Clinical Manual for Management of the HIV-Infected ... - myCME.com

♦
♦
Nutrient losses (eg, due to diarrhea, vomiting)
Potential confounding factors (eg, use of multiple
overlapping or questionable supplements)
Evaluate Dietary Intake
Assess the following diet-related issues:
♦
♦
♦
♦
Expected excesses or deficiencies from dietary
history or interview
Rating of food security, including access to cooking
and refrigeration
Food intolerances, aversions, or allergies likely to
affect adequacy of intake
Special needs related to other conditions (eg,
documented cardiovascular disease, diabetes,
hypertension)
Evaluate Weight, Body Composition, and Weight
Distribution
Assess physical findings of malnutrition and
confirm with nutrition history, laboratory tests, and
anthropometric evidence. Table 7 describes normal
and abnormal findings of anthropometric tests and
recommendations for monitoring changes over time.
Table 7. Evaluating the Findings of Anthropometric Tests
Monitoring Trends and Recommendations
Adults • Chart trends over time relative to previous
•
•
•
•
measurements and the following population norms:
BMI (healthy range: 19-25)
BIA:
•
•
•
BCM (% of weight): women 30-35%; men: 40-45%
Fat (% of weight): women 20-30%; men 15-25%
Phase angle: women >5; men >6
Skinfold thicknesses and circumferences: Chart changes
in absolute measures and percentiles
Changes in body contours: Evaluate lipodystrophy
(excess accumulation of fat in abdomen, breasts,
dorsocervical area) and lipoatrophy (loss of
subcutaneous fat in face, extremities, buttocks)
Children • Plot measurements on growth charts and track
percentiles over time (the consistency of percentiles
rather than the absolute percentile is important)
• Skinfold thicknesses and circumferences: Chart changes
in absolute measures and percentiles
Key to abbreviations: BMI = body mass index; BIA = bioelectrical impedance
analysis; BCM = body cell mass.
Section 2—Health Maintenance and Disease Prevention | 2–9
Evaluate Laboratory Findings
♦
♦
Evidence of malnutrition (eg, low iron or protein
stores)
Evidence of disease or risk of disease for which
dietary treatment is indicated (eg, high fasting
glucose, hypertension, hyperlipidemia)
Develop a Problem List
Table 8 suggests a useful format for a nutrition-related
problem list.
Table 8. Nutrition-Related Problem List Format
Problem # Description of Problem (circle/describe)
Nutrition barriers: insufficient knowledge, poor
appetite, food insecurity, no food preparation or
storage facilities, homelessness
Lifestyle: substance abuse, smoking, erratic eating,
frequent fast-food intake, high stress
Weight or body composition: undesirable weight
gain or loss (adult), changes in growth trajectory
(children), loss of lean body mass (wasting), gain of
excess fat (obesity), lipoatrophy or lipodystrophy
Physical problems: fatigue, pain, early satiety, poor
dentition, clinical signs of malnutrition
Laboratory findings: low hematocrit or hemoglobin,
low protein or albumin, low or high fasting glucose,
high total cholesterol, high low-density lipoprotein,
high triglycerides, low high-density lipoprotein, low
testosterone
Gastrointestinal: diarrhea, vomiting, reflux,
constipation
Poor diet: poor food choices, bingeing, skipping meals,
high sugar intake, high alcohol consumption, high
intake of refined foods, low fruit and vegetable intake,
insufficient protein, insufficient calcium, food allergies
or intolerances limiting intake
Comorbid conditions: diabetes, hypertension,
cardiovascular disease, cancer, gastroesophageal reflux
disease (GERD)
Medications: drug-drug or drug-nutrient interactions
or difficulty coordinating medicines with meals
Supplements: insufficient or excessive intakes, cost of
supplements unaffordable, supplements with potential
or unknown risks