The Team Approach

The clinical laboratory provides the B for Biochemical information for the A through E assessment of nutritional status by the Registered Dietitian.

essential nutrients - molecules that are required for metabolism but cannot be produced by the body; required in the diet energy malnutrition - nutritional deficiency caused by inadequate intake of calories, proteins, or both, seen in children under age 5 years or persons undergoing stress of major illness; also called protein-calorie malnutrion albumin and thyroxine-binding prealbumin (TBPA) (also known as transthyretin), provides information about the duration of malnutrition. Measurement of the essential fatty acids, total cholesterol, lipoproteins, and triglycerides establish the nutritional status of these important nutrients. Carbohydrate nutritional status may be evaluated through laboratory testing of fasting glucose, glycated hemoglobin, and tolerance to glucose loading. Micronutrient status may be assessed through laboratory testing of plasma levels of vitamins and minerals and through functional testing of the processes to which micronutrients contribute. Functional laboratory testing includes the assessment of the organs, such as the kidney, liver, heart, and bone, which may be affected by inadequate nutrition.

The dietitian employs all categories of information for the determination of current nutritional status and for the determination of the nutritional care plan. The nutritional care plan is based on an individual's age, gender, current state of health, and nutrition-related diagnosis. Concurrent pathology, such as obesity, diabetes, cardiovascular disease, or hypertension, as well as organ function will influence the plan. The dietitian instructs the individual on the implementation of the nutritional care plan and continues to follow up on these nutritional recommendations and work closely with the health-care team to assure compliance.

Malnutrition may occur in one category or several categories of essential nutrients. Energy malnutrition may occur with deficient intake of carbohydrates, lipids, and proteins. Carbohydrates and lipids are important sources of calorie requirements in the body. Protein malnutrition may be caused by poor diet or by insufficient nutritional support of hospitalized patients. Twenty amino acids are important to human body function. Eight of these amino acids cannot be made by the adult human and are essential nutrients. These eight are isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Nutritional deficiency of these essential amino acids will cause severe malnutrition. Humans are also unable to produce two important fatty acids, linoleic acid and linolenic acid. These fatty acids must be included in the diet. Fatty acid deficiency may cause skin, immune system, and circulatory system disorders.

Support of the patient with nutritional deficiencies includes oral therapy that is rich in energy and protein foods, tube feeding directly into the gastrointestinal tract, and parenteral feeding directly into the circulatory system.

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