170SECT|ON‖· WHAT TO DO WITH THE INFORMATI○N 3. "The guidelines form a framework within which specific dietary recommendations can be made for individuals based on their health status dietary preferences, and cultural background. This chapter focuses on the components of a healthy diet. It includes a ractical discussion of the influence of macronutrients, vitamins and minerals upon health, with special emphasis on nutrition's effect upon lipoproteins blood pressure, diabetes, and the lifecycle. Chapter 6 discusses the important role of physical activity, which must generally be combined with the nutrition interventions discussed here to promote wellness and reduce weight. NUTRITIONAL ASSESSMENT Dietary Assessment Chapter 2 discusses screening and exploratory questions that clinicians can use in the periodic health examination to quickly assess a patient,'s dietary habits. The 24- to 72-hour dietary recall has also been a useful tool in evaluating normal habits, intakes, and evidence of possible deficiencies in the dict. An ongoing record or a checklist that is possibly conpleted at mealtime may be one of the better methods of completing a dietary recall. Limited memory, cognitive impairment, increased time to complete the recall, and other difficulties created by health problems may make it difficult to obtain representative information without multiple sampling Anthropometric Assessments See Chapter 3(pages 57-61)regarding the measurement of height and weight to calculate the body mass index (bmi) Biochemical Assessment of nutritional Status Serum prealbumin has a half-life of 2 days and is more sensitive than albumin in evaluating nutritional changes Improved nutritional intake can increase prealbumin levels by approximately 10 mg/L/day. A lower increase may indicate inadequate nutritional support, poor response, and a poor prognosis Low levels of insulin-like growth factor 1, another very sensitive indicator of nutritional change, is associated with increased morbidity. Evidence does not support the use of either serum prealbumin or insulin-like growth factor as a single marker of nutritional status Nutrition Screening of older Adults Nutritional screening of seniors has gained in popularity as an effort to identify individuals who are at risk and need further intervention. The Nutrition Screening Initiative, a project of the American Academy of Family Physicians, American Dietetic Association, and the National Council on Aging, provides