Chapter 072. Malnutrition and Nutritional Assessment (Part 6)

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Anthropometrics Anthropometric measurements provide information on body muscle mass and fat reserves. The most practical and commonly used measurements are body weight, height, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Body weight is one of the most useful nutritional parameters to follow in patients who are acutely or chronically ill. Unintentional weight loss during illness often reflects loss of lean body mass (muscle and organ tissue), especially if it is rapid and not caused by diuresis. This can be an ominous sign since it indicates use of vital body protein stores as a metabolic fuel. ...

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Chapter 072. Malnutrition and Nutritional Assessment (Part 6) Anthropometrics Anthropometric measurements provide information on body muscle mass and fat reserves. The most practical and commonly used measurements are body weight, height, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Body weight is one of the most useful nutritional parameters to follow in patients who are acutely or chronically ill. Unintentional weight loss during illness often reflects loss of lean body mass (muscle and organ tissue), especially if it is rapid and not caused by diuresis. This can be an ominous sign since it indicates use of vital body protein stores as a metabolic fuel. The reference standard for normal body weight, body mass index (BMI, or weight in kilograms divided by height, in meters, squared), is discussed in Chap 75. BMIs
considered underweight, 18.5–24.9 are normal, 25–29.9 are overweight, and ≥30 are obese. Measurement of skinfold thickness is useful for estimating body fat stores, because about 50% of body fat is normally located in the subcutaneous region. Skinfold thicknesses can also permit discrimination of fat mass from muscle mass. The TSF is a convenient site that is generally representative of the body's overall fat level. A thickness of
outlined in Table 72-5. The table also provides tips to help avoid assigning nutritional significance to tests that may be abnormal for nonnutritional reasons. Table 72-5 Laboratory Tests for Nutritional Assessment Test Nutritional Causes of Other Causes (Normal Values) Use Normal Value of Abnormal Value Despite Malnutrition Serum 2.8–3.5: Dehydratio Low albumin(3.5–5.5 Compromised n g/dL) protein status
balance intake Burns, trauma Congestive heart failure Fluid overload Severe liver disease Uncommon: Nephrotic syndrome Zinc deficiency
Bacterial stasis/overgrowth of small intestine Serum 10–15 Chronic Similar to prealbumin, also mg/dL: Mild renal failure serum albumin called transthyretin protein depletion (20–40 mg/dL; lower in 5–10 mg/dL: prepubertal Moderate protein children) depletion
Serum total
Anticoagulant therapy (warfarin) Severe liver disease Serum 24-h Low creatinine 500– muscle wasting due
1200 mg/d to prolonged energy collection (standardized for deficit height and sex) Decreasing Incomplete serum creatinine urine collection Increasing serum creatinine Neuromuscular wasting 24-h urinary Determine urea nitrogen level of catabolism (UUN)
5–10 g/d = mild catabolism or normal fed state 10–15 g/d = moderate catabolism >15 g/d = severe catabolism Estimate protein balance Protein balance = protein intake – protein loss where protein loss (protein catabolic rate) = [24-h UUN
(g) + 4] x 6.25 Adjustments required in burn patients and others with large nonurinary nitrogen losses and in patients with fluctuating BUN levels (e.g., renal failure) Blood urea
>23: Anabolic state Possibly excessive protein intake If serum Syndrome of creatinine is normal, inappropriate use BUN antidiuretic hormone If serum High creatinine is elevated, use BUN/creatinine ratio (normal range is essentially the same as for BUN) Despite poor protein intake: Renal failure (use BUN/creatinine
ratio) Congestive heart failure Gastrointestina l hemorrhage