Nutrition-Focused Physical Exam Cheat Sheet
For Micronutrients (mostly)
Body Healthy Abnormal Significance of abnormal
System
Hair1,2 Normal Thin, dull, dry, brittle, Chemo, protein/ biotin deficiency
distribution, corkscrew Vitamin C Deficiency
shiny Hair Loss Deficiency in iron, vitamin D, zinc, or
selenium
Eyes1 Bright, clear, Sunken, dull, pale, dry Deficiency of vitamin A, zinc,
pink conjunctiva conjunctiva, light sensitivity riboflavin
Lips1,5 Moist, good Swollen, dry, cracked, red, Deficiency riboflavin, pyridoxine,
color cracks in corners of mouth, niacin, thiamine, B12, iron
ulcers in mouth
Gums1 Pink, firm Sore, spongy, red, swollen, Deficiency Vitamin C
bleed easily
Tongue1,5 Pink, presence of Purple, white or gray coating, Deficiency riboflavin, pyridoxine,
papillae smooth, slick, inflamed/ painful folate, niacin, vitamin B12, iron
Skin1 Smooth slightly Pale, scaly, dry, bruises easily, Deficiency iron, vitamin A/C, zinc,
moist, good color pressure ulcers, dermatitis fatty acid, protein; excess niacin
Legs1 Well developed, Calf tenderness, flaccid Deficiency protein, vitamin A/C/D,
firm muscles, pain, edema, bone or calcium
musculature joint pain
Nails1,3,4 Smooth • Brittle nails • Hypothyroid, Deficiency iron, zinc
(shows Note: nails • Soft or weak nails • Deficiency Vitamin D, A, B
nutrition exposed vitamins, calcium, iron, fatty acids
for the frequently to • Peeling • Deficiency iron
past 6 water/soap may • Ridges- horizontal • Kidney disease, zinc Deficiency
months) be soft or tear • Ridges- vertical/ nail • Deficiency iron, calcium
easily such as splitting
from frequent • Horizontal white bands • Deficiency calcium, zinc,
hand washing, riboflavin; chemotherapy
doing dished,
frequent • Half-moons disappear • Depression, anemia, malnutrition
manicures. (not everyone has them, but if
they lose them that is significant)
• Spoon-shaped nails • Hypochromic anemia, Deficiency
iron, vitamin C, malnutrition
• Nails separating from the • Deficiency calcium, iron
nail bed
• Dark spots/thick lines on • Deficiency B12
nails (hyperpigmentation)
• Splinter hemorrhages (very • Deficiency vitamin C
thin dark lines)
Lindsey Zirker Nutrition Consulting, 2022
Nutrition-Focused Physical Exam Cheat Sheet
For Micronutrients (mostly)
How to use this guide
Malnutrition is often considered from a protein malnutrition side. This guide is more focused on helping
you assess for micronutrient deficiency by looking at patterns in symptoms to better identify how to
support your patient’s health. It can provide signposts so you better know where you might look to help
resolve symptoms. Other points of data can validate your nutrition diagnosis. You can use:
• 3-day food log to estimate intake vs estimated need
• Medications which may impact nutrient status
• Health history- diseases/ conditions which may indicate an increased nutrient need or increased
risk for Deficiency
• Lab tests of vitamins/ minerals (which on their own, may not be accurate but with additional
points of data can be helpful)
References
1. Width M, Reinhard T. The Clinical Dietitian’s Essential Pocket Guide. 1st Ed 2009. Lippincott
Williams and Wilkins. Baltimore Maryland
2. These vitamin Deficiencyiciencies can cause hair loss. WebMD.
https://www.webmd.com/connect-to-care/hair-loss/vitamin-Deficiencyiciencies-that-can-
cause-hair-loss Accessed 1/4/22
3. Cobb C. From ridges to peeling: what these 8 fingernail signs say about your health. 2021.
https://www.healthline.com/health/beauty-skin-care/healthy-nails Accessed 1/4/22
4. Seshadri D, De D. Nails in nutritional Deficiencyiciencies. Indian Journal of dermatology,
Venereology, and Leprology. 2012;78(3):237-441. DOI:10.4103/0378-6323.95437
5. Sheetal A, Hiremath V, Patil A, Sajjansetty S, Kumar S. Malnutrition and its oral outcome- A
review. J Clin Diagn Res. 2013;7(1):178-180. doi: 10.7860/JCDR/2012/5104.2702
Lindsey Zirker Nutrition Consulting, 2022
