clinical nutrition assessment dr niikee schoendorfer uq medical school n.schoendorfer@uq.edu.au

Clinical NutritionAssessmentDr Niikee SchoendorferUQ Medical Schooln.schoendorfer@uq.edu.au

Session objectives

1. Understand the role that nutrition and lifestyle play in the development of chronic disease

2. Provide an assessment of patients diet and lifestyle

3. Gain practical skills in the provision of basic nutritional and lifestyle advice

4. Identify useful adjunct patient information resources

What Causes Chronic Disease?

Many chronic diseases are preventable

Adopt healthy behaviours –

controlling body weight

eating nutritious foods

avoiding tobacco use

increasing physical activity

Source: Australian Institute of Health and Welfare (AIHW) 2002. Chronic diseases and associated risk factors in Australia, 2001. Canberra: AIHW.

(a) rheumatoid arthritis(b) osteoarthritis

Chronic conditions

Contributing Factors Tobacco smoking

Physical inactivity

Risky alcohol consumption

Poor diet

Obesity Hypertension High blood fats

Heart disease

Stroke

Diabetes II Kidney disease

Arthritis (a) (b) (b) Osteoporosis Lung cancer

Colorectal cancer COPD

Asthma Depression Oral health

What Causes Chronic Disease?

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Source(s): Australian Health Survey: Updated Results, 2011-12Health Statistics in

Australia

Public Health Campaigns

Cardiovascular Disease/ Diabetes RiskTotal Waist Measurement Waist : Hip Ratio

Additional Weight Loss MeasuresCircumferences –

- thigh- bicep- bust

Taking Measurements

Australian Dietary Guidelines

Recommendations: Fruits and vegetables – variety of colours both

cooked and raw, also include legumes, nuts and

seeds

Cereals – preferably wholegrain

Meat, seafood and alternatives

Milk, Yoghurts and Cheese – reduced fat varieties

Drinking plenty of water

Australian Dietary Guidelines

and take care to: Limit saturated fat and moderate total fat intake

Choose foods low in salt

Limit your alcohol intake if you choose to drink

Consume only moderate amounts of sugars and

foods containing added sugars.

Australian guide to health eating https://www.eatforhealth.gov.au/guidelines

How does your diet measure up?

Taken from the Australian Dietary Guidelines Summaryhttp://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55a_australian_dietary_guidelines_summary_131014.pdf

Recommended Food Servings

Recommended Food Servings

Recommended Food Servings

Recommended Food Servings

Recommended Food Servings

Portion Distortion

38

Creeping portion distortion

Are you aware of how much food

portion sizes have increased in 20

years?

Are you aware of how much food

portion sizes have increased in 20

years?

Slides marked by are adapted from “Portion Distortion” by the National Heart, Lung and Blood Institute Obesity Education Initiative at

http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/portion/index.htm

BURGER

20 Years Ago Today

333 calories How many calories are in today’s burger?

Calorie Difference: 257 calories

590 calories

BURGER

20 Years Ago Today

333 calories

Maintaining a Healthy Weight is a Balancing Act

How long will you have to lift weights in order to burn the extra 257 calories?*

*Based on a 60kg person

1 hour and 30 minutes

Calories In = Calories Out

FRENCH FRIES 20 Years

AgoToday

210 Calories How many calories are intoday’s portion of fries?

610 Calories

Calorie Difference: 400 Calories

FRENCH FRIES

20 Years Ago

Today

210 Calories

How long will you have to walk leisurely in order to burn those extra 400 calories?*

*Based on 72kg person

1 hour and 10 minutes

Calories In = Calories Out

85 Calories 250mL

How many calories are in today’s portion?

SOFT DRINK20 Years Ago

Today

Calorie Difference: 165 Calories

250 Calories 600mL

85 Calories 250mL

SOFT DRINK20 Years

AgoToday

How long will you have to work in the garden to burn those extra calories?*

*Based on 72kg person

35 minutes

Calories In = Calories Out

320 calories How many calories are in today’s sandwich?

SANDWICH20 Years Ago

Today

Calorie Difference: 500 calories

820 calories 320 calories

SANDWICH20 Years Ago

Today

How long will you have to ride a bike in order to burn those extra calories?*

*Based on A 72kg person

1 hour and 25 minutes

Calories In = Calories Out

COFFEE

20 Years AgoCoffee (with whole milk and sugar)

TodayMocha Coffee(with steamed whole milk and mocha syrup)

45 calories How many calories are in today's coffee?

COFFEE

20 Years Ago Today

45 calories 350 calories

Calorie Difference: 305 calories

How long will you have to walk in order to burn those extra 305 calories?*  

*Based on 60kg person

1 hour and 20 minutes

Calories In = Calories Out

59

Larger portions add up100 extra

calories per day

4.5kg weight gain

per year

Maintaining a healthy weight is a balancing actMaintaining a healthy weight is a balancing act

MUFFIN

20 Years Ago Today

210 calories How many calories are in today’s muffin?

20 Years Ago Today

Calorie Difference: 290 calories

500 calories

MUFFIN

210 calories

How long will you have to vacuum in order to burn those extra 290 calories?* *Based on a 60kg

person

1 hour and 30 minutes

Calories In = Calories Out

CHOCOLATE CHIP COOKIE

20 Years Ago Today

55 calories How many calories are in today’s large cookie?

CHOCOLATE CHIP COOKIE

20 Years Ago Today

55 calories

275 calories

Calorie Difference: 220 calories

How long will you have to wash the car to burn those extra 220 calories?*

*Based on 60kg person

1 hour and 15 minutes

Calories In = Calories Out

SPAGHETTI AND MEATBALLS

20 Years Ago

Today

500 calories1 cup spaghetti with sauce and 3 small meatballs

How many calories do you think are in today's portion of spaghetti and meatballs?

Calorie Difference: 525 calories

1,025 calories 2 cups of pasta with sauce and 3 large meatballs

20 Years Ago

Today

500 calories1 cup spaghetti with sauce and 3 small meatballs

SPAGHETTI AND MEATBALLS

70

Which portion would you choose?

71

You can save 300 calories by choosing the 1 cup portion.

72

Why not fill up on vegetables??!!?

73

Useful web resources Activity calorie comparison http://www.8700.com.au/balance-and-

burn/kj-activity-comparison/

Public Health Resources http://www.eatforhealth.gov.au/Nutrient Reference Values http://www.nrv.gov.au/ Drug and Supplement Information http://

www.nlm.nih.gov/medlineplus/druginformation.html