Provided Courtesy of Nutrition411.com Assessment of Declining Health Status Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC, CHES Updated by Nutrition411.com staff Review Date 4/14 G-1223 How to Identify Declining Health Status • • • • • 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) • • • • • Body mass index (BMI) Percent weight change Percent usual body weight Arm muscle area Subjective global assessment BMI • 2.2 lb in 1 kg • 2.54 cm in 1″ • 100 cm in 1 m cm=centimeter, kg=kilogram, lb=pound, m=meter Category BMI Range kg/m2 Severe thinness Moderate thinness Mild thinness Normal Overweight Obese Class I Obese Class II Obese Class III Source: http://www.who.int/en/ <16 16-16.99 17-18.49 18.5-24.99 25-29.99 30-34.99 35-39.99 40+ BMI Online Resources 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_cal culator/bmi_calculator.htm (ages 20+) BMI Printable Chart www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf Anthropometrics • • • • • BMI Percent weight change Percent usual body weight Arm muscle area Subjective global assessment Percent Weight Change • Percent recent weight change= Usual Weight – Actual Weight X 100 =10% 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? Percent Weight Change (cont’d) • Percent recent weight change= Usual Weight (150) – Actual Weight (135) X100 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? Percent Weight Change (cont’d) • Significant weight loss: − 5% loss over 1 month or − 7.5% loss over 3 months or − 10% loss over 6 months • Severe weight loss: − 5% loss over 1 month or − >7.5% loss over 3 months or − 10% loss over 6 months Source: Blackburn et al, 1977. Declining Weight Status • • • • • BMI Percent weight change Percent usual body weight Arm muscle area Subjective global assessment Usual Body Weight • The stable body weight of the person during the past 6 to 12 months % Usual Body Weight (cont’d) • % Usual Body Weight= Actual Body Weight 100 Usual Body Weight % Usual Body Weight (cont’d) Mildly malnourished 85%-90% Moderately malnourished 75%-84% Severely malnourished <74% Absolute minimum weight 48%-55% for survival Declining Health Status • • • • • BMI Percent weight change Percent usual body weight Arm muscle area Subjective global assessment 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 (cont’d) • 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. What You Need to Calculate AMA • 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 Finding the Point to Measure the MUAC or MAC • 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 midpoint MAC=mid-arm circumference, MUAC=mid-upper arm circumference Mid-Upper Arm Muscle Circumference Triceps Skinfold (TSF) • Technique: Use right side Final Step • 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 Guidelines for Interpreting Percentile Values for Arm Muscle Area Category Percentile Wasted <5th percentile Below average 5th-15th percentile Average 15th-85th percentile Above average 85th-95th percentile High muscle >95th percentile Practice Example (make everything cm) • • • • 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–(3.14x3 cm)=22.33=squared 498.62 =39.69 cm2 12.56 • Individual is in the 10th percentile mm Hg=millimeters of mercury Result • Patient is at increased nutritional risk secondary to AMA results of 10%, categorized as below average Category Percentile Below average 5th-15th percentile • One negative: AMA not validated in people who are older than 75 years of age Declining Weight Status • • • • • BMI Percent weight change Percent usual body weight Arm muscle area Subjective global assessment 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 (cont’d) • 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 Questions?