Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
1
Measurement of basal metabolic expenditure
Compiling daily diet
Evaluation of nutritional state
Physiology II – practice
Spring, weeks 1–3

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
2
Measurement of basal metabolic expenditure using indirect calorimetry and  calculation

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
3
Metabolism
All chemical and energy transformations in the body
̶In relation to food: energy and chemical transformations after food intake (includes processing,
digestion, absorption and distribution to cells)
̶A living organism oxidizes nutrients to produce H2O, CO2 and energy needed for life processes
̶Catabolism: a complex, gradual process of decomposing substances into simpler compounds, with the
release of energy. Energy is released as heat or as chemical energy (stored in macroergic
compounds, e.g. ATP)
̶Anabolism: process of formation of more complex substances from simpler ones, with a consumption
of energy

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
4
Calorimetry
̶Calorimetry – a measurement of heat released in the studied system during a certain process
(chemical, physical, biological)
̶Heat = energy, unit joule (J)
̶Assessment of animal metabolism: based on the assumption that all metabolic processes are
accompanied by heat production
̶Food metabolism is almost equivalent to direct food oxygenation (burning)
̶
̶Direct calorimetry – measurement of direct heat with a calorimeter
̶Heat caused by food burning with a sufficient supply of oxygen
̶Heat emitted by the metabolising animal with a sufficient supply of oxygen
̶

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
5
Direct calorimetry
̶Technically more difficult
̶If used in animals, then only in small ones
̶Isothermal calorimeter
̶The temperature does not change during the experiment. The generated heat is removed, and it
causes, for example, a phase transformation of a matter (ice into water)
water
thermoisolation
Air income
Air outcome

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
6
Heat of combustion
̶Total energy released as heat when a 1 g of substrate undergoes complete combustion with oxygen –
energy of a 1 g of substrate
̶Physical heat of combustion – energy created via burning the substrate
̶Physiological heat of combustion – energy created via substrate oxidation by a living organism
̶
̶Carbohydrates and fats: physiological = physical heat of combustion
̶Proteins: physical > physiological heat of combustion
̶The burning of proteins produces nitrogen oxides. Proteins metabolism produces urea which contains
a part of the chemical energy
̶Combustion heat of nutrients:
̶Carbohydrates = 17.1 kJ/g
̶Fats = 38.9 kJ/g
̶Physical combustion heat of proteins = 23 kJ/g
Physiological combustion heat of proteins = 17.1 kJ/g

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Indirect calorimetry
Principle: O2 consumption, CO2 output and waste of nitrogen metabolites are related to energy
consumption
̶Possibility to measure it in the open or closed system
̶In practicals – Krogh spirometer (equipped with soda lime – ensures absorption of CO2)
̶
̶Caloric (energy) equivalent of oxygen (EE) – energy related to litre of oxygen
̶The amount of energy that is released when consuming 1 liter of oxygen
̶Universal constant for calculating energy expenditure in a mixed diet
    EE = 20.19 kJ / litre O2
̶EE of nutrients:
̶Glucose 21.4 kJ / litre O2
̶Proteins 18.8 kJ / litre O2
̶Lipids 19.6 kJ / litre O2
̶

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
8
Respiratory quotient (RQ)
̶Ratio: CO2 produced / O2 consumed
̶Provides information about the processed substrate
̶Saccharides : RQ = 1 – the same ratio of C and O as in water and CO2
̶Lipids: RQ = 0.7 – contain less oxygen
̶Proteins: RQ = 0.8 - 0.9 - more complicated because urine must be taken into account
̶Mixed food: RQ = 0.85
̶Glucogenesis: RQ ≈ 0.4
̶Lipolysis: RQ ≈ 0.7
̶Lipogenesis: RQ ≈ 2.75
̶Fasting, starvation: RQ <0.85 – lipolysis, gluconeogenesis
̶Other factors affecting RQ
̶Hyperventilation RQ > 1 – CO2 is exhaled
̶During exercise or metabolic acidosis RQ > 1
̶Hypoventilation or metabolic alkalosis: RQ < 0.7
̶Particular organs – brain RQ = 0.97-0.99 (glucose consumption), stomach RQ < 1

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
9
Nitrogen balance
The ratio between the nitrogen ingested in the diet (proteins, amino acids) and the excreted
nitrogen (mainly in the urine)
̶Indicator of protein and amino acid decomposition or new tissue formation (protein incorporation)
̶Negative nitrogen balance
̶Nitrogen is more excreted than consumed
̶Sign of protein and amino acid degradation
̶Starvation, forced long-term immobility, lack of some essential amino acids, tissue breakdown
(extensive injuries, burns, tumor breakdown, postoperative conditions)
̶Positive nitrogen balance
̶Nitrogen is more absorbed than excreted
̶Growth, pregnancy, reconvalescence

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Basal metabolism
The amount of energy necessary to maintain basic vital functions
̶Basal energy expenditure (BEE): energy expenditure of the organism under defined – basal
conditions:
̶Thermoneutral environment
̶Physical and mental peace (in the morning before getting out of a bed)
̶Protein-free diet 12-18 hours before measurement
̶BEE varies depending on many factors
̶Muscle tissue increases BEE
̶Repeated weight loss reduces BEE
̶The obtained value is only an estimation of the actual energy associated with basal metabolism
̶Resting energy expenditure – measurement of expenditure in clinical conditions, when it is not
possible to exactly meet all basal conditions – slightly higher than BEE

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
11
Measurement of O2 consumption in practicals
Expirium
(the respirometer reservoir is rising up)
Inspirium
(the respirometer reservoir is descending)
Total O2 consumed during resting
while lying at rest
after exercise
time (s)
The total amount of oxygen consumed after the exercise
The slope of the volume decrease in spirometer vn (L/s)
= consumtion of O2 per time
Oxygen from the respirometer is metabolized, CO2 is captured by soda lime → O2 consumption is
measured as the loss of O2 in the respirometer
A curve describing a volume changes in Krogh respirometer while breathing

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
12
Actual energy expenditure (AEE)
Expenditure measured under current conditions
In practicals: AEE
̶While resting (≠ resting energy expenditure!) – lying down
̶While standing
̶After exercise – walking on the steps for 5 min
̶Determine
̶vn – consumption of O2 (L/s)
̶vr – value corrected to 0°C a 101,325 kP (L/s)
t: temperature °C, B: barometric pressure kPa (1 mmHg = 0.133 kPa), pressure of water vapour kPa
(in the table)
̶Calculate AEE (error of the calculation is aprox. 8%)
̶AEE (kJ/s) = 20.19 * vr
̶AEE (kJ/day) = 20.19 * vr * 86400

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Calculation of energy expenditure via equation
̶Basal energy expenditure (BEE) – Harris-Benedict equation
̶Man (kcal/day)
̶Woman (kcal/day)
̶m: weight (kg), h: height (cm), r: age (years)
̶BEE (kJ/day) = BEE (kcal/day) * 4.184
̶AEE (kJ/day) = BEE * AF * TF * IF
̶Basal energy expenditure (BEE, kJ/day)
̶Activity factor (AF) – in practicals: healthy (AF = woman 1.55; man 1.6)
̶Temperature factor (TF) – normal (TF = 1)
̶Injury factor (IF) – no injury (IF = 1)
Increased temperature and damage increases AEE
The BEE and AEE calculation is just an estimation of a real value. The equation was based on
statistical evaluation but two people with the same parameters will never have the same AEE, only
similar. For example, the equation does not take into account the composition of body mass, the
proportion of muscle
and fat, and the individual metabolism.

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
14
Conclusion
Compare the calculated BEE and the measured AEE while lying down and after exercise
Expected results:
             BEE < AEE resting < AEE after exercise
Explain observed results
It might happen :
             BEE ≥ AEE resting
Explain

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
15
Compiling daily diet
Principles of proper nutrition

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
16
Principles of proper nutrition
̶Energy intake and expenditure should be in balance
̶Try to maintain adequate body weight (according to BMI and waist circumference)
̶Eat at least 3 times a day at regular intervals (every 3-4 hours) – the number of meals depends on
the total energy intake
̶Exercise regularly – at least 30 minutes of mild physical activity at least 5 times a week (or 30
minutes of intermediate physical activity 3-4 times a week)

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
17
Principles of proper nutrition
̶The diet should be varied – it should include:
̶All the necessary nutrients (proteins, fats, sugars) of the right composition, energy value and
ratio
̶Vitamins
̶Minerals in the optimal amount
̶Water
̶Fibre
̶
̶To limit
̶Alcohol <30 g/day
̶Limit your intake of canned food and semi-finished products, fried foods and sausages  (probably
important factors causing diabetes mellitus type II)
̶NaCl <5 g/day
̶Cholesterol <300 mg/day
̶Other factors – optimal dining culture
  and don't smoke!
̶

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
18
Daily diet
̶For assessment of food intake:
̶Determination of caloric intake, diet composition, distribution of food during the day
̶For therapeutic intervention:
̶Daily diet plan according to the individual needs and the principles of proper nutrition,
adjusting the diet regarding diseases, health status, allergies, activity, weight adjustment
̶The table should contain
̶Food
̶Meal time
̶Amount in g
̶Energy value of food in kJ
̶Ingredients – proteins, fats, sugars
̶Vitamins, minerals
̶Resulting values of all parameters and recommended daily doses
̶Ideally calculated daily energy expenditure for an approximate comparison with income
̶Specific dynamic effect of nutrients

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
19
Nutrients
̶Recommendation: 10% proteins, 26% lipids, 64% carbohydrates
   (alcohol is also a source of energy, but not recommended)
̶
̶Protein – RDA adults: 0.8–1.2 g/kg, children: 1.2-1.5 g/kg
̶Must contain all the essential amino acids in the correct ratio suitable for the synthesis of new
proteins – intake replaces 20-30 g of proteins that are daily degraded
̶Animal proteins have a balanced ratio of amino acids, plant proteins often lack some amino acids –
a plant diet is more difficult to compile
̶Function: structural, signalling (hormones, receptors), as a source of energy only exceptionally
(during starvation).
̶Saccharides – RDA adults: 4-6 g/kg
̶The fastest energy source (17.1 kJ/g), mainly of plant origin.
̶Usable carbohydrates – 64% of energy intake (simple saccharides should be <10%)
̶Unusable carbohydrates – indigestible, part of fibre (mainly cellulose), RDA 25-35 g/day – GIT
motility support

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Nutrients
̶Fats: RDA adults 1g/kg
̶The largest source of energy (38.9 kJ/g) – mainly storage functions
̶Other functions – fat-soluble vitamins, building, thermoregulation (brown adipose tissue,
isolation), mechanical protection of organs and bones
̶Optimal ratio of fats in the diet: 10% saturated fatty acids (FA), 10-12% monounsaturated FA,
8-10% polyunsaturated FA
̶Cis-configuration FA – vegetable and most animal fats.
̶Trans-configuration – dairy products, beef and mutton, industrially hardened fats (margarine) –
increase in LDL-cholesterol concentration
̶Cholesterol (animal products only) – a structural component of brain tissue, cell membranes,
steroid hormone precursor, vit. D, bile acids - 4% of total cholesterol circulates in the blood.
   75% of cholesterol is produced in the liver, 25% is obtained from food
̶
̶Specific dynamic effect of nutrients (SDE): the energy needed for nutrient processing, about 10%
of the energy from consumed mixed foods (proteins have a higher SDE than glucose)

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Metabolic syndrome (MS)
̶MS is a cluster of 3 or more of the following conditions together
̶Obesity: waist circumference >102 cm in men, >88 cm in women
̶Dyslipidemia: TAG >1.7 mmol/L
                             HDL <1 mmol/L in men, <1.3 mmol/L in women
̶Hypertension: BP >130/85 mmHg or treatment
̶Hyperglycaemia: fasting glycaemia >5.6 mmol/L ← insulin resistance, diabetes II. type (DM II)
̶Czech Republic: 32% men, 24% women, mainly in the elderly population
̶Genetic predisposition (mainly insulin resistance) and poor lifestyle (higher energy intake, lack
of exercise)
̶Significant pro-inflammatory, procoagulatory and proatherogenic state, the risk for cardiovascular
diseases is higher than the risk caused by the simple sum of the risks of its individual risk
factors – all factors mutually support each other
̶Consequences: reduced quality of life and life expectancy: DM II with complications,
cardiovascular and cerebrovascular thrombotic events (heart attack, stroke, embolism)
̶It is a complex disease of the whole organism

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Diabetes mellitus (DM)
̶It includes a heterogeneous group of chronic metabolic diseases, the basic manifestation is
hyperglycemia.
̶It is caused by a lack of insulin, its lack of effect (sometimes referred to as relative
deficiency) or a combination of both.
̶Impairment of glucose transport from the blood to the cell through the cell membrane →
hyperglycaemia and glucose deficiency intracellularly
̶DM I – starts in childhood, autoimmune destruction of pancreatic beta-cells – insulin substitution
required, absolute insulin deficiency
̶DM II – in adulthood, insulin resistance (insensitivity) of target tissues (insulin resistance),
relative insulin deficiency
̶
̶DM complicates treatment, increases the risk and worsens the other diseases, worsens healing. As a
result, DM is a disease also of the cardiovascular system

Adobe Systems
Protocol: prepare before your lesson!
̶Write the weight, height, age and gender of the person for whom you will compile the menu
̶Calculate his/her daily energy expenditure
̶Compile the daily diet on www.myfitnesspal.com
̶Print the menu, write down BEE and AEE calculated based on weight, height, age and gender and
daily activities. Copy BEE and AEE in the protocol (not printed automatically)
̶Write in the protocol:
̶Sum of received energy, nutrients, minerals and vitamins
̶Specific dynamic effect of nutrients (SDE)
̶Recommended values of all monitored parameters
̶Compare energy intake and expenditure, received and recommended daily doses of nutrients, minerals
and vitamins. Evaluate whether the subject's diet is correct,
describe the mistakes and suggest improvements
̶
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AEE + SDE
Energy intake
(BEE + daily activity)

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
24
Evaluation of nutritional status

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Obesity
̶Obesity – excessive storage of energy reserves in the form of fat. Energy intake is for various
reasons higher than expenditure.
̶CZ adults: 35% overweight, 17% obese – more in men
      children 6-12 years: 10% overweight and 10% obese; 13-17 years together 11%
̶Obesity is caused by a combination of factors – rarely just one factor
̶A combination of higher energy intake, lack of exercise
̶Hereditary influences – genetic (usually only predisposition, purely genetic cause is rare)
̶Psychological influences – distress, depression
̶Prenatal influences (mother's behaviour during pregnancy, diabetes, obesity – prenatal
programming), delivery, early childhood, learned eating habits
̶Endocrine diseases – hypothyroidism, Cushing disease
̶It can be the result of other illnesses or injuries
̶Consequence of treatment – some antidepressants
̶Low socioeconomic status, lack of nutritional education
̶
̶The problem from the healthcare professional's point of view: more demanding
patient handling, a complication in the treatment of other diseases

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
26
Malnutrition
̶Malnutrition is a disease caused by insufficient intake of nutrients, inability to absorb
nutrients in diseases of the digestive tract, excessive catabolism of nutrients (septic shock),
serious diseases (oncological), nauzea,…
̶Even the obese patients can be malnourished – despite their high energy intake, some nutrients may
be lacking
̶In western countries, the cause is not a lack of food, but rather a poor diet, eating disorders,
diseases causing impaired absorption and processing of nutrients

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Adipose and muscle tissue
̶Lipolytic hormones (and increasing glycaemia):
Adrenalin, Noradrenalin, Somatotropin, Glucagon, ACTH, Prolactin, Glucocorticoids
̶Body mass: active (muscles) and passive (fat)
̶Slow weight gain with increasing age is physiological (insulin sensitivity decreases, slower
metabolism). Being overweight in old age (from about 65 years) is not harmful if it is the result
of slow weight gain (about 0.25 kg/year).
̶Types of adipose tissue
̶White subcutaneous – not harmful (within physiological values)
̶White abdominal – "beer belly" (between the abdominal organs) – strongly hormonally and
metabolically active, production of pro-inflammatory factors, high cardiovascular risks – greater
incidence in men
̶White organ adipose tissue – protection/storage in some organs – around the kidneys, around the
heart, pancreas, in the liver – useful (within physiol. values) – mobilization faster than
subcutaneous (during weight loss)
̶Brown adipose tissue – thermogenic – mainly in young children, rarely present in some adults
between the shoulder blades and on the neck (useful, overweight prevention)
•Beige adipose tissue – white containing a lot of mitochondria – a consequence of physical
activity.
•Newly discovered pink adipose tissue – can differentiate into other cells, the mammary gland
̶
̶

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
28
Adipose and muscle tissue – gender difference
̶Men have a larger portion of muscles, it is easier to increase muscle tissue (testosterone), which
is a greater energy consumer – easier weight loss
̶The same BMI in men and women has different risks – the similar risk of developing diabetes in
women is usually at a much higher BMI than in men
̶Different stages of weight gain – women during pregnancy and after menopause, men during lifestyle
change (starting a family, divorce, change of job)
̶
Android type of fat storage (apple)
̶Accumulation of fat in the abdomen, subcutaneous tissue and
   between organs
̶More harmful (higher cardiovascular risks)
Gynoid type of fat storage (pear)
̶Storage in the thighs and buttocks – the function is storage
̶Energy for pregnancy and breastfeeding (lower cardiovascular risk)
̶
̶
Android
Gynoid
Above waist
Below waist

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
29
Adipose and muscle tissue
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Underweight
Normal weight
Overweight
Obesity
 1st gr.
Obesity
 2nd gr.
Obesity
 3rd gr.

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
30
A relatio between compounds of MS
̶Dyslipidemia – overweight – hyperglycemia – hypertension
̶High LDL → atherosclerosis
̶Overweight and DM II
̶Insulinoresistance
̶DM II and hypertension
̶Hyperglycemia + hyperinsulinemia + dyslipidemia → endothelial dysfunction → higher vascular
resistance → hypertension
̶Insulin resistance (and hyperglycemia) ↔ sympathetic activity → hypertension
̶Hyperglycemia → autonomic neuropathy → blood pressure regulation disorder
̶Dyslipidemia – atherogenic process – hypertension
̶
̶Atherosclerosis – thrombembolic complications

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
31
Healthy life style
̶Principles of behavior that support our body in maintaining health for as long as possible
̶Generally: a healthy diet, sufficient exercise, sufficient sleep, a healthy environment (no smog,
no smoking), stress management, well-being, etc. (just everything you, as a student or health care
professional, have no chance to accomplish)
̶Slim people without sufficient exercise have worse cardiovascular prognosis than overweight people
who exercise (unfit-unfat / fit-fat)
̶Regular physical activity
̶Helps weight loss
̶Improves parameters of DM and metabolic syndrome
̶Positive effect on the psychical health (important in the therapy of depression)
̶Muscle strength (such as a handgrip test) is an important indicator of a patient's ability to
recover
̶Reduces postprandial inflammation in adipose tissue (immune response that occurs after a meal)
̶
̶

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
32
Evaluation of nutritional state
̶Indices based on anthropometric indicators
̶Measurement of body fat with a caliper
̶Measurement of fat in the body by bioimpedance method
̶Measurement of muscle mass

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
33
Indices based on anthropometric indicators
̶Degree of obesity according to the Broca index
̶Based on the calculation of the ideal weight and the percentage of the ideal weight
̶Some physiological parameters are estimated based on the ideal weight – for example, the initial
setting of tidal volume in mechanical ventilation
̶
̶Ideal weight:
̶For men:
̶Height (cm) – 100
̶Or (height in m)2 – 23
̶For women:
̶Height (cm) – 100 – 10%
̶Or (height in m)2 – 21.5
̶Index = actual weight/ideal weight x 100
Degree of obesity
% of ideal weight
Mild
115 – 129
Medium
130 – 149
Heavy
150 – 199
Morbid
> 200

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
34
Indices based on anthropometric indicators
̶BMI (body mass index) = weight (kg)/height (m)2
̶
For adults
BMI – various tables for men / women, adults / teens / children
man
woman
Underweight
< 20
< 19
Norm
20 – 24.9
19 – 23.9
Overweight
25 – 29.9
24 – 28.9
Obesity
30 – 39.9
29 – 38.9
Serious obesity
> 40
> 39

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Indices based on anthropometric indicators
̶Advantages: simple calculation
̶Disadvantages
̶BMI does not take into account the constitution of body mass. A man with great musculature can be
in the overweight area of a table without having a nutrition problem
̶Broca index uses a linear relationship between height and weight – the index is approximate
̶BMI – a quadratic relationship between height and weight – better than Broca, but it is still
necessary to use different tables for adults, adolescents and children – BMI 17 is normal at 15
years, but in adulthood it means underweight
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̶Rohrer‘s index (100 * weight (g) / height (cm)3).
Weight is determined by volume (the cube of the dimension), so this index is the best.
More consistent in age. More suitable for children and teenagers.

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
36
Waistline, waist/hip ratio
̶Very simple but effective predictive parameters for nutrition evaluation
̶
̶Waist/hip ratio
̶Men < 1
̶Women < 0.8
̶
Waistline in cm
Category
Men
Women
Recommended
≤ 94
≤ 80
Necessary to reduce weight
95 – 102
81 – 90
Weight loss requires medical assistance
> 102
> 90

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
37
Measurement of body fat with a caliper
̶The subcutaneous fat layer is measured
̶It reflects the energy balance of the organism
̶It does not cover possible differences in the distribution of subcutaneous and visceral fat
̶The most common place of measurement: the triceps skinfold (other places: above the shoulder
blade, the abdomen, the spina iliaca, the thigh, the lower leg)
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The triceps skinfold
Normal (mm)
Mild to moderate deficit (mm)
Significant deficit (mm)
Women
> 16.5
 10 – 15
< 10
Men
> 12.5
 7.5 – 11
< 7.5

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
38
Bioimpedance method
Measurement of fat portion in the body
̶Different body tissues have different impedance for very small electric currents (muscle
conductivity versus adipose tissue)
̶The method is based on bioelectrical impedance analysis; the bioelectric impedance (resistance) of
the adipose tissue is measured
̶The ratio of adipose tissue to other tissues is calculated
̶It depends on the amount of fluid in non-fat tissues – on the hydration of the organism (reason
for fluctuations in values during the day if the standard conditions of individual measurements are
not observed)
̶The device can evaluate the % of fat, water and bone tissue

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
39
Bioimpedance method
Measurement of fat portion in the body
̶The handpiece measures the upper half of the body, the scale measures the lower half
̶Whole body measuring devices are now used
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40
Measurement of muscle mass
Muscle tissue is an important parameter of nutritional status
Arm muscle circumference (OSP) – in cm
̶
̶Corected area of arm muscle (kPSP) – in cm
̶Men
̶
̶
̶Women
Muscle loss
No loss
(cm)
Medium (cm)
Heavy
(cm)
Women
> 23.2
14.1 – 23.1
< 14
Men
> 25.3
15.1 – 25.2
< 15
Deficit
No deficit
Mild
Medium
Heavy
Women
> 36.3
29.1 – 36.2
25.5 – 29.0
< 25.4
Men
> 40.9
32.8 – 40.8
28.7 – 32.7
< 28.6

Adobe Systems
Department of Physiology, Faculty of Medicine, Masaryk University
41
Conclusion
̶Evaluation of the nutritional state is an important indicator in all areas of medicine
̶Both malnutrition and obesity may be detrimental to the human organism
̶The process of evaluation of nutritional state starts with simple formulas and continues with
sophisticated measuring instruments
̶The results help to set the diet correctly (rational, reducing, high-energy, etc.)