Valoración Clínica de la

DESNUTRICIÓN
Lic. José Daniel Núñez Paz
Especialista en Nutrición Clínica
Objetivo

Analizar y aprender un conjunto de técnicas de

exploración física, las cuales permitan identificar una
perdida de masa muscular y/o grasa subcutánea.
PUNTOS A CONSIDERAR

Analizar la desnutrición asociada con la enfermedad

Valorar la perdida de grasa corporal clínica

Valorar la perdida de masa muscular clínica

Nutr Hosp Suplementos. 2013;6(1):10-23
White et al, JPEN, 2012 Consensus Statement
White et al, JPEN, 2012 Consensus Statement
White et al, JPEN, 2012 Consensus Statement
 Signos y
Historia Clínica y Datos
Síntomas
Diagnóstico antropométricos
clínicos

Exámenes de Estado
laboratorio Funcional

CONDICIÓN ACTUAL DEL PACIENTE – HISTORIA NATURAL DE LA ENFERMEDAD

White et al, JPEN, 2012 Consensus Statement
Entrevista clínica

Visión general (Cabeza-Pies) Estado de Hidratación

Deficiencia nutricionales
Masa Magra/Grasa
Piel
Empleo de técnicas de observación Uñas
Pelo
y palpación Cabeza
Conjuntivas
Mucosas

White et al, JPEN, 2012 Consensus Statement

 ¿COMO EVALUAR LA PERDIDA DE MASA MUSCULAR?

Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
 ¿COMO EVALUAR LA PERDIDA DE GRASA?

Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
 ¿COMO EVALUAR LA PERDIDA DE MASA MUSCULAR?

Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
 ¿COMO EVALUAR LA PERDIDA DE GRASA?

Adaptado de Malone A, MS, Hamilton C. (2013) The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice. Nutrition in Clinical Practice 28 Num 6
Dec. 2013(639–650)
 Integración en el diagnóstico
Malnutrición severa en el contexto de un proceso inflamatorio
crónico con ingesta inadecuada que se evidencia con una pérdida de
peso del 16% en 9 meses, consumiendo un 25% menos de los
requerimientos energéticos que precisa desde hace más de un mes.
Presenta atrofia muscular severa bilateral tanto superior como
inferior y severa pérdida de tejido subcutáneo manifestándose a
nivel periorbital , tricipital y zona costal, determinándose por medio
de observación clínica nutricional.