By Elia, Marinos
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1 Number of days necessary to obtain estimates of dietary intake within 10% of average intake in healthy people using weighed food intakes. Data from Bingham (1987). Dietary component Number of days Energy Carbohydrate Fat Dietary fibre Calcium Iron Thiamin Riboflavin Cholesterol Vitamin C 5 6 7 10 10 12 15 19 27 36 Such a history can be undertaken by clinicians as part of the general clinical history, but a more detailed evaluation can be undertaken by dietitians. Clinical examination Protein–energy malnutrition Clinical examination can reveal evidence of chronic protein energy malnutrition: ●● ●● ●● ●● Muscle: muscle wasting is often visible, particularly in certain parts of the legs (quadriceps in proximal leg), proximal arms (deltoids), and face (temporalis muscle).
Anorexia: major and persistent changes in subjective impression of appetite may also indicate risk of malnutrition. Other symptoms: persistent swallowing difficulties, vomiting and diarrhoea, poor- or ill-fitting dentures, and painful mouth conditions can also mark the development of protein-energy malnutrition. Socio-economic: the history may elicit poverty, social isolation, and difficulties with shopping. These can be particularly problematic in patients who have become weak and unable to shop or cook as a result of their malnutrition.
Leyton GB. The effects of slow starvation. Lancet 1946; ii: 73–79. Rudman D, Millikan WJ, Richardson TJ, Bixler TJ II, Stackhouse WJ, McGarity WC. Elemental balances during intravenous hyperalimentation of underweight adult subjects. J Clin Invest 1975; 55: 94–104. Scientific Advisory Committee on Nutrition. Dietary reference values for enery, 2011. London: The Stationary Office, 2013. Sobotka L, editor. Basics in Clinical Nutrition, 4th edn. Prague: Galen, 2011. Stratton RJ, Green CJ, Elia M. Disease-related Malnutrition.
Clinical nutrition by Elia, Marinos