© 2005 Elsevier Ltd. All rights reserved.

The clinical evaluation of nutritional status is a fundamental component of health assessment at any age. Along with anthropometry, dietary assessment, and laboratory tests, the physical examination is one of the key tools to evaluate nutritional status.

The two most common settings for a clinical examination are the hospital (inpatient or outpatient) and the field health care unit. In the first situation, the physician or examiner may have access to resources that are usually not available in the field. Because of this and other constraints, the assessment of nutritional status in the field is frequently more narrowly aimed at identifying a specific clinical condition or set of signs and symptoms. In either case, it is essential that information on history and physical findings be collected in a standardized manner in terms of both format and procedures. The former is usually best achieved by the use of preprinted or computerized forms. Electronic forms can be programmed to perform immediate range checking as values are entered, thus alerting the operator when values out of range are entered. Procedures for examination must be clearly defined in writing, and any health worker should be able to follow the instructions and perform an acceptable measurement. Although many components of the examination are subjective, it is important to standardize as much as possible terms such as 'minor,' 'average,' and 'large' within the group of examining persons, attributing a numeric value whenever possible. If data entry requires selecting from a numeric scale, they should be also standardized by cross-validation with experienced personnel or by means of photographs or models.

The two components of the clinical assessment are the medical history and the physical examination (Table 1).

Table 1 Major components of a nutrition-oriented medical history

Medical history

History of weight loss or gain

Gastrointestinal symptoms (nausea, diarrhea, flatulence, pain, etc.) History of changes in color or texture of skin, hair, conjunctiva, buccal mucosa Use of medications

Physical activity level (work-related, leisure) History of fatigue, shortness of breath, muscle cramps Other lifestyle practices

Places of residence, travel (exposure to toxins, sunlight, food contaminants) In children and adolescents

- Growth history

- Neurodevelopmental history

- General school performance

- Parental and siblings' body size (body mass index)

- Pubertal stage

- Food preferences, fads

Dietary history

Habitual dietary intake and preferences Past diet history Alcohol consumption Food allergies and intolerances Assessment of dietary intake

- 24-hr recall

- Food frequency questionnaire

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