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INITIAL NUTRITION ASSESSMENT

The transplant dietitian should conduct an initial nutrition assessment on prospective transplant candidates prior to approval for transplant. The assessment should include the following:

  • Anthropometrics: Measure height, weight, body mass index (BMI), percentage of standard, usual and ideal body weight, waist circumference, and weight change rates/trends. (Refer to Table 22-1 for BMI weight classifications.)

  • Nutrition-focused physical exam (NFPE): Conduct a physical assessment to identify indicators of malnutrition (refer to Table 22-3 for malnutrition criteria). Patients are assessed for loss of subcutaneous fat, muscle depletion, generalized or localized fluid accumulation, and reduced grip strength.

  • Patient history: Assess nutritionally relevant medical, surgical, and social history.

  • Biochemical data and relevant lab values, including but not limited to:

    • Lipid profile (cholesterol, triglycerides, high-density lipoprotein [HDL], low-density lipoprotein [LDL])

    • Electrolytes and renal indices: sodium, potassium, magnesium, phosphorus, blood urea nitrogen (BUN), serum creatinine, glomerular filtration rate (GFR)

    • HbA1c and 24-hour blood glucose monitoring

    • Markers for bone metabolism: calcium, vitamin D, parathyroid hormone (PTH)

    • Serum proteins: prealbumin, albumin (decrease during inflammation)

    • Anemia profile

    • Fluid status

  • Food allergies or intolerances

  • Dietary intake and adequacy:

    • Social, cultural, and religious dietary influences on food intake; availability of support from family and friends; ability to cook and shop for food

    • Dietary history for analysis of macronutrients and micronutrients, including energy, protein, carbohydrates (CHOs), amount and types of fat, sodium (Na) and fluid intake, potassium (K), calcium (Ca), and phosphorus (P)

    • Changes in appetite, intake, and eating patterns

    • Gastrointestinal (GI) distress: nausea, vomiting, diarrhea, or constipation

    • Chewing/swallowing difficulty

  • Dietary supplements: vitamins, minerals, modular protein, high-calorie protein shakes

  • Knowledge, beliefs, or attitudes: readiness to change nutrition and lifestyle behaviors

  • Lifestyle patterns: eating patterns, quantity and quality of the meals, timing of the meals, frequency and type of restaurant foods, physical activity

  • Herbals/botanicals: assess safety of over-the-counter herbal supplements, reviewed elsewhere in the literature.1

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TABLE 22-1 BMI/Weight Classifications

Category

BMI

Underweight

<18.5

Normal weight

18.5–24.9

Overweight

25–29.9

Obese Class 1

30–34.9

Obese Class 2

35–39.9

Obese Class 3

>40

PRETRANSPLANT OBJECTIVES

The dietitian should work with the transplant candidate to optimize nutritional status prior to transplant surgery, achieve health targets, and educate the patient on posttransplant nutrition therapy, food safety, food–drug interactions, and long-term health management.

Optimize Nutritional Status

  • Achieve target BMI through weight management strategies:

    • Most transplant departments have a BMI cutoff for eligibility for both recipients and donors, such as BMI ≥18.5 and <40 for recipients and <35 for donors. However, BMI is not always the best indicator of body habitus and should be individualized. Waist circumference, or waist-to-height ratio, may be a better indicator, as a high BMI could be attributable to either high muscle mass or excessive fat mass.

  • Achieve acceptable lab values through diet, vitamin/mineral supplementation, exercise, and medication adherence. For guidance on micronutrient supplementation, ...

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