Nutrition-Focused Physical Exam

“Nutrition-Focused Physical Exam” was written by Genevieve Bowman, RDCS & edited by Ashlee Mikles, RD, CD, CLS. Final review/edit completed by Aly Bouzek, MS, RDN.

What is a Nutrition-Focused Physical Exam?

A nutrition-focused physical exam (NFPE) is a focused review of your body’s systems. It is a helpful tool that dietitians use to evaluate a patient’s nutritional status. (1,2)

A dietitian will look at body appearance, composition, and other clues that can suggest: 

• overall nutritional health
• nutrient deficiencies
• malnutrition

The exam can be done either visually, or alongside a physical exam. Dietitians perform NFPEs as a part of a thorough nutrition assessment.

Why Perform a Nutrition-Focused Physical Exam?

Dietitians are skilled in performing NFPEs to identify any nutritional concerns, particularly malnutrition and dehydration. 

Malnutrition happens when we are not getting the number of calories, protein, or nutrients that we need to maintain our health. 

Malnutrition is diagnosed when at least two of the following criteria are met (3):

• weight loss
• muscle loss
• subcutaneous fat loss (fat that’s under our skin)
• insufficient energy intake (not consuming enough calories)
• fluid accumulation (in a specific area, or spread throughout the body)
• reduced functional status

It is especially common in the hospital setting due to common illnesses that occur. In the hospital, a NFPE can also identify areas to help prevent additional infections and to prevent slowed healing.

Dehydration is when we don’t replace the fluids lost daily by our bodies (such as when you go to the bathroom, sweat, etc.). In other words, when we use or lose our body’s water supply and don’t replenish it, we are at risk for dehydration. 

Older adults are at higher risk for malnutrition, dehydration, and nutrient deficiencies. There is a higher risk for older adults due to issues such as: 

• taking multiple medications
• changes in appetite
• trouble chewing and/or swallowing
• dementia
• reduced mobility

Certain medical conditions can also put a higher demand on nutrition to maintain our health. Chronic diseases such as chronic kidney disease, cancer, diabetes, stroke, and stomach or intestinal issues often affect the number of nutrients that we need.

A NFPE is just as important in an outpatient setting. With many older adults being at higher risk for malnutrition and its complications, early identification and targeted treatment is important to preventing unfortunate situations such as: 

• falls
• fractures
• poor wound healing
• reduced immune function

What to Expect During a Nutrition-Focused Physical Exam

Before the Exam

Before beginning the NFPE, the dietitian will review your medical history, current condition, and past lab results. The dietitian will also review your current height, weight, vital signs, and will compare them to your medical history. 

Next, the dietitian will ask you about your current symptoms and will likely ask you to share what you’ve been eating and drinking. 

They may ask you questions about how your clothing, glasses, if your dentures have been fitting, or if you’ve noticed any changes in your physical abilities.

Before beginning a physical exam, the dietitian will make sure that you are comfortable and OK with having the exam. They will explain:

• what the exam will look like
• what they may be looking for
• where they need to examine you

You may be asked to change your position from sitting to standing, or to perform simple tasks such as pinching the skin on the top of your hand.

Depending on the exam setting (hospital or outpatient) or nutritional concerns, the appointment may involve a more thorough exam.

For example, a NFPE performed in a hospital setting or on someone who is ill is often more complex than one performed in an outpatient setting.

During the Exam

During a NFPE, the dietitian will begin by visually looking at exposed areas such as your head, arms, legs, as well as a survey of your overall state of health.

The dietitian will be using a technique called palpation (gentle touch with pads of fingers).

The dietitian may examine certain areas of your body assessing for muscle or fat loss.

Noting muscle and fat loss in areas around the eyes, collarbone, legs, and arms might be a sign that you are not getting adequate calories or protein in your diet.

The dietitian will assess your fluid status by looking at your ankles, the back of your hands, and the eye area. Through this, they are able to identify signs of too much fluid retention or signs of dehydration. 

Signs of malnutrition or nutrient deficiencies may be identified by examining your hair, eyes, mouth, skin, or fingernails. 

How many areas the dietitian examines is often determined by your current medical condition, but also by what they discover as they are performing the NFPE itself. 

If they see signs of malnutrition in one area of your body, then it may prompt them to examine other related areas on your body.

After the Exam

After performing a NFPE, the dietitian will discuss their findings and any nutritional areas of concern with you. They will work with you to come up with a medical nutrition treatment plan to help you meet your goals and reduce any potential health complications.

The dietitian may also suggest further testing if more information is needed. All findings will be entered into your medical record and will be available to your doctor and any other specialists that you have.

What Nutrition-Focused Physical Exams Might Tell Us

A NFPE can reveal nutritional concerns that may not be discovered during routine lab tests. 

Some examples include (4): 

• dull hair might mean that you are not getting enough protein in your diet
• issues in the mouth such as ulcers or inflamed gums might point to deficiencies in zinc, vitamin C, or various B vitamins
• prominent bones or sagging skin might indicate malnutrition

Lab test results can sometimes be unclear, or may show slow downward progression. This means that they should not be the only means of assessing nutritional health.

Nutrition deficiencies and imbalances are often not caught for some time when only lab tests are used. 

By performing a NFPE, along with a thorough review of your medical history, current symptoms, and nutrition assessment, the dietitian can find areas to focus on in your nutrition treatment plan.

Conclusion

Whether you are meeting with a dietitian for the first time or as a follow-up, try not to be nervous. It’s a time to evaluate your health and nutrition so that you can maintain or improve your overall health. 

Your dietitian is an important part of your medical care team with the goal of preventing a decline in your health status, reduced immunity, or reduced mobility and physical ability. 

By incorporating a NFPE into their nutrition assessment, your dietitian will be able to have a more thorough understanding of your condition and nutritional needs. This will allow them to help you understand how nutrition can positively or negatively affect your health. 

Together, you can maintain a better quality of life and health while managing any symptoms of chronic medical conditions.

References

1. Gordon, B. What is the Nutrition Focused Physical Exam. Eat Right. Published September 12, 2022. https://www.eatright.org/food/nutrition/healthy-eating/what-is-the-nutrition-focused-physical-exam#:~:text=The%20Nutrition%20Focused%20Physical%20Exam%2C%20or%20NFPE%2C%20is%20a%20physical,you%20meet%20with%20an%20RDN. 
2. Dennett, C. Nutrition-focused Physical Exams. Today’s Dietitian. Published February 2016.  https://www.todaysdietitian.com/newarchives/0216p36.shtml. 
3. White JV, Guenter P, Jensen G, et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2012;36(3):275-83. doi: 10.1177/0148607112440285. 
4. Hamilton, C. Nutrition-focused physical exam for adults: an illustrated handbook. 2^nd ed. American Society for Parenteral and Enteral Nutrition ASPEN; 2021.