Assessing Your Health

There are many factors that determine whether you are “healthy.” Although the WHO definition describes health as not just the absence of disease, but also encompassing psychological, emotional, and social well-being, most of Western medicine is focused on a person’s physical health. As we have discussed previously, and will continue to discuss throughout this course, nutrition plays an enormous role in determining our overall health. Assessing one’s nutritional status can help us determine whether nutritional intake (or lack of) is affecting the development or continuance of nutrition-related health conditions. No one eats 100% healthy foods 100% of the time, but with assessment we look at the overall eating pattern and how it affects overall health. Nutrition assessment uses many tools to help determine whether a person is well-nourished or malnourished (referring to either undernourished or overnourished).

There are six areas to consider when assessing health through a nutrition lens. An easy way to remember these areas is using the letters ABCDEF:

1. anthropometric
2. biochemical
3. clinical
4. dietary
5. environmental
6. family history

A: Anthropometric Assessment

The word anthropometric comes from two terms: anthropo meaning “human” and metric meaning “measure.” There are many different measures used to assess growth in humans including height, weight, body mass index (BMI), head circumference, girth measurements of limbs, waist, hip, and body composition measures such as skinfold/fat fold thickness or bioelectrical impedance analysis. We then compare those measures to known health standards. Often these types of measurements are used to assess the growth of children and adolescents. However, some of these measures such as height and weight are used throughout our lifetimes, comparing measurements over time, or comparing one person to another.

B: Biochemical Assessment

Biochemical assessment includes laboratory tests that can measure a nutrient or its metabolites in the blood, urine, feces, or other bodily secretions. We can learn quite a bit about a person’s health by looking at these tests and they are routinely collected and examined as part of a general physical by your doctor. In nutrition, for example, we look at the levels of glucose in the blood and in the urine to determine if a person has or is at risk for diabetes. We look at blood cholesterol profiles to help determine risk for some forms of cardiovascular disease. The amount of iron in the blood can indicate a person’s risk for anemia. It is recommended that you keep copies of your lab tests so that you can look at trends over time.

C: Clinical Assessment

In addition to anthropometric and biochemical measures, clinical signs and symptoms are used to assess nutritional status such as a potential nutrient deficiency or toxicity. Signs are those things that can be easily seen such as bleeding, vomiting, or fainting. Symptoms are those things that a patient may be experiencing that cannot easily be seen and must be described such as a headache, nausea, dizziness, or pain. Special attention is given to a person’s organs such as skin, eyes, tongue, ears, mouth, hair, nails, and gums. Clinical methods of assessing nutritional status involve checking signs at specific points on the body, or asking patients about any symptoms that may indicate a nutrient deficiency. Often other clinical measures such as temperature and blood pressure are also taken.

If a nutrient deficiency is suspected based on signs or symptoms, often a biochemical test is completed to help identify the exact nutrient that may be inadequate or missing. There are two types of nutrient deficiencies a person may develop. A primary nutrient deficiency occurs when a person does not consume enough of an essential nutrient. A secondary nutrient deficiency occurs when enough of the nutrient is consumed, but for some reason the body is unable to use that nutrient effectively. Secondary nutrient deficiencies can occur because of functional problems in the digestive tract, medications that may be interfering with the body’s absorption or metabolism of a particular nutrient, the body’s natural aging process, and many other reasons.

D: Dietary Assessment

Dietary methods of assessment include looking at past and current intake of nutrients from food by individuals or a group to help determine their nutritional status. Completing a dietary assessment is crucial when trying to determine whether or not your intake is related to a disease or condition. There are several methods that may be used to do this:

• 24-hour dietary recall. A trained professional asks a person to recall all food or drink consumed in the previous 24-hours. This is a quick and easy method. However, it is dependent upon the person’s short-term memory and may not be very accurate. It also looks at just one day, which may not be a “typical” day of intake for the individual.
• Food Frequency Questionnaire. The person is given a list of foods and asked to indicate average intake per day, per week, and per month. This method is inexpensive and easy to administer, however it often lacks detail and may not be very accurate. It can still provide a broad overview of one’s overall eating pattern.
• Food Diary. Food intake is recorded at the time of eating. This is also known as a food journal or food record. These diaries can be done with paper and pencil, but are more likely to be recorded using apps on a phone or other electronic device. This method is generally reliable but is difficult to accurately maintain for more than a few days, and portion sizes can be difficult to estimate.
• Observed Food Consumption. This method requires food to be weighed and the nutrient content exactly calculated. It is very accurate, but time consuming and expensive, and is usually done only for research purposes.

E: Environmental Assessment (Lifestyle)

Where and how you live can have a profound effect on your health and nutritional status. Many environmental factors play a role including your living situation (alone, with a family, with friends, etc.), geographic location (urban vs rural, north vs south, etc.), socioeconomic position, access to healthy foods, your ability to prepare food, and other lifestyle factors such as exercise and sleep patterns, emotional health, and work-life balance.

An assessment of your environment includes evaluating not only your nutrition, but also your personal habits. Many diseases are preventable by simply staying away from certain behaviors (smoking, excessive alcohol use, risky sexual activity, etc.). Instead adopt healthful measures like participating in regular physical activity, wearing seat belts in the car and helmets while cycling, and finding healthy ways to minimize your response to stressors like meditation or spending time outdoors. As stated earlier, health is more than just physical. Emotional health is often hard to talk about; however, a person’s quality of life is highly affected by emotional stability. Finding balance between work and life is a difficult and continuous process involving keeping track of your time, taking advantage of job flexibility options, saying no, and finding support when you need it. Work-life balance can influence what you eat too.

F: Family Medical History

Everyone starts out in life with the genes handed down to them from their mother and father. Genes are responsible for your many traits as an individual and are defined as the sequences of DNA that code for all the proteins in your body. The expression of different genes can determine the color of your hair, skin, and eyes, and even if you are more likely to be fat or thin and if you have an increased risk for a certain disease. The sequence of DNA that makes up your genes and determines your genetic makeup is called your genome. In 2003, the Human Genome Project was completed and now the entire sequence of DNA in humans is known. It consists of about three billion individual units and contains between 25,000 and 30,000 genes. The human genome that was sequenced was taken from a small population of donors and is used as a reference DNA sequence for the entire population. Each of us has a similar but unique DNA sequence. Only identical twins and cloned animals have the exact same DNA sequence.

Epigenetics is the study of how your behaviors and your environment may turn genes “on” or “off,” causing changes that can affect how your genes work. In recent years scientists have been studying the possible epigenetic links between genes and nutrients. Initial studies looked at nutrigenomics, the study of the intake of nutrients and their effects on genetic expression in an individual. Not all epigenetic changes are permanent. A beneficial change in nutrient intake, increased physical activity, or quitting smoking can reverse some epigenetic modifications and improve health.

A second way to look at the interplay between nutrients and genes is to identify genetic markers in individuals that may modify their need for or use of various nutrients which may influence health outcomes. This is called nutrigenetics. Genetic differences may help explain why some people achieve weight loss with certain diets and others do not. Or whether a person may benefit more from a low sodium diet than someone else might. You may see internet sites touting personalized nutrition, their ability to help you (for a hefty fee), “eat right for your genes.” Although this is an exciting area of research, the science is complicated. Be sure that if you access these services, that there is a health professional such as an RD/RDN who can help you interpret your individual results.

Because genetics play a large role in defining your health it is a good idea to learn whether there are some diseases and conditions that may be more likely to affect you based on your inherited genes. To do this, record your family’s medical history. Start by drawing a chart that lists your immediate family and relatives. The next time you attend a family event or see extended family members, start filling in the blanks. What did people die from? What country did Grandpa come from? While this may be an interesting project historically, it can also provide you with a practical tool to determine to what diseases you might be more susceptible. This will allow you to make better dietary and lifestyle changes early on to help prevent a disease from being handed down from your family to you. It is good to compile your information from multiple relatives.

Risk Factors

Assessing your current health status based on these six categories can help you identify some of your risk factors. A risk factor is something that makes you more likely to develop adverse health conditions. Some risk factors are inherited through your genes as discussed previously. These risk factors are part of your DNA, but may be affected by your health behaviors, either positively or negatively. However, scientists consider them non-modifiable because they are part of your genetic code which cannot be altered. Other risk factors such as biological sex, age, and race are also non-modifiable. Some risk factors are modifiable because they are choices an individual makes each day. For example, if you smoke you are more likely to develop lung cancer than someone who does not smoke. Thus smoking is a risk factor for lung cancer. Some people can smoke for years and never develop lung cancer, while others may develop lung cancer and never smoke. However, the chances that you will develop lung cancer if you’re a smoker are much higher than if you never smoked. If you quit smoking, you may reduce your risk of developing this terrible disease. Obesity, physical inactivity, and dietary factors such as low fiber intake and high saturated fat intake are risk factors for many different health conditions including heart disease, type 2 diabetes, and some forms of cancer. Choosing healthier meals and exercising regularly can go a long way to reducing the chances that you will develop one of these debilitating health conditions. The more risk factors you have for a health condition the more likely you are to eventually suffer from it. Assessing your health using ABCDEF allows you to identify your current risk factors and to take steps to modify those you can.

references

Chapter 1, section 1.2 from Consumer Nutrition by Megan Grimsley and Susan Kazen published in 2021 under a CC BY-NC-SA license.