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Last 4-digits of PSU ID: 9546

Nutr 453 Spring 2016


Body Weight, BMI, TDE Homework
16 points
TO RECEIVE CREDIT YOU MUST SHOW ALL OF YOUR CALCULATIONS!
Mr. Sparrows wife (Mrs. Sparrow) has decided to come see you. She is a 40 y/o African
American female who is 56 tall with a small frame who weighed 250 lb 3 months ago. She
was recently ill and feels her poor lifestyle and eating habits are to blame. You learn that she lost
25 pounds unintentionally during the past 3 months due to illness. She is healthy now and does
not want to gain back the weight she has lost. You measure her waist and find that it is currently
40.
Obesity Assessment:
1. a. What is Mrs. Sparrows current BMI?
Anthropometrics and Conversions:

BMI Formula:
BMI = weight (kg) / height (meters)2

250 lb -25 lb = 225 lb current weight


wt in kg = 225 lb x 0.45 kg/lb = 101.25 kg

BMI Calculation:
BMI = 101.25 kg / (1.65m)2
= 101.25 kg / 2.7225
= 37.2

5 6 = 66 in
66 in x 0.025 m/in = 1.65 m

b. What is her weight classification based upon her BMI?


Based upon her BMI of 37.2, patients weight is classified as Obesity, Class II.
c. What health risks are associated this weight category according to the 2013
AHA/ACC/TOS guideline?
Patient is at increased risk of cardiovascular disease and mortality of all causes. Health
complications may arise due to excessive body fat.
d. What is advised for someone classified this way according to the 2013
AHA/ACC/TOS guideline?
To lessen the chance of disease and mortality, weight loss is advised for patient.
2. a. What is the AHA/ACC/TOS cut-point for abdominal obesity?
Recommended waist circumference threshold for abdominal obesity in United States
according to AHA/ACC/TOS Organizations, 2013
Men 102 cm (40 in)
Women 88 cm (35 in)

Last 4-digits of PSU ID: 9546


Would Mrs. Sparrow be classified as having abdominal obesity according to the
2013 guideline?
Anthropometric Conversion
40 = ? cm
40 in x 2.54 cm/in = 101.6 cm

Abdominal Obesity Classification:


Patients waist circumference measures 101.6 cm (40
inches).
Patients waist circumference is above the cut-point
of 88 cm (35 inches).
Therefore, patient is classified as having abdominal
obesity according to the 2013 guideline.

3. a. How much should she weigh according to the Miller equation? You must show your
calculations to get credit using the formula provided in the lecture notes.
Miller Equation
Females:
118# for first 5

How much should patient weigh according to Miller?


118 + (3 x 6) = 136 lb

3# for each additional inch

Small frame = - 10% of wt

Then adjust for frame size

136 (0.1 x 136) = 122.4 = 122 lb


IBW = 122 lb

b. Now go to calculator.net and compare your answer to the answers they provide
for the Robinson, Miller, Devine, or Hamwi formulas. How does your calculated
value using the Miller equation compare to the value you got using calculator.net
for Miller body weight? BE SURE TO ADJUST FOR FRAME SIZE FOR YOUR
CALCULATED VALUE AS WELL AS FOR THE VALUES PROVIDED BY
CALCULATOR.NET.
IBW according to Calculator.net - Adjusted for small frame
Robinson:
130.5 (0.1 x 130.5)
= 130.5 13.5
= 117 lb
Miller:
= 135.1 (0.1 x 135.1)
= 135.1 13.51
= 121.59
= 122 lb

Devine:
= 130.7 (0.1 x 130.7)
= 130.7 13.07
= 117.63
= 118 lb
Hamwi:
= 129.4 (0.1 x 129.4)
= 129.4 12.94
= 116.46 lb
= 117 lb

Last 4-digits of PSU ID: 9546


The IBW value I calculated above using the Miller equation (122 lb) is the same value
calculated by calculator.net (122 lb).
c. Which IBW is the highest for the following equations: Robinson, Miller,
Devine, or Hamwi? Which is the lowest? Are they all within the range provided
by the healthy BMI recommendation after adjusting for frame size?
The IBW is highest for the Miller equation: 122 lb

BMI Calculations Based on IBW Adjusted for Frame Size

The IBW is lowest for the Hamwi equation: 116.46 lb Miller: BMI based 2on 122 lb = 122 lb x 0.45 kg/lb = 54.9 kg
= 54.9 kg / (1.65m) = 54.9 / 2.7225 = 20.17 = 20 BMI
Devine: BMI based on 118 lb = 118 lb x 0.45 kg/lb = 53.1 kg
= 53.1 kg / (1.65m)2 = 53.1 / 2.7225 = 19.5 = 20 BMI
Robinson: BMI based on 117 lb = 117 lb x 0.45 kg/lb = 52.65
kg
= 52.65 kg / (1.65m)2 = 52.65 / 2.7225 = 19.34 = 19 BMI
Hamwi: BMI based on 116.46 lb = 116.46 lb x 0.45 kg/lb =
52.407
= 52.407 kg / (1.65m)2 = 52.407 / 2.7225 = 19.25 = 19 BMI

After adjusting for frame size and using the calculated weights to calculate BMI using patients
anthropometric data, all fall within the normal range. However, the weight values calculated
using the Hamwi and Robinson values resulted in BMI of 19, which is very close to the
underweight classification of 18.5. Therefore, using clinical judgment, I would use the
calculations found using the Miller equation, which I believe is most reliable.
Malnutrition Assessment:
4. As mentioned above, Mrs. Sparrow was recently ill and lost 25 pounds over the last
3 months. Prior to that her weight had been fairly stable for a year. Mrs. Sparrow
currently weighs what % of her usual weight?
(225/250) x 100 = 90%
Patient weighs 90% of her usual weight
5. What % of her usual weight did Mrs. Sparrow lose in the past 3 months?
% BW lost = Former (or USUAL) BW Current BW / Former (or USUAL) BW
= 250 225 / 250
= 25 / 250
= 0.1 x 100
= 10%

Last 4-digits of PSU ID: 9546


Patient lost 10% of her usual weight in the past 3 months.
6. Since her weight loss was unintentional how would this amount of weight loss be
classified? Why (be sure to cite your source for your classification and reason)?
Given that patients unintentional weight loss of 10% of BW, her % change within a 3month time frame is greater than 7.5% and is therefore classified as severe malnutrition
due to acute illness.
Unintentional Body Weight Change Due to Acute Illness or Injury as an Indicator of
Malnutrition From: White, JV et al. J Acad Nutr Diet. 2012;112:730-738. Consensus
Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and
Enteral Nutrition:Characteristics Recommended for the Identification and Documentation of
Adult Malnutrition (Undernutrition)
Calculating Energy Needs:
Mrs. Sparrow currently works as a law enforcement officer on rotating shifts; therefore she does
not get much exercise on a regular basis.
7. Calculate Mrs. Sparrows current TDE using the Mifflin St.-Jeor equation and her
current body weight. Round your final answer to the nearest 50 kcal.
TDE = REE x AF x IF
Determining REE
Women: Women: [9.99 X wt (kg)] + [6.25 X ht (cm)] - [4.92 X age] -161
= [9.99 x 101.25kg] + [6.25 x 165 cm] [4.92 x 40 y/o] 161
= 1684.9
= 1685 kcal
Activity Factor
Given that patient is a law enforcement officer on rotating shifts and therefore does not get
much exercise, she fits activity factor of 1.3
Injury Factor:
N/A. Patient has no injuries.
TDE = REE x AF x IF
= 1685 X 1.3 x 1
= 2190.5 = 2200 kcal
Mrs. Sparrow is hospitalized about a week later after being in an automobile accident and
suffering skeletal trauma as a result. She is currently bed-ridden and will be for the next
month. As a result, she will not be able to return to work during that time. You have been
called to consult on the case.

Last 4-digits of PSU ID: 9546

8. What is Mrs. Sparrows TDE now? (Round your final answer to the nearest 50 kcal)
TD = REE x AF x IF
Determining REE
Women: Women: [9.99 X wt (kg)] + [6.25 X ht (cm)] - [4.92 X age] -161
= [9.99 x 101.25kg] + [6.25 x 165 cm] [4.92 x 40 y/o] 161
= 1684.9
= 1685 kcal
Activity Factor
Patient is bed-ridden: AF of 1.1
Injury Factor:
Patient is experiencing skeletal trauma: IF of 1.35
TDE = REE x AF x IF
= 1685 x 1.1 x 1.35
= 2502.2 = 2500 kcal
9. If Mrs. Sparrow continues to eat the same amount of energy that she did before her
accident
a. How much weight would she be expected to gain or lose during the 30-day recovery
period?
TDE prior to injury TDE after injury = kcal difference / day
2200 2500 = -300 kcal / day
(Kcal diff/day) x # days = total kcal difference during recovery period
- 300 kcal / day x 30 days = -9000 kcal
Total kcal diff/kcal per pound = # lbs gained (+) or lost (-)
-9000 kcal/ 3500 kcal per lb = -2.57 lb = -2.6 lb lost in 30 days
Patient would be expected to lose 2.6 lbs during the 30-day recovery period due to a 9000 kcal
deficit.
2.6/ weight prior to injury
= 2.6 / 225 lbs
= 1.2% loss of weight 30 days
This 2.6 lb lost equates to 1.2% loss of body weight within 30 days.
b. Should you be concerned? Why or why not? Be sure to cite your sources!
Based on the following information:

Last 4-digits of PSU ID: 9546

Patient lost 2.6 lbs in 30 days


Patient experienced 1.2% loss of weight in 30 days
Within 1 month time frame, moderate malnutrition is classified as % change between 12%
Patient experienced 10% loss in previous 3 months
Therefore, patient is consistent with the indicators of moderate malnutrition and this
requires immediate attention.

Unintentional Body Weight Change Due to Acute Illness or Injury as an Indicator of


Malnutrition From: White, JV et al. J Acad Nutr Diet. 2012;112:730-738. Consensus
Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and
Enteral Nutrition:Characteristics Recommended for the Identification and Documentation of
Adult Malnutrition (Undernutrition)