Plea for Reapplication of Some of the Older Nutrition Assessment Techniques

The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper

“…Imaging holds the potential of emerging as a “biomarker” for standardized nutrition assessment in the future as limitations are overcome 48 . In addition, the use of other assessment measures, including creatinine height index, can be considered 49 …”

Nutrition Considerations in Cryptic Cachexia

“…Although there would be a small contribution of urinary protein at 400 mg per 24 hours and some protein loss into the gut, the hypoalbuminemia with hyper‐γ‐globulinemia is primarily a consequence of chronic, severe inflammation with limited impact of anorexia, malabsorption, or nephropathy, as suggested by the authors, because protein loss into the gut with protein losing enteropathy is not selective for protein size, thus lowering both serum albumin, globulin, and total protein levels, and neither anorexia nor this level of urinary protein loss would produce hypoalbuminemia 4 . Finally, although the serum creatinine was said to be normal, almost certainly this was quite low, and when corrected for the expected serum creatinine, given the patient's gender and height, the observed serum creatinine and derived creatinine height index 5 would likely have further supported the principal diagnosis of cachexia or severe chronic disease–related malnutrition. This discussion highlights the value of nutrition considerations in pathophysiology, medical diagnosis, and, often, treatment.…”

A Catabolic Index Adjusted for the Creatinine Height Index: Can It Help in Nutrition Assessment?

“…One simple method to estimate skeletal muscle mass (the largest protein reserve in the body) that already adjusts for these variables is the creatinine height index (CHI), a technique formulated initially for use in children 2 and later adapted to adults, 3 which remains clinically useful today. 4 This estimate requires a 24-hour urine sample for measurement of creatinine excretion, which is then compared with normal values for height and sex. Recently, it has been suggested that in patients with normal renal function (as estimated by a normal serum urea nitrogen level of <20 mg/dL), one can estimate creatinine excretion from serum creatinine levels, assuming a normal creatinine clearance (CC) of 80 cc/min and then solving the standard urine creatinine (UV) concentration (U) times urine volume (V) to get the amount of UV (24-hr urine creatinine) in the standard CC equation of CC = UV/P, in which P is the plasma creatinine concentration.…”

“…Recently, it has been suggested that in patients with normal renal function (as estimated by a normal serum urea nitrogen level of <20 mg/dL), one can estimate creatinine excretion from serum creatinine levels, assuming a normal creatinine clearance (CC) of 80 cc/min and then solving the standard urine creatinine (UV) concentration (U) times urine volume (V) to get the amount of UV (24-hr urine creatinine) in the standard CC equation of CC = UV/P, in which P is the plasma creatinine concentration. 4 This manipulation has the sometimes helpful characteristic of not requiring a 24-hour urine collection, as well as allowing the retroactive assessment of body composition from routine serum chemistries usually performed in all hospitalized patients. The other variable, the severity of metabolic stress, can also be estimated by the 24-hour urinary urea nitrogen excretion that can be measured in the same urine sample.…”

“…However, some of these values have to be normalized by an index to improve relevance, given the impact of sex and height on body composition. One simple method to estimate skeletal muscle mass (the largest protein reserve in the body) that already adjusts for these variables is the creatinine height index (CHI), a technique formulated initially for use in children 2 and later adapted to adults, 3 which remains clinically useful today 4 . This estimate requires a 24‐hour urine sample for measurement of creatinine excretion, which is then compared with normal values for height and sex.…”