Measures of Nutritional and Functional Status

Classically, nutritional status has been assessed by simple measurements of body weight, body mass index (BMI), anthropometry or body composition (e.g. lean body mass [LBM], body cell mass [BCM]). More advanced methods of assessing physiological/metabolic aspects of nutritional status have also been advocated, including resting energy expenditure (REE), muscle fatigue, immune function and protein kinetics. Nutritional outcomes that have been assessed in cachexia intervention trials have included a variety of these anthropometric/biochemical [5-8] and physiological variables [8-10] (Fig. 1).

Fig. 1. Nutritional outcomes. REE, resting energy expenditure; TEE, total energy expenditure; PAL, physical activity level

Clinically useful end-points to assay changes in functional status have proved more controversial. One basic method that simply relies on subjective questioning of patients about current activities is physician-assessed performance score (PS) (e.g. the Karnofsky PS score or the World Health Organization [WHO] PS score).

Objective techniques used to assess functional status in cachexia intervention trials have included treadmill tests [11, 12] and handgrip dynamome-try [13]. Recently, spontaneous physical activity has been proposed as a more useful index of patient-orientated quality of life (QoL) [1]. This proposition will be discussed later in this chapter.

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