PE9.{2,4-7} | Nutritional Assessment Workflow — Summary & Reflection

KEY TAKEAWAYS

Nutritional assessment is a four-domain process: anthropometry, dietary recall, clinical examination, and biochemical markers. The five anthropometric measurements are weight, height/length, MUAC, head circumference, and skinfold thickness — each interpreted against WHO Growth Standards (0-5 years) or IAP growth charts using z-scores. MUAC is the primary community screening tool: <11.5 cm = SAM, 11.5-12.5 cm = MAM. The 24-hour dietary recall, using open-ended probing for quantities across household measures, yields a caloric intake estimate to calculate the gap against Holliday-Segar requirements (100/50/20 rule). Nutritional status is classified by WHO z-scores (wasting = WHZ < −2; stunting = HAZ < −2), Gomez (weight-for-age %), and Waterlow (separate wasting + stunting grades). Diet planning must specify energy target, macronutrient distribution, meal frequency, food types from locally available sources, and disease-specific modifications. The IAP recommends nutritional screening at every clinical encounter; identifying malnutrition early — before the child reaches SAM — dramatically reduces mortality and morbidity.

REFLECT

Imagine you are assigned to a rural health sub-centre for a month with no laboratory facilities and only a weighing scale and a MUAC tape. How would you adapt your nutritional assessment workflow to function within these constraints? Which of the four assessment domains can be performed without equipment, which require basic tools, and which require laboratory support? This reflection exercise highlights that nutritional assessment at its clinical core is a skill of systematic observation and structured questioning — high technology adds specificity but the essential diagnosis begins with the hands-on assessment.