From the Guidelines
To assess nutritional and exercise status, I recommend using a combination of validated screening tools, including the Nutritional Risk Screening (NRS)-2002, Subjective Global Assessment (SGA), Nutrition Risk Index, and Perioperative Nutrition Score for nutritional assessment, and the International Physical Activity Questionnaire (IPAQ) for exercise assessment. These tools have been validated in various studies, including those published in Advances in Nutrition 1 and Journal of Crohn's and Colitis 1, and are recommended by reputable organizations such as the European Society for Clinical Nutrition and Metabolism (ESPEN).
For nutritional assessment, the NRS-2002 score has been shown to be independently associated with increased risk of postoperative complications and worse overall survival in patients with cancer 1. The SGA incorporates both patient history and physical examination and has demonstrated similar efficacy to the NRS-2002 score in geriatric patients. The Nutrition Risk Index was developed specifically for cancer patients and has been shown to be sensitive and specific for identifying patients at risk of developing surgical complications. The Perioperative Nutrition Score was developed specifically for surgical malnutrition risk and has been validated to predict risk of adverse postoperative outcomes.
In addition to these tools, other studies have recommended the use of the Malnutrition Universal Screening Tool (MUST) 1, the Malnutrition Screening Tool (MST) 1, and the Mini Nutritional Assessment (MNA) 1 for nutritional assessment. For exercise assessment, the IPAQ measures activity levels across multiple domains, while the Physical Activity Readiness Questionnaire (PAR-Q) screens for health concerns before beginning exercise programs 1. The Senior Fitness Test is valuable for older adults to assess functional fitness.
These tools should be supplemented with objective measurements including body mass index (BMI), waist circumference, and basic laboratory tests like complete blood count, lipid panel, and blood glucose levels. Using these screening tools together provides a comprehensive picture of an individual's nutritional and exercise status, allowing for targeted interventions to address specific deficiencies or concerns and improve overall health outcomes.
Some studies have also recommended the use of digital platforms, such as MyFitnessPal and Lose It, for diet self-monitoring and tracking 1. However, it is essential to note that the selection of screening tools should be tailored to the individual's disease history and specific needs.
Key points to consider when selecting screening tools include:
- Validity and reliability of the tool
- Sensitivity and specificity of the tool
- Ease of use and administration
- Cost and availability of the tool
- Individual's disease history and specific needs
By using a combination of validated screening tools and objective measurements, healthcare professionals can provide comprehensive care and improve health outcomes for their patients.
From the Research
Screening Tools for Nutritional and Exercise Assessment
To assess nutritional and exercise habits, several screening tools can be utilized. These tools help in evaluating dietary intake, physical activity, and body composition.
- Dietary Intake Assessment: Classic methods such as questionnaires, food and activity records, and recalls can be used to capture dietary intake in healthy adult populations 2. However, these tools have been shown to underestimate energy intake and expenditure compared to direct measures like doubly labeled water. Recent technological advancements, including remote sensing devices, digital photography, and multisensor devices, have the potential to improve the assessment of dietary intake 2.
- Physical Activity Assessment: The International Physical Activity Questionnaire-Short Form (IPAQ-SF) is a tool used to assess physical activity levels 3. This questionnaire evaluates the time spent on moderate to vigorous physical activity (MVPA) per week.
- Body Composition Assessment: Anthropometric variables such as height, weight, body mass index (BMI), waist and hip circumferences, and skinfold thickness can be used to evaluate body composition 4. These measurements provide prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention.
- Morphological Assessment: Trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) can be used to assess nutritional status 4. Handgrip strength (HGS) serves as a proxy for functional ability and its association with body composition and physical activity in adults 3.
Joint Effects of Physical Activity and Body Composition
The joint effects of physical activity and body composition on health risks have been evaluated in several studies.
- Heart Failure Risk: The joint associations of physical activity and different indicators of adiposity (body mass index, waist circumference, and waist-to-hip ratio) with heart failure risk have been studied 5. The results show that general overweight and general and abdominal obesity are independently associated with an increased risk of heart failure, whereas moderate or high levels of physical activity are associated with a reduced risk of heart failure.
- Mortality Risk: The effects of physical activity, body mass index, waist-to-hip ratio, and waist circumference on total mortality risk have been analyzed 6. The results indicate that sedentary individuals with a high body mass index, waist-to-hip ratio, or waist circumference have an increased risk of mortality compared to physically active individuals with a normal body mass index or waist circumference.