A Look into the Nutrition Focused Physical Exam

By Megan Ng

A registered dietitian’s (RD) job reaches far beyond only discussing food choices. Dietitians have many tools that can be used to determine the nutritional state and needs of their patients. One of these tools is called the Nutrition Focused Physical Exam (NFPE). The NFPE is a part of the nutrition care process and assessment. It is used to detect any vitamin and mineral deficiencies, toxicities, and malnutrition. 

Why Do We Need NFPE?

Malnutrition and nutrient deficiencies are dangerous on a national and global level. Nutrient deficiencies are especially prevalent in the hospital setting. 

• An estimated one in three patients admitted to the hospital in the United States have malnutrition (Tappenden et al., 2013)
• • • Only 3% leave with a malnutrition diagnosis (White et al., 2012) 

Malnourished patients who don’t get appropriate treatment will continue to decline nutritionally. This often leads to worse health outcomes including (Tappenden et al., 2013): 

• •  Increased risk of infections and pressure ulcers
  •  Slowed wound healing
  •  Muscle wasting
  •  Functional losses that increase the risk of falls
  •  Longer hospital stays
  •  More frequent readmissions
  •  Greater risk of death

NFPE helps RDs to complete the most accurate and comprehensive nutrition assessment. This will determine the most appropriate nutrition diagnosis, intervention, plan for monitoring, and plan for evaluation.

What Exactly Is NFPE?

The NFPE uses a head-to-toe approach across all life stages. Micronutrient deficiencies and hydration are examined through hair, skin, eyes, mouth, and nails. Muscle loss, fat mass, fluid retention, and functional capacity are examined through grip strength and feeling for the muscle and fat stores along the body.

Four essential physical exam techniques include (Willis, 2007): 

• •  Inspection: visual observation to see changes in color, texture, and shape.
  •  Palpation: examination where the dietitian touches and feels the body to examine:
    • Size and location of an organ or body part.
    • Consistency and texture of an organ or body part.
    • Tenderness of an organ or body part
  • Percussion: tapping parts of the body to help locate:
    • Organ borders
    • Identify organ shape and position
    • Determine if an organ is solid or filled with fluid or gas
  • Auscultation: listening to body sounds to check for the functioning of the:
    • Circulatory system
    • Respiratory system
    • Gastrointestinal system.

NFPE is different from a medical physical exam because it focuses on nutrition and how a lack of nutrition can manifest. As a result, an RD may be able to identify problems that were missed during the medical exam. Curious about what the full NFPE process looks like? Look at this video from the University of California, San Diego Health System.

Summary

The Nutrition Focused Physical Exam (NFPE) is one of the most helpful tools used by dietitians to identify nutrient deficiencies, toxicities, and malnutrition. This full-body examination and inspection allow dietitians to take preventative measures and is a trusty option for when lab markers may not be as reliable.

References

1. ​​Dennett, C. (2016). Nutrition-Focused Physical Exams. Today’s Dietitian. Retrieved 29 June 2022, from https://www.todaysdietitian.com/newarchives/0216p36.shtml. 
2. Gordon, B., & Ellis, E. (2021). What is the Nutrition-Focused Physical Exam? Eat Right. Retrieved 29 June 2022, from 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.
3. Hummell, A., & Cummings, M. (2021). Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness. Nutrition In Clinical Practice, 37(1), 41-49. https://doi.org/10.1002/ncp.10797
4. Lichford M. Putting the nutrition-focused physical assessment into practice in long-term care. Ann Longterm Care. 2013;21(11). https://www.researchgate.net/publication/287475237_Putting_the_nutrition-focused_physical_assessment_into_practice_in_long-term_care
5. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219-1237. https://doi.org/10.1016/j.jand.2013.05.015
6. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012;112(5):730-738. https://doi.org/10.1177/0884533614557642
7. Willis, L. (2007). Health Assessment Made Incredibly Visual! (3rd ed.). Lippincott Williams & Wilkins.

Megan Ng is a graduate student of Food Science and Human Nutrition at the University of Illinois at Urbana Champaign

Photo by Kampus Production