Protein Status

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Protein Status

• Anthropometric
• Biochemical
• Clinical
• physical exam
• medication information
• Dietary

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Protein Status

• Clinical
• physical exam

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McClaren 41. Hair is dull, dry, lacks lustre.
Kwashiorkor and marasmus.
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McClaren 42. Flag-sign of marasmus and
kwashiorkor.
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McClaren 40. Moon face of kwashiokor.
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Protein Status

• Two compartment model
• somatic protein is muscle
• visceral protein is organs, RBC, lymphocytes,
  serum proteins

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Protein Status

• Somatic protein stores
• Arm muscle circumference
• Arm muscle area
• Gender and age specific

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McClaren 1. Cachexia.
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Protein Status

• Visceral protein
• organs
• rbc
• granulocytes
• lymphyocytes
• serum proteins

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Protein Status

• Guidelines interpreting AMA
• lt5th percentile wasted, no muscle stores
• 5th to lt15th below average
• gt15th to lt85th average
• gt85th to lt95th above average
• gt95th high muscle

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Protein Status

• Somatic protein stores
• 30 total body protein
• Visceral protein stores
• 50 total body protein

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Protein Status

• Visceral protein stores
• Albumin
• 3.5 - 5.0 g/dL or 35 - 50 g/L
• Half-life is 14 - 21 days

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Protein Status

• Alb
• Responds slowly to nutritional repletion
• Poor indicator of nutritional support in acute
  care
• Better for initial assessment

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Protein Status

• Prealbumin, thyroxine-binding pre-albumin,
  transthyretin
• 20 - 50 mg/dL
• Half-life is 2 to 3 days

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Protein Status

• Prealbumin
• More sensitive measuring nutritional therapy
• Decreased in trauma and infection

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Protein Status

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

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Protein Status

• CBC with differential count
• WBC X lymphocytes
• 12,300 X .25 3,075 cells/mm3

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Protein Status

• Normal WBC
• 4,500 - 11,000 cells/mm3
• Normal lymphocytes
• 20 - 40
• Normal TLC
• 2,000 cells/mm3

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Protein Status

• TLC
• severe delpletion is lt 800 cells/mm3
• moderate is 800 - 1199 cells/mm3
• mild is 1,200 - 1,800 cells/mm3

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Protein Status

• TLC
• Practice looking at a CBC form

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Protein Energy Malnutrition

• No risk
• Alb gt3.2 g/dL
• Prealb gt17 mg/dL
• Moderate risk
• Alb 2.5 - 3.2 g/dL
• Prealb 10 to 17 mg/dL

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PEM

• Severe risk
• Alb lt2.5 g/dL
• Prealb lt10 mg/dL

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PEM

• Using Alb and weight loss
• Criteria grid, Funk Ayton, JADA, 1995

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

• Using Diagnostic Related Groups of the
  International Disease Classification system

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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

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PEM

• Case 3
• wt is 80 of wt/ht
• Alb 3.0 g/dL

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Summary Protein Status

• Somatic protein
• Visceral protein
• Dietary intake
• Physical exam or clinical
• Anthropometrics

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END

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