Assessment of Assessment of Declining Health Declining Health

StatusStatus

Provided Courtesy of Nutrition411.com

Review Date 4/14G-1223

Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC, CHESUpdated by Nutrition411.com staff

How to Identify Declining Health Status

• Body mass index (BMI)• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

• Body mass index (BMI)• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

How to Identify Declining Health Status (cont’d)

• 2.2 lb in 1 kg• 2.54 cm in 1″• 100 cm in 1 m

cm=centimeter, kg=kilogram, lb=pound, m=meter

BMI

Source: http://www.who.int/en/

Severe thinness <16

Moderate thinness

16-16.99

Mild thinness 17-18.49

Normal 18.5-24.99

Overweight 25-29.99

Obese Class I 30-34.99

Obese Class II 35-39.99

Obese Class III 40+

Category BMI Range kg/m2

http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

http://www.consumer.gov/weightloss/bmi.htm

http://apps.nccd.cdc.gov/dnpabmi/Calculator .aspx (for ages 2-19)

http://www.cdc.gov/nccdphp/dnpa/healthy weight/assessing/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.htm (ages 20+)

BMI Online Resources

www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

BMI Printable Chart

• BMI• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

Anthropometrics

• Percent recent weight change=Usual Weight – Actual Weight

Usual Weight

• Mary Jane was 150 lb last time you saw her 3 weeks ago

• Today you visit her and she is 135 lb• What is her percent weight change?

X 100 = 10%

Percent Weight Change

• Percent recent weight change=Usual Weight (150) – Actual Weight (135)

Usual Weight (150)

• Mary Jane was 150 lb last time you saw her 3 weeks ago

• Today you visit her and she is 135 lb• What is her percent weight change?

X 100

Percent Weight Change (cont’d)

Source: Blackburn et al, 1977.

Percent Weight Change (cont’d)

• Significant weight loss:−5% loss over 1 monthor−7.5% loss over 3 monthsor−10% loss over 6 months

• Severe weight loss:−5% loss over 1 monthor−>7.5% loss over 3 monthsor−10% loss over 6 months

• BMI• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

Declining Weight Status

• The stable body weight of the person during the past 6 to 12 months

Usual Body Weight

• % Usual Body Weight=

Actual Body Weight Usual Body Weight

100

% Usual Body Weight (cont’d)

Mildly malnourished 85%-90%

Moderately malnourished

75%-84%

Severely malnourished

<74%

Absolute minimum weight for survival

48%-55%

% Usual Body Weight (cont’d)

• BMI• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

Declining Health Status

Arm Muscle Area (AMA)

• AMA is an estimate of overall muscle mass

• The National Health and Nutritional Examination Survey (NHANES) data indicate a depletion of lean body mass (ie, malnutrition and/or declining health status)

• Assumptions:– Arm, muscle, bone are circular– TSF is 2 the thickness of fat– Bone area is constant

TSF=triceps skinfold

• AMA is a better predictor of mortality than BMI in chronic obstructive pulmonary disease patients

Source: Soler-Cataluña JJ. Chest. 2005;128(4):2108-2115.

AMA (cont’d)

• The equation:[MAC – (π x TSF)]2

4π– Where π=3.14

• MAC—mid-arm circumference (cm)• TSF—triceps skinfold (cm)• Calculator• Chart to interpret results

What You Need to Calculate AMA

• Conduct on the nondominant arm

• Bend elbow 90 degrees• Measure the distance

from the boney protrusion on the shoulder (acromion) and the point of the elbow (olecranon process)

• Mark the midpointMAC=mid-arm circumference, MUAC=mid-upper arm circumference

Finding the Point to Measure the MUAC or MAC

Mid-Upper Arm Muscle Circumference

• Technique: Use right side

Triceps Skinfold (TSF)

• Put results into AMA equation• AMA=[MAC – (π x TSF)]2

4π• Use Appendix R from Lee and Nieman’s

Nutritional Assessment book to calculate results by finding the closest number in the appropriate category

Final Step

Category Percentile

Wasted <5th percentile

Below average 5th-15th percentile

Average 15th-85th percentile

Above average 85th-95th percentile

High muscle >95th percentile

Guidelines for Interpreting Percentile Values for Arm Muscle Area

• Age 51• If the MAC=12.5″ x 2.54=31.75 cm• If the TSF=30 mm Hg=3 cm • AMA=[MAC – (π x TSF)]2

4π• AMA=31.75 cm – (3.14 x 3

cm)=22.33=squared 498.62 12.56

• Individual is in the 10th percentile

=39.69 cm2

mm Hg=millimeters of mercury

Practice Example(make everything cm)

• Patient is at increased nutritional risk secondary to AMA results of 10%, categorized as below average

• One negative: AMA not validated in people who are older than 75 years of age

Category Percentile

Below average 5th-15th

percentile

Result

• BMI• Percent weight change• Percent usual body weight• Arm muscle area• Subjective global assessment

Declining Weight Status

Subjective Global Assessment (SGA)

SGA:• Is truly a subjective means of

assessing nutritional status, which corresponds to the subjective opinion of the patient’s nutritional status

• Classifies the patient as A, B, or C, which is based on the subjective ratings in two broad areas:– Medical history– Physical examination

• SGA is not a scoring system—not appropriate to score or add the number of A, B, and C ratings to arrive at the overall SGA classification

• If a patient has more B and C ratings, malnutrition is more likely

• A well-nourished patient will have ratings on the left-hand side of the SGA scoring sheet

SGA (cont’d)

Questions?