Clinical Assessment and Protein Status

Clinical Assessment and Protein Status

Clinical assessment consists of a medical history and a physical examination to detect physical signs (observations made by the examiner) and symptoms (manifestations reported by the patient) associated with poor nutritional status.  It is very common for our clients to present with multiple health challenges that result from metabolic imbalances related to sub-optimal diet and lifestyle choices.  As we collect information, we want to identify a chief complaint to help direct us in further investigation and, ultimately, appropriate recommendations.  Very often, by supporting a client in resolving their chief complaint, many related issues will resolve as well.

It is important to be aware of subtle signs of sub-optimal nutrition. As you first meet your client, be alert to visual clues such as loss of muscle mass (floppy” triceps, “saggy” gluteal muscles, and overall muscle definition), skin tone (clear with healthy coloring, wrinkled, elasticity, rashes, blemishes), hair (quality, thickness, texture), and nails (shape, color, texture).  Two slide shows are presented in your assignments with photos of some signs of sub-optimal nutrition. 

Although many of the severe symptoms associated with nutrient deficiencies are not commonly observed in the United States, it is important for nutritionists to be aware of them.  It should also be kept in mind, however, that many of the critical physical signs are nonspecific and must, therefore, be interpreted in conjunction with biochemical, anthropometric, and dietary data before specific nutritional deficiencies can be identified. It is also helpful to be aware of the population groups at risk for some conditions. For example, although most Americans have adequate protein intake, it is still very possible to observe the symptoms of protein-energy malnutrition in certain population groups, such as those with AIDS, cancer, and eating disorders such as anorexia. Assessing protein and micronutrient status has also become a factor in follow-up of those patients who have undergone gastric bypass surgery.

Proteins are essential for structural and regulatory functions, as well as acting as specific protein carriers and mediators of the immune response. There are no dispensable protein stores in humans, and therefore loss of body protein results in loss of essential structural elements as well as impaired function. Most of the body protein is found in the skeletal muscle (somatic protein) and in the smaller visceral protein pool which includes serum proteins, blood cells, and solid tissue organs such as liver, kidneys, pancreas, and heart. These are the metabolically active protein. The other noncellular protein components of the body found in the connective tissue are not readily exchangeable with other body pools of protein. Therefore, during protein malnutrition and disease, alterations occur in somatic and visceral proteins, but not in the extracellular connective tissue.

Recently, there has been greater emphasis on testing individual amino acids or groups of amino acids, especially for those practicing functional medicine.  Some of this testing has been done routinely for years.  For example, blood spot testing of phenylalanine is a routine screening test for phenylketonuria (PKU) performed on newborns.  Newer applications for amino acid assessment include attempting to identify individuals in need of supplementation of essential amino acids or other therapies to correct abnormal amino acid status.