Name: Numer: Study group: hypertension hypercholesterolemia, dyslipidaemia abdominal obesity The combination of these four findings increases the risk of occurrence and development of atherosclerosis (fatty and sclerotic plaques) in blood vessels and its complications, such as a heart attack or stroke. The crucial step in therapy of metabolic syndrome is the therapy of obesity since obesity plays an important role in the development of the resistance of tissues to insulin (and thus hyperglycemia), and also arterial hypertension (mostly through the activation of the sympathetic nervous system). Our aim is, therefore, to reduce weight, and motivate the patient to exercise and move around more. METABOLIC SYNDROME P. 9k hyperglycaemia after fasting This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Protocol Assessment of energy expenditure using indirect calorimetry Methods Equipment Krogh's respirometer with 5 liters of oxygen, mouthpiece, examination bed, nose clip, Master's steps, metronome, PoweLab system. Procedure Actual energy expenditure in rest: • Examined person lies down on the examination bed. Connect the examined person to the respirometer placing mouthpiece (with filter) into their mouth and prevent them breathing through the nose using a nose clip. • Keep the side valve of the respirometer in the position „OPEN", which means that the examined person breaths atmospheric air and not the oxygen from the respirometer. Let the person breathe for at least 5 minutes. • Start the program BASAL METABOLISM by double-clicking the icon on the screen. • Start the recording and ask the examined person to breathe out and hold their breath. Then, quickly turn the valve 180° degrees to the position „CLOSED". The person is now breathing the oxygen from the respirometer. • Make a 3-minute recording of breathing at rest. Then press STOP and the recording will be interrupted. Actual energy expenditure in standing position: • Ask the person to stand up. Start recording again and make a 3-minute recording of breathing in standing position. Stop the recording. Actual energy expenditure after workload: • Disconnect the examined person from the respirometer - don't forget to close the valve. Ask them to walk all the way up and down the Master's steps in the rhythm of the metronome set to the frequency of 80 beats/minute (one beat = one step) • Meanwhile, ask the assistant of the practicals to refill in the oxygen into the tank of the respirometer. After having finished exercising, the examined person needs to lie down as fast as possible on the examination bed. Connect them to the respirometer by placing the mouthpiece into their mouth and turning the valve to the „OPEN" position. Don't forget about the nose clip! • Start the recording. Make a 3-minute recording of breathing after workload. • At the end, insert the comments about each situation and save the record under the name „Basal metabolism XY", whereby XY corresponds to the initials of the name of the examined person. File type is Data Chart File (*.adicht). This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Evaluation In each situation, select a block of the recording without artefacts. Average value of oxygen consumption in 1/s will appear in the mini-window. Measured values need to standardized in order to be able to compare them (with other values measured in different conditions that could be in the examination room). This can be done by correcting the measured values to eliminate the effect of barometric pressure, room temperature and water tension in the room. From the corrected values, you can further calculate actual energetic expenditure in each situation. Correction of oxygen consumption (1/s) to 0 °C and 101,325 kPa (760 mmHg): 273 B-e Vr = V-n----\1/S] r 71 273 + t 101.325 L 1 J *Vr- corrected value of oxygen consumption vn - measured value of oxygen consumption in l/s t - room temperature in °C B - barometric pressure in kPa (1 torr = 1 mmHg = 0,133 kPa) e - water tension in kPa by room temperature — see the table t(°C) 0 1 2 3 5 6 7 8 9 10 1,219 1,303 1,391 1,485 1,585 1,691 1,801 1,920 2,044 2,174 20 2,314 2,462 2,617 2,781 2,953 3,134 3,328 3,529 3,741 3,965 30 4,201 4,449 4,709 4,986 5,269 5,570 5,887 6,225 6,567 6,933 Calculation of actual energy expenditure (AEE) by indirect calorimetry can be performed based on the following relationships: if we know the value of the consumed oxygen in liters per minute (value vr) we can multiply it by the energetic equivalent of the oxygen (EE = 20,19 kMiter 02): AEE (kj/s) = 20,19 • Vr the error of calculation is about 8 % This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Results Space for your calculations (do not hand in the protocol without them): Study group: REST STANDING WORKLOAD v„ Vr v„ Vr v„ ............1/s ...............1/s ............1/s ..........1/s ............1/s ............1/ i> AEE AEE AEE AEE AEE AEE ............kJ/s ........kJ/day k.l/s k.T/dav ..........kJ/s kJ/day This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Protocol Assessment of energy expenditure by Harris-Benedict formula Methods Equipment scales, height measuring device, table for calculation of AEE (look below) Procedure Assessment of AEE can be broken down to several steps: a) Calculation of basal energy expenditure (BEE) in kcal/day: Use Harris-Benedict formula to calculate BEE: tf: BEE = 66+ (13,7 m + 5 h) -(6,8 r) 9: BEE = 66+ (13,7 m + 5 h) -(6,8 r) * h = height in cm, r = age Results should be transformed to kj/day (1 kcal = 4,18 kj). b) Calculation of AEE: AEE = BEE x AF x TF x IF This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: The factors that we take into account: activity- AF lying patient 1,1 lying but mobile patient 1,2 mobile patient 1,3 healthy light working 1,55 9 1,60 ď healthy middle working 1,64 9 1,78 ď healthy hard working 1,82 9 2,10 ď body temperature-TF 37 °C 1,0 38 °C 1,1 39 °C 1,2 40 °C 1,3 41 °C 1,4 injury- IF uncomplicated patient 1,0 after surgery 1,1 fractures 1,2 sepsis 1,3 peritonitis 1,4 multiple injuries 1,5 multiple injuries + sepsis 1,6 burns 30-50 % 1,7 burns 50-70 % 1,8 burns 70-90 % 2,0 Use in your calculations (based on the presumption that the examined person is healthy): TF: 37°C and AF: lying but mobile patient (AEE at rest), mobile patient (AEE in standing position), healthy light working (AEE after workload). (This procedure is illustrative and serves only for didactical purposes of this practical) Results Space for your calculations: (do not hand in the protocol without them): This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Calculated values of BEE and AEE for the same person: (fill in all the blank spaces) BEE= ................................KJ/day.................................KJ/s AEE at rest ..................................KJ/day.................................KJ/s AEE in standing position=................................KJ/day.................................KJ/s AEE after workload=................................ KJ/day.................................KJ/s..............................KJ/hour Interpretation and conclusions Why does the examined person need to breath for at least 5 minutes prior to our experiment? Which factors is the resting energy expenditure dependent on? How did the energy expenditure change in standing position in contrast to the one at rest and why? How did the energy expenditure change after workload in contrast to standing position and resting state? Explain. Compare the measured (corrected) and calculated values. Provided that they are different, try to give a possible explanation of this. This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Protocol Compiling a daily diet: principles of proper nutrition Go to www.myfitnesspal.com Create your account or use your Facebook login for sign in. It is not possible to use the app without login. ITiyfitriGSSpBl Food Exercise Apps Blog Community H Shop Premium Login Lose Weight with MyFitnessPal The fastest, easiest to use calorie counter app. f Sign up with Facebook Mready have an account? Log In After login go to „My Home-Settings". From options, chose „Diary Settings". Use kilojoules (kj) as an energy unit. mVf JtneSSpal Hi,llllthy1 fflO I 0 Help Settings Logout Follow Us: OOO MY HOME FOOD EXERCISE REPORTS APPS COMMUNITY BLOG H SHOP PREMIUM Home Goals Check-In Mail Profile t iy Blog Friends Settings Přemi jm Account Settings Subscription Settings Change Password Change email address/email preferences Change Username Change Time Zone . Jnd;i'fH t1 h" "ih^ r: iv e I ^ a > -|j_3S Privacy Settings Automatic News Feed Update Settings Change Units FacebookyTwitter sharing settings Change Language Delete Account J (UNDER ARMOUR CONNECTED FIT NESS In option „Nutrients Tracked" chose „Carbohydrates", „Fat", „Proteins", „Calcium", and „Vitamin C". In option „Meal Names" enter „Breakfast", „Snack I", „Lunch", „Snack II", and „Dinner". Save by click on „Save Changes". This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Food and Exercise Diary Settings Nutrients Tracked: Change Nutrients Tracked Kilojoules [Required] Carbohydrates T If yaud like ta ahanae whiah nutrients you e aaTtra 5 la In? ?ft la anaas? »vn ai ijl" ?nt e tracking in four faod diary, just use the yaud la lraa-<. ť>?n a ak "Save Chenges". Fat Calcium WtBminC M aero nutrients In The Diary Change Ma era nutrients In Th Diary Premium rnemaer= est es= y s.vlan aek\^ híí t?s ,3.1 í:j ijO.r J sr.. V',- Ja n ^j'stiš 3Td aer??Tia:i?= ľ, í í-í in ti? j arj Default Add Food View: Change Add Food Default View Change Meal Names ?, yau aauld ahanae y: ~a j? ?t? ? ti??. jsl ed 1 It? ti -=:- = = -y.= :"x. cr?.- d.ib faad d a"y For adding the foods go to „Food-Food Diary". Click on „Add Food", enter name or key words and find appropriate food. Estimate amount of the food and click on „Add Food to Diary". _ MY HOME FOOD EXERCISE REPORTS APP5 COMMUNITY B LOG J{ SHOP PREMIUM Food Diary Dale base My Foods My Meals Recipes Settings Your Food Diary For: Lunch Add Food I Quick Tools Dinner Add Food I Quick Tools Snacks Add Food I Quick Tools Totals 0 0 0 0 0 0 Your Daily Goal 7.366 235 53 94 2.300 71 Remaining 7.356 235 S3 94 2.300 71 When you're fin is he d logging all foods and exercise for this day, click here: Complete This Entry After completion of the list for whole day, go to web myfitnesspal.com and open the food diary („Food-Food Diary"). Set the window size to fit the entire list including sums of the parameters on the screen. Use „Print Screen" to take a copy of the screen, save it as a picture, crop it and fit it into A4 page format. This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: MY HOME FOOD E XERCI5E REPORTS APPS COMMUNITY BLOG M SHOP PREMIUM Food Diary Database My Foods My Meals Recipes Settings Your Food Diary For: Friday, December 30, 201B Breakfast Kilojoules ti Garbs g Fat g Protein g Sodium ing Sugar H fl ■ Bread, egg, 1 oz 340 14 2 3 ioa i e Add Food Quick Tools 34C 14 í 3 ice i Lunch Ilia - Lasagne. 1 >4 cooked Erin - Chicken Soap. 1 cap 1,937 209 33 0 21 2 34 2 651 690 5 9 2 e Add Food QuicK Tools 2.146 33 23 35 1.341 7 □ inner YolWs-Yogurt, 150 g Caka - Chocslste. ivith frosting, 1 oz Add Food QuicK Tools 41B 435 13 15 28 2 S 7 a 1 r. 105 9S íi;i: a e : e Í Snacks Panara Bread - French Bagel, Ibaget 623 3D 2 5 370 a 9 Add Food QuicK Tools í i .'7': i: Totals Your Daily Goal Remaining 3,957 14,309 10,342 105 428 323 34 114 80 53 171 118 2,019 2,300 281 16 113 Kik>k>uleB Carlas Fat Protein Sodium 'You've earned 6.443 exlra kilojoules from e Open the "Exercise" and "Exercise diary". „Print Screen" to take a copy of the screen, save it as a picture, crop it and fit it into A4 page format. MY HOME FOOD EXERCISE REPORTS APPS COMMUNITY BLOG H SHOP PREMIUM Exercise Diary Database My Exercises Settings Your Exercise Diary for: Q Friday, December 30, 2016 Cardiovascular Running [jogging), 9.6 Kph [6.2 min per km) Walking,7.5 minsper Km uick Tools Daily Total / Goal Weekly Total / Goal 150/60 150/180 5,444/1,423 S.444 ■■ 4.2SS Strength Training Add Exercise | Quick Tools Repsyset Weight/Set Print the lists and bring them on practice. This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Evaluation of energy balance (EB): EB = Daily energy intake - Daily energy expenditure (DEE) (+ = positive, - = negative EB) DEE = BEE (basal energy expenditure) + SDE (specific dynamic effect of nutrients) + PA (physical activity) BEE - we can calculate using Harrison-Benedict formula: tf: BEE = 66.5 + (13.75 • m + 5.003 • h) - (6,775 • r) 9: BEE = 655.1 + (9.563 • m + 1.85 • h) - (4.676 • r) * * m = weight in kg, h = height in cm, r = age SDE (specific dynamic effect of nutrients) - 10% of daily energy intake Results Fill in the information about the examined person: Gender................ Age.............. Height............(m) Weight............(kg) BMI.......................(kg/m2) BEE....................(kJ/day) SDE....................(kJ/day) Physical activity....................(kJ/day) EB....................(kJ/day) allergens (food and other):......................................................................... Smoking............... number of cigarettes per day................. Alcohol................. amount of liters per day (including beer).................... This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Conclusion Evaluate the daily diet of the examined person comparing the acquired and recommended values of nutrients, ions and vitamins. Quantitative aspect - Based on EB of the person, will they be prone to gain or lose weight? Explain Qualitative aspect of nutrition Give adequate recommendations as to how their life style and nutrition could be improved based on all the errors that you have observed during your examination: This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Protocol Evaluation of nutritional state Indexes calculated from anthropometric parameters Equipment scales, device for height measurement, measuring tape, calculator Results 1) Broca's index (ideal body mass): cf: height in cm - 100 or (height in m) x 23 9 : (height in cm - 100) - 10 % or (height in m)2 x 21 Result:................ % ideal body mass*: (actual body mass/ideal body mass) x 100 Results.................. Evaluation Obesity degree % ideal body mass mild 115-129 moderate 130-149 severe 150-199 morbid >200 2) Quetelet's index or body mass index (BMI): RMI = body weight (kg) height (m)2 BMI:.................. This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Evaluation of BMI BMI (kg.m-2) Category Men Women Underweight < 20 < 19 Healthy 20-24,9 19-23,9 Overweight 25-29,9 24-28,9 Obesity 30-39,9 29-38,9 Morbid obesity > 40 > 39 3) Waist circumference Waist circumference is measured in standing position in the narrowest part of the trunk (slightly above the belly button) Hip is measured in the widest part of the upper part of the body (over gluteus area) Evaluation Waist circumference (cm) Category Men Women Normal value <94 <80 Necessity to decrease body mass 95-102 81-90 Medical assistance with decreasing of body mass necessary > 102 > 90 4) Waist/Hip Ratio = WHR WHR recommended for women < 0,80 for men < 1,00 Waist..............cm Hip...............cm Waist/Hip.............. Body fat measurement by caliper Thickness of subcutaneous fat layer informs us about the energy balance of the organism. However, it does not reflect possible differences in distribution of subcutaneous and visceral fat. The simplest method widely used in the clinical practice to determine the skinfold thickness is the measurement with a caliper over the triceps brachii muscle. For the purposes of our practical we will determine the skinfold thickness over the triceps brachii muscle and also under the scapula, (positions 1 and 2 in the picture below) Equipment caliper This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Procedure The measurement is conducted in a sitting position (for the triceps skinfold) or standing (for scapular skinfold). Your hand should hang loose and stay relaxed. The measurement should be performed on the non-dominant upper extremity (right-handed people on the left and vice versa). When measuring with a caliper, the skinfold is grasped with the thumb and index finger and pulled up from the underlying muscle. Using the other hand put the measuring facets of the caliper about 1 cm from the top of the skinfold held by your fingers, and then release the caliper arms in order to apply a constant force to the skin. The skinfold thickness should be read within 2 seconds. At least 3 measurements should be performed, and the arithmetic mean calculated to make the measurement more exact. From the values of the skinfold thickness, you are able to determine the portion of the fat mass in the organism by using nomogram (see below). Note that it is only an approximate value. Other possible places where skinfold thickness can be measured (see also the picture above): 3 - over biceps brachii 4 - over crista iliaca 5 - on the thigh Evaluation Assessment of percentage of body fat (calculated from the two skinfolds, according to Slaughter) cf: % fat = 0,735 * [under scapula (mm) + over triceps (mm)] + 1,0 9: % fat = 0,610 * [under scapula (mm) + over triceps (mm)] + 5,1 Results 1. measurement 2. measurement 3. measurement the mean value over triceps (mm) under scapula (mm) Nomogram: by matching the measured values of the skinfolds, you will get % of body fat. % fat by Slaughter................................% % fat from nomogram.........................% This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Body fat measurement by bioimpedance method Equipment Hand bioimpedance device and bioimpedance scales Procedure Device OMRON TBF-551: 1. Set the personal data of your experimental subject into the memory of the device: press the button SET and choose always one from the offered parameters that are being displayed in the bottom part of the screen as different figures: adult/child/sportsman, man/woman, height of the experimental subject 2. After setting 0 on the display, the experimental subject stands carefully barefoot on the scales. After a while the values the values of weight in kg and body fat in % appear. Write down the values and use the cloth with desinfection to desinfect the device. Device OMRON BF300: 1. Turn the device on by pressing the button ON/OFF. For the first few seconds, display test is running and then zero values are shown. Proceed by pressing following buttons: a. HGT: enter the height of the examined person in cm using numerical buttons (in case you make a mistake, press HGT again and repeat) b. WT: enter the body weight in kg c. AGE: enter the age (interval is 10 - 80) d. M/F: press this button to set up the gender (You can press this button again if you make a mistake.) 2. After all values are entered, press SET. After a short while, the device will beep and READY will appear on the display. 3. Grab the device properly with both hands and your arms stretched out in front horizontally and press START using your right thumb. After the measurement is completed, the device emits a single beep and the results will be shown on the display. Evaluation Age (years) < 30 > 30 Women 17-24 % 20-27 % Men 14-20 % 17-23 % Results 1) measurement by hand device % fat................. 2) measurement by scales % fat................... This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Measurement of amount of muscle tissue Equipment measuring tape Procedure Circumference of arm muscles (CAM) is determined - measure the circumference (CA) of the non-dominant hanging and relaxed arm (where the muscle size is the greatest) using measuring tape. Be careful not to press the arm! Obtained value has to be corrected to subcutaneous tissue: CAM = CA - 3,14 x skinfold over triceps in cm Evaluation Muscle tissue loss not present moderate severe Women > 23,2 cm 14-21 cm < 14 cm Men > 25,3 cm 15-23 cm < 15 cm Corrected surface of arm muscles (c-SAM) In addition, the value of CAM needs to be corrected to the arm bone (humerus). From this reason, c-SAM value is calculated (in cm ): „ . . , (CAM-n-skinfold over the arm)2 , _ for women: c - SAM = ----— - 6.5 4-7T „ . . , (CAM-n-skinfold over the arm)2 . _ for men: c - SAM =----- - 10 4-7T Evaluation Deficiency not present mild moderate severe 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 This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Results Space for your calculations: (do not hand in the protocol without them): CAM =................................. c-SAM =................................. Summary of results • Gender: male/female • Age..........years • Height...........cm • Weight...........kg • Broca's index........... • % ideal body mass:...............(mild/moderate/severe/morbid) • BMI:...............kg/m (underweight/normal/overweight/obesity/morbid obesity) • Waist:...............cm (normal value/necessity to decrease body mass/ medical assistance with decreasing of body mass necessary) • Hip:...............cm • WHR:...............(normal/increased) • % fat by Slaughter................................% (decreased/normal/increased) • % fat from nomogram.........................% (decreased/normal/increased) • % fat (measurement by hand device)................% (decreased/normal/increased) • % fat (measurement by scales)...................% (decreased/normal/increased) • CAM.............(not present/moderate/severe) • c-SAM.............(not present/mild/moderate/severe) This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University). Name: Numer: Study group: Discussion and conclusion Evaluate the nutritional state of the examined person based on all examined parameters. Would you recommend them to lose or rather gain weight or gain more muscle mass or combination of these? Explain. Do your results differ based on the method/parameter that you have used? Try to explain why by filling in the table of advantages/disadvantages of the methods. Type of method/index Advantages Disadvantages Broca's index BMI WHR Caliper Bioimpedance method This text was supported by project FRMU no. MUNI/FR/1552/2015 (Faculty of Medicine, Masaryk University).