Evaluation of nutritional state MUDr. Matej Pekař Introduction • Obesity - the excessive accumulation of energy reserves in the form of fat. Energy intake is higher than the supply. The cause is usually a combination of higher energy intake, lack of exercise, hereditary factors, psychological factors and a bad diet in childhood. Rarely it is only one specific cause (antidepressants, endocrinological diseases). • Malnutrition - a disease is caused by insufficient intake of nutrients, inability to absorb nutrients because of diseases of the gastrointestinal tract or excessive catabolism for example in tumor diseases. Key words • Structural and storage fat • Lipolytic hormones • Active body mass • Bioimpedance • Metabolic syndrome • The relationship between overweight and DM • The relationship between overweight and hypertension • Healthy lifestyle Structural and storage fat • Structural fat: not consumed (base of biological membranes) • Storage fat: reserve, deposit Lipolytic hormones • adrenaline • noradrenaline • growth hormone • glucagon • ACTH • prolactin • cortisol Active body mass • Musculoskeletal system • Passive - fat Bioimpedance • Measurement of electrical conductivity / "resistance" of the tissue Metabolic syndrome • X syndrome (increased risk of death from cardiovascular complications) • Diabetes Mellitus • Hypertension • Obesity • Dyslipidemia (LDL, TAG) The relationship between overweight and DM • DM type II – insulin resistance The relationship between overweight and hypertension • High blood cholesterol • Atherosclerosis of the arteries • Reduced arterial compliance Healthy lifestyle • Principles that support our bodies to maintain health as long as possible • General: a healthy diet (for actual energy consumption adapted intake of fat, carbohydrate, proteins, minerals, vitamins), sufficient exercise, enough sleep, a healthy environment (smog, smoking), stress management, etc. Objective evaluation of nutritional status • 1. Based on anthropometric indicators • 2. Measurement of body fat by caliper • 3. Measurement representation of fat in the body by bioelectrical impedance method • 4. Measurement of muscle mass 1. Based on anthropometric indicators • Broca's index • Based on the calculation of ideal weight • Ideal weight • Men: • Height cm – 100 /// height v m2 – 23 • Women: • Height cm – 100 – 10% /// height v m2 – 21,5 • Index: actual weight / ideal weight x 100 Broca's index Obesity category % ideal weight Slight 115 – 129 Very 130 – 149 Heavy 150 – 199 Morbid > 200 BMI (body mass index) • BMI = kg / m2 Category men women Malnutrition < 20 < 19 Normal 20 – 24.9 19 – 23.9 Overweight 25 – 29.9 24 – 28.9 Obesity 30 – 39.9 29 – 38.9 Severe obesity > 40 > 39 Waistline waistline (cm) Category men women Recommended range ≤ 94 ≤ 80 Necessary to reduce weight 95 – 102 81 – 90 Weight loss requires medical help > 102 > 90 Waist / Hip ratio • Recommended range • women: < 0.8 • men: < 1.0 2. Measurement of body fat by caliper • Measurement of the layer of fat under the skin • It shows the energy balance of the organism • The triceps skinfold (the scapula, the abdomen, etc.) The triceps skinfold (mm) Physiological Mild to moderate deficit Significant deficit Women > 16.5 10 – 15 < 10 Men > 12.5 7.5 – 11 < 7.5 3. Measurement representation of fat in the body by bioelectrical impedance method • Principle of the method: • Various tissues of the body have different electrical permeability according to the amount of water (muscle vs. fat) • Measurement of permeability is called bioelectrical impedance • It calculates the ratio of fatty tissue to other tissues • Depends on the amount of fluid in the body - hydration • https://www.chponline.com/store/cart.php?m=product_list&c=87 • http://nutritiondarling.com/2011/08/bio-impedance-analysis/ 4. Measurement of muscle mass • Arm muscle circumference • The corrected arm muscle area Arm muscle circumference • AMC = AC - π TTS • AMC – arm muscle circumference • AC – arm circumference • TTS – the triceps skinfold Muscle mass loss none mild heavy Women > 23.2 cm 14 – 21 cm < 14 cm Men > 25.3 cm 15 – 23 cm < 15 cm The corrected arm muscle area • Corrected to the skin tissue and fat • Corrected to the bones • Men: cAMA = (AMC2 / 4 π) – 10 • Women: cAMA = (AMC2 / 4 π) – 6.5 Deficit none mild moderate heavy Women > 36.3 29.1 – 36.3 25.5 – 29.0 < 25.4 Men > 40.9 32.8 – 40.8 28.7 – 32.7 < 28.6 Conclusion • Evaluation of nutritional state is an important indicator in all areas of medicine • Both malnutrition and obesity may be detrimental for the human organism • The process of evaluation of nutritional state starts with simple formulas and continues to using sophisticated measuring instruments • The results help to set the diet correctly (rational, reducing, high-energy, etc.)