Assessment of Protein Status.ppt

Assessment of Protein Status FCSN 442 - Nutrition Assessment Laboratory Dr. David L. Gee Central Washington University Assessment of Protein Status Anthropometric Assessment body composition estimations midarm muscle circumference/area Laboratory Assessment serum albumin other serum proteins (transferrin, prealbumin, retinol-binding protein) urinary creatinine excretion total lymphocyte count Midarm Muscle Area Estimate of MAMA is an estimate of overall muscle mass single point vs serial measurements Assumptions arm, muscle, bone are circular TSF is 2X the thickness of fat bone area is constant Midarm Muscle Circumference MAMC = AC - (.314 x TSF) MAMC = midarm muscle circumference in cm AC = arm circumference in cm TSF = tricep skinfold in mm “…change in arm muscle area is greater than the change in mid-arm circumference. Consequently, changes in upper-arm musculature are not as easily detected by measurement of mid-arm circumference as by AMA. Therefore, AMA is the preferred nutritional index.” Arm Muscle Area AMA = ((MAC - (3.14 x TSF)2 ) / (4 x 3.14) AMA = arm muscle area (cm2) MAC = mid-arm circumference (cm) TSF = tricep skinfold thickness (cm) Or units of AMA, MAC, TSF all in mm To convert mm2 to cm2, divide mm2/100 adjusted AMA corrected for “bone free” AMA Subtract constant from AMA to account for bone, nervous tissue, vascular tissue. p-304 Table 7.6Guidelines for Interpreting Percentile Values for Arm Muscle Area (appendix R) Biochemical Assessment of Protein Status Two protein compartment model Somatic protein (skeletal muscle protein) ~75% of total body protein Visceral protein (internal organs, blood cells, serum proteins) ~ 25% of total body protein “No single test or group of tests can be recommended at this time as a routine and reliable indicator of protein status.” Young, 1990 “…a combination of measures can produce a more complete picture of protein status.” Biochemical, anthropometric, dietary, and clinical findings Serum Albumin Major