Assessment of Declining Health Status

1. Provided Courtesy of Nutrition411.com Assessment of Declining Health Status Review Date 4/14 G-1223 Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC, CHESUpdated by Nutrition411.com staff

2. How to Identify Declining Health Status • Body mass index (BMI) • Percent weight change • Percent usual body weight • Arm muscle area • Subjective global assessment

3. 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

4. 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

5. Category BMI Range kg/m2 Source: http://www.who.int/en/

6. 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_calculator/bmi_calculator.htm (ages 20+)

7. BMI Printable Chart www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

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

9. Percent Weight Change • 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? X100=10%

10. Percent Weight Change (cont’d) • 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? X100

11. 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.

12. Declining Weight Status • BMI • Percent weight change • Percent usual body weight • Arm muscle area • Subjective global assessment

13. Usual Body Weight • The stable body weight of the person during the past 6 to 12 months

14. % Usual Body Weight (cont’d) • % Usual Body Weight= Actual Body Weight Usual Body Weight 100

15. % Usual Body Weight (cont’d)

16. Declining Health Status • BMI • Percent weight change • Percent usual body weight • Arm muscle area • Subjective global assessment

17. 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

18. 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.

19. 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

20. 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

21. Mid-Upper Arm Muscle Circumference

22. Triceps Skinfold (TSF) • Technique: Use right side

23. Final Step • Put results into AMA equation • AMA=[MAC–(π x TSF)]2 4π • Use Appendix R from Lee and Nieman’sNutritional Assessment book to calculate results by finding the closest number in the appropriate category

26. Guidelines for Interpreting Percentile Values for Arm Muscle Area

27. 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=squared498.62 12.56 • Individual is in the 10th percentile =39.69 cm2 mm Hg=millimeters of mercury

28. Result • 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

29. Declining Weight Status • BMI • Percent weight change • Percent usual body weight • Arm muscle area • Subjective global assessment

30. 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

31. 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

33. Questions?