Editing Nutrition (section)

== Nutritional Assessment ==

=== Anthropometrics ===

* '''Body mass index''' equals weight in kilograms divided by height in meters squared. Underweight is below 18.5, normal is 18.5 to 24.9, overweight is 25.0 to 29.9, and obesity is 30.0 and above. BMI does not distinguish muscle from fat and is unreliable in athletes, in older adults with sarcopenia, and in the presence of edema or ascites.
* '''Weight change''' is the single most useful bedside indicator. Unintentional loss of more than 5 percent of body weight in one month or more than 10 percent in six months is clinically significant malnutrition.
* '''Daily weights''' are the most accurate measure of fluid status. Weigh at the same time each day, on the same scale, with the same amount of clothing, after voiding. One kilogram of weight change equals approximately one liter of fluid, or about 2.2 pounds per liter.
* Waist circumference above 40 inches in men or above 35 inches in women indicates central adiposity and increased cardiometabolic risk.

=== Clinical and Dietary Assessment ===

Inspect hair, skin, nails, oral mucosa, gums, and conjunctiva. Assess dentition, fit of dentures, swallowing, appetite, and the ability to shop for and prepare food. Ask about food insecurity, cultural and religious food practices, food allergies, alcohol use, and supplement or herbal use. A 24-hour recall or a three-day food diary provides intake data.

=== Food, Drug, and Nutrient Interactions ===

* '''Warfarin and vitamin K:''' keep green vegetable intake consistent.
* '''Monoamine oxidase inhibitors and tyramine:''' aged cheeses, cured and smoked meats, fermented soy, tap and draft beer, red wine, sauerkraut, and overripe fruit can cause hypertensive crisis.
* '''Grapefruit juice''' inhibits intestinal CYP3A4 and raises levels of statins, many calcium channel blockers, and some immunosuppressants.
* '''Tetracyclines, fluoroquinolones, and levothyroxine''' bind to calcium, iron, magnesium, aluminum, and zinc. Separate from dairy, antacids, and mineral supplements. Levothyroxine is taken on an empty stomach 30 to 60 minutes before breakfast.
* '''Corticosteroids''' raise blood glucose and promote sodium retention, potassium loss, and bone loss.
* '''Loop and thiazide diuretics''' waste potassium and magnesium; potassium-sparing diuretics retain potassium.
* '''Metformin and proton pump inhibitors''' reduce vitamin B12 absorption over the long term.
* '''Alcohol''' displaces nutrient-dense calories and impairs thiamine, folate, and magnesium status.