Appropriate Testing Nutritional Status.

Nutritional assessment can be divided into three main categories: a) clinical signs and symptoms, b) dietary history to reveal risk of inadequate intake and c) laboratory testing. In this paper discussion is limited to laboratory testing. It should be borne in mind that clinical conditions may increase nutrient requirements and that there is substantial variation in requirements due to biochemical individuality (1). This has been discussed elsewhere (2,3). An excellent list of common clinical signs of specific nutrient deficiencies can be found in Werbach’s superb monograph “Nutritional Influences on Illness” (4) and is covered elsewhere (5). When assessing specific nutrient status it should be borne in mind that seldom does a single nutrient deficiency occur – more usually several occur together in the same individual because of poor nutrient intake, poor absorption or poor retention. Interestingly the most common symptoms encountered in general practice are also symptoms of nutrient deficiencies, such as vitamin B complex (fatigue, depression, anxiety, sleep disturbances etc.) muscle and joint aches and pains, irregular heart rhythms (magnesium, copper, manganese and calcium).