2.6 Spontaneous in vivo responses,

388

(1)

15.2.7 Growth responses,

389

(1)

15.2.8 Developmental responses,

389

(1)

15.2.9 Sleep behavior,

390

(1)

15.3 Characteristics of laboratory tests,

390

(3)

15.3.1 Precision,

390

(1)

15.3.2 Analytical accuracy,

391

(1)

15.3.3 Analytical sensitivity,

392

(1)

15.3.4 Analytical specificity,

393

(1)

15.3.5 Validity,

393

(1)

15.3.6 Predictive value,

393

(1)

15.4 Evaluation of laboratory indices,

393

(10)

15.4.1 Reference distribution and reference limits,

394

(2)

15.4.2 Cutoff points,

396

(7)

16 ASSESSMENT OF PROTEIN STATUS,

403

(40)

16.1 Assessment of somatic protein status,

407

(3)

16.1.1 Urinary creatinine excretion,

407

(2)

16.1.2 Excretion of 3-methylhistidine,

409

(1)

16.2 Assessment of visceral protein status,

410

(10)

16.2.1 Total serum protein,

411

(1)

16.2.2 Serum albumin,

411

(2)

16.2.3 Serum transferrin,

413

(2)

16.2.4 Serum retinol-binding protein,

415

(2)

16.2.5 Serum transthyretin,

417

(2)

16.2.6 Insulin-like growth factor I,

419

(1)

16.2.7 Plasma alkaline ribonuclease activity and fibronectin,

420

(1)

16.3 Metabolic changes as indices of protein status,

420

(6)

16.3.1 Plasma amino acid ratio,

420

(1)

16.3.2 Urinary 3-hydroxyproline excretion,

421

(1)

16.3.3 Nitrogen balance,

422

(1)

16.3.4 Estimated nitrogen balance and apparent net protein utilization,

423

(3)

16.3.5 Urea nitrogen: creatinine ratios,

426

(1)

16.4 Muscle function tests,

426

(3)

16.4.1 Skeletal muscle function after electrical stimulation,

426

(2)

16.4.2 Handgrip strength,

428

(1)

16.5 Immunological tests,

429

(6)

16.5.1 Lymphocyte count,

430

(1)

16.5.2 Thymus-dependent lymphocytes,

431

(1)

16.5.3 Lymphocyte proliferation assays,

432

(1)

16.5.4 Delayed cutaneous hypersensitivity,

432

(2)

16.5.5 Cytokine production,

434

(1)

16.5.6 Other methods,

435

(1)

16.6 Summary,

435

(8)

17 ASSESSMENT OF IRON STATUS,

443

17.1 Hemoglobin,

446

(4)

17.1.1 Factors affecting hemoglobin concentrations,

446

(2)

17.1.2 Interpretive criteria,

448

(1)

17.1.3 Using hemoglobin distribution to assess population iron status,

449

(1)

17.1.4 Measurement of hemoglobin,

450

(1)

17.2 Hematocrit,

450

(1)

17.2.1 Interpretive criteria,

451

(1)

17.2.2 Measurement of hematocrit,

451

(1)

17.3 Red cell indices,

451

(3)

17.3.1 Mean cell volume,

452

(1)

17.3.2 Mean cell hemoglobin,

453

(1)

17.3.3 Mean cell hemoglobin concentration,

453

(1)

17.4 Red cell distribution width,

454

(1)

17.5 Serum iron, TIBC, and transferrin saturation,

454

(5)

17.5.1 Factors influencing serum iron, TIBC, and transferrin saturation,

455

(2)

17.5.2 Interpretive criteria,

457

(1)

17.5.3 Measurement of serum iron and I'IBC,

458

(1)

17.6 Serum ferritin,

459

(4)

17.6.1 Factors affecting serum ferritin,

459

(3)

17.6.2 Interpretive criteria,

462

(1)

17.6.3 Measurement of serum ferritin,

463

(1)

17.7 Zinc protoporphyrin and free erythrocyte protoporphyrin,

463

(3)

17.7.1 Factors affecting ZnPP and PEP,

464

(1)

17.7.2 Interpretive criteria,

464

(1)

17.7.3 Measurement of ZnPP and FEP,

464

(2)

17.8 Serum transferrin receptor,

466

(4)

17.8.1 Factors affecting serum TfR,

466

(2)

17.8.2 Interpretive criteria,

468

(1)

17.8.3 Measurement of serum TfR,

469

(1)

17.9 Multiple indices,

470

(1)

17.10 Summary,

470

18 ASSESSMENT OF THE STATUS OF VITAMINS A, D, AND E,

417

(112)

18.1 Vitamin A,

478

(19)

18.1.1 Serum retinol,

480

(4)

18.1.2 Serum retinol-binding protein,

484

(2)

18.1.3 Serum retinyl ester,

486

(1)

18.1.4 Serum carotenoids,

486

(1)

18.1.5 Breast milk retinol,

487

(1)

18.1.6 Relative dose response,

488

(2)

18.1.7 Modified relative dose response,

490

(1)

18.1.8 Subjective assessment of night blindness,

490

(2)

18.1.9 Rapid dark adaptation test,

492

(1)

18.1.10 Pupillary and visual threshold test,

493

(1)

18.1.11 Conjunctival impression cytology with transfer,

494

(2)

18.1.12 Stable isotope methods and total body stores of vitamin A,

496

(1)

18.1.13 Multiple indices,

496

(1)

18.2 Vitamin D,

497

(11)

18.2.1 Serum 25-hydroxyvitaminD,

501

(5)

18.2.2 Serum 1,25(OH)2D,

506

(1)

18.2.3 Serum alkaline phosphatase,

507

(1)

18.2.4 Serum parathyroid hormone,

508

(1)

18.2.5 Calcium and phosphorus in serum and urine,

508

(1)

18.3 Vitamin E,

508

(8)

18.3.1 Serum a-tocopherol,

511

(3)

18.3.2 Serum a-tocopherol: cholesterol ratio,

514

(1)

18.3.3 Erythrocyte tocopherol,

514

(1)

18.3.4 Platelet tocopherol,

514

(1)

18.3.5 Tissue tocopherol,

514

(1)

18.3.6 Erythrocyte hemolysis test,

515

(1)

18.3.7 Erythrocyte malondialdehyde release in vitro,

515

(1)

18.3.8 Breath pentane and ethane,

516

(1)

18.4 Summary,

516

(13)

19 ASSESSMENT OF VITAMIN C STATUS,

529

(16)

19.1 Serum ascorbic acid,

531

(4)

19.1.1 Interpretive criteria,

534

(1)

19.1.2 Measurement of serum ascorbic acid,

534

(1)

19.2 Ascorbic acid in leukocytes and specific cell types,

535

(3)

19.2.1 Interpretive criteria for leukocytes and other cell types,

537

(1)

19.2.2 Measurement of ascorbic acid in leukocytes and other cell types,

537

(1)

19.3 Ascorbic acid in erythrocytes and whole blood,

538

(1)

19.4 Urinary excretion of ascorbic acid and metabolites,

538

(1)

19.5 Salivary and buccal cell ascorbic acid,

539

(1)

19.6 Body pool size,

539

(1)

19.7 Capillary fragility, 539 19.8 Summary,

540

(5)

20 ASSESSMENT OF THE STATUS OF THIAMIN, RIBOFLAVIN, AND NIACIN,

545

(30)

20.1 Thiamin,

545

(9)

20.1.1 Erythrocyte transketolase,

547

(4)

20.1.2 Urinary thiamin excretion,

551

(1)

20.1.3 Total thiamin in whole blood and erythrocytes,

552

(2)

20.2 Riboflavin,

554

(8)

20.2.1 Erythrocyte glutathione reductase activity,

557

(3)

20.2.2 Urinary riboflavin excretion,

560

(2)

20.2.3 Riboflavin and FAD in blood,

562

(1)

20.3 Niacin,

562

(6)

20.3.1 Urinary excretion of niacin metabolites,

565

(2)

20.3.2 Niacin and niacin coenzymes in plasma and erythrocytes,

567

(1)

20.4 Summary,

568

(7)

21 ASSESSMENT OF VITA-MIN B6 STATUS,

575

(20)

21.1 Erythrocyte aminotransferases,

577

(4)

21.1.1 Factors affecting activity of erythrocyte aminotransferases,

579

(1)

21.1.2 Interpretive criteria,

580

(1)

21.1.3 Measurement of erythrocyte transaminase activities,

581

(1)

21.2 Plasma pyridoxal-5'-phosphate,

581

(3)

21.2.1 Factors affecting plasma PLP levels,

582

(1)

21.2.2 Interpretive criteria,

583

(1)

21.3 Erythrocyte pyridoxal-5'-phosphate,

584

(1)

21.4 Urinary vitamin B6,

584

(2)

21.5 Urinary 4-pyridoxic acid,

586

(1)

21.6 Tryptophan load test,

587

(2)

21.7 Kynurenine load test,

589

(1)

21.8 Methionine load test,

589

(1)

21.9 Multiple indices,

590

(1)

21.10 Summary,

590

(5)

22 ASSESSMENT OF FOLATE AND VITAMIN B12 STATUS,

595

(46)

22.1 Folate,

597

(18)

22.1.1 Red cell indices,

600

(1)

22.1.2 Serum folate concentrations,

600

(4)

22.1.3 Erythrocyte folate,

604

(4)

22.1.4 Formiminoglutamate excretion,

608

(1)

22.1.5 Serum homocysteine,

608

(5)

22.1.6 Neutrophil lobe count,

613

(1)

22.1.7 Multiple indices,

614

(1)

22.2 Vitamin B12,

615

(16)

22.2.1 Serum vitamin B12,

618

(5)

22.2.2 Erythrocyte vitamin B12,

623

(1)

22.2.3 Serum holotranscobalamin II,

623

(1)

22.2.4 Deoxyuridine suppression test,

624

(1)

22.2.5 Methylmalonic acid excretion,

625

(1)

22.2.6 Serum methylmalonic acid,

626

(2)

22.2.7 The Schilling and other tests,

628

(2)

22.2.8 Multiple indices,

630

(1)

22.3 Summary,

631

(10)

23 ASSESSMENT OF CALCIUM, PHOSPHORUS, AND MAGNESIUM STATUS,

641

(42)

23.1 Calcium,

642

(15)

23.1.1 Serum calcium,

645

(1)

23.1.2 Serum ionized calcium,

646

(1)

23.1.3 Bone alkaline phosphatase activity in serum,

647

(1)

23.1.4 Serum osteocalcin,

648

(2)

23.1.5 Urinary pyridinium cross-links,

650

(3)

23.1.6 Radiogrammetry,

653

(1)

23.1.7 Single-photon absorptiometry,

653

(1)

23.1.8 Dual X-ray absorptiometry (DXA),

654

(2)

23.1.9 Computerized tomography,

656

(1)

23.1.10 Quantitative ultrasound,

656

(1)

23.1.11 Neutron activation,

656

(1)

23.2 Phosphorus,

657

(8)

23.2.1 Serum phosphorus,

659

(2)

23.3 Magnesium,

661

(4)

23.3. I Serum magnesium,

665

(7)

23.3.2 Ionized magnesium in serum and erythrocytes,

666

(2)

23.3.3 Erythrocyte magnesium,

668

(1)

23.3.4 Magnesium in leukocytes and other cell types,

669

(1)

23.3.5 Urinary magnesium and the magnesium load test,

670

(2)

23.3.6 Muscle magnesium,

672

(1)

23.4 Summary,

672

(11)

24 ASSESSMENT OF CHROMIUM, COPPER AND ZINC STATUS,

683

(66)

24.1 Chromium,

685

(12)

24.1.1 Serum chromium,

688

(2)

24.1.2 Changes in serum chromium after a glucose load,

690

(1)

24.1.3 Erythrocyte and whole blood chromium,

690

(1)

24.1.4 Urinary chromium,

690

(3)

24.1.5 Changes in urinary chromium after a glucose load,

693

(1)

24.1.6 Hair chromium concentrations,

693

(1)

24.1.7 Oral glucose tolerance test,

694

(2)

24.1.8 Multiple indices,

696

(1)

24.2 Copper,

697

(14)

24.2.1 Serum copper,

700

(3)

24.2.2 Serum ceruloplasmin,

703

(2)

24.2.3 Erythrocyte superoxide dismutase,

705

(2)

24.2.4 Cytochrome C oxidase,

707

(1)

24.2.5 Skin lysyl oxidase,

708

(1)

24.2.6 Diamine oxidase,

709

(1)

24.2.7 Hair copper concentrations,

710

(1)

24.2.8 Other indices of copper status,

710

(1)

24.2.9 Multiple indices,

711

(1)

24.3 Zinc,

711

(20)

24.3.1 Serum zinc,

715

(6)

24.3.2 Erythrocyte zinc,

721

(1)

24.3.3 Leukocyte and neutrophil zinc,

721

(1)

24.3.4 Urine zinc concentrations,

722

(1)

24.3.5 Hair zinc concentrations,

723

(1)

24.3.6 Salivary zinc,

724

(1)

24.3.7 Zinc-dependent enzymes,

724

(2)

24.3.8 Serum thymulin,

726

(1)

24.3.9 Metallothionein,

726

(1)

24.3.10 Monocyte metallothionein messenger RNA,

727

(1)

24.3.11 Kinetic markers: pool sizes and turnover rates,

728

(1)

24.3.12 Oral zinc tolerance test,

729

(1)

24.3.13 Taste acuity tests,

729

(1)

24.3.14 Multiple indices,

730

(1)

24.4 Summary,

731

(18)

25 ASSESSMENT OF IODINE AND SELENIUM STATUS,

749

(48)

25.1 Iodine,

750

(16)

25.1.1 Thyroid size by neck palpation,

754

(1)

25.1.2 Thyroid volume by ultrasonography,

755

(2)

25.1.3 Urinary iodine excretion,

757

(3)

25.1.4 Thyroid stimulating hormone in serum or whole blood,

760

(3)

25.1.5 Serum thyroglobulin,

763

(1)

25.1.6 Thyroxine and triiodothyronine in serum,

764

(1)

25.1.7 Radioactive iodine uptake,

765

(1)

25.1.8 Multiple indices,

766

(1)

25.2 Selenium,

766

(31)

25.2.1 Plasma selenium,

771

(3)

25.2.2 Whole blood selenium concentrations,

774

(1)

25.2.3 Erythrocyte and platelet selenium,

775

(1)

25.2.4 Urinary selenium,

776

(1)

25.2.5 Glutathione peroxidase,

777

(3)

25.2.6 Selenoprotein P,

780

(1)

25.2.7 Hair selenium,

781

(1)

25.2.8 Toenail selenium,

782

(1)

25.2.9 Multiple indices,

783

(14)

26 CLINICAL ASSESSMENT,

797

(12)

26.1 Medical history,

797

(3)

26.2 Physical examination,

800

(5)

26.2.1 Limitations of the physical examination,

802

(1)

26.2.2 Classification and interpretation of physical signs,

803

(1)

26.2.3 Functional assessment,

804

(1)

26.3 Summary,

805

(4)

27 NUTRITIONAL ASSESSMENT OF HOSPITAL PATIENTS,

809

(18)

27.1 Screening using a single index,

811

(2)

27.1.1 Screening with a single biochemical index,

811

(1)

27.1.2 Screening using anthropometry,

812

(1)

27.1.3 Screening using a functional index,

812

(1)

27.1.4 Characteristics of single-index screening protocols,

812

(1)

27.2 Multiparameter screening,

813

(8)

27.2.1 Prognostic Nutritional Index,

814

(2)

27.2.2 Nutritional Risk Index,

816

(1)

27.2.3 Subjective Global Assessment,

816

(2)

27.2.4 Mini Nutritional Assessment,

818

(2)

27.2.5 Nutritional scores for use by nurses,

820

(1)

27.3 The prognostic value of multi-parameter scoring systems,

821

(1)

27.4 Summary,

822

(5)

APPENDIX A,

827

(58)

INDEX,

885

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