1. Protein Status Anthropometric Biochemical Clinical –physical exam –medication information Dietary

2. Protein Status Clinical –physical exam

3. McClaren 41. Hair is dull, dry, lacks lustre. Kwashiorkor and marasmus.

4. McClaren 42. ‘Flag-sign’ of marasmus and kwashiorkor.

5. McClaren 40. Moon face of kwashiokor.

6. Protein Status Two compartment model –somatic protein is muscle –visceral protein is organs, RBC, lymphocytes, serum proteins

7. Protein Status Somatic protein stores –Arm muscle circumference –Arm muscle area –Gender and age specific

8. McClaren 1. Cachexia.

9. Protein Status Visceral protein –organs –rbc –granulocytes –lymphyocytes –serum proteins

10. Protein Status Guidelines interpreting AMA –<5th percentile = wasted, no muscle stores –5th to <15th = below average –>15th to <85th =average –>85th to <95th = above average –>95th = high muscle

11. Protein Status Somatic protein stores –30% total body protein Visceral protein stores –50% total body protein

12. Protein Status Visceral protein stores –Albumin –3.5 - 5.0 g/dL or 35 - 50 g/L –Half-life is 14 - 21 days

13. Protein Status Alb –Responds slowly to nutritional repletion –Poor indicator of nutritional support in acute care –Better for initial assessment

14. Protein Status Prealbumin, thyroxine-binding pre- albumin, transthyretin –20 - 50 mg/dL –Half-life is 2 to 3 days

15. Protein Status Prealbumin –More sensitive measuring nutritional therapy –Decreased in trauma and infection

16. Protein Status TLC Protein malnutrition causes decrease in TLC Do not use in immunocompromised pt.

17. Protein Status CBC with differential count WBC X %lymphocytes 12,300 X.25 = 3,075 cells/mm3

18. Protein Status Normal WBC –4,500 - 11,000 cells/mm3 Normal %lymphocytes –20 - 40% Normal TLC –2,000 cells/mm3

19. Protein Status TLC –severe delpletion is < 800 cells/mm3 –moderate is 800 - 1199 cells/mm3 –mild is 1,200 - 1,800 cells/mm3

20. Protein Status TLC Practice looking at a CBC form

21. Protein Energy Malnutrition No risk –Alb >3.2 g/dL –Prealb >17 mg/dL Moderate risk –Alb 2.5 - 3.2 g/dL –Prealb 10 to 17 mg/dL

22. PEM Severe risk –Alb <2.5 g/dL –Prealb <10 mg/dL

23. PEM Using Alb and weight loss Criteria grid, Funk & Ayton, JADA, 1995

24. Criteria grid for determining malnutrition dx. Funk & Ayton, JADA, 1995

25. PEM Using Diagnostic Related Groups of the International Disease Classification system

26. PEM Case 1 –wt is 75% of wt/ht –Alb 4.0 g/dL Case 2 –wt is 93% of wt/ht –TLC 1,000 cells/mm3

27. PEM Case 3 –wt is 80% of wt/ht –Alb 3.0 g/dL

28. Summary Protein Status Somatic protein Visceral protein Dietary intake Physical exam or clinical Anthropometrics

29. END Questions on protein status?