Will you measure BMI, waist & hip circumferences and/or skinfolds to assess the body composition of your client?

Nutritional Assessment:Vegan

 Background

Nutritional assessment can be defined as “the interpretation of information from dietary, anthropometric, clinical and laboratory studies” (Gibson, 2005).  Such information can be used to assess the nutritional status of populations and/or individuals, though it is recognised that the evaluation of nutritional status is not an exact science since there are so many interactive parameters that affect health, disease and nutrition (Elia et al., 2012).

Well-planned vegan diets can be nutritious and support healthy living for people of all ages. However, it is important people include a wide variety of healthy whole foods to ensure their diet is balanced and this can take some planning (British Dietetic Association, 2019).

Please note that although Registered Nutritionists (RNutr) can work at individual and population levels and can provide nutrition advice directly to individuals and groups, it is recognised that Registered Associate Nutritionists (ANutr) should not normally engage in wholly independent practice, but will be supervised, working within a team and/or with relevant professional oversight and/or mentoring.It is also essential RNutr and ANutr have indemnity insurance (Association for Nutrition, 2020).

Aim: This assessment asks you to consider a practical case where you have a client who is currently happy with their weight but wants to follow a vegan diet.  How will you approach this to ensure your client does so in a healthy way?(Please note your client is you!).The specific aim is to design and carry out an assessment to evaluate the current nutritional status including the energy balance status of a client using methods taught on this and on previous modules.

NOTE:

·To help you collect data for this report, there is an Energy Expenditure practical in week 2, where you can measure energy expenditure experimentally using Douglas bags. In addition, there is a body composition practical in week 3, where you will be shown different techniques for measurement of body composition. You can then choose how you use this information in the assessment of the client’s nutritional status.

·You can chose whether your client wants advice when changing to a vegan diet, or whether they want to ensure that their current, vegan diet is nutritionally sound and balanced both with regards to nutrients and energy.

·The findings should be written up as a report,not a case study. 

In preparation for the report consider:

1)Body composition - Will you measure BMI, waist & hip circumferences and/or skinfolds to assess the body composition of your client?

2)Energy balance - Energy expenditure – how will you calculate your client’s energy needs?  Will you measure BMR/RMR using Douglas bags or use an equation? Will you ask them to complete a physical activity diary, wear a pedometer, or other lab measurements of energy expenditure? Will you use PALs to calculate overall 24h energy expenditure?

Dietary intake – what method will you use to plan a suitable vegan diet, will you create a menu or will you ask them to complete a food diary or a FFQ, and how will you provide advice based on this?How does the dietary intake relate to the reference nutrients intakes (RNIs) and does the energy intake match the energy expenditure? 

3)Ethics, medical conditions & other questions you may wish to ask -

For this assessment, a form detailing medical concerns and family history has revealed no health issues, the client has no medical concerns.But you may need to ask about dietary restrictions e.g. religious, allergies, even food likes and dislikes.   You will also need to complete a health screen questionnaire and consent form.

Writing up the Report

The report should be written using the following guidelines –

·Please ensure your work is anonymous and the name of the client is confidential.

·2000 words

Introduction

Describe the reasons for nutrition assessment for a person following a vegan diet including the importance of measuring body composition, dietary intake (including energy intake), energy expenditure and energy balance. 

Aim

Nutritional assessment of a healthy person (you) who wants to follow a vegan diet. 

Methods

Give a detailed and concise description of the methods you used and if necessary, the instructions provided to the client.

Results

Present your findings from the body composition, energy expenditure, and dietary intake measurements, compare to standards such as the RNIs using text and tables as necessary. 

Raw data should be put in an appendix.

Will you measure BMI, waist & hip circumferences and/or skinfolds to assess the body composition of your client?

Discussion

Points to consider:

Did the body composition assessment provide useful information?

Was the diet appropriate, did it meet the RNIs, what changes to the food intake would you make if your client is to continue following a vegan diet?

Did you measure BMR or RMR or total energy expenditure?

Is your participant in energy balance and what are the long term implications for this?

Does your participant need to be referred to another health professional e.g. a GP or a physio?

How could your assessment be improved for greater accuracy?

Conclusion

Summarise your findings and put them in into the vegan context, what was the overall outcome?

References 

Instructions if you are measuring energy expenditure 

Using the Douglas bag method:

Prepare the participant by ensuring they are in thermoneutral conditions, rested and are familiar with the mouthpiece.  After approx. 5 mins of acclimatisation to the mouthpiece, the measurement may begin.

Analyse the contents of the Douglas bag using the Servomex Gas Analysers to measure O2 and CO2 content and the Harvard Dry gas meter to measure the volume of air the Douglas bag contains.

At the end of the measurements, the data can be used to determine energy expenditure using the following modified version of Weir’s equation (1949):   

REE (kcal/day) = ([3.94 x VO2] + [1.11 x VCO2]) * 1.44

Where:

 REE = Resting energy expenditure

 VO2 = oxygen uptake (ml/min)

 VCO2 = carbon dioxide output (ml/min)

(Note that VO2 and VCO2 will be calculated on the day of the practical in the lab).

Alternatively, BMR can be calculated using other equations (please refer to lecture on Energy Balance).  If calculating BMR this way, state which specific equation you use (Schofield, Mifflin St Jeor or Oxford). 

How will you calculate your client’s energy needs?Will you measure BMR/RMR using Douglas bags or use an equation?

References

Association for Nutrition (2020) http://www.associationfornutrition.org/. Accessed 23rd Jan 2023.

British Dietetic Association (2019) Plant based Diets. https://www.bda.uk.com/food-health/food-facts.html. Accessed 23rd Jan 2023.

Elia M, Ljungqvist O, Stratton RJ, Lanham-New S (2012) Clinical Nutrition. Wiley Blackwell: London. 

FAO/WHO/UNU (1985). Energy and Protein Requirements.  WHO

Gibson RS (2005) Principles of Nutritional Assessment, OUP: Oxford.

Weir, J.B. d. V. (1949). New methods for calculating metabolic rate with special references to protein metabolism.  Journal of Physiology 109, 1-9.

Lam YY and Ravussin E (2016): Analysis of energy metabolism in humans: A review of methodologies. Molecular Metabolism, Volume 5, Issue 11,  Pages 1057-1071

Hills AP et al (2014): Assessment of physical activity and energy expenditure: an overview of objective measures. Front.Nutr., Sec. Nutrition Methodology, Volume 1 https://doi.org/10.3389/fnut.2014.00005

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