Lab Assessment Resource Tool

Lab Assessment Resource Tool

Lab Assessment Resource Tool

Please review the instructions prior to completing this worksheet.

TIP! As you learn about additional biomarkers in future classes, add those details to this tool to maximize its usefulness in your future clinical practice.

Biomarker

Above reference Range (HIGH)

Below Reference Range

(LOW)

Notes

Module 1, CMP Part 1

Glucose (serum)

Potential Nutritional Contributors:

·       High intake of sugary foods such as carbonated soda, fruit juices, and energy drinks.

·       Excessive and frequent intake of diet high in saturated fats such as processed meat, fast foods, and

Potential Clinical Nutrition Factors:

·       High docosahexaenoic acid, C22:6 (Ma et al., 2021).

Potential Nutritional Contributors:

·       Reduce protein intake, resulting in protein-energy malnutrition.

·       Reduced food intake caused by impaired nutrition absorption and potential loss of appetite.

Potential Clinical Nutrition Factors:

N/A

·       Use glycated hemoglobin A1c (HbA1c) alongside fructosamine and glycated albumin (GA) to increase its sensitivity to determining type 1 diabetes (Feskens et al., 2020).

·       GA is promising for determining glycemic exposures, but high-fat mass can compromise efficacy.

·        Low serum glucose results in inflammatory factors in 3T3-L1 cells and increases the activation of protein kinase B (Akt) and nuclear factor (NF-κB) signaling (Kugo et al., 2021).

·       Corticosteroids (e.g., prednisone): Can induce insulin resistance, leading to elevated blood sugar.

·       Insulin sensitivity may decrease with age, affecting glucose metabolism.

BUN

Potential Nutritional Contributors:

·       Intake of High protein diets.

·       High intake of processed foods, sweets, meat, seafood, and eggs (Syauqy et al., 2020)

·       Increase intake of dairy milk and products.

·       Emphasis on vegetables, grains, and fruits.

Potential Clinical Nutrition Factors:

·       Consumption of high-protein meals

·       Reduced fluid intake results in dehydration.

·       Impaired kidney function

·       Gastrointestinal bleeding

Potential Nutritional Contributors:

·       Low protein intake.

·       Excess fluid intake

·       Liver dysfunction.

Potential Clinical Nutrition Factors:

·       Crohn’s disease that impairs protein digestion and results in increased nitrogen production.

·       Anabolic steroid use that results in high protein utilization and contributes to nitrogenous waste.

·       High-processed foods such as milk products, processed meat, and sweets increase BUN levels, which increases the risk of chronic kidney disease (CKD)

·       Reducing protein consumption provides potential benefits in lowering the risk of CKD.

·       Assess the patient for signs of dehydration, especially the skin or orbital area.

·       Low protein diets can lower BUN but aggravate patient nutrition (Lee et al., 2022).

·       Monitor for incidences of increase in BUN concentration since it is associated with a higher risk of diabetes (Xie et al., 2018).

·        

Creatinine

Potential Nutritional Contributors:

·       Increased consumption of animal products and high total daily protein intake (Vukovic et al., 2023).

·       Low fluid intake

·       Excessing salt consumption

Potential Clinical Nutrition Factors:

N/A

Potential Nutritional Contributors:

N/A

Potential Clinical Nutrition Factors:

N/A

·       Increased creatinine levels contribute to a negative glomerular filtration rate.

·       Both low and high creatinine levels aid in assessing kidney function.

·       Assessing upper and lower body muscle mass wasting is important, especially if the patient does not engage in significant physical activity.

·       Use other kidney function markers such as BUN or estimated glomerular filtration rate (eGFR) when assessing kidney health.

·       Consider the gender and age of patients when assessing creatinine levels since the elderly and women tend to have lower creatinine levels regardless of normal kidney function (Suwanrungroj et al., 2024).

BUN/Creatinine Ratio

Potential Nutritional Contributors:

·       High animal protein intake, fast foods, and saturated fat diets.

Potential Clinical Nutrition Factors:

N/A

Potential Nutritional Contributors:

·       Reduced consumption of protein diets or substitution of such diets with Mediterranean diets.

Potential Clinical Nutrition Factors:

N/A

               N/A

Total Protein

Potential Nutritional Contributors:

·       Overconsumption of high-protein processed foods that exceed the recommended limit over an extended period (Campbell et al., 2015; Ortega et al., 2024).

·       Overconsumption of dairy products, including cheese

·       Excessive consumption of plant protein

Potential Clinical Nutrition Factors:

N/A

Nutritional Contributors/Needs:

·       Intake of plant protein such as beans and lentils.

·        

Lifestyle Contributors:

·       Chronic stress contributes to the elevation of stress hormones such as cortisol, which inhibit the secretion of albumin and globulin.

·       Intense training, such as resistance training or strength-building exercises, that result in muscle loss and protein synthesis.

·       Smoking

·       Following high-protein diets combined with weightlifting and bodybuilding.

·       Total protein helps in assessing the severity of illness, especially in determining kidney function, chronic inflammation, nutritional deficiency, and cancer.

·       High animal protein intake harms health as it is associated with higher-cause and all-cause mortality.

·       Physiological factors that can contribute to this biomarker include intense physical training or bodybuilding exercise that results in muscle loss.

·       Changes in Total protein can influence body composition.

·       Increased plant protein consumption benefits health since it is associated with reduced CVDs.

·       Plant-based diets, when not carefully planned, may increase the risk of malnutrition due to the lower bioavailability of certain amino acids and potential deficiencies in key micronutrients such as vitamin B12, iron, zinc, and vitamin D (Chen et al., 2020).

·       Assess the patient for decreased muscle mass that may indicate a reduction in muscle protein.

Albumin

Potential Nutritional Contributors:

·       Inadequate caloric intake.

·       Intake of high protein foods.

Potential Clinical Nutrition Factors:

N/A

Potential Nutritional Contributors:

·       Reduced intake of both proteins and calories.

·       Consumption of excessive refined carbohydrates.

Potential Clinical Nutrition Factors:

·       Electrolyte imbalance, such as deficiencies in magnesium and zinc.

·       Excessive alcohol consumption.

·       Malnutrition, which is common among hospitalized patients, increases the risk of elevated albumin, which results in higher morbidity and mortality (Bretschera et al., 2022).

·       Albumin serum concentrations are ineffective in determining patients who require nutritional interventions.

·       Low albumin concentration in hospitalized patients increases the risk of mortality.

·       Albumin cannot be used to assess nutritional status since its levels and clinical assessments are discordant (Eckart et al., 2020).

·       It is mostly used to assess nutritional status among the elderly.

Globulin

Potential Nutritional Contributors:

·       Consumption of a low-fat vegetarian diet.

·       Diets low in protein

·       Low-fat, high-fiber diets

·       Low glucemic load (GL) and glucemic index (GI) diets.

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

N/A

Potential Clinical Nutrition Factors:

·       Globulin functions as a biomarker for determining disease severity in inflammatory bowel disease (IBD) (Hashash et al., 2022).

·       Total protein, albumin, and C-reactive protein (CRP) can be considered alongside this biomarker.

·       Anlotinib drugs used in lung cancer patients increase the albumin-to-globulin ratio (AGR), which increases their overall survival (OS) (Chen et al., 2023).

·       Schizophrenia (SCH) and depression contribute to the alteration of TP, globulin, and albumin.

·       Highly active antiretroviral therapy (HAAT) contributes to high globulin levels.

Module 2, CMP Part 2

Sodium

Potential Nutritional Contributors:

·       Addition of high amounts of salt to food

·       Eating high-sodium foods such as herbal licorice, pizza, poultry, burgers, and egg dishes (Almeida et al., 2020).

Potential Clinical Nutrition Factors:

·       Dehydration which leaves sodium concentrated in the body.

·       Nasogastric feeding may also increase sodium levels (Almeida et al., 2020).

Potential Nutritional Contributors:

·       Low salt diets contribute to low sodium in the body.

·       Excessive water intake or administration can decrease sodium levels (Almeida et al., 2020).

Potential Clinical Nutrition Factors:

·       Diarrhea and vomiting trigger sodium loss trough the gut.

·       Excessive sweating causes sodium loss from the body.

·       Muscle wasting in severe malnutrition contributes to sodium loss through urine (Almeida et al., 2020). Lab Assessment Resource Tool

·       Sodium is a critical biomarker involved in maintaining fluid balance and neurotransmission.

·       Sodium levels in the blood is a marker of hydration status and renal function.

·       Sodium is also involved in acid base balance and regulating the blood pressure (Almeida et al., 2020).

·       Some medications such as lithium and mannitol may increase the sodium levels while drugs such as thiazide or loop diuretics may decrease the levels of sodium.

·       Pregnancy is associated with hormonal imbalances that cause fluid and sodium imbalances (Almeida et al., 2020).

·       Sodium is a critical determinant of blood pressure, and optimal levels should be maintained to prevent hypertension.

·       Blood pressure has been shown to be moderately controlled with the reduction in dietary sodium among individuals, blacks, persons with hypertension, and the middle-aged and older adults (Almeida et al., 2020).

·       Urinary sodium can be used to measure dietary intake of sodium.

·       Kidney failure, syndrome of inappropriate ADH (SIADH) and adrenal gland impairments are associated with dysregulation of sodium levels (Almeida et al., 2020). Lab Assessment Resource Tool

Potassium

Potential Nutritional Contributors:

·       Foods rich in potassium such as bananas and potatoes especially in when kidney function is suboptimal (Feskens et al., 2020). 

Potential Clinical Nutrition Factors:

·       Supplementation with potassium-rich substitutes may increase the potassium levels.

·       Dehydration is associated with high potassium levels (Vukovic et al., 2023).

Potential Nutritional Contributors:

·       Inadequate dietary intake due to poor or restrictive diets that do not have legumes, fruits, and vegetables.

·       Chronic malnutrition causes the depletion of potassium in the body.

·       Consumption of highly refined glucose diet and soda, which have minimal potassium (Feskens et al., 2020). Lab Assessment Resource Tool

Potential Clinical Nutrition Factors:

·       Diarrhea or vomiting causes gastrointestinal loss of potassium.

·       Use of licorice supplement excessively.

·       Magnesium deficiency increases the loss of potassium in urine (Vukovic et al., 2023).

·       Potassium is the major intracellular ion and helps in maintaining cellular function, neurotransmission, contraction of muscles, and heart rhythm (Vukovic et al., 2023).

·       Potassium is a critical component of the sodium potassium pump, which is necessary for cardiac cell functioning and maintaining osmotic equilibrium.

·       It is essential in the function of heart muscles; thus, imbalances highly impact heart function.

·       The levels of potassium should be evaluated in the context of other electrolytes such as sodium, chloride and bicarbonate to interpret on metabolic acidosis or alkalosis (Feskens et al., 2020).

·       Impaired kidney function reduces the excretion of potassium resulting in high levels.

·       Condition such as diabetic ketoacidosis triggers the movement of glucose into cells in exchange for potassium, leading to hyperkalemia.

·       Potassium sparing diuretics such as spironolactone are associated with increased potassium levels.

·       Referral to a nephrologist is critical for individuals with impaired renal function (Vukovic et al., 2023).

Chloride

Potential Nutritional Contributors:

·       Excessive consumption of chloride basically in the form of sodium chloride. Consumption of high sodium foods such as high salt content and processed foods.

·       Drinking salty water of saline solution may cause high chloride levels (EFSA Panel on Nutrition et al., 2019).

Potential Clinical Nutrition Factors:

·       Dehydration causes fluid loss and increases chloride concentration.

·       Hypernatremia is associated with elevated chloride levels as the two ions go together (Dharmarajan, 2021).

Potential Nutritional Contributors:

·       Inadequate salt intake in meals, given that salt is the main source of chloride (Syauqy et al., 2020). Lab Assessment Resource Tool

·       Low intake of sodium diets is associated with decreased chloride as it often accompanies the sodium ion.

·       Intake of excessive water could cause dilution of chloride levels.

·       Vomiting can also cause low chloride levels.

Potential Clinical Nutrition Factors:

·       Hyponatremia contributes to low chloride levels (EFSA Panel on Nutrition et al., 2019).

·       Chloride is an essential marker for assessing fluid balance and acid-base balance (EFSA Panel on Nutrition et al., 2019).

·       It is involved in the maintenance of osmotic pressure and balance of electrolytes in conjunction with sodium and bicarbonate.

·       Assessing the chloride levels should go hand in hand with the overall acid-base and electrolyte balance hence determining the levels of sodium, potassium and bicarbonate is critical (Syauqy et al., 2020).

·       Administration of hypertonic saline solutions could increase chloride levels whereas the use of loop diuretics and excessive bicarbonate use triggers low chloride levels.

·       Conditions of the respiratory system such as chronic obstructive pulmonary disease (COPD) impacts chloride levels through acid-base regulation (EFSA Panel on Nutrition et al., 2019).

·       A patient with respiratory conditions which affect acid base balance should be referred to a pulmonologist whereas kidney related chloride imbalances require review by the nephrologist.

CO2/Bicarbonate

Potential Nutritional Contributors:

·       Excessive consumption of bicarbonate rich supplements triggers high bicarbonate levels (Lee et al., 2022).

Potential Clinical Nutrition Factors:

·       High consumption of antacids contributes to alkaline levels characterized by high bicarbonate levels.

·       Vomiting can also trigger high bicarbonate levels through the loss of hydrogen ions (Hosohata, 2021).

Potential Nutritional Contributors:

·       Inadequate consumption of bicarbonate rich food could cause low levels although this is a rare scenario (Hosohata, 2021).

Potential Clinical Nutrition Factors:

·       Chronic diarrhea can cause loss of bicarbonate hence decreased levels (Lee et al., 2022). Lab Assessment Resource Tool

·       Bicarbonate is an essential buffer which helps in maintaining pH balance in the body and is critical in evaluating metabolic acidosis or alkalosis (Lee et al., 2022).

·       It buffers hydrogen ions maintaining the body’s acid-base balance and addressing changes in the pH thus keeping them in control (Hosohata, 2021).

·       Measurement of bicarbonate is done with other ions such as sodium, chloride and potassium to provide a picture of the body’s acid-base status.

·       Bicarbonate may be increased by excessive consumption of antacids and diuretics such as thiazides.

·       Diabetic ketoacidosis and lactic acidosis contribute to the depletion of bicarbonate as the body tries to neutralize the excessive hydrogen ions (Hosohata, 2021).

·       Kidney damage results in poor excretion of hydrogen ions and depletion of bicarbonate leading to reduced levels.

·       Compensatory mechanisms for chronic respiratory or metabolic disorders can cause variations in bicarbonate levels (Lee et al., 2022).

·       An endocrinologist is needed to address conditions such as diabetic ketoacidosis while a nephrologist will be consulted in case a client has renal issues.

Anion Gap

Potential Nutritional Contributors:

·       High consumption of processed or acidic foods contributes to a higher load of metabolic acid, thus increasing the anion gap (Ortega et al., 2024).

Potential Clinical Nutrition Factors:

·       Excessive protein consumption may cause metabolic acidosis and eventually high anion gap (Haber et al., 2023).

·       Ingestion of toxins such as salicylates, ethylene glycol or methanol increases the anion gap.

Potential Nutritional Contributors:

·       The anion gap is lower with the consumption of excessive alkaline foods and drinks sch as antacids and bicarbonate supplements (Haber et al., 2023).

Potential Clinical Nutrition Factors:

·       Low protein diet reduces the acid load and closes on the anion gap (Ortega et al., 2024).

·       The anion gap may also be lowered by low albumin levels and hyponatremia.

·       The anion gap is a measure to evaluate acid-base imbalances and associated disorders. Lab Assessment Resource Tool

·       It offers insight into kidney function, electrolyte balance and establishes what is contributing to metabolic acidosis (Ortega et al., 2024).

·       A high anion gap symbolizes metabolic acidosis whereas decreased gap may be suggestive of bromide intoxication (Vukovic et al., 2023).

·       Kidney disease adversely affects the excretion of ions thus increasing the anion gap. Diseases like diabetes is associated with ketone production and an associated elevation in the anion gap (Ortega et al., 2024).

·       A nephrologist referral is necessary for imbalances resulting from renal dysfunction whereas endocrine conditions such as diabetes should be sent to the endocrinologist (Vukovic et al., 2023).

Calcium

Potential Nutritional Contributors:

·       Excessive intake of calcium from supplements and fortified foods could result in hypercalcemia (Daley & Myrie, 2021). Lab Assessment Resource Tool

Potential Clinical Nutrition Factors:

·       Vitamin D toxicity is associated with increased gastrointestinal calcium absorption (Guo et al., 2021).

Potential Nutritional Contributors:

·       Inadequate intake of calcium rich foods such as fish, dairy, nuts and vegetables especially during childhood (Xie et al., 2018).

Potential Clinical Nutrition Factors:

·       Vitamin D deficiency in the body triggers low calcium levels since vitamin D is critical in its absorption.

·       Magnesium deficiency impairs calcium regulation and decreases its levels (Guo et al., 2021). Lab Assessment Resource Tool

·       Calcium is a critical biomarker of the bone health and the functioning of the parathyroid system (Guo et al., 2021).

·       It is involved in maintaining bone structure, neurotransmission, muscle functioning and blood clotting (Xie et al., 2018).

·       Calcium is also involved in the activation of enzymes and cell signals.

·       The levels of calcium should be interpreted in the context of albumin levels whose low levels could cause a wrong interpretation of calcium levels (Xie et al., 2018).

·       Medications which increase calcium include calcium supplements, lithium and thiazide diuretics while corticosteroids and bisphosphonates may decrease calcium levels (Xie et al., 2018).

·       Calcium demands are increased in pregnancy to facilitate bone development in the growing fetus.

·       In old age there is reduced calcium absorption and the risk of bone loss is increased (osteoporosis) predisposing to bone fractures.

·       Deficiency or increased vitamin D levels affect calcium absorption and contribute to imbalances.

·       Suspected disorders related to vitamin D as well as hyperparathyroidism require that the patient is sent to an endocrinologist.

·       Bilirubin, Total

Potential Nutritional Contributors:

·       Consumption of fatty and fried foods could increase pressure on the liver and slow down bilirubin processing thus increasing its concentration (Lee et al., 2022).

Potential Clinical Nutrition Factors:

·       Starvation increases the levels of bilirubin in the body given that glucuronidation is impaired (Creeden et al., 2021).

·       A low protein diet may also affect liver function thus increasing bilirubin which is usually processed by the liver.

·       A desired nutritional outcome.

·       Low bilirubin levels are rarely clinically significant (Tymchuk et al., 2000).

·       Bilirubin levels are indictors of how the liver is functioning, hemolysis ad metabolism of bile (Tymchuk et al., 2000).

·       It is a byproduct arising from the breakdown of hemoglobin after which it goes to the liver for excretion.

·       Elevated levels of bilirubin should be reviewed together with other liver enzymes such as ALT, ALP, AST to provide an overview of the liver function concentration (Lee et al., 2022).

·       Bilirubin production may be increased by some antibiotics such as amoxicillin and chemotherapy agents including Irinotecan.

·       The underdeveloped liver function among neonates could contribute to elevated bilirubin kevels and subsequently jaundice (Tymchuk et al., 2000).

·       Viral infections of the liver such as hepatitis increase the bilirubin levels given that the liver expected to process it is injured and unable to function optimally.

·       A gastroenterologist or hepatologist should be consulted to handle elevations resulting from gastrointestinal or liver disorders concentration (Lee et al., 2022). 

Alkaline Phosphatase (ALP)

Potential Nutritional Contributors:

·       Intake of high phosphorus amounts from dairy, fish, whole grains and nuts  increases the ALP levels (Hashash et al., 2022).

Potential Clinical Nutrition Factors:

·       ALP levels can be elevated by compensatory mechanisms when there is excessive calcium, especially in the face of underlying bone condition (Chen et al., 2020).

Potential Nutritional Contributors:

·       Malnutrition in which a client lacks protein and calories may result in low ALP levels (Hashash et al., 2022).

Potential Clinical Nutrition Factors:

·       Deficiencies in zinc, magnesium and vitamin B6 is associated with low ALP since these micronutrients are critical in its enzymatic activity.

·       ALP is also reduced by vitamin D deficiency which impairs bone mineralization (Hashash et al., 2022).

·       ALP is a biomarker for the health of the bones and liver and can be used to diagnose liver dysfunction, bone disease and blockages in the biliary tract (Hashash et al., 2022).

·       It is highly concentrated in the liver, bones and kidneys and is essential in the breakdown of proteins (Chen et al., 2020).

·       Elevation in alkaline phosphatase is suggestive of an underlying condition affect the bone or the liver and the biliary tract.

·       A bone disorder is suspected when a patient presents with elevated ALP and normal liver enzymes (Hashash et al., 2022). Lab Assessment Resource Tool

·       Medications such as phenytoin could increase ALP lees, but it is reduced in hypothyroidism and zinc deficiency (Chen et al., 2020).

·       Naturally children and teens have high ALP levels given that they are in a period of increased bone growth.

·       Placental activity particularly towards the end of pregnancy increases ALP due to production of the same biomarker in the placenta.

·       Clients with suspected bone disorders should be referred to the endocrinologists while those with conditions affecting the liver and the biliary tract should be referred to the hepatologist (Hashash et al., 2022).

Alanine Aminotransferase (ALT)

Potential Nutritional Contributors:

·       High fat diets elevate the ALT by damaging the liver through the development of non-alcoholic fatty liver disease (Eckart et al., 2020).

Potential Clinical Nutrition Factors:

·       High alcohol consumption causes liver damage thus raising the ALT levels.

·       Muscle injury also contributes to elevated ALT given that it is also found in these tissues (Chen et al., 2023).

Potential Nutritional Contributors:

·       ALT may be decreased when one takes food that is low in carbohydrates and protein, denying one the nutrients required for ALT production (Eckart et al., 2020).

Potential Clinical Nutrition Factors:

·       Vitamin B6 (pyridoxine) deficiency is associated with low ALT, given that it is a coenzyme in its activity (Chen et al., 2023).

·       ALT is a liver enzyme hence used to evaluate hepatic function especially where there is liver injury (Eckart et al., 2020).

·       The biomarker is used in the metabolism of amino acids and gets into the bloodstream upon destruction of injury of the liver cells.

·       ALT is more specific in highlighting liver damage compared to AST, and is suggestive of liver damage especially when the AST is also increased (Eckart et al., 2020). Lab Assessment Resource Tool

·       Overdose of acetaminophen and statins can cause high ALT due to damage of the liver cells.

·       Low ALT is generally not a cause for alarm but may be seen in severe liver disease.

·       ALT is elevated on obesity due to increased fat storage and chronic consumption of alcohol (Chen et al., 2023).

·       Patients with a possible liver condition should be seen by the hepatologist and gastroenterologist (Eckart et al., 2020).

Aspartate Amino-Transferase (AST)

Potential Nutritional Contributors

·       High caloric and carbohydrate high diets are associated with increased transaminase activity in blood thus resulting in elevated AST (Campbell et al., 2015).

·       Eating foods high in saturated fat such as beef and pork is associated with increased AST given that they increase the amount of fat in the liver (Rivera et al., 2021).

·       High alcohol consumption also increases AST levels, and this is aways out of proportion when compared with the levels of ALT rise (Campbell et al., 2015).

Potential Clinical Nutrition Factors:

·       Muscle trauma can increase the levels of AST as it is also found in the muscles (Rivera et al., 2021).

Potential Nutritional Contributors:

·       This is mostly not a cause of concern.

Potential Clinical Nutrition Factors:

·       Vitamin B6 deficiency is associated with reduced AST levels. 

·       AST is a biomarker for damage to the liver or an injury to the muscles.

·       AST is used in conjunction with ALT to evaluate the function of the liver (Campbell et al., 2015).

·       The enzyme is required in the metabolism of amino acids and gets to the bloodstream in case of damage to the liver cells or muscle cells (Campbell et al., 2015).

·       Given that it is also found in the muscles, AST is a less specific measure of liver function.

·       The AST/ALT ratio is used to provide insight into different types of liver conditions (Campbell et al., 2015).

·       Increased AST levels may be seen in case of acetaminophen overdose and statins use. Lab Assessment Resource Tool

·       Having a lot of muscle mass can be associated with elevated AST levels particularly in the event of muscle damage (Rivera et al., 2021).

·       Lower levels of AST can be evident when a person has wasting leading to lose of muscle mass or sever liver disease (Shibata et al., 2019).

·       Clients suspected to have liver issues should be sent to the hepatologist while a Rheumatologist or Orthopedist will address AST elevation arising from muscle conditions (Rivera et al., 2021).

Gamma Glutamyl- Transferase (GGT)

Potential Nutritional Contributors:

·       High fat and red meat diet increase GGT due to the liver damage and high concentration of heme iron (Suwanrungroj et al., 2024).

Potential Clinical Nutrition Factors:

·       Excessive alcohol consumption is a major cause of elevated GGT (Kugo et al., 2021) . Lab Assessment Resource Tool

·       A desired nutritional outcome (Kugo et al., 2021).

·       GGT is a biomarker for liver and biliary tract conditions (Kugo et al., 2021).

·       It sensitively helps to rule out conditions arising from alcohol use and some drugs (Suwanrungroj et al., 2024).

·       The biomarker works by aiding the movement of amino acids across the cell membrane, in the liver and bile ducts.

·       Liver disease from alcohol use, cholestasis and obstruction of the bile duct are associated with high GGT levels (Kugo et al., 2021).

·       GGT is a more sensitive indicator of damage to the liver compared to the other liver enzymes.

·       Alcohol, rifampin and other hepatotoxic drugs are associated with elevated GGT levels.

·       A low GGT has no clinically significant impact (Suwanrungroj et al., 2024).

·       The patient should be seen by the hepatologist or gastroenterologist in case the reason for imbalance is liver related or gastrointestinal related respectively (Suwanrungroj et al., 2024).

Module 3 CBC part 1

Total RBC

Potential Nutritional Contributors: High intake of iron-rich foods (e.g., red meat, fortified cereals), excessive iron supplementation

Potential Clinical Nutrition Factors: Polycythemia vera, dehydration causing hemoconcentration

Potential Nutritional Contributors: Low intake of iron, vitamin B12, or folate, poor dietary intake, malabsorption

Potential Clinical Nutrition Factors:

N/A Lab Assessment Resource Tool

·       Monitor hydration levels, as dehydration can falsely elevate RBC count.

·       Evaluate dietary history for iron and vitamin intake.

·       Chronic dehydration can lead to an artificially high RBC count.

·       Assess for iron overload in cases of excessive supplementation.

·       Consider testing for underlying conditions such as anemia.

Hemoglobin

Potential Nutritional Contributors: Increased intake of heme iron

Potential Clinical Nutrition Factors: Chronic hypoxia, smoking, dehydration

Potential Nutritional Contributors: Deficiency in iron, vitamin B12, or folate, vegetarian diets without supplementation.

Potential Clinical Nutrition Factors:

N/A Lab Assessment Resource Tool

·       Assess dietary intake, particularly in vegetarian or vegan individuals.

·        Check for signs of bleeding or hemorrhage(Pfeiffer et al., 2013)  

·       Supplement with B12 and iron if necessary.

·       Evaluate for other underlying chronic diseases..

·       Address malabsorption issues that may affect nutrient absorption.

·       Hematocrit

·       Potential Nutritional Contributors: High iron intake, dehydration

·       Potential Clinical Nutrition Factors: COPD, living at high altitudes

·       Potential Nutritional Contributors: Low intake of iron, vitamin B12, or folate

·       Potential Clinical Nutrition Factors:

·       N/A Lab Assessment Resource Tool

MCV

Potential Nutritional Contributors: Excessive alcohol intake, high folate supplementation

Potential Clinical Nutrition Factors: Vitamin B12 or folate deficiency

Potential Nutritional Contributors: Low intake of iron, chronic malnutrition

Potential Clinical Nutrition Factors: Thalassemia, anemia of chronic disease

·       Assess macrocytic anemia causes (e.g., folate or B12 deficiency) if MCV is high.

·       Low MCV often indicates microcytic anemia (e.g., iron deficiency).

·       Monitor alcohol intake and its impact on MCV levels.

·       Consider other vitamin deficiencies when MCV is high.

·       Evaluate underlying diseases like liver disorders.

MCH

Potential Nutritional Contributors: Overconsumption of fortified foods (high in folate or B12)

Potential Clinical Nutrition Factors: Macrocytosis

Potential Nutritional Contributors: Low intake of iron

Potential Clinical Nutrition Factors: Microcytic anemia

·       Monitor MCH levels to assess anemia severity.

·        Overconsumption of fortified foods may mask deficiencies.

·       Consider the type of anemia when MCH is low.

·       Track B12 and folate levels regularly.

·       Provide appropriate supplementation for identified deficiencies.

MCHC

Potential Nutritional Contributors: Excessive vitamin C supplementation (affects iron absorption).

Potential Clinical Nutrition Factors: Spherocytosis, hereditary disorders

Potential Nutritional Contributors: Low intake of iron

Potential Clinical Nutrition Factors: Chronic blood loss

·       Helps identify types of anemia (e.g., hypochromic anemia).

·       Consider with RDW and RBC for anemia diagnosis.

·       Correct vitamin C supplementation if levels are excessive.

·       Evaluate for hereditary blood disorders like spherocytosis.

·       Regularly monitor MCHC in patients with chronic blood disorders.

RDW

Potential Nutritional Contributors: Variable iron intake, malabsorption

Potential Clinical Nutrition Factors: Mixed anemia types, nutritional deficiencies

A desired nutritional outcome.

Achieve balanced iron intake and correct malabsorption to improve red cell distribution.

·       High RDW often requires correlation with MCV for diagnosis.

·       Assess for variable iron intake and malabsorption.

·       Evaluate for mixed anemia types if RDW is high.

·       Malabsorption may require additional supplementation.

·       A high RDW can suggest nutrient deficiencies, which should be addressed (Brindle et al., 2014)

Platelets (count)

Potential Nutritional Contributors: Diets high in inflammatory foods (e.g., saturated fats)

Potential Clinical Nutrition Factors: Infection, chronic inflammation

Potential Nutritional Contributors: Malnutrition, alcohol use

Potential Clinical Nutrition Factors:

N/A Lab Assessment Resource Tool

·       Investigate diet history for inflammatory triggers.

·       Monitor platelet levels in response to diet and inflammation.

·       Ensure adequate intake of anti-inflammatory nutrients.

·       Correct malnutrition or alcohol use contributing to platelet dysfunction.

·       Use platelet count in conjunction with other blood markers for diagnosis.

Serum iron

Potential Nutritional Contributors: High intake of iron supplements

Potential Clinical Nutrition Factors: Hemochromatosis, acute liver disease

Potential Nutritional Contributors: Low intake of heme and non-heme iron

Potential Clinical Nutrition Factors: Chronic blood loss, malabsorption

·       Pair with ferritin for a complete iron assessment.

·       Excessive iron supplementation can lead to toxicity.

·        Assess serum iron alongside total iron binding capacity (TIBC).

·       Monitor serum iron regularly in patients at risk for iron overload.

·       Consider the patient’s liver function when evaluating serum iron levels.

Total Iron Binding Capacity (TIBC)

Potential Nutritional Contributors: Iron-deficient diet

Potential Clinical Nutrition Factors: Iron deficiency anemia

Potential Nutritional Contributors: Excessive iron intake

Potential Clinical Nutrition Factors: Chronic diseases (e.g., liver disease)

% Transferrin Saturation

Potential Nutritional Contributors: Excessive iron or vitamin C supplementation

Potential Clinical Nutrition Factors: Hemochromatosis

Potential Nutritional Contributors: Poor dietary iron intake, low protein intake

Potential Clinical Nutrition Factors: Iron deficiency anemia

·       High transferrin saturation is often associated with iron overload.

·       Low transferrin saturation suggests iron deficiency.

·       Monitor transferrin saturation alongside ferritin and TIBC.

·       Iron supplementation should be carefully monitored to prevent excess saturation (Pfeiffer  et al., 2013)

·       Use transferrin saturation as a diagnostic tool for iron overload or deficiency.

Ferritin

Potential Nutritional Contributors: High iron intake or supplementation

Potential Clinical Nutrition Factors: Chronic inflammatory states, liver disease

Potential Nutritional Contributors: Low iron intake

Potential Clinical Nutrition Factors: Iron-deficiency anemia, chronic blood loss

·       Ferritin is the most reliable biomarker for iron stores in the body.

·       Correlate with other iron markers (serum iron, TIBC).

·       Low ferritin typically indicates depleted iron stores (Pfeiffer & Looker, 2017)

·       Consider chronic inflammation, which can elevate ferritin levels despite low iron stores.

·       Use ferritin to assess iron status in patients with liver disease.

Module 4, CBC Part 2

Total WBC

Potential Nutritional Contributors:

·       High iron intake such as from red meat promotes oxidative stress and raise the WBCs.

·       Intake of high saturated fats.

·       Consumption of excessive processed foods and refined sugars (Pfeiffer & Looker, 2017).

·       Dehydration makes WBC seem elevated due to increased concentration.

Potential Clinical Nutrition Factors:

·       Consumption of pro inflammatory foods such as processed meats and refined sugar (Brindle et al., 2014).

·       Poor antioxidant intake e.g. low vitamin C, vitamin E, selenium and polyphenols leading to oxidative stress.

·       High stress levels triggering  cortisol producton and high WBC (Pfeiffer & Looker, 2017).

Potential Nutritional Contributors:

·       Deficiency in B12, folate, iron, and protein which are essential in production of WBC.

·       Low protein intake reducing amino acids needed for WBC synthesis.

·       Excessive alcohol consumption suppresses bone marrow activity and WBC production (Brindle et al., 2014).

·       Insufficient intake of zinc and selenium essential for WBC synthesis.

Potential Clinical Nutrition Factors:

·       Chronic stress reduces WBC synthesis.

·       Nutrient malabsorption inhibits the absorption of essential B12, folate, iron, and protein needed for WBC synthesis.

·       Oxidative stress exerts strain on immune function and lowers WBC.

·       White blood cells evaluate the immune response and infection status.

·       High WBC count suggests inflammation, infection or stress.

·       Reduced WBCs are suggestive of nutritional deficiencies or immune suppression.

·       WBCs should be assessed together with neutrophils, lymphocytes, monocytes, ESR and CRP (Pfeiffer & Looker, 2017).

·       WBCs are lowered by drugs such as corticosteroids and chemotherapy (Brindle et al., 2014).

·       Aging and chronic stress may also lower WBCs.

·       Referral to hematologist or immunologist is needed when there is persistently elevated or low WBC.

Neutrophils

Potential Nutritional Contributors:

·       High omega-6 fatty acid intake from vegetable oils ad fast foods.

·       Excessive caffeine consumption stimulating stress hormones.

·       Low fiber diet reducing diversity of gut microbiota (Brindle et al., 2014).

Potential Clinical Nutrition Factors:

·       Leaky gut or digestive dysfunction increase permeability ad activate neutrophils. Lab Assessment Resource Tool

·       Oxidative stress.

·       Exposure to environmental toxins which could be in food (Pfeiffer et al. 2013).

Potential Nutritional Contributors:

·       Deficiencies in Copper, B12, folate which are needed in neutrophil synthesis.

·       Excessive intake of sugar depressing the immune system. Lab Assessment Resource Tool

·       Low protein intake impacting cell formation (Brindle et al., 2014).

Potential Clinical Nutrition Factors:

·       Exposure to toxins such as heavy metals and pesticides suppressing neutrophil activity.

·       Processed foods cause oxidative stress and disrupt immune cell function.

·       Chronic inflammation can cause neutrophil depletion (Pfeiffer & Looker, 2017).

·       Neutrophils are key indicators of bacterial infections and acute inflammation.

·       High levels of neutrophils suggest stress or infection and low levels may indicate immune suppression or chronic illness.

·       Neutrophils should be assessed together with WBC, CRP and ESR (Brindle et al., 2014).

·       Chemotherapy and immunosuppressants can decrease neutrophil levels.

·       Acute stress, smoking and exercise can increase neutrophils acutely.

·       Neutropenia requires referral to a hematologist when the levels are persistently low (Pfeiffer & Looker, 2017).

Lymphocytes

Potential Nutritional Contributors:

·       Increased antioxidant supplements such as vitamin C and E overstimulating immune function.

·       Excessive polyphenols from herbal teas, turmeric, or green tea (Pfeiffer & Looker, 2017).

·       Frequent fasting triggering stress immune response.

Potential Clinical Nutrition Factors:

·       Endurance exercise results in oxidative stress and high lymphocytes.

·       Exposure to toxins such as pesticides and mold toxins activating immune response.

·       High stress lowering neutrophils and increasing lymphocytes (Brindle et al., 2014).

Potential Nutritional Contributors:

·       Low vitamin D, C and omega acids weakening the immune response and lymphocyte activation (Brindle et al., 2014).

·       Low calorie due or fasting decrease lymphocyte count.

·       Inadequate intake of polyphenol which is essential in immune modulation.  

Potential Clinical Nutrition Factors:

·       Chronic stress impairs immune function and lymphocyte production.

·       Environmental toxins destroy immune cells (Pfeiffer & Looker, 2017).

·       Chronic sleep deprivation lowers immune function and reduces lymphocyte count.

·       Lymphocyets regulate adaptive immunity and response to vital infection.

·       High levels are suggestive of viral infection or autoimmune disorder.

·       Reduced lymphocytes are suggestive of immune suppression (Brindle et al., 2014).

·       Measurement should be made in the presence of other markers such as WBC, neutrophils and ESR.

·       Corticosteroids, chemo and radiotherapy are associated with lower lymphocytes.

·       Fasting can reduce the number of lymphocytes.

·       Lymphopenia in the presence of chronic infection need referral to the immunologist (Brindle et al., 2014).

Monocytes

Potential Nutritional Contributors:

·       High cholesterol meals and red meat causing systemic inflammation.

·       Iron overload leading to oxidate stress.

·       Low omega3 intake reduces anti-inflammatory activity increasing monocyte levels (Brindle et al., 2014).

Potential Clinical Nutrition Factors:

·       Poor dietary habits increase monocyte levels due to chronic inflammation.

·       Sedentary lifestyle causes low- rate inflammation systemically and increases monocyte activity.

A desired nutritional outcome.

Potential Nutritional Contributors:

·       Poor nutritional intake of B12, folate, and zinc which are essential in monocyte development. Lab Assessment Resource Tool

·       Deficiency in omega 3 reducing monocyte function.

·       Low intake of fiber and plant-based foods impacting immune balance due to impaired gut microbiota (Brindle et al., 2014).

Potential Clinical Nutrition Factors:

·       Chronic inflammation causes monocyte depletion. Lab Assessment Resource Tool

·       Digestive dysfunction reduces absorption of nutrients essential for monocyte function.

·       Exposure to environmental toxins impairs bone marrow synthesis of monocytes.

·       Monocytes are critical in addressing chronic inflammation and facilitating tissue repair (Pfeiffer et al. 2013).

·       High levels are evident in chronic infections or inflammation.

·       Related biomarkers include WBC, CRP, ESR and monocytosis should always have these other factors considered.

·       Reduced levels are suggestive of immune deficiency (Pfeiffer & Looker, 2017).

·       An hematologist should evaluate patient with persistent monocytosis which may be suggestive of chronic infection or hematologic disorders.

·       Levels may also be lowered by chronic alcohol consumption and corticosteroids (Pfeiffer et al. 2013).

Eosinophils

Potential Nutritional Contributors:

·       Allergies from foods such as dairy, gluten, soy, nuts, shellfish trigger immune response (Brindle et al., 2014).

·       High histamine foods such as fermented foods, alcohol and aged cheese activate eosinophil activation.

·       Excessive sugar intake worsening inflammatory response.

Potential Clinical Nutrition Factors:

·       Gut dysbiosis triggers allergic response.

·       High stress elevating histamine levels and eosinophil count.

·       Immune hyperactivity may be caused by exposure to toxins leading to high eosinophil levels (Pfeiffer et al. 2013).

A desired nutritional outcome.

Potential Nutritional Contributors:

·       Vitamin C, zinc and selenium deficiency (Pfeiffer et al. 2013).

·       Excessive caffeine intake.

·       Low intake of plant-based antioxidants.

Potential Clinical Nutrition Factors:

·       Chronic stress ad high cortisol.

·       Poor diet and oxidative stress causing disrupted immune regulation (Pfeiffer & Looker, 2017).

·       Eosinophils are mediators of allergic reactions, immune reactions, or parasitic infections.

·       They are elevated in the presence of allergies or bacterial infection.

·       Low levels of eosinophils are not clinically significant.

·       Eosinophils should be assed together with WBC, IgE and histamine levels.

·       Seasonal allergies, asthma, and food sensitivities may contribute to eosinophilia (Brindle et al., 2014).

·       Levels are reduced by antihistamines and corticosteroids. Patients with asthma or season allergies require review by immunologist due to persistent eosinophilia.

Basophils

Potential Nutritional Contributors:

·       Basophils are increased by histamine rich foods including fermented foods and alcohol.

·       Deficient omega-3 fatty acids reduce anti-inflammatory pathways (Pfeiffer & Looker, 2017).

·       Processed sugars causing immune hyperactivity.

Potential Clinical Nutrition Factors:

·       Chronic inflammation and stress increase histamine release and subsequently basophil levels (Brindle et al., 2014).

·       Poor digestive function such as leaky gut and low gastric acid could trigger basophil activation.

·       High exposure to airborne allergens.

A desired nutritional outcome.

Potential Nutritional Contributors:

·       Reduced intake of histamine containing foods such as aged cheese and fermented foods.

·       Reduced vitamin B6 and magnesium intake (Pfeiffer & Looker, 2017).

Potential Clinical Nutrition Factors:

·       Chronic stress and prolonged exercise increase cortisol and reduces basophils.

·       Chronic inflammation reduces immune reserves.

·       Basophils regulate inflammation, allergic reaction and histamine release.

·       Elevated levels suggest allergy or inflammation.

·       Related biomarkers that should be assessed together are WBC and IgE (Brindle et al., 2014).

·       Basophil levels reduce in the presence of antihistamines and corticosteroids.

·       Chronic allergy symptoms with basophilia may require allergy and hematologist referral (Pfeiffer et al. 2013).

Erythrocyte Sedimentation Rate (ESR)

Potential Nutritional Contributors:

·       High trans-fat consumption from processed foods and refined sugars triggers chronic inflammation (Brindle et al., 2014).

·       Poor intake of anti-inflammatory foods such as turmeric, berries, and leafy greens.

Potential Clinical Nutrition Factors:

·       Smoking triggers inflammation increasing ESR.

·       Pollutants and poor diet also raise the inflammation markers.

·       Sedentary lifestyle is associated with systemic inflammation.

A desired nutritional outcome.

Potential Nutritional Contributors:

·       Consumption of leafy green vegetables

·       Eating whole grains and spices such as turmeric, ginger and garlic to reduce inflammation. Lab Assessment Resource Tool

Potential Clinical Nutrition Factors:

·       Maintaining hydration to prevent muscle damage (Pfeiffer et al. 2013).

·       Refraining from junk foods to avoided saturated trans fats that cause inflammation.

·       ESR measures the rate at which RBCs settle, especially with inflammation.

·       High ESR is  marker of chronic inflammation (Pfeiffer & Looker, 2017).

·       Elevated ESR indicates autoimmune disease, infection or inflammation.

·       Levels should be measured along with CRP, WBC and fibrinogen (Brindle et al., 2014). Lab Assessment Resource Tool

·       NSAIDs and corticosteroids reduce the level of ESR.

·       Rheumatology consult is needed for clients with persistent ESR elevation with unexplained inflammation.

C-Reactive Protein (CRP)

Potential Nutritional Contributors:

·       Consumption of refined sugars and processed foods that have high trans fats associated with chronic inflammation.

·       Low omega-3, polyphenols and fiber consumption increasing inflammation since these are anti-inflammatory (Brindle et al., 2014).

·       Low fiber diet triggers gut dysbiosis and chronic inflammation.

Potential Clinical Nutrition Factors:

·       Smoking, pollutants and poor diet trigger exudative stress resulting in elevated CRP due to inflammation (Pfeiffer et al. 2013).

·       Lack of exercise triggers high CRP due systemic inflammation.

·       Exposure to toxins such as heavy metals and pollution increase CRP activity (Brindle et al., 2014).  

·       CRP is also increased by chronic sleep deprivation.

A desired nutritional outcome.

Potential Nutritional Contributors:

·       Consumption of high fiber diet.

·       Consumption of dark green leafy vegetables.

·       Eating spices such as turmeric, ginger, and cinnamon.

Potential Clinical Nutrition Factors:

·       Maintaining optimal body mass index reduces inflammation.

·       Reducing trans fats from fried diet (Pfeiffer et al. 2013). Lab Assessment Resource Tool

·       It is a sensitive marker of acute inflammation and cardiovascular risk.

·       Elevated CRP suggests systemic inflammation or infection.

·       It should be measured along with ESR, fibrinogen, WBC (Pfeiffer et al. 2013).

·       CRP is elated with habits such as obesity, smoking and sedentary lifestyle (Pfeiffer & Looker, 2017).

·       Cardiology or rheumatology evaluation i.e. necessary for elevated CRP without known infection (Brindle et al., 2014).

Module 5, Micronutrients

Retinol, plasma

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

25(OH)D

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

PLP, plasma

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

N/A

Folate, RBC

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

N/A

Cobalamin, serum

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Magnesium (RBC)

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Zinc, plasma

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Copper, serum

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Ceruloplasmin

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Selenium, plasma and RBC

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Module 6 Lipids & Blood Sugar Regulation

HbA1C

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

N/A

Insulin

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

N/A

Cholesterol

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

LDL

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

HDL

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors: Lab Assessment Resource Tool

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

TGs

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors: Lab Assessment Resource Tool

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

ApoA1

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Apo B

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors: Lab Assessment Resource Tool

A desired nutritional outcome.

Lp(a)

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

A desired nutritional outcome.

LDL Pattern A

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

N/A

LDL Pattern B

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors:

A desired nutritional outcome.

Uric Acid

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors: Lab Assessment Resource Tool

Potential Nutritional Contributors:

Potential Clinical Nutrition Factors: