Skip to main content
SpringerLink
Log in

The Nutrition-Focused Physical Exam

  • Chapter
  • First Online:
Book cover Integrative and Functional Medical Nutrition Therapy

  • 2651 Accesses

Abstract

A key component of the nutritional assessment is the nutrition-focused physical exam (NFPE). Competency in performing this exam and interpreting its findings are paramount to making sound clinical decisions and to correctly diagnosing a patient’s nutritional problem(s). However, research reveals that the NFPE is underutilized and that dietitians and healthcare practitioners lack competency and appreciation for its role in nutritional assessment and the provision of quality care. This chapter aims to engage the dietitian, nutritionist, and healthcare provider in learning more about the rationale, techniques, and clinical findings of the NFPE. Extensive tables on how to perform specific physical examination techniques are accompanied by nutritional and medical interpretations of possible clinical findings. A wide array of signs and functional tests are covered from the head to toe along with comprehensive information on anthropometric measures. The nutrition-focused physical exam provides clinicians with objective methods to assess both insufficiencies and excesses of macronutrients, micronutrients, and fluid status and provides the functional nutrition or medical provider with tools to detect early signs of imbalances in organ systems and physiologic function. Finally, an added benefit of the NFPE is the unique opportunity it provides to connect provider and patient in a healing and potentially transformative manner.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Esper DH. Utilization of nutrition-focused physical assessment in identifying micronutrient deficiencies. Nutr Clin Pract. 2015;30(2):194–202.

    Article  CAS  PubMed  Google Scholar 

  2. Hammond K. Nutrition-focused physical assessment. Home Healthc Nurse. 1999;17(6):354–5.

    Article  CAS  PubMed  Google Scholar 

  3. Hammond KA. The nutritional dimension of physical assessment. Nutrition. 1999;15(5):411–9.

    Article  CAS  PubMed  Google Scholar 

  4. Litchford M. Putting the nutrition-focused physical assessment into practice in long-term care settings. Ann Longterm Care. 2013;21(11):38–41.

    Google Scholar 

  5. Dennett C. Nutrition-focused physical exams. Today’s Dietitian. 2016;18(2):36.

    Google Scholar 

  6. Baker JP, Detsky AS, Wesson DE, Wolman SE, Stewart S, Whitewell J, et al. Nutritional assessment: a comparison of clinical judgement and objective measures. N Engl J Med. 1982;306(16):969–72.

    Article  CAS  PubMed  Google Scholar 

  7. Detsky AS, Smalley PS, Chang J. The rational clinical examination. Is this patient malnourished? JAMA. 1994;271(1):54–8.

    Article  CAS  PubMed  Google Scholar 

  8. Touger-Decker R. Physical assessment skills for dietetics practice. The past, the present, and recommendations for the future. Top Clin Nutr. 2006;21(3):190–8.

    Article  Google Scholar 

  9. Stankorb SM, Rigassio-Radler D, Khan H, Touger-Decker R. Nutrition focused physical examination practices of registered dietitians. Top Clin Nutr. 2012;25(4):335–44.

    Article  Google Scholar 

  10. Mackle TJ, Touger-Decker R, Maillet JO, Holland BK. Registered dietitians’ use of physical assessment parameters in professional practice. J Am Diet Assoc. 2003;103:1632–8.

    Article  PubMed  Google Scholar 

  11. Jauhar S. The demise of the physical exam. N Engl J Med. 2006;354:548–51.

    Article  CAS  PubMed  Google Scholar 

  12. Rathe R. The complete physical. Am Fam Physician. 2003;68(7):1439–44.

    PubMed  Google Scholar 

  13. Verghese A, Horwitz RI. In praise of the physical examination. It provides reason and ritual. BMJ. 2009;339:b5448.

    Article  PubMed  Google Scholar 

  14. Adams KM, Kohlmeier M, Zeisel SH. Nutrition Education in U.S. medical schools: latest update of a National Survey. Acad Med. 2010;85(9):1537–42.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mordarski B. Nutrition-focused physical exam hands-on training workshop. J Acad Nutr Diet. 2016;116(5):868–9.

    Article  PubMed  Google Scholar 

  16. Litchford MD. Nutrition focused physical assessment: making clinical connections. Greensboro: CASE Software and Books; 2013.

    Google Scholar 

  17. Mahan LK, Raymond JL. Krause’s food & the nutrition care process. 14th ed. St. Louis: Elsevier; 2017.

    Google Scholar 

  18. Ford D, Raj S, Batheja RK, DeBusk R, Grotto D, Noland D, et al. American Dietetic Association: standards of practice and standards of professional performance for registered dietitians (competent, proficient, and expert) in integrative and functional medicine. J Am Diet Assoc. 2011;111(6):902–11.

    Article  PubMed  Google Scholar 

  19. Dean S. Introduction to integrative and functional nutrition. Conference handout. California Academy of Nutrition & Dietetics (CAND) annual meeting and exhibition. 2015 Apr 9–11; Riverside. Available from: http://www.dietitian.org/d_cda/docs/annual_mtg_2015/conference_handouts/thu4-9-15/Dean_IntroductionIFN.pdf.

  20. Noland D. The University of Kansas Medical Center Clinical Nutrition Seminar. Kansas City: Department of Dietetics & Nutrition and Department of Integrative Medicine; 2011. Courtesy of Diana Noland

    Google Scholar 

  21. Bickley LS, Szilagyi PG. Bates’ pocket guide to physical examination and history taking. 7th ed. Philadelphia: Wolters Kluwer Health|Lippincott Williams & Wilkins; 2007.

    Google Scholar 

  22. James AG, Austin CJ, Cox DS, Taylor D, Calvert R. Microbiological and biochemical origins of human axillary odour. FEMS Microbiol Ecol. 2013;83:527–40.

    Article  CAS  PubMed  Google Scholar 

  23. Callewaert C, Lambert J, Van de Wiele T. Towards a bacterial treatment for armpit malodour. Exp Dermatol. 2017;26:388–91.

    Article  PubMed  Google Scholar 

  24. Ishikawa T, Toyoda Y, Yoshiura K, Nikawa N. Pharmacogenetics of human ABC transporter AVBCC11: new insights into apocrine gland growth and metabolite secretion. Front Genet. 2013;3(306):1–13.

    Google Scholar 

  25. Hur E, Gungor O, Bozkurt D, Bozgul SMK, Dusunur F, Caliskan H, et al. Trimethylaminuria (fish malodour syndrome) in chronic renal failure. Hippokratia. 2012;16(1):83–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Lee RD, Nieman DC. Nutritional assessment. 6th ed. New York: McGraw-Hill; 2013.

    Google Scholar 

  27. Musa-Veloso K, Likhoidi SS, Cunnane SC. Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. Am J Clin Nutr. 2002;76:65–70.

    Article  CAS  PubMed  Google Scholar 

  28. Sadock BJ, Sadock VA. Kaplan & Sadock’s pocket handbook of clinical psychiatry. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  29. Noland D, Huls A. Nutritional assessment by location table. University of Kansas Med Center Seminar; 2011.

    Google Scholar 

  30. nsight.org [Internet]. Federal Way: Institute of Functional Medicine. Functional Nutrition Evaluation. Skin Exam Quick Reference Guide;c2016 [cited 2016 Feb 7]. Available from: https://www.ifm.org/learning-center/skin-exam-n-sight-companion-guide/.

  31. McGee S. Evidence-based physical diagnosis. 3rd ed. Philadelphia: Elsevier Saunders; 2012.

    Google Scholar 

  32. Newton C. Let me hear your body talk: the functional nutrition-focused physical exam: Integrative and Functional Nutrition Academy [Webinar]; 2016. http://integrativerd.org/wp-content/uploads/2014/06/DIFM-webinar-Body-Talk-2014-corrected.pdf

  33. Suzuki D. Vancouver: David Suzuki Foundation;c2014 [cited Feb 26]. ‘Dirty Dozen’ cosmetic chemicals to avoid; [about 2 screens]. Available from: http://www.davidsuzuki.org/issues/health/science/toxics/dirty-dozen-cosmetic-chemicals/.

  34. Mangione S, editor. Physical diagnosis secrets. Philadelphia: Hanley & Belfus Inc; 2000.

    Google Scholar 

  35. Brown SE. Better bones [Internet]. East Syracuse: Brown SE. 2015 Sep 14 – [cited 2017 Feb 23]. Available from: http://www.betterbones.com/bone-health-basics/whats-the-cause-of-your-osteoporosis/.

  36. Sanders RD, Gilling PM. Gait and its assessment in psychiatry. Psychiatry (Edgmont). 2010;7(7):38–43.

    Google Scholar 

  37. nsight.org [Internet]. Federal Way: Institute of Functional Medicine. Functional Nutrition Evaluation. Blood Pressure Quick Reference Guide; c2016 [cited 2016 Feb 7]. Available from: https://www.ifm.org/learning-center/blood-pressure-n-sight-companion-guide/.

  38. DeBusk R, Jaffe Y. It’s not just your genes. Your diet. Your lifestyle. Your genes. San Diego: BKDR Publishing; 2006. p. 36–8.

    Google Scholar 

  39. National Institute of Health [Internet]. Bethesda: National Heart, Lung, and Blood Institute; [cited e2017 Feb 23]. Description of the DASH eating plan. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/dash.

  40. Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527–36.

    PubMed  Google Scholar 

  41. Zhu QO, Tan CSG, Tan HL, Wong RG, Joshi CS, Cuttilan RA, et al. Orthostatic hypotension: prevalence and associated risk factors among the ambulatory elderly in an Asian population. Singap Med J. 2016;57(8):444–51.

    Article  Google Scholar 

  42. Wolters FJ, Mattace-Raso FUS, Koudstaal PJ, Hofman A, Ikram MA. Orthostatic hypotension and the long-term risk of dementia: a population-based study. PLoS Med. 2016;13(10):e1002143.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Oishi E, Sakata S, Tsuchihashi T, Tominaga M, Fujii K. Orthostatic hypotension predicts a poor prognosis in elderly people with dementia. Intern Med. 2016;55:1947–52.

    Article  PubMed  Google Scholar 

  44. Veronese N, De Rui M, Bolzetta F, Zambon S, Corti MC, Baggio G, et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro V.A. Study. Am J Hypertens. 2015;28(10):1248–56.

    Article  CAS  PubMed  Google Scholar 

  45. Ye Q, D’Urzo AD. Challenge of alpha 1-antitrypsin deficiency diagnosis in primary care. Can Fam Physician. 2016;62:899–901.

    PubMed  Google Scholar 

  46. Mayo Clinic. Scottsdale: Mayo Foundation for Medical Education and Research; c1998–2017 [cited 2017 Feb 23]. Anhidrosis; [about 1 screen]. Available from: http://www.mayoclinic.org/diseases-conditions/anhidrosis/basics/risk-factors/con-20033498.

  47. Bronsnick R, Murzaka EC, Rao BK. Diet in dermatology. Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer. J Am Acad Dermatol. 2014;71:1039.e1–12.

    Article  CAS  Google Scholar 

  48. Van Hattem S, Bootsma AH, Thio HB. Skin manifestations of diabetes. Cleve Clin J Med. 2008;75(11):772–87.

    Article  PubMed  Google Scholar 

  49. Hughes MC, Williams GM, Fourtanier A, Green AC. Food intake, dietary patterns, and actinic keratosis of the skin: a longitudinal study. Am J Clin Nutr. 2009;89:1246–55.

    Article  CAS  PubMed  Google Scholar 

  50. Nuzzo V, Tauchmanova L, Colasanti P, Zuccoli A, Colao A. Idiopathic chronic urticaria and thyroid autoimmunity. Experience of a single center. Dermatolendocrinol. 2011;3(4):225–8.

    Google Scholar 

  51. Godse KV. Urticaria and treatment options. Indian J Dermatol. 2009;54(4):310–2.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pal L, Kidwai N, Glockenburg K, Schneller N, Altun T, Figueroa A. Skin wrinkling and rigidity are predictive of bone mineral density in early postmenopausal women. Proceedings of the Endocrine Society’s 93rd annual meeting & expo; 2011 Jun 4–7; Boston. https://doi.org/10.1210/endo-meetings.2011.PART3.P23.P3-126.

  53. Ferreira AC, Hochman B, Furtado F, Bonatti S, Ferreira LM. Keloids: a new challenge for nutrition. Nutr Rev. 2010;68(7):409–17.

    Article  PubMed  Google Scholar 

  54. Fawcett RS, Linford S, Stulberg DL. Nail abnormalities: clues to systemic disease. Am Fam Physician. 2004;69(6):1417–24.

    PubMed  Google Scholar 

  55. Fitzgerald K. [Internet] Sandy Hook: Dr. Kara Fitzgerald Functional Medicine;c2017 [cited 2017 Feb 13]. Fingernails: a window into your metabolic soul. [about 1 screen]. Available from: http://www.drkarafitzgerald.com/2014/08/30/fingernails-a-window-into-your-metabolic-soul/.

  56. Fitzgerald K. [Internet] Sandy Hook: Dr. Kara Fitzgerald Functional Medicine;c2017 [cited 2017 Feb 13]. Nutrition physical exam: tongue & nails suggest gut health. Available from: https://www.drkarafitzgerald.com/2015/07/09/nutrition-physical-exam-tongue-nails-suggest-gut-health/.

  57. Marz RA. Medical nutrition from Marz. 2nd ed. Portland: OmniPress; 1997.

    Google Scholar 

  58. Weatherby D. Signs and symptoms analysis from a functional perspective. 2nd ed. Ashland: Bear Mountain Publishing; 2004.

    Google Scholar 

  59. Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE. Male pattern baldness and coronary heart disease. The Physicians Health Study Arch Intern Med. 2000;160:165–71.

    CAS  PubMed  Google Scholar 

  60. Gaby A. Nutritional medicine. 1st ed. Fritz-Perlberg: Concord; 2011.

    Google Scholar 

  61. Bartley GB. The differential diagnosis and classification of eyelid retraction. Trans Am Opthalmol Soc. 1995;93:371–89.

    CAS  Google Scholar 

  62. Sundelin T, Lekander M, Kecklund G, Van Someren EJW, Olsson A, Axelsson J. Cues of fatigue: effects of sleep deprivation on facial appearance. Sleep. 2013;36(9):1355–60.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Fuerst N, Langelier N, Massaro-Giordano M, Pistilli M, Stasi K, Burns C, et al. Tear osmolarity and dry eye symptoms in diabetics. Clin Opthalmol. 2014;8:507–15.

    Google Scholar 

  64. Nam GE, Kim S, Paik JS, Kim HS, Na KS. Association between pterygium and obesity status in a South Korean population. Medicine. 2016;95(50)

    Google Scholar 

  65. Astafurov K, Elhawy E, Ren L, Dong CQ, Igboin C, Hyman C, et al. Oral microbiome link to neurodegeneration in glaucoma. PLoS One. 2014;9(9):e104416.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Mayo Clinic. [Internet]. Scottsdale: Mayo Foundation for Medical Education and Research; c1998–2017 [cited 2017 Feb 23]. [about 1 screen]. Available from: http://www.mayoclinic.org/diseases-conditions/poor-color-vision/basics/causes/con-20022091.

  67. Mercola.com. [Internet]. Dr. Joseph Mercola; c1997-2017 [cited 2017 Feb 21]. Effective strategies to identify and correct the inflammation caused by mold exposure. [About 1 screen]. Available from: http://articles.mercola.com/sites/articles/archive/2012/07/22/mold-and-other-chronic-diseases.aspx.

  68. Biotoxinjourney.com c2016 [cited 2017 Feb 20] Are You Moldy? [About 1 screen]. Available from: http://biotoxinjourney.com/areyoumoldy/-VCSTest.

  69. Singh C, Kawatra R, Gupta J, Awasthi V, Dungara H. Therapeutic role of vitamin B12 in patients of chronic tinnitus: a pilot study. Noise Health. 2016;18(81):93–7.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Freiherr J, Gordon AR, Alden EC, Ponting AL, Hernandez MF, Boesveldt S, et al. The 40-item Monell extended Sniffin’ sticks identification test (MONEX-40). J Neurosci Methods. 2012;205(1):10–6.

    Article  PubMed  Google Scholar 

  71. Mackay-Sim A, Johnston AN, Owen C, Burne TH. Olfactory ability in the healthy population: reassessing presbyosmia. Chem Senses. 2006;31(8):763–71.

    Article  PubMed  Google Scholar 

  72. Sohrabi HR, Bates KA, Weinborn MG, Johnston ANB, Bahramian A, Taddei K, et al. Olfactory discrimination predicts cognitive decline among community-dwelling older adults. Transl Psychiatry. 2012;2:e118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Wilson RS, Yu L, Bennett DA. Odor identification and mortality in old age. Chem Senses. 2010;36:63–7.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Hawkes C. Disorders of smell and taste. In: Office practice of neurology. 2nd ed. Philadelphia: Churchill Livingstone; 2003. p. 102–12.

    Chapter  Google Scholar 

  75. Stamps JJ, Bartoshuk LM, Heilman KM. A brief olfactory test for Alzheimer’s disease. J Neuro Sci. 2013;15:333.

    Google Scholar 

  76. Radler DR, Lister T. Nutrient deficiencies associated with nutrition-focused physical findings of the oral cavity. Nutr Clin Pract. 2013;28(6):710–2.

    Article  PubMed  Google Scholar 

  77. Lankarani KB, Sivandzadeh GR, Hassanpour S. Oral manifestation in inflammatory bowel disease: a review. World J Gastroenterol. 2013;19(46):8571–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. nsight.org [Internet]. Federal Way: Institute of Functional Medicine. Functional Nutrition Evaluation. Dental Exam Quick Reference Guide; c2016 [cited 2016 Feb 7]. Available from: https://www.ifm.org/learning-center/dental-exam-n-sight-companion-guide/.

  79. Stewart R, Weyant RJ, Garcia ME, Harris T, Launer LJ, Satterfield S, et al. Adverse oral health and cognitive decline: the health, aging and body composition study. J Am Geriatr Soc. 2013;61(2):177–84.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Darnaud C, Thomas F, Pannier B, Danckin N, Bouchard P. Oral health and blood pressure: the IPC cohort. Am J Hypertens. 2015;28(10):1257–61.

    Article  PubMed  Google Scholar 

  81. He K, Zun P, Liu K, Morris S, Reis J, Guallar E. Mercury exposure in young adulthood and incidence of diabetes later in life. The CARDIA Trace Element Study. Diabetes Care. 2013;36(6):1584–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Pugazhenthan T, Singh H, Kumar P, Hariharan BI. Dysgeusia going to be a rare or a common side-effect of amlodipine? Ann Med Health Sci Res. 2014;4(Suppl 1):S43–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Fitzgerald K. [Internet]. Sandy Hook: Dr. Kara Fitzgerald Functional Medicine. c2017; [cited 2017 Feb 25]. Introduction to Tongue Nutrient Diagnosis in Functional Medicine; [about 1 screen]. Available from: http://www.drkarafitzgerald.com/2015/09/11/introduction-to-tongue-nutrient-diagnosis-in-functional-medicine-2/.

  84. Rhim E, Han K, Yun KI. Association between temporomandibular disorders and obesity. J Craniomaxillofac Surg. 2016;44:1003–7.

    Article  PubMed  Google Scholar 

  85. Hoffman RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011;27:268–74.

    Article  Google Scholar 

  86. Keris EY, Yaman SD, Demirag MD. Temporomandibular joint findings in patients with rheumatoid arthritis, ankylosing spondylitis, and primary Sjögren’s syndrome. J Investig Clin Dent. 2017;8(24)1–7.

    Google Scholar 

  87. Mann T, Heuberger R, Wong H. The association between chewing and swallowing difficulties and nutritional status in older adults. Aust Dent J. 2013;58:200–6.

    Article  CAS  PubMed  Google Scholar 

  88. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia. 2008;23:244–50.

    Article  PubMed  Google Scholar 

  89. Miura H, Kariyasu M, Yamasaki K, Arai Y. Evaluation of chewing and swallowing disorders among frail community-dwelling elderly individuals. J Oral Rehabil. 2007;34:422–7.

    Article  CAS  PubMed  Google Scholar 

  90. Hansen EF, Vestbo J, Phanareth K, Kok-Jensen A, Dirksen A. Peak flow as a predictor of overall mortality in asthma and chronic obstructive pulmonary disease. Am J Resp Crit Care Med. 2001;163:690–3.

    Article  CAS  PubMed  Google Scholar 

  91. Hall MW, Sowden DS, Gravestock N, Greenbaum DS, Joseph JG, Freeman E. Abdominal wall tenderness tests. Lancet. 1991;337(8757):1606–7.

    Article  Google Scholar 

  92. Muno T, Patel J, Badilla-Porras R, Kronick J, Mercimek-Mahmutoglu S. Severe scoliosis in a patient with severe methylenetetrahydrofolate reductase deficiency. Brain Dev. 2015;37:168–70.

    Article  Google Scholar 

  93. Lee SY, Ro HJ, Chung SG, Kang SH, Seo KM, Kim DK. Low skeletal muscle mass in the lower limbs is independently associated with to knee osteoarthritis. PLoS ONE. 2016;11(11):e0166385.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Lee DC, Shook RP, Drenonutz C, Blair SN. Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism. Future Sci OA. 2016;2(3):FS0127.

    Article  CAS  Google Scholar 

  95. Kärkkäinen M, Rikkonen T, Kröger H, Sirola J, Tuppurainen M, Salovaara K. Physical tests for patient selection for bone mineral density measurements in postmenopausal women. Bone. 2009;44:660–5.

    Article  PubMed  Google Scholar 

  96. Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body composition and mortality. Intl J Epidemiol. 2007;36:228–35.

    Article  Google Scholar 

  97. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandi A, et al. Prognostic value of grip strength: findings from the prospective urban rural epidemiology (PURE) study. Lancet. 2015;386:266–73.

    Article  PubMed  Google Scholar 

  98. Youbin Y, Shim JS, Oh BM, Seo HG. Grip strength on the unaffected side as an independent predictor of functional improvement after stroke. Am J Phys Med Rehabil. 2017;96:616–20.

    Article  Google Scholar 

  99. Robinson S, Cooper C, Sayer AA. Nutrition and sarcopenia: a review of the evidence and implications for preventive strategies. J Aging Res. 2012;2012:510801.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cedarholm T, Landi F. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Jensen GL. Inflammation: roles in aging and sarcopenia. JPEN J Parenter Enteral Nutr. 2008;32(6):656–9.

    Article  CAS  PubMed  Google Scholar 

  102. Greene L, Hartz C, Ma A. Vitamin B12 deficiency. Act early to prevent neurological damage. Adv NPs PAs. 2006;14(7):63.

    Google Scholar 

  103. Gilman S. Joint position sense and vibration sense: anatomical organisation and assessment. J Neurol Neurosurg Psychiatry. 2002;73:473–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DO. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.

    Article  CAS  PubMed  Google Scholar 

  105. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. CDC.gov National Center for Injury Prevention and Control. [Internet]. Atlanta: STEADI. 2016 Nov 23; [cited 2017 Feb 25]; The Timed Up and Go (TUG) Test [Download]. Available from: https://www.cdc.gov/steadi/pdf/tug_test-a.pdf.

  107. Nelms M, Sucher KP, Lacey K. Nutrition therapy and pathophysiology. 3rd ed. Boston: Cengage; 2016.

    Google Scholar 

  108. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56(5):303–7.

    Article  PubMed  Google Scholar 

  109. Ashwell M, Gunn P, Gibson S. Waist-to-Height Ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13:275–86.

    Article  CAS  PubMed  Google Scholar 

  110. Zeng Q, He Y, Dong S, Zhao X, Chen Z, Song Z, et al. Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults. Br J Nutr. 2014;112:1735–44.

    Article  CAS  PubMed  Google Scholar 

  111. Browning LM, Hsieh DS, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23:247–69.

    Article  PubMed  Google Scholar 

  112. Yan W, Bingxian H, Yao H, Jianghong D, Jun C, Dongliang G, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity. 2007;15(3):748–52.

    Article  Google Scholar 

  113. Osler W. Sir William Osler: aphorisms from his bedside teachings and writings. Springfield: Charles C. Thomas Publisher; 1961:129. Quoted from Thayer W. Osler, the teacher. Bull Johns Hopkins Hosp 1919;30:198

    Google Scholar 

  114. Kelly M, Tink W, Nixon K, Dornan T. Losing touch? Refining the role of physical examination in family medicine. Can Fam Physician. 2015;61:1041–3.

    PubMed  PubMed Central  Google Scholar 

  115. Arthur Conan Doyle. London: The Sir Arthur Conan Doyle Literary Estate; c2000-2017 [cited 2017 Feb 22] Biography; [about 1 screen]. Available from: http://www.arthurconandoyle.com/about-us.html.

  116. Zaman J, Verghese A, Elder A. The value of the physical examination: a new conceptual framework. South Med J. 2016;109(12):754–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nutrition & Integrative Health, Maryland University of Integrative Health (MUIH), Laurel, MD, USA

    Mary R. Fry

Authors
  1. Mary R. Fry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary R. Fry .

Editor information

Editors and Affiliations

  1. Noland Nutrition, Burbank, CA, USA

    Diana Noland

  2. Professor Emeritus, School of Medicine, University of Kansas Health System, Kansas City, KS, USA

    Jeanne A. Drisko

  3. Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, KS, USA

    Leigh Wagner

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fry, M.R. (2020). The Nutrition-Focused Physical Exam. In: Noland, D., Drisko, J., Wagner, L. (eds) Integrative and Functional Medical Nutrition Therapy. Humana, Cham. https://doi.org/10.1007/978-3-030-30730-1_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30730-1_39

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-30729-5

  • Online ISBN: 978-3-030-30730-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation