Assessment Of Protein Nutritional Status Research Articles

Assessment of protein nutritional status in children

When considering the effects of disease on nutritional status it is useful to think of the body consisting of lean mass and fat mass. The latter relates to energy status and the former to protein nutritional status. In addition, childhood growth in length/height is to a high degree dependent upon having an adequate protein intake. If insufficient non-protein energy is fed, then protein is used to help meet energy needs. Hence achieving an optimum protein nutritional status also requires receiving sufficient energy. Assessment of protein nutritional status starts with measurement of length/height and weight in relationship to growth standards. Next comes using mid-upper arm parameters in which the measurement of muscle area or circumference is a reflection of protein nutritional status while triceps skin-fold thickness is a measurement of energy status. Serum albumin remains the number one short term parameter reflecting protein nutritional status followed by serum transferrin. Plasma amino acid profiles can be measured but are mostly dependent on recent dietary intake and so are hard to interpret. Classically, nitrogen balance has been used as a reflection of dietary protein intake. While it has been used extensively on a research basis its clinical applicability is limited.

Selective use of transthyretin and retinol-binding protein as markers in the postoperative assessment of protein nutritional status.

We evaluated several markers to judge the postoperative state of protein nutriture in eight patients following surgery for cancer. Seven patients had a good prognosis and had no evidence of infections or other complications. Following surgery, all of the patients showed a shift toward abnormal values for the serum concentrations of albumin, transthyretin (TT), retinol-binding protein (RBP), and the amino acid (AA) ratio of nonessential to essential amino acids. In patients without complications, the AA ratio returned to normal first. When blood specimens were collected at 7-day intervals, concentrations of RBP and TT were revealed to be decreased and recovered at the same time, or TT was recovered after RBP was normalized. RBP and TT were usually abnormal until the AA ratio became normal. Although albumin moved toward normal concentrations after RBP and TT, the albumin concentrations in some patients were slightly above the lower reference value, whereas RBP and TT were significantly below their lower reference limits. In these patients, assessments over the next 7-14 days showed persistently low values for albumin, TT, and RBP. We recommend the selective use of TT and RBP for the postoperative assessment of protein nutriture in surgical patients.

Creatinine kinetic modelling: a simple and reliable tool for the assessment of protein nutritional status in haemodialysis patients

While the mathematical modelling of urea kinetics is in wide use for evaluating treatment adequacy and protein nutrition in dialysis patients, the kinetics of creatinine generation in dialysis patients has been relatively unexplored. In this study creatinine kinetic modelling as a clinical tool was investigated in a group of 90 patients treated by haemodialysis (n = 20), haemodiafiltration (60), haemofiltration (7), or biofiltration (3) over a 6-36-month period. A single pool model of creatinine kinetics was employed to obtain monthly values of creatinine distribution space and creatinine appearance rate. Extrarenal creatinine degradation rate, estimated using a clearance of 0.038 l/kg/24 h as suggested by Mitch and co-workers, was added to creatinine appearance rate in urine and dialysate to calculate a corrected creatinine index (CI). Extrarenal degradation accounted for 12 +/- 2% of CI. CI was higher in males (22.4 +/- 4.5 mg/kg/24 h) than females (19.8 +/- 4.8) and decreased with age, falling off more sharply for the female group (CI = 29.9-0.185.age, R = 0.72) than the males (CI = 24.1-0.030.age, R = 0.31). CI was found to correlate strongly with protein catabolic rate determined by urea kinetic modelling (CI = 8.84 +/- 10.91.PCR). Low or reduced CI was associated in this study group with severe malnutrition status and high mortality rate. CI is suggested as a strong predictor of patient morbidity and mortality.

Assessment of Protein Nutritional Status

An evaluation of protein status can be approached by use of anthropometric, clinical, and biochemical data, either singly or in combination, and further aided with dietary data. Each of these approaches has advantages and limitations. Biochemical evaluation has the potential of being the most objective and quantitative. Indicators that have been or might be used include plasma hormone responses to reduced protein intake, plasma levels of specific proteins or specific amino acids, urinary excretion of specific amino acids and other nitrogen-containing compounds, anthropometric and physical measurements of body muscle mass, and functional tests of muscle strength. Several measurements can be combined to produce nutritional indices of broader potential value. The importance of concomitant infection and inflammation, with its many effects on protein metabolism, cannot be ignored in making these assessments. Unfortunately, no single test or group of tests can be recommended at this time as a routine and reliable indicator of protein status. Nonetheless, our increasing knowledge of the metabolism and functions of proteins, together with the recent use of noninvasive stable isotope techniques and of sophisticated physicochemical measurements, provides encouragement that more appropriate indicators are in the offing.

Field use of hair epilation force in nutrition status assessment

The nutritional status of 69 Nigerians, age 1 month to 75 yr was assessed with the Krumdieck trichotillometer, which measures the force required to epilate a hair (epilation force, EF). EF of normal subjects (serum albumin ≥ 3.5 g/dl) was 36.5 ± 9.5 g (mean ± SD). EF was significantly lower (25.7 ± 10.6 g) in malnourished subjects (serum albumin ≤ 3.0 g/dl). EF correlated significantly with weight-for-height, mid-arm circumference, mid-arm muscle circumference, and serum albumin (r = 0.36, 0.32, 0.30, and 0.30, respectively, p < 0.05), but did not correlate significantly with triceps skinfold. These findings are in agreement with the clinical impression that hair pluckability is affected more by protein depletion than by energy depletion. The trichotillometer may be a useful tool in assessment of protein nutritional status in the field since it requires little training, and no laboratory.

Racial differences in nitrogen content of nails among adolescents

Ectodermal derivatives provide a readily accessible means of chemically evaluating body protein composition. Therefore, it has been postulated that the analysis of nail nitrogen content may reflect recent nutritional status. Assessment of nail nitrogen content has been previously reported in a small group of neonates and school children. The present study was undertaken to determine if standards for nail nitrogen content could be established for adolescents which could then be used in the assessment of protein nutritional status. Nail clippings were obtained from 118 economically indigent urban black youth, 10 black and 39 white subjects from wealthy suburban communities in the New York area, and 10 poor white-Indian adolescents residing within a barrio in Lima, Peru. Nail samples were analyzed for protein content using the micro Kjeldahl technique. Mean nail nitrogen content for wealthy suburban and impoverished urban black youth was 136 and 137 mg N/g of nail, respectively. Values for poor Peruvian white-Indian and affluent suburban white adolescents were 142 and 141 mg N/g of nail, respectively. The differences between ethnic groups were significant using t test analysis at a P value of less than 0.001. No differences, however, were found between either wealthy and poor of the same racial background or when the data were analyzed by gender. These results suggest that differences in nail nitrogen content are at least in part a reflection of ethnicity. These racial differences must be considered in assessing nutritional status by nail nitrogen analysis.

An assessment of the clinical usefulness of plasma ribonuclease assays

The usefulness of plasma ribonuclease assays was studied in: (i) patients with possible protein deficiency, (ii) patients with myelomatosis, (iii) patients with carcinoma of the breast. In each group, the major factor associated with elevation of plasma ribonuclease was impairment of renal function. The assay was therefore of little value in the assessment of patients with myelomatosis or carcinoma of the breast. However, in the patients with possible protein deficiency and normal renal function, an elevation of plasma ribonuclease is, in general, associated with a decrease in serum albumin, transferrin and cholinesterase. Plasma ribonuclease may therefore be a useful parameter in the assessment of protein nutritional status.

Assessment of Protein Nutritional Status: A Committee Report

Assessment of Protein Nutritional Status: A Committee Report

Enzymes and the assessment of protein nutrition

This symposium is concerned with the assessment of protein nutritional status in man. The question we have to examine is whether measurements of enzyme activity are, or may be in the future, of any value for this purpose. There are several concepts which may be useful in considering this problem, such as the nature of enzymes and the regulation of their amount in the body, the effect on activity of a biochemical lesion at the cellular level, and the adaptive changes that reflect an altered balance of metabolic pathways.

Enzymes and the assessment of protein nutrition

This symposium is concerned with the assessment of protein nutritional status in man. The question we have to examine is whether measurements of enzyme activity are, or may be in the future, of any value for this purpose. There are several concepts which may be useful in considering this problem, such as the nature of enzymes and the regulation of their amount in the body, the effect on activity of a biochemical lesion at the cellular level, and the adaptive changes that reflect an altered balance of metabolic pathways.