NUTRITIONAL STATUS          

          Nutritional status is a multidimensional phenomenon that requires a variety of methods of assessment. It is the assessment of indicators related to nutrition, nutrient intake, energy use (body mass index, BMI), and biochemical markers. Anthropometric measurements such as the thickness of the layers of the skin (skin folds), the surface area of ​​the triceps (triceps skin fold, TSF), and upper arm muscle circumference measurements (mid-arm muscle circumference, MAMC) will assist in the assessment of nutritional status in patients with acute stroke (Wiryana, 2007).

      Assessment of nutritional status is an early stage in the delivery of nutritional care for patients. Assessment of nutritional status is the foundation that provides the data for implementation of the nutrition care or nutrition therapy and the optimal diet for patients. Assessment of nutritional status includes four components, namely nutrition and diet history, anthropometric measurements, laboratory tests and physical examination (Hartono, 2006).

Direct assessment of nutritional status consists of four forms, namely anthropometric, clinical, biochemical, and biophisical.

A. Anthropometric

        Anthropometric interpreted generally is a measure of the human body. Nutritional Anthropometric means dealing with a wide range of measuring body dimensions and body composition of various age levels and nutrient levels. Anthropometric used to see an imbalance of protein and energy intake.

        Anthropometric measurement is a measurement of weight and size proportions of the human body. These measurements include height, weight, skin fold thickness (TSF) and arm circumference (MAC). Head, chest, and arms are areas anthropometric measurements (Hartono, 2006).

1. Body Weight

Body weight (BW) is one indicator of the patient's nutritional status. However in certain circumstances  measurements of actual BWcould not be done because of the patient's disability or helplessness. To overcome these problems, BW can be estimated based on the ideal length of the patient's body (Hartono, 2006).

2. Height

Height measurement on patients who are bed rest can be done with several measurement techniques. Estimating height based on knee height (Cairella et al, 2004). The equation used is:

Male, height = 64.19 - (0.04 x age) + (2.02 x knee height)

Women, height = 84.88 - (0.24 x age) + (1.83 x knee height)

The other techniques of estimate the height is to use the arm-span (the length measured from the tip of your finger left to right hand fingertips stretched position (Shahar & Pooy, 2003). For Asia, the equation used is: men, high body = 53.4 + (0.67 x armspan)

Women, height = 81.0 + (0.48 x armspan).

3. Body mass index (BMI)

BMI is calculated based on BB (in kg) and TB (in cm). BMI is used to measure the patient's nutritional status and estimate the size of body fat. IMT measurement results, although still limited, but more accurate estimates compared to just using the BB alone.

The general formula, BMI = (weight (kg)) / [TB (m)] ^ 2

Relations BMI with MAC

Men; BMI = 1.01 x (MAC - 4.7)

Women; BMI = 1.10 x (MAC - 6.7)

Default Values ​​BMI (proposed for asia, 2000)

<18.5 Weight less

18.5 to 22.9 weight nrmal

> 23 Preobese

23 to 24.9 Obese light

25 to 29.9 Obese being

> 30 Obese heavy

4. Triceps Skinfolds, MAC, Mid-Arm Muscle Circumference (MAMC)

Measurement of ticeps skinfold thickness (TSF) aims to determine the status of body fat while upper arm circumference / mid-arm circumference (MAC) and upper arm muscle circumference / mid-arm muscle circumference (MAMC) to determine the status of the muscle protein.

MAMC = MAC (cm) - {3.14 x TSF (cm)}

Until now, the normal value for Indonesian adults MAMC is do not exist, but for the Caucasian, normal values​​: 90% standard = 22.5 cm for males, 20.9 cm for women (Dudek, 2001 in Hartono, 2007).

B. Clinical

Clinical examination is a very important method to assess nutritional status. This method is based on changes in tissue due to lack of nutrients. This can be seen in the epithelial tissue (supervicial epithelial tissues) such as skin, eyes, hair and oral mucosa or in organs close to the surface of the body such as the thyroid gland.

Physical examination of a patient associated with the early signs of malnutrition or nutritional deficiencies. The principle of physical examination is cephalo caudal, from head to toe. Physical examination is composed of swallowing function, the absorption function, anthropometric measurements, and physical abnormalities or complaints related to nutritional deficiencies (Delaune & Ladner, 2002).

C. biochemical

Assessment of nutritional status using the labolatoris specimen examination conducted in various body tissues. Network among others; blood, urine, feces, and also some body tissues such as the liver and muscle. This method is used as the information of the possibility of malnutrition state is more severe. However, the information can not show the state of malnutrition or nutritional status.

Biochemical examination which is used as the data on nursing care is total lymphocyte levels, albumin, iron, hemoglobin, transferrin, creatinine, hematocrit, nitrogen balance, and skin test antigen. The value of these biochemical tests and anthropometric together will help give you an idea of nutritional status and immunological responses of patients (Nurachmah, 2001).

Laboratory tests can provide information about the nutritional status especially on the somatic and visceral compartment of the body (creatinine-height index and urinary 3-methylhistidine). Somatic compartment composed of skeletal muscle and adipose tissue. Visceral compartment includes examining albumin, transferrin and prealbumin, retinol binding.

Visceral Proteins that Can Used in Assessing Nutrition

half time                                       Limit                                          Normal Part

Albumin                                      18 days                                      3.5 - 5.5 mg / dl

Transferrin                                   8 days                                       200-400 mg / dl

Thyroxine-binding prealbumin      2 days                                       15.7 - 29.6 mg / dl

Retinol-binding protein                12 hours                                     2.6 - 7.6 mg / dl

Sources: Hartono, 2006

Visceral Protein and Malnutrition

                                                  albumin (g / dl)                        Transferrin (g / dl)

Mild Malnutrition                           3.0 - 3.5                                   1.5 - 2

moderate Malnutrition                    2.1 - 3.0                                   1 - 1.5

Severe malnutrition                           < 2.0                                         < 1

Sources: Hartono, 2006

D. Biophysical

It is a method of determining the nutritional status by looking at the ability to function (particularly networking) and see the changes in the structure of the network. Generally it can be used for specific situations such as the incidence of blindness twilight epidemic (epidemic of night blindness). Method used was dark adaptation tests.