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For more than two decades, the practice of risk assessment has been applied to human public health issues, and policy makers have used the results of risk assessments in their decision-making process. Approaches for risk assessment have been developed for nonnutrients such as drugs, food additives, and pesticides, but approaches for risk assessment have received less attention in the nutrition area. Some aspects of the risk assessment approach used for nonnutrients are applicable to the assessment of risks related to nutrition. The overall approach, however, must be adapted and modified to take into account the unique aspects of nutrients, including the fact that both high and low nutrient intakes are associated with risk. Experience with the application of a risk assessment process to the setting of upper levels of intake for essential nutrients, for example, has uncovered a number of challenges. Adapting and developing risk assessment strategies for application in nutrition science could lead to improved approaches to the development of dietary and nutritional recommendations and thus is a topic of considerable interest. One nonscientific but overall challenge to nutritional risk assessment relates to increasing and improving communication among experts from key disciplines in ways that could inform the nutritional risk assessment process. Among these key disciplines are nutrition, toxicology, dietary exposure assessment, economics, risk analysis, and epidemiology. How can the perspectives and methods of these diverse fields be brought together to develop more effective approaches for quantitative nutritional risk assessment? How can they be applied to a spectrum of topics related to food and nutrition-micronutrients, macronutrients, dietary supplements, whole foods, food groups, and dietary patterns? How can they help overcome the data challenges that confront nutritional risk assessors? As a step toward improving the communication and sharing methods and information across disciplines, members of the Interagency Risk Assessment Consortium, the U.S. Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, the Institute of Medicine's Food Forum, and the International Life Sciences Institute planned the Nutritional Risk Assessment Workshop. The workshop was held on February 28 and March 1, 2007, in Washington, D.C. This workshop, which was envisioned as one in a series, focused on opening a dialogue to explore the unique questions and challenges faced by nutritionists and the potential use of risk assessment methodologies to answer them. Nutritional Risk Assessment : Perspectives, Methods, and Data Challenges, Workshop Summary summarizes the happenings of this workshop.
This book is the first of a new series which will present the proceedings of the newly established Nestlé Nutrition Workshop Series: Clinical & Performance Programme aimed at adult nutrition. Undernutrition is a common phenomenon in elderly people, and malnutrition reaches significant levels in those being in hospital, nursing homes or home care programs. Consequences of malnutrition often go unrecognised owing to the lack of specific validated instruments to assess nutritional status in frail elderly persons. The Mini Nutritional Assessment (MNA) provides a single, rapid assessment of nutritional status in the elderly of different degrees of independence, allowing the prevalence of protein-energy malnutrition to be determined and to evaluate the efficacy of nutritional intervention and strategies. Easy, quick and economical to perform, it enables staff to check the nutritional status of elderly people when they enter hospitals or institutions and to monitor changes occurring during their stay. Moreover, the MNA is predictive of the cost of care and length of stay in hospital. This publication will be of immense assistance to heads of geriatric teaching units, teachers in nutrition, clinicians general practitioners and dieticians, enabling them to better detect, recognise and start treatment of malnutrition in the elderly.
Dietary Risk Assessment in the WIC Program reviews methods used to determine dietary risk based on failure to meet Dietary Guidelines for applicants to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Applicants to the WIC program must be at nutritional risk to be eligible for program benefits. Although "dietary risk" is only one of five nutrition risk categories, it is the category most commonly reported among WIC applicants. This book documents that nearly all low-income women in the childbearing years and children 2 years and over are at risk because their diets fail to meet the recommended numbers of servings of the food guide pyramid. The committee recommends that all women and children (ages 2-4 years) who meet the eligibility requirements based on income, categorical and residency status also be presumed to meet the requirement of nutrition risk. By presuming that all who meet the categorical and income eligibility requirements are at dietary risk, WIC retains its potential for preventing and correcting nutrition-related problems while avoiding serious misclassification errors that could lead to denial of services for eligible individuals.
This book reviews the scientific basis for nutrition risk criteria used to establish eligibility for participation in the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The volume also examines the specific segments of the WIC population at risk for each criterion, identifies gaps in the scientific knowledge base, formulates recommendations regarding appropriate criteria, and where applicable, recommends values for determining who is at risk for each criterion. Recommendations for program action and research are made to strengthen the validity of nutrition risk criteria used in the WIC program.
The model for risk assessment of nutrients used to develop tolerable upper intake levels (ULs) is one of the key elements of the developing framework for Dietary Reference Intakes (DRIs). DRIs are dietary reference values for the intake of nutrients and food components by Americans and Canadians. The U.S. National Academy of Sciences recently released two reports in the series (IOM, 1997, 1998). The overall project is a comprehensive effort undertaken by the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (DRI Committee) of the Food and Nutrition Board (FNB), Institute of Medicine, National Academy of Sciences in the United States, with active involvement of Health Canada. The DRI project is the result of significant discussion from 1991 to 1996 by the FNB regarding how to approach the growing concern that one set of quantitative estimates of recommended intakes, the Recommended Dietary Allowances (RDAs), was scientifically inappropriate to be used as the basis for many of the uses to which it had come to be applied.
Written in conjunction with the British Dietetic Association, Advanced Nutrition and Dietetics in Nutrition Support provides a thorough and critical review of the fundamental and applied literature in nutrition support. Extensively evidence-based and internationally relevant, it discusses undernutrition, nutritional screening, assessment and interventions, as well as key clinical conditions likely to require nutrition support, and the approaches to managing this in each of these conditions. Clinically oriented, Advanced Nutrition and Dietetics in Nutrition Support is the ideal reference for all those managing undernutrition in a range of clinical areas.
With over 200 newly drafted figures & many new tables drawn from the wealth of data published over the last 15 years, this new edition has been thoroughly revised.
FAO provides countries with technical support to conduct nutrition assessments, in particular to build the evidence base required for countries to achieve commitments made at the Second International Conference on Nutrition (ICN2) and under the 2016-2025 UN Decade of Action on Nutrition. Such concrete evidence can only derive from precise and valid measures of what people eat and drink. There is a wide range of dietary assessment methods available to measure food and nutrient intakes (expressed as energy insufficiency, diet quality and food patterns etc.) in diet and nutrition surveys, in impact surveys, and in monitoring and evaluation. Differenct indicators can be selected according to a study's objectives, sample population, costs and required precision. In low capacity settings, a number of other issues should be considered (e.g. availability of food composition tables, cultural and community specific issues, such as intra-household distribution of foods and eating from shared plates, etc.). This manual aims to signpost for the users the best way to measure food and nutrient intakes and to enhance their understanding of the key features, strengths and limitations of various methods. It also highlights a number of common methodological considerations involved in the selection process. Target audience comprises of individuals (policy-makers, programme managers, educators, health professionals including dietitians and nutritionists, field workers and researchers) involved in national surveys, programme planning and monitoring and evaluation in low capacity settings, as well as those in charge of knowledge brokering for policy-making.
Intro -- Foreword -- Acknowledgements -- Contents -- Part I: Nutritional Care in Geriatrics -- 1: Overview of Nutrition Care in Geriatrics and Orthogeriatrics -- 1.1 Defining Malnutrition -- 1.2 Nutrition Care in Older Adults: A Complex and Necessary Challenge -- 1.3 Malnutrition: A Truly Wicked Problem -- 1.4 Building the Rationale for Integrated Nutrition Care -- 1.5 Managing the Wicked Nutrition Problems with a SIMPLE Approach (or Other Tailored Models) -- 1.5.1 Keep It SIMPLE When Appropriate -- 1.5.2 A SIMPLE Case Example -- 1.5.2.1 S-Screen for Malnutrition -- 1.5.2.2 I-Interdisciplinary Assessment -- 1.5.2.3 M-Make the Diagnosis (es) -- 1.5.2.4 P-Plan with the Older Adult -- 1.5.2.5 L-Implement Interventions -- 1.5.2.6 E-Evaluate Ongoing Care Requirements -- 1.6 Bringing It All Together: Integrated Nutrition Care Across the Four Pillars of (Ortho) Geriatric Care -- 1.7 Summary: Finishing Off with a List of New Questions -- References -- Recommended Reading -- 2: Nutritional Requirements in Geriatrics -- 2.1 Nutritional Recommendations for Older Adults, Geriatric and Orthogeriatric Patients -- 2.2 Nutritional Recommendations for Older Adults -- 2.2.1 Energy Requirement and Recommended Intake -- 2.2.2 Protein Requirement and Recommended Intake -- 2.2.3 Micronutrients and Dietary Fibers -- 2.3 Nutritional Risk Factors in Older Adults -- 2.4 Estimating Intake in Older Adults -- 2.5 Nutritional Status of Older Adults, Geriatric and Orthogeriatric Patients -- 2.6 Summary -- References -- Recommended Reading -- 3: Nutritional Assessment, Diagnosis, and Treatment in Geriatrics -- 3.1 The Nutrition Care Process -- 3.2 Nutritional Screening/Risk Detection -- 3.3 Nutritional Assessment and Diagnosis -- 3.3.1 Nutrition Impact Symptoms -- 3.3.2 Nutritional Diagnosis -- 3.3.3 Etiologic Criteria.