Nutrition in Clinical Medicine

Deficiency of nutrients can cause deterioration of health (on a background of disease or without it), in turn some pathological conditions (for example, malabsorption) can cause deficiency of nutrients. In addition, many patients (for example, elderly patients with emergency hospitalization) are unaware of a nutritional deficiency that requires the necessary treatment. Many medical centers have teams of trained specialists - doctors, nurses, dieticians and pharmacists - to help clinicians in the prevention, diagnosis and treatment of hidden nutrient deficiencies.

Excessive food intake can lead to chronic diseases, such as cancer, hypertension, obesity, diabetes and coronary artery disease. Dietary restrictions are necessary for many hereditary metabolic diseases (eg, galactosemia, phenylketonuria).

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Evaluation of nutrition

Indications for assessing the nature of the diet include unwanted mass or body shape, suspected specific deficiency or toxicity of essential nutrients, and in newborns and children, growth or development retardation. At the same time, the nature of nutrition should be evaluated as part of a clinical survey of infants and children, the elderly, and people taking multiple medicines, people with mental disorders and patients with systemic diseases lasting more than a few days.

Number of daily servings required

Food group	The level of calories (kcal)
	About 1600	About 2200	About 2800
Bread	6th	9	Eleven
Fruit	2	3	4
Milk	2-3
Meat	2 (total, 5 ounces)	2 (total, 6 ounces)	3 (total, 7 ounces)
Vegetables	3	4	5

Pregnant, breast-feeding women, adolescents and boys (up to 24 years of age) need 3 servings.

Evaluation of the general nature of nutrition includes anamnesis, physical examination, and sometimes some tests. If there is a suspicion of malnutrition, then laboratory tests and skin turgor are performed. Body shape evaluation is used to assess the extent and quality of obesity.

Anamnesis includes a survey of food intake, weight changes, risk factors for food deficiency and general examination of organs and systems. The nutritionist can get more detailed information on the anamnesis of nutrition. An anamnesis usually includes a list of food items eaten in the last 24 hours, and a questionnaire about the patient about consumed food. You can use a special diary to make notes about all the food you eat. The most accurate report for assessing the diet is a weighted free diet, in which the patient records the weight and all the food consumed.

A complete physical examination should be performed, which includes determining the height, weight and distribution of fat tissue.

Body mass index (BMI) - weight (kg) / height (m) ² determines the weight-to-height ratio more accurately than the growth and weight tables. There are certain standards for increasing the growth and weight of infants, children and adolescents.

It is important to consider the distribution of adipose tissue in the body. The disproportionate obesity of the trunk (ie, the ratio of the waist / hip> 0.8) is associated with cardiovascular and cerebrovascular disorders, hypertension and diabetes more often than the deposition of adipose tissue located elsewhere in the body. There are certain methods for assessing the distribution of adipose tissue in the body: the thickness of the skin fold and the definition of bioelectric resistance.

[4], [5], [6], [7], [8], [9], [10], [11]