Evaluation of nutritional state MUDr. Matej Pekař Introduction lObesity - 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). l lMalnutrition - 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 lStructural and storage fat lLipolytic hormones lActive body mass lBioimpedance lMetabolic syndrome lThe relationship between overweight and DM lThe relationship between overweight and hypertension lHealthy lifestyle Structural and storage fat lStructural fat: not consumed (base of biological membranes) lStorage fat: reserve, deposit Lipolytic hormones ladrenaline lnoradrenaline lgrowth hormone lglucagon lACTH lprolactin lcortisol Active body mass lMusculoskeletal system lPassive - fat Bioimpedance lMeasurement of electrical conductivity / "resistance" of the tissue Metabolic syndrome lX syndrome (increased risk of death from cardiovascular complications) l lDiabetes Mellitus lHypertension lObesity lDyslipidemia (LDL, TAG) l l The relationship between overweight and DM lDM type II – insulin resistance The relationship between overweight and hypertension lHigh blood cholesterol lAtherosclerosis of the arteries lReduced arterial compliance Healthy lifestyle lPrinciples that support our bodies to maintain health as long as possible lGeneral: 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 l1. Based on anthropometric indicators l2. Measurement of body fat by caliper l3. Measurement representation of fat in the body by bioelectrical impedance method l4. Measurement of muscle mass 1. Based on anthropometric indicators lBroca's index lBased on the calculation of ideal weight l lIdeal weight lMen: lHeight cm – 100 /// height v m2 – 23 lWomen: lHeight cm – 100 – 10% /// height v m2 – 21,5 lIndex: actual weight / ideal weight x 100 l Broca's index Obesity category % ideal weight Slight 115 – 129 Very 130 – 149 Heavy 150 – 199 Morbid > 200 BMI (body mass index) lBMI = kg / m2 l 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 lRecommended range l lwomen: < 0.8 l lmen: < 1.0 2. Measurement of body fat by caliper lMeasurement of the layer of fat under the skin lIt shows the energy balance of the organism lThe 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 lPrinciple of the method: lVarious tissues of the body have different electrical permeability according to the amount of water (muscle vs. fat) lMeasurement of permeability is called bioelectrical impedance lIt calculates the ratio of fatty tissue to other tissues lDepends on the amount of fluid in the body - hydration l lhttps://www.chponline.com/store/cart.php?m=product_list&c=87 lhttp://nutritiondarling.com/2011/08/bio-impedance-analysis/ 1 2 4. Measurement of muscle mass lArm muscle circumference lThe corrected arm muscle area Arm muscle circumference lAMC = AC - π TTS l lAMC – arm muscle circumference lAC – arm circumference lTTS – 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 lCorrected to the skin tissue and fat lCorrected to the bones lMen: cAMA = (AMC2 / 4 π) – 10 lWomen: cAMA = (AMC2 / 4 π) – 6.5 l 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 lEvaluation of nutritional state is an important indicator in all areas of medicine lBoth malnutrition and obesity may be detrimental for the human organism lThe process of evaluation of nutritional state starts with simple formulas and continues to using sophisticated measuring instruments lThe results help to set the diet correctly (rational, reducing, high-energy, etc.)