A Functional Nutrition Exam Guides Personalized Wellness

We are as different on the inside as we are on the outside…

Therefore, a personalized approach to assessing and addressing chronic disease risk is imperative.

• Individual Health Factors: Each person’s unique genetic, lifestyle, and environmental factors significantly impact their health, visible through physical exams and lab biomarkers.
• Challenges in Detection: Identifying nutrient deficiencies and abnormal biomarker levels is difficult in clinical practice due to limited clinician training, time constraints, and misconceptions about the rarity of these signs.
• Functional Nutrition Evaluation: Incorporating functional nutrition evaluations can enhance patient screenings and personalized wellness programs, aiding in early detection and prevention of health issues.
• LIFEHOUSE Study Findings: The Lifestyle Intervention and Functional Evaluation—a Health OUtcomes SurvEy (LIFEHOUSE) study analyzed 369 employees and identified distinct physical and biomarker patterns, helping to recognize early signs that precede chronic non-communicable diseases.
• Clinical Applications: These identified patterns can assist clinicians in developing diagnostic and therapeutic interventions to prevent the onset of age-related chronic diseases.

Comprehensive nutritional screening and assessment can help identify early dysfunction and preclinical mileposts for non-communicable chronic diseases (NCDs), including heart disease, diabetes, obesity, hypertension, and renal disease. These disorders are often associated with or attributed to aging but are preventable with early and effective intervention.

Early intervention is essential and economical, as 70-80% of health resources are focused on acute responses to established NCDs instead of a more logical approach focused on prevention.

Even in seemingly healthy individuals, recognizable patterns can help identify underlying physiological dysfunction and nutrition insufficiencies caused by a less-than-optimal diet, toxin exposure, genetic factors, and poor lifestyle choices.

A comprehensive approach must include:

• Physical examination
• Laboratory biomarkers
• Anthropometric measures

Components of the Functional Nutrition Evaluation (FiNE); Anthropometric and Clinical Exam

Anthropemetrics

• Body temperature, blood pressure, pulse, respiratory rate and oxygen saturation. Height, weight, waist circumference, hip circumference, body composition analysis, peak flow, and grip strength
• Body Composition Evaluation: Body Mass Index, waist to hip ratio, percent body fat, skeletal muscle mass, extracellular water/total body water
• Body Type: Underweight, desirable weight, overweight, obese, over fat, android body type, gynoid body type

Clinical Exam

Scalp/Hair

• Distribution: Normal, alopecia areata, androgenic alopecia (female)

Mouth

• Jaw Movement: symmetric, asymmetric, auscultated crepitus or click, pain, mouth opening >4 cm.
• Lips: Normal, dry, cracking, angular cracks or sores, ulcerations, fissures, perioral rash, loss of lip borders, other lesions, edema, angioedema, piercings.
• Soft palate, hard palate, tonsillar pillars: hard palate—normal, cleft or oropharyngeal defects. Soft palate—lesions, symmetry. Tonsil beds and pillars—hypertrophy, regressed.
• Tongue: size-enlarged, small, shape-scalloping present, color- red, magenta, coating- grade 0, 1, 2 and color, tastebud distribution and prominence, fissuring (longitudinal, transverse, lambda) ankyloglossia, lesions, ventral varicosities, blocked Wharton duct blocked.
• Gums: normal, lesions, gum line darkening-burtons lines, bruising, lesions, macules, tenderness, gingivitis, periodontal disease, gum hyperplasia.
• Teeth: Healthy-no restorations, missing teeth, tooth attrition or abrasions, silver/mercury restorations, silver abutting gold restorations, periodontal ligament pain, enamel dysplasia, discoloration (fluorosis) plaque (tartar).

Skin

• Texture: normal, xerosis, hyperkeratosis pilari, seborrhea, eczematous rash.
• Color: Normal, acanthosis nigricans, ecchymosis
• Hair: distribution, swan neck hairs
• Lesions: normal, acne vulgaris, keratosis (seborrheic, actinic, arsenic),
• Cancers: basal cell, squamous cell, melanoma, poor wound healing.

Fingernails, Toenails

• Shape: normal, koilonychia, parrot
• Color: normal, terry nails, leukonychia
• Texture: brittle, chipping nails
• Growth pattern changes: Beau’s lines, longitudinal ridging, nail beading
• Artificial surfaces: acrylic nails, or polished nails

Neurological exam

• Monofilament (5.07/10 g)
• Vibratory sense (128 Hz)
• Balance
• Standing (eyes closed)
• Single-leg stand (eyes closed)
• Motor- Timed Up and Go
• Smell test (cranial nerve 1)
• Taste test (bitter) (cranial nerves, 7, 9, 10)

Statistically Significant Associations (p ≤ 0.05) between Physical Exam/Anthropometric Findings and BioMarkers.

Abbreviations/Explanations: ANA—anti-nuclear antibody; Anti-CCP—anti-cyclic citrullinated peptide antibodies; BMI—Body Mass Index; BP—blood pressure; LDLp—LDL particle number; F/B ratio—Firmicutes/Bacteroidetes ratio; HbA1c—Hemoglobin A1c; HOMA-IR—homeostatic model assessment for insulin resistance; IgG—immune globulin G; RF—rheumatoid factor; sIgA—serum immune globulin A; TG—triglycerides; TPO—Thyroid peroxidase antibodies; TTG IgA—tissue transglutaminase immune globulin A; TTG IgG—tissue transglutaminase immune globulin G.

Statistically Significant Associations (p ≤ 0.05) between Biomarkers and Physical Exam/Anthropometric Findings.

Notable findings and patterns

• We noted significant expected associations between normal BMI vs. overweight and obese BMI and metabolic markers (HOMA-IR, HbA1c, hs-CRP, triglycerides, LDL particle number, elevated blood pressure).
• Paradoxically, being overweight was associated with a decreased firmicutes/bacteroidetes ratio and not associated with Akkermansia levels.
• Interestingly, being overweight or obese is significantly associated with decreased 25-OH vitamin D levels.
• Skin findings were frequently significantly associated with essential fatty acids levels.
  • Seborrhea was positively associated with omega-6 fatty acids levels, xerosis was positively associated with omega-3 fatty acids level
  • Both hyperkeratosis pilaris and acne vulgaris were negatively associated with omega-3 and omega-6 levels.
  • Lip cracking was also positively significantly associated with omega-6 levels and negatively associated with omega-3 levels.
  • Greater than 25% of participants had vertical ridging of their fingernails. Whereas vertical ridging can be a normal variant, it is also associated with maldigestion or malabsorption, autoimmune conditions such as rheumatoid arthritis and psoriasis, and peripheral circulatory inadequacy.
• IgG antibodies were significantly associated with tongue findings—both coating and fissuring as well as skin findings including seborrhea, hyperkeratosis pilaris, and acne vulgaris.
• Abnormal taste and smell perception and abnormal balance and grip strength were all negatively associated with 25-OH vitamin D levels.
• Half of our participants with a low BMI (<18.5 kg/m2) had a history of persistent inflammatory gastrointestinal conditions. Chronic inflammatory bowel conditions are associated with an increased incidence of nutrition insufficiency and abnormal biomarkers in over 20% of patients seen in the outpatient clinic setting and clinical malnutrition in 16 percent of IBD patients.

Reference

Stone, Michael et al. “LIFEHOUSE's Functional Nutrition Examination (Physical Exam, Anthropometrics, and Selected Biomarkers) Informs Personalized Wellness Interventions.” Journal of personalized medicine vol. 13,4 594. 28 Mar. 2023, doi:10.3390/jpm13040594 This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).