PRACTICAL ASPECTS

Anthropometric Worksheet for Use With Hemodialysis Patients Laura Ann Yates, RD, LD*

NTHROPOMETRIC measurement pro- A vides additional information in the nutri- tional assessment of the hemodialysis patient. Assessing current status as well as monitoring changes in fat and somatic protein stores of the patient provide the clinician with information useful in addressing adequacy of protein and energy intake.

Measuring triceps skin-fold thickness (TSF) allows the clinician to separate the mid-upper arm circumference (MUAC) into an estimation of fat stores as TSF and somatic protein status represented by mid-arm muscle circumference (MAMC) and corrected arm muscle area (&MA). Fat and somatic protein stores vary by age, gender, and race, as reflected by the National Health and Nutrition Examination Survey (NHANES). An indicator of obesity, Quetelet’s Index or Body Mass Index (BMI), compares weight to height and correlates well with body fatness.

Comparison of TSF, MAMC, and MUAC to NHANES provides the clinician with a more detailed picture of the nutritional status of the patient compared with the general population. Repeat anthropometric measurements allow the clinician to monitor changes in stature, fat stores, and somatic protein status within the patient.

The Anthropometric Worksheet (Fig 1) was developed to facilitate efficient measurement of a large number of dialysis patients over a short period of time. The form constitutes part of both the initial and the annual assessment of the patient.

Height and wrist circumference measure- ments are performed at the first treatment to calculate the diet prescription. Arm measure-

*Renal Nurrition Specialist, Dia6ysis Clinic, Im, North Columbus, GA.

Address reprint requests to Laura Ann Yates, RD, LD, 4560 Jminey Loop, Columbus, CA 31909.

Q 1996 by the Natioml Kidney Foundation, Inc. 1051~2276/96/0603-0007%03.00/0

ments are delayed until an accurate postdialysis dry weight is achieved.’ Arm measurements may not be completed for several treatments. Annual anthropometric measurements are per- formed on all patients over a 2-day period during the summer when patients are wearing sleeveless or short-sleeve clothes. Height is measured before treatment. All other measure- ments are performed after treatment.

Measurements are performed using pub- lished techniques. 2,3 Height is measured with the patient standing, in stocking feet, against a nonstretchable tape measure attached to a wall. The head is held in the Frankfort horizontal plane. A right angle headboard is used to read the tape measure. Heights for patients who cannot stand are estimated using knee height and the formula based on age, gender, and race.3

Mid-arm circumference is measured with a flexible, nonstretchable tape measure at the point midway between the lateral projection of the acromion process of the scapula and the olecra- non process of the ulna of the nonaccess arm with the elbow flexed 90”. The TSF is measured using Lange skin-fold calipers (Beta Technology, Inc, Cambridge, MD) on the posterior of the nonaccess arm, over the triceps muscle. Wrist circumference is measured in the nonaccess arm by placing a flexible, nonstretchable tape measure distal to the styloid process of the radius and ulna.

Measurements are taken at the scale as the patient leaves the unit. The work area for measurement of the patients consists of a chair available for the comfort of the patient, a plastic basket containing all of the equipment used, and a bottle of disinfectant for wiping each piece of equipment between patient measurements.

The percent ideal body weight lost as a result of an above-knee amputation (AKA) is esti- mated to range between 7.1% and 18.5%.4 The figure by Grant and DeHoo& depicts an estima-

162 ]ourd ofRenal Nutrition, Vol6, No 3 (July), 1996: pp 162-164

ANTHROPOMETRIC WORKSHEET IN HEMODUL.YSIS 163

Figure 1. Anthropometric worksheet form. Post-TX Wt, post-treatment weight; T Wt, target or dry weight; BKA, below-knee amputation; AKA, above-knee amputa- tion; TSF, triceps skin-fold thickness; MUAC, mid-up- per arm circumference; MAMC, mid-arm muscle cir- cumference; cAMA, cor- rected arm muscle area. (De- veloped by Laura Ann Yates, RD, LD.)

Race-Gender-Age- Date

Post-TX Wt (kg) (1b)T Wt (kg) (IblProsthesis weight (kg) (lb)

lit (ml) (in)Wrist circumference (NOWACCESS) (a) (in)

Frame Size: h‘ I= elg t Asw.8Ratm Males : Females: - 1 > 10.4 (sm+l) r > 11

r = 9.6 - 10.4 IE;:"

r = 10.1 - 11 I < 9.6 r < 10.1

Ideal Body Weight (IBW) Calculation for Adults: Male: FeLU?.le -

106 106 lb. for 5 ft. - + 6 lb. for each __ additional inch - +/- frame adjustment'

+ 10 lbs. > 65 y - - amputation adjustment' - IBW'

100 lb. for 5 ft. 100 + 5 lb. for each additional inch

__ +/- frame adjustment' + 10 lbs. > 65 y - amputati& adjustment2 IBW'

' Add ect) 10% IBW (without age adjus&KKt) for large (small)

' Subtract 1% IBW (without age adjustment) for BKA and 7 - 18.5% IBW (without age adjustment) for AKA

' Multiply IBW by 0.95 for paraplegia or 0.85 for quadraplegia

Percent IBW Calculation for Adults:

% IBW = [(T Wt - Prosthesis Wt)/IBW] X 100

% IBW = [( I/ I x 100

TSF (nun) 6 --- -

MUAC (cm) - =- .

--

MFU4C (cm) = [MDAC in cm] - [(TSF in mm/lo) x 3.141 = .

‘ CAM?+ (cn?): Female =[V48aMC)'/12.56] - 6.5 = Male = [(MAHC)'/12.56] - 10 =

'Compared to NHANES

Body Mass Index (BMI) = kc+ = __ 0= -lb.+ X 703 = -

Underweight Acceptable weight Overweight Severe overweight Morbid obesity

Male Female <20.7 7rx-r 20.7 - 27.8 19.1 - 27.3 > 27.8 > 27.3 5 31.1 7 32.3 F 45.4 7 44.0

tion of the distribution of leg weight between the hip (18.5%) and knee (7.1%) but without intermediate figures. Grant and DeHoog sug- gest the figure be used only as a guide because patients vary in their distribution of weight.

All measurements are entered into a com- puter-generated spreadsheet programmed with appropriate formulas to perform the anthropo- metric calculations. The spreadsheet provides information for completing the anthropometric worksheet, calculating statistics on patient an- thropometrics, and performing future annual measurements. The spreadsheet is used primar- ily as a tool to speed the process of calculating the formulas involved. Additional information about the nutritional status of the patient can be

Signed

Date

gained by entering pertinent laboratory data available at the time of the anthropometric measurements.

References 1. Nelson BE: Anthropometry in the nutritional assessment

of adults with end-stage renal disease. J Renal Nutr 1:162-172, 1991

2. Lee RD, Nieman DC: Anthropometry, in Nutritional Assessment. Madison, WI, Brown & Benchmark, 1993, pp 121-165

3. Nelson E, Hong CD, Desee AL, et al: Anthropometric measurement techniques, in Anthropometric Reference Manual for the Adult Hemodialysis Population. Nashville, TN, Graphic Resources, DCI, 1990, pp 3-11

4. Grant A, DeHoog S: Anthropometry, in Nutritional Assess- ment and Support. Seattle, WA, Grant & DeHoog, 1985, p 11