Nutrition is an area that many believe can only be assessed via outside appearance. However, nutrition goes much deeper than the naked eye can see. In fact, nutrition affects our bodies to the very cellular level. A common way to assess nutritional status, aside from anthropometric measurements, is laboratory values. There are numerous laboratory values health professionals use to assess an individual’s health state. Below, are common conditions and disease states and their corresponding laboratory values that nutrition professionals work with in long-term care settings.

Malnutrition

  • Serum Albumin & Prealbumin
    • Historically used to assess protein stores. This is no longer considered a good indicator of malnutrition or protein repletion due to being affected by several factors such as dehydration, trauma, ascites, metabolic stress, etc.
  • Total Cholesterol
    • It is suggested that total cholesterol under 160 mg/dL is considered a reflection of low lipoproteins and therefore low visceral protein status. This can be associated with malnutrition and an increase in mortality. However, low total cholesterol can also be indicative of severe liver disease or malabsorption.

Refeeding Syndrome

  • A potentially fatal condition that occurs after nutrition (usually artificial) is initiation after periods of prolonged starvation. Classic manifestations of this condition include: hypophosphatemia, hypomagnesemia, hypokalemia, abnormal glucose metabolism, abnormal fluid balance, and vitamin deficiencies (most commonly vitamin B1 – thiamine).

Renal Status

  • Blood Urea Nitrogen (BUN)
    • Increased levels observed with: renal failure, shock, dehydration, infection and diabetes mellitus.
    • Decreased levels observed with: hepatic failure, malnutrition, malabsorption and overhydration.
  • Creatinine
    • Increased levels observed with: acute and chronic renal disease, muscle damage, hyperthyroidism, starvation, and diabetic acidosis
    • Decreased levels can be seen with pregnancy
  • Potassium
    • Increased levels observed with: renal failure, tissue damage, acidosis, uncontrolled diabetes mellitus, overuse of vitamin K supplementation
    • Decreased levels observed with: GI loss, alcohol abuse, malabsorption, malnutrition, vit K depleting diuretics, renal disease, and hepatic disease with ascites
  • Phosphorus
    • Increased levels observed with: end stage renal disease, severe nephritis, hypocalcemia, Addison’s disease, sickle cell anemia
    • Decreased levels observed with: hyperparathyroidism, alcoholism, rickets or osteomalacia, hyperinsulinism, diabetes mellitus.

Diabetes

  • Glycated Hemoglobin (Hemoglobin A1C)
    • Increased levels observed in poorly controlled or newly diagnosed cases of diabetes, thalassemia, iron deficiency.
  • Glucose
    • Increased levels are seen in poorly controlled diabetes mellitus, Cushing’s syndrome, pancreatitis, chronic malnutrition, and K deficiency
    • Decreased levels can be observed if an individual has had an insulin overdose, hypothyroidism, alcohol abuse and starvation

Nutritional assessment can be thought of as a puzzle. Laboratory measures are a large piece of the puzzle but without other information such as an individual’s anthropometrics, medical history, etc., you are not able to make conclusions regarding their nutritional state. When utilizating all aspects of the ADIME (Assessment, Diagnosis, Intervention, Monitoring/Evaluation) process, nutrition professionals can practice best.

 

Sources

Batra, A., & Puntis, J. (2018). Refeeding syndrome. Oxford Medicine Online. doi:10.1093/med/9780198759928.003.0013

Nutrition 411: Using Laboratory Data to Evaluate Nutritional Status. (n.d.). Retrieved from https://www.o-wm.com/content/using-laboratory-data-evaluate-nutritional-status

Pronsky, Z. M., Elbe, D., & Ayoob, K. (2015). Food medication interactions. Birchrunville (Penn.): Food-Medication Interactions.