Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status

Article Abstract:

Total body electric conductivity measurement and bioelectrical impedance analysis provide a rapid and convenient means for estimating fat-free mass (FFM) and body fat mass (BFM). However, the current practice of reporting FFM and BFM as percentages of body weight or as absolute weights (in kilograms or pounds) can be misleading. When FFM and BFM are expressed as percentages of total body weight or absolute weight, a healthy man can have the same values for these parameters as a similarly aged, taller individual who has protein-energy malnutrition (PEM). To overcome this problem, the fat-free mass index (FFMI) and body fat mass index (BFMI) were developed. These indices, called height-normalized, take into account the height of the individual. FFMI and BFMI were calculated in a reference population of 124 healthy young men and 32 nonobese young men. (The latter group was from the Minnesota Study, conducted during World War II, in which men were fed diets providing only 50 percent of the calories necessary for maintaining their body weight). FFMI and BFMI were calculated before, during and after experimental starvation. When values for FFMI and BFMI falling below the fifth percentile cutoff point were used as a criterion for PEM, these indices resulted in a diagnosis of PEM in 27 of the 32 Minnesota study subjects. These results indicate that FFMI and BFMI may be useful in assessing nutritional status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Nutrition, Nutritional assessment, Adipose tissues, Adipose tissue, Stature, Body height

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Overfeeding: cardiovascular and metabolic response during continuous formula infusion in adult humans

Article Abstract:

Overfeeding of adults results in an excess of energy, or a positive energy balance. This condition is particularly relevant with regard to the development of congestive heart failure due to involuntary refeeding of malnourished hospitalized patients and the development of obesity as a result of a chronic positive energy balance. The cardiovascular and metabolic effects of continuous formula feeding through a nasogastric tube were assessed in eight healthy men. The balance in body elements, body temperature, and radioactive studies were assessed during three phases of feeding: a period of maintenance and stabilization; a period of overfeeding; and a period following overfeeding. Two distinct effects were observed during overfeeding, and occurred over days one to four and days four to seven. Weight gain was primarily due to changes in the amount of extracellular fluid, or fluid outside of the cell. Individuals differed in the percentage of excess fuels or energy sources retained during overfeeding, and such differences were related to variations in processes controlling digestion and body temperature. These physiologic changes persisted during the period following overfeeding. Thus, individuals differ in their physiologic responses to overfeeding, and the occurrence of physiologic changes should be considered when developing approaches to prevent abnormalities in circulation associated with refeeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Physiological aspects, Parenteral feeding, Parenteral nutrition, Body composition, Diet therapy, Thermogenesis

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Congestive heart failure: clinical management by use of continuous nasoenteric feeding

Article Abstract:

Congestive heart failure (CHF) is a condition in which the heart is unable to pump blood efficiently and excess fluid may accumulate in the lungs. Patients who have advanced congestive heart failure are often undernourished. This malnutrition, called cardiac cachexia, may be caused by a combination of factors including inadequate food intake, increased metabolic rate, and medication side effects. While malnutrition weakens the person and is considered undesirable in most circumstances, some have suggested that it actually helps the heart in CHF. Because the heart is straining to pump blood, the smaller body mass resulting from malnutrition may lighten the burden on the heart. This theory was tested in four patients with stable CHF and cardiac cachexia. They were tube-fed for two weeks, which involved delivering a nutritious liquid diet by tube; the tube was inserted through the nose and passed into the stomach. By using tube-feeding, the researchers supplied extra nutrition to patients who were not able to eat enough on their own. Results of extensive tests showed that the patients' nutritional status improved, but the heart was not adversely affected. Patients gained lean (muscle) tissue and lost excess fluid; overall they benefited from the intensive nutritional therapy. The authors conclude that cardiac cachexia can be safely managed by nutritional support from tube-feeding.

Care and treatment, Usage, Congestive heart failure, Enteral feeding, Enteral nutrition, Cachexia

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