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] |
and\nsulfasalazine,\tthose\twith\tchronic\talcohol\tconsumption,\tthose\twith\tmethyltetrahydrofolate\treductase\n(MTHFR)\tgenetic\tpolymorphisms,\tand\tthose\twith\trheumatoid\tarthritis\ttaking\tmethotrexate\t(see\nChapters\t5\n\tand\t\n8\n).\nVitamin\tB\n12\n\tassessment.\nVitamin\tB\n12\n\tis\tmeasured\tin\tthe\tserum,\tand\tall\tindications\tare\tthat\tthe\tserum\tlevel\tgives\tas\tmuch | [
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] |
information\tabout\tvitamin\tB\n12\n\tstatus\tas\tdoes\tthe\tRBC\tlevel.\n\tIf\tvitamin\tB\n12\n\tstatus\tis\tcompromised,\nintrinsic\tfactor\tantibodies\t(IFAB)\tand\tparietal\tcell\tantibodies\tare\tmeasured;\tthe\tpresence\tof\nantibodies\tsuggests\tthe\tmain\tcause\tof\tmacrocytic\tanemia.\tHistorically\tthe\tSchilling\ttest\twas\tused\tto\ndetect\tdefects\tin\tvitamin\tB\n12 | [
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detect\tdefects\tin\tvitamin\tB\n12\n\tabsorption;\tit\trarely\tis\tused\ttoday\tbecause\tthe\ttest\trequires\tthat\tthe\npatient\tbe\tgiven\tradioactive\tvitamin\tB\n12\n\t(see\t\nChapter\t32\n).\t\nMethylmalonic\tacid\t(MMA)\n\tlevels\tin\nserum\tor\turine\tare\tmore\tuseful\tto\tassess\tB\n12\n\tstatus.\nVitamin\tB\n12\n\tand\tmethylmalonic\tacid. | [
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12\n\tstatus.\nVitamin\tB\n12\n\tand\tmethylmalonic\tacid.\nOnce\ta\tgenetic\tor\tautoimmune\tcause\tis\truled\tout,\tthe\tmost\tstraightforward\tbiochemical\tmethod\tfor\ndifferentiating\tbetween\tfolate\tand\tvitamin\tB\n12\n\tdeficiencies\tis\tby\tmeasuring\tthe\tserum\tor\turinary\nMMA\tlevel.\tMMA\tis\tformed\tduring\tthe\tdegradation\tof\tthe\tamino\tacid\tvaline\tand\todd-chain\tfatty\nacids. | [
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acids.\n\tMMA\tis\tthe\tside\tproduct\tin\tthis\tmetabolic\tpathway\tthat\tincreases\twhen\tthe\tconversion\tof\nmethylmalonic\tcoenzyme\tA\t(CoA)\tto\tsuccinyl\tCoA\tis\tblocked\tby\tlack\tof\tvitamin\tB\n12\n,\ta\tcoenzyme\tfor\nthis\treaction.\tTherefore\tdeficiency\tleads\tto\tan\tincrease\tin\tthe\tMMA\tpool,\twhich\tis\treflected\tby\tthe | [
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serum\tor\turinary\tMMA\tlevel.\tThe\turinary\tMMA\ttest\tis\tmore\tsensitive\tthan\tthe\tserum\tB\n12\n\ttest\nbecause\tit\tindicates\n\ttrue\ttissue\tB\n12\n\tdeficiency.\tThe\tserum\tMMA\ttest\tmay\tgive\tfalsely\thigh\tvalues\tin\nrenal\tinsufficiency\tand\tintravascular\tvolume\tdepletion.\tThe\turinary\tMMA\ttest\tis\tthe\tonly\tB\n12 | [
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Vitamin\tA\nVitamin\tA\tstatus\tcan\tbe\testimated\tusing\tserum\tretinol,\tand\tthe\n\tnormal\tlevel\tin\tadults\tis\t30\tto\t80\nmcg/dL.\tA\tprimary\tdeficiency\tof\tvitamin\tA\tcan\tresult\tfrom\tinadequate\tintake,\tfat\tmalabsorption,\tor\nliver\tdisorders.\tA\tsecondary\tdeficiency\tof\tvitamin\tA\tmay\tbe\tdue\tto\tdecreased\tbioavailability\tof | [
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mechanisms\twith\tvitamin\tD,\tserum\nretinol\talways\tshould\tbe\tassessed\tin\tthe\tpresence\tof\tvitamin\tD\tsupplementation.\nAcute\tor\tchronic\tvitamin\tA\ttoxicity\tis\tdefined\tas\tretinol\tlevels\tgreater\tthan\t100\tmcg/dL.\nHypervitaminosis\tA\thas\tbeen\treported\tin\talmost\t50%\tof\tpatients\ttaking\t150%\tof\tthe\tRDA\tfor\tvitamin | [
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] |
A,\tin\tthe\tform\tof\tretinol,\tbetween\t6\tto\t12\tmonths\tafter\tlaparoscopic\tsleeve\tgastrectomy\t(\nAarts\tet\tal,\n2011\n).\tChronic\tvitamin\tA\ttoxicities\tare\tassociated\twith\tloss\tof\thair;\tdry\tmucous\tmembranes;\tdry,\nrough\tskin;\tand\teven\tcortical\tbone\tloss\tand\tfractures\t(see\t\nAppendix\t12\n).\nVitamin\tD | [
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] |
Appendix\t12\n).\nVitamin\tD\nIndividual\tvitamin\tD\tstatus\tcan\tbe\testimated\tby\tmeasuring\tplasma\t\n25\thydroxy\tvitamin\tD\n(25[OH]D\n3\n)\n\tlevels.\tCurrent\tclinical\tpractice\treference\tranges\thave\tbeen\tupdated\tby\tthe\tInstitute\tof\nMedicine\t(IOM,\t2011).\tTraditional\n\tlevels\tdefining\tvitamin\tD\tsufficiency\thave\tbeen\tbased\ton\tthe | [
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consensus\tstatement\ton\tvitamin\tD\tand\tcalcium\tsupplementation\tfor\treduction\tof\tfalls\tand\tfractures\nin\tadults\t65\tyears\tand\tolder\tand\tfor\thigh-risk\tpopulations\twith\tmalabsorption\tsyndromes,\tthose\nusing\tmedications\tthat\taccelerate\tvitamin\tD\tmetabolism,\tthe\n\tobese,\tand\tthose\twith\tminimal\tsun\nexposure\t(\nAGS,\t2014\n). | [
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obese,\tand\tthose\twith\tminimal\tsun\nexposure\t(\nAGS,\t2014\n).\nVitamin\tD\tsufficiency\tis\tdefined\tas\t25(OH)D\n3\n\tat\t75\tnmol/L,\tor\t30\tng/mL\t(\nAGS,\t2014\n).\tSerum\tlevels\neven\thigher\tat\t90\tto\t100\tnmol/L\t(36\tto\t40\tng/mL)\tare\trecommended\tby\tsome\t(\nBischoff-Ferrari,\n2014\n).\tThe\tU.S.\tPreventive\tServices\tTask\tForce\t(USPSTF)\tfound\tadequate\tevidence\tthat\tdaily | [
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increased\trisk\tfor\tfalls,\tor\ta\tdiagnosis\tof\tosteoporosis\t(\nUSPSTF,\t2018\n).\tOptimal\tlevels\tof\t25(OH)D\n3\nhave\tnot\tbeen\tdefined,\tand\tthe\tmeasurement\tof\tserum\tlevels\tlacks\tstandardization\n\tand\tcalibration.\nA\tvitamin\tD\tdeficiency\tmay\tbe\tdue\tto\tinadequate\tdietary\tintake,\tinadequate\texposure\tto\tsunlight, | [
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] |
or\tmalabsorption.\tDeficiency\tof\tvitamin\tD\talso\tcan\tlead\tto\tsecondary\tmalabsorption\tof\tcalcium.\nCalcium\tmalabsorption\toccurs\tin\tchronic\trenal\tfailure\tbecause\trenal\thydroxylation\tis\trequired\tto\nactivate\tvitamin\tD,\twhich\tpromotes\tsynthesis\tof\ta\tcalcium-binding\tprotein\tin\tintestinal\tabsorptive\ncells\t(see\t\nChapter\t34 | [
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] |
cells\t(see\t\nChapter\t34\n).\tVitamin\tD\ttoxicity\tis\trare,\tbut\tit\thas\tbeen\treported\tin\ta\tfew\tpatients\ttaking\nmegadoses\tof\tvitamin\tD.\tReported\tadverse\teffects\tinclude\thypercalcemia,\thyperphosphatemia,\nsuppressed\tparathyroid-hormone\tlevels,\tand\thypercalciuria\t(\nTaylor\tand\tDavies,\t2018\n).\nVitamin\tE | [
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symptoms\tof\ta\tvitamin\tE\tdeficiency\tinclude\tmild\themolytic\tanemia\tand\tnonspecific\tneurologic\neffects.\tIn\tadults,\talpha-tocopherol\tlevels\tless\tthan\t5\tμg/mL\t(<11.6\tμmol/L)\tare\tassociated\twith\ta\ndeficiency.\tIn\tadults\twith\n\thyperlipidemia,\ta\tlow\tratio\tof\tserum\talpha-tocopherol\tto\tlipids\t(<0.8\tmg/g\ntotal\tlipid)\tis\tthe\tmost\taccurate\tindicator. | [
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demonstrated\nthat\tsupplementation\twith\tvitamin\tE\tappears\tto\thave\tno\teffect\ton\tall-cause\tmortality\tat\tdoses\tup\tto\n5500\tIU/d\t(\nAbner\tet\tal,\t2011\n).\nVitamin\tK\nVitamin\tK\tstatus\tcan\tbe\testimated\tusing\tprothrombin\ttime\t(PT).\tPT\tis\tused\tto\tevaluate\tthe\tcommon | [
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] |
pathway\tof\tblood\tclotting.\tThe\tsynthesis\tof\tclotting\tfactors\tII,\tVII,\tIX,\tand\tX\tare\tvitamin\tK\tdependent.\nOsteocalcin\n\tor\tbone\tG1a\tprotein\t(BGP),\n\ta\tbone\tturnover\tmarker,\tmay\talso\tbe\tused\tto\tassess\tvitamin\nK\tstatus.\tThe\tproduction\tof\tBGP\tis\tstimulated\tby\t1,25\tdihydroxy\tvitamin\tD\t(1,25[OH]\n2\nD\n3\n)\tand | [
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2\nD\n3\n)\tand\ndepends\ton\tvitamin\tK.\tVitamin\tK\tincreases\tthe\tcarboxylation\tof\tosteocalcin\tor\tBGP,\tbut\tit\tdoes\tnot\nincrease\tits\toverall\trate\tof\tsynthesis.\tA\treduced\tvitamin\tK\tstatus\tis\tassociated\twith\treduced\tBGP\tor\nserum\tosteocalcin\tlevels.\tThis\trelationship\tmay\n\texplain\tthe\tpathophysiologic\tfindings\tof\tvitamin\tK– | [
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explain\tthe\tpathophysiologic\tfindings\tof\tvitamin\tK–\ndeficiency\tosteoporosis.\tThe\tfunction\tof\tosteocalcin\tis\tunclear;\thowever,\tit\tmay\texist\tas\ta\tdeposition\nsite\tfor\thydroxyapatite\tcrystals\tor\tit\talso\tmay\taffect\tenergy\tmetabolism\tvia\tthe\tproduction\tand\taction\nof\tinsulin\t(\nHammami,\t2014\n). | [
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Water-soluble\tvitamins\tand\ttrace\tminerals\nAscorbic\tacid\nAscorbic\tacid\tor\tvitamin\tC\tis\ta\twater-soluble\tvitamin\n\tand\talso\tan\tantioxidant.\tVitamin\tC\tstatus\tcan\nbe\tdetermined\tby\tmeasuring\tblood\tascorbic\tacid\tlevels.\tValues\tless\tthan\t6\tmg/dL\t(<34\tmicromol/L)\nsuggest\tinsufficiency\tand\tvalues\tless\tthan\t2\tmg/dL\t(<11\tmicromol/L)\tsuggest\ta\tdeficiency. | [
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Deficiencies\tare\trare\tin\tdeveloped\tcountries\tunless\tself-imposed\tdietary\tintake\tis\thighly\trestrictive.\nSymptoms\tof\ta\tdeficiency\tinclude\tbleeding\tgums,\tloose\tteeth,\n\tpoor\twound\thealing,\tand\tperifollicular\nhemorrhages.\tToxicities\thave\tbeen\treported\tin\tindividuals\ttaking\tmore\tthan\t2\tg/d\tfor\tan\textended | [
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] |
period\tof\ttime.\tIndividuals\tconsuming\tmore\tthan\t1000\tmg\tof\tascorbic\tacid\tdaily\tmay\tincrease\ttheir\nrisk\tof\tkidney\tstones.\tRebound\tscurvy\tmay\toccur\tin\tindividuals\twho\tabruptly\tstop\ttaking\tmegadoses\nof\tascorbic\tacid\t(\nFerraro\tet\tal,\t2016\n).\nB-vitamins\nVitamin\tB\n12\n\tand\tfolate\tare\tthe\tmost\tcommon\twater-soluble\tvitamin\tdeficiencies\treported\tin\tadults. | [
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dry\tberiberi\tare\tprimarily\tneurologic\tfindings\t(i.e.\tperipheral\tneuropathy,\timpairment\tof\tsensory,\nmotor,\tand\treflex\tfunctions).\tSymptoms\tof\tWE\tinclude\tabnormal\teye\tmovement,\tcerebellar\ndysfunction,\tand\tconfusion.\nSubclinical\tdeficiencies\tof\twater-soluble\tvitamins\tand\tother\ttrace\tminerals\tmay\tbe\tpresent\tin\tsome | [
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] |
individuals.\tHowever,\tthe\tcurrent\tmethodologies\tfor\tevaluating\tnutritional\tstatus\tof\tthese\ncomponents\tare\texpensive\tand\tcontroversial.\tSee\t\nAppendix\t12\n\tfor\tfurther\tdiscussion\tof\ttests\tfor\nassessing\tspecific\tvitamin\tand\ttrace\tmineral\tadequacy.\nMarkers\tof\tbody\tcomposition\nCreatinine\nCreatinine | [
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] |
Markers\tof\tbody\tcomposition\nCreatinine\nCreatinine\n\tis\tformed\tfrom\tcreatine,\tfound\talmost\texclusively\tin\tmuscle\ttissue.\tSerum\tcreatinine\tis\nused\talong\twith\tblood\turea\tnitrogen\t(BUN)\tto\tassess\tkidney\tfunction\t(see\t\nChapter\t34\n).\tUrinary\ncreatinine\thas\tbeen\tused\tto\tassess\tsomatic\t(muscle)\tprotein\tstatus.\tCreatine\tis\tsynthesized\tfrom\tthe | [
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little\treabsorption.\nThe\tuse\tof\turinary\tcreatinine\tto\tassess\tsomatic\tprotein\tstatus\tis\tconfounded\tby\tomnivorous\tdiets.\nBecause\tcreatine\tis\tstored\tin\tmuscle,\tmuscle\tmeats\tare\trich\tsources.\tThe\tcreatinine\tformed\tfrom\ndietary\tcreatine\tcannot\tbe\tdistinguished\tfrom\tendogenously\tproduced\tcreatinine.\tWhen\ta\tperson | [
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equation\tfor\tcreatinine-height\tindex\t(CHI):\nCalculated\n\tCHI\tgreater\tthan\t80%\tis\tnormal,\t60%\tto\t80%\tsuggests\tmild\tskeletal\tmuscle\tdepletion,\n40%\tto\t60%\tsuggests\tmoderate\tdepletion,\tand\tless\tthan\t40%\tsuggests\tsevere\tdepletion\t(\nBlackburn\net\tal,\t1977\n).\nDaily\tcreatinine\texcretion\tvaries\tsignificantly\twithin\tindividuals,\tprobably\tbecause\tof\tlosses\tin | [
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0.0717293918132782,
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0.03245517238974571,
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0.07923035323619843,
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0.06971100717782974,
0.17129452526569366,
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0.03037819266319275,
0.059005528688430786,
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0.017958663403987885,
0.11459546536207199,
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0.01762480102479458,
0.039148129522800446,
0.08099853247404099,
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0.02169194258749485,
0.04039483889937401,
0.05217094346880913,
0.06420175731182098,
-0.042355284094810486
] |
sweat.\tIn\taddition,\tthe\ttest\tis\tbased\ton\t24-hour\turine\tcollections,\twhich\tare\tdifficult\tto\tobtain.\nBecause\n\tof\tthese\tlimitations,\turinary\tcreatinine\tconcentration\tas\ta\tmarker\tof\tmuscle\tmass\thas\nlimited\tuse\tin\thealth\tcare\tsettings\tand\tis\tused\ttypically\tonly\tin\tresearch\t(\nTable\t5.6\n). | [
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8.116411048538686e-34,
0.040507130324840546,
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0.013295091688632965,
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0.12228575348854065,
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0.03839987516403198,
0.039434973150491714,
0.06436058133840561,
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0.08178464323282242,
0.02418616972863674,
0.05220841243863106,
-0.032953958958387375
] |
TABLE\t5.6\nExpected\tUrinary\tCreatinine\tExcretions\tfor\tAdults\tBased\ton\tHeight\nADULT\tMALES\n*\nADULT\tFEMALES\n†\nHeight\t(cm)\nCreatinine\t(mg)\nHeight\t(cm)\nCreatinine\t(mg)\n157.5\n1288\n147.3\n830\n160.0\n1325\n149.9\n851\n162.6\n1359\n152.9\n875\n165.1\n1386\n154.9\n900\n167.6\n1426\n157.5\n925\n170.2\n1467\n160.0\n949\n172.7\n1513\n162.6\n977\n175.3\n1555\n165.1\n1006\n177.8\n1596\n167.6 | [
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3.594837681625194e-33,
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160.0\n949\n172.7\n1513\n162.6\n977\n175.3\n1555\n165.1\n1006\n177.8\n1596\n167.6\n1044\n180.3\n1642\n170.2\n1076\n182.9\n1691\n172.7\n1109\n185.4\n1739\n175.3\n1141\n188.0\n1785\n177.8\n1174\n190.5\n1831\n180.3\n1206\n193.0\n1891\n182.9\n1240\n*\nCreatinine\tcoefficient\tmales\t23\tmg/kg\t“ideal”\tbody\tweight.\n†\nCreatinine\tcoefficient\tfemales\t18\tmg/kg\t“ideal”\tbody\tweight.\nNitrogen\tbalance | [
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Nitrogen\tbalance\nNitrogen\tbalance\tstudies\tare\tused\tprimarily\tin\tresearch\tstudies\tto\testimate\tthe\tbalance\tbetween\nexogenous\tnitrogen\tintake\t(orally,\tenterally,\tor\tparenterally)\tand\tremoval\tof\tnitrogen-containing\ncompounds\t(urinary,\tfecal,\twound),\tand\tother\tnitrogen\tsources.\tThese\tstudies\tare\tnot\ta\tmeasure\tof | [
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addition,\n\tchanges\tin\trenal\tfunction\tare\tcommon\tin\tpatients\twith\tinflammatory\tmetabolism,\tmaking\nstandard\tnitrogen\tbalance\tcalculations\tinaccurate\twithout\tcalculation\tof\tnitrogen\tretention\n(\nDickerson,\t2016\n).\tClinicians\tusing\tnitrogen\tbalance\tto\testimate\tprotein\tflux\tin\tcritically\till\tpatients | [
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must\tremember\tthe\tlimitations\tof\tthese\tstudies\tand\tthat\tpositive\tnitrogen\tbalance\tmay\tnot\tmean\nthat\tprotein\tcatabolism\n\thas\tdecreased,\tparticularly\tin\tinflammatory\t(disease\tand\ttrauma)\tconditions.\nChronic\tdisease\trisk\tassessment\nLipid\tindices\tof\tcardiovascular\trisk | [
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Chronic\tdisease\trisk\tassessment\nLipid\tindices\tof\tcardiovascular\trisk\nThe\tAmerican\tCollege\tof\tCardiology\t(ACC)\tand\tAmerican\tHeart\tAssociation\t(AHA)\treleased\tpractice\nguidelines\tfor\tthe\tassessment\tof\tcardiovascular\trisk\t(\nStone\tet\tal,\t2014\n).\tThese\tguidelines\tare\nreferred\tto\tas\tthe\tAdult\tTreatment\tPanel\t4\t(ATP\t4) | [
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referred\tto\tas\tthe\tAdult\tTreatment\tPanel\t4\t(ATP\t4)\n\tand\treplace\tthe\tAdult\tTreatment\tPanel\t3\t(ATP\t3).\nFour\thigh-risk\tgroups\tare\tidentified:\n•\t\nAdults\twith\tatherosclerotic\tcardiovascular\tdisease\t(ASCVD)\n•\t\nAdults\twith\tdiabetes,\taged\t40\tto\t75\tyears,\twith\tlow-density\tlipoprotein\t(LDL)\tlevels\t70\tto\n189\tmg/dL\n• | [
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Box\t5.1\n).\tThe\tACC/AHA\tGuidelines\tdeemphasize\tuse\tof\nany\tmarkers\tother\tthan\tLDL\tcholesterol\tand\tHDL\tcholesterol.\tEmerging\trisk\tmarkers\tfor\natherosclerotic\tcardiovascular\tdisease\t(ACVD)\tthat\tare\tnot\trecommended\tin\tATP\t4\tinclude\ndifferentiating\tsubparticles\tof\tLDL\tby\tsize\tand\tgrouping\tby\tpattern,\tapolipoprotein\tB\t(apoB),\tand | [
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] |
apolipoprotein\tE\t(apoE)\tphenotype.\tThe\tCholesterol\tExpert\tPanel\tdetermined\tthat\tthese\n\tmarkers\tare\nnot\tindependent\tmarkers\tfor\trisk\tand\tdo\tnot\tadd\tto\tprediction\tequations.\tOther\tresearchers\tpropose\nmathematical\tmodels\tthat\tpredict\tthe\trisk\tof\tplaque\tformation\tfor\tcombined\tlevels\tof\tLDL\tand\tHDL\n(\nHao\tand\tFriedman,\t2014 | [
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(\nHao\tand\tFriedman,\t2014\n).\tHowever,\tthe\tSystematic\tReview\tfor\tthe\t2018\tAHA,\tACC,\tand\tnumerous\nprofessional\torganizations\tand\tsocieties\tpublished\t\nGuideline\ton\tthe\tManagement\tof\tBlood\nCholesterol\n.\tThese\tGuidelines\tproposed\tthe\tuse\tof\tnonstatin\tlipid\tmodifying\tmedications\tto\treduce | [
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the\trisk\tof\tASCVD.\tPCSK9\tinhibitors\tand\tezetimibe\twere\tidentified\tas\tbeneficial,\tbut\tniacin\tand\ncholesterol-ester\tprotein\tinhibitors\twere\tnot\teffective\tin\treducing\tASCVD\trisk\t(\nGrundy\tet\tal,\t2018\n). | [
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BOX\t5.1\nLipid\tAnd\tLipoprotein\tAtherosclerotic\tCardiovascular\tRisk\nFactors\nLaboratory\ttest\tcutpoints\tused\tto\n\tcalculate\t10-year\trisk\tof\tACVD\nTotal\tcholesterol:\t>200\tmg/dL\nHDL:\t<40\tmg/dL\nLDL:\t>131\tmg/dL\nIn\tselected\thigh-risk\tindividuals,\tthese\tlaboratory\ttest\tcutpoints\tmay\tbe\tconsidered:\nhs-CRP\tcutpoints\tused\tto\tassign\trisk\n•\t\n<1.0\tmg/L\t=\tlow\trisk\n• | [
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Serum\thomocysteine:\n\tIncreased\t=\tgreater\trisk\nRBP4:\n\tElevated\tlevels\tmay\tidentify\tearly\tinsulin\tresistance\tand\tassociated\tcardiovascular\trisk\nfactors\nHDL\n,\tHigh-density\tlipoprotein;\t\nhs-CRP\n,\thigh-sensitivity\n\tC-reactive\tprotein;\t\nLDL\n,\t\nlow-density\tlipoprotein;\nLp(a)\n,\tlipoprotein\tlittle\ta;\t\nRBP4\n,\tretinol-binding\tprotein\t4;\t\nVLDL\n,\tvery | [
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RBP4\n,\tretinol-binding\tprotein\t4;\t\nVLDL\n,\tvery\t\nlow-density\tlipoprotein.\nAdapted\tfrom\tStone\tNJ\tet\tal:\t2013\tACC/AHA\tguideline\ton\tthe\ttreatment\tof\tblood\tcholesterol\tto\treduce\natherosclerotic\tcardiovascular\trisk\tin\tadults:\ta\treport\tof\tthe\tAmerican\tCollege\tof\tCardiology/American\nHeart\tAssociation\tTask\tForce\ton\tpractice\n\tguidelines,\t\nCirculation | [
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Heart\tAssociation\tTask\tForce\ton\tpractice\n\tguidelines,\t\nCirculation\n\t129(25\tSuppl\t2):S1,\t2014.\nSee\t\nChapter\t32\n\tfor\tfurther\tdiscussion\tof\tthe\tlipid\tprofile\tand\tcardiovascular\trisk.\nThe\tNational\tLipid\tAssociation\t(NLA)\tExpert\tPanel\tpresents\tsomewhat\tdifferent\ttreatment\tgoals | [
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from\tthe\tATP\t4.\tThe\tNLA\tincludes\ttreatment\tgoals\tfor\tnon–HDL\tcholesterol,\tLDL\tcholesterol,\tand\napoB\t(\nJacobson\tet\tal,\t2014\n;\tsee\t\nChapter\t32\n).\nPatients\tundergoing\n\tlipid\tassessments\tshould\tbe\tfasting\tfor\t12\thours\tat\tthe\ttime\tof\tblood\tsampling.\nFasting\tis\tnecessary\tprimarily\tbecause\ttriglyceride\tlevels\trise\tand\tfall\tdramatically\tin\tthe | [
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postprandial\tstate,\tand\tLDL\tcholesterol\tvalues\tare\tcalculated\tfrom\tmeasured\ttotal\tserum\tcholesterol\nand\tHDL\tcholesterol\tconcentrations.\tThis\tcalculation,\tbased\ton\tthe\tFriedewald\tequation,\tis\tmost\naccurate\twhen\ttriglyceride\tconcentrations\n\tare\tless\tthan\t400\tmg/dL. | [
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accurate\twhen\ttriglyceride\tconcentrations\n\tare\tless\tthan\t400\tmg/dL.\nThe\tFriedewald\tequation\tgives\tan\testimate\tof\tfasting\tLDL\tcholesterol\tlevels\tthat\tis\tgenerally\nwithin\t4\tmg/dL\tof\tthe\ttrue\tvalue\twhen\ttriglyceride\tconcentrations\tare\tless\tthan\t400\tmg/dL\n(\nFriedewald,\t1972\n).\nDiabetes\nIn\tadults | [
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(\nFriedewald,\t1972\n).\nDiabetes\nIn\tadults\n\twith\tnormal\tglucose\tcontrol,\tapproximately\t4%\tto\t6%\tof\tthe\ttotal\tHgb\tis\tglycosylated.\tThe\npercent\tof\tthis\tglycohemoglobin\tor\t\nhemoglobin\tA1C\t(Hgb\tA1C)\n\tin\tthe\tblood\tis\trelated\tdirectly\tto\nthe\taverage\tblood\tglucose\tlevels\tfor\tthe\tpreceding\t2\tto\t3\tmonths\tand\tdoes\tnot\treflect\tmore\trecent | [
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value\tis\tconfirmed\tby\ta\trepeat\tHgb\tA1C\tabove\t6.5%,\tor\tplasma\tglucose\tabove\t200\tmg/dL\t(11\nmmol/L).\tHistorically,\tHgb\tA1C\twas\tnot\tused\tas\ta\tdiagnostic\tcriterion\tfor\tgestational\tdiabetes\nbecause\tof\tchanges\tin\tred\tcell\tturnover\n\t(\nAmerican\tDiabetes\tAssociation\t[ADA],\t2018\n).\tOther | [
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(\nAmerican\tDiabetes\tAssociation\t[ADA],\t2018\n).\tOther\nresearchers\tsuggest\tthat\tcombined\tHgb\tA1C\tand\toral\tglucose\ttolerance\ttest\t(OGTT)\tmay\tbe\tuseful\tin\ndiagnosing\tgestational\tdiabetes\t(\nRenz\tet\tal,\t2015\n).\nHgb\tA1C\tcan\tbe\tcorrelated\twith\tdaily\tmean\tplasma\tglucose\t(\nBox\t5.2\n).\tEach\t1%\tchange\tin\tHgb\tA1C | [
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] |
Box\t5.2\n).\tEach\t1%\tchange\tin\tHgb\tA1C\nrepresents\tapproximately\t35\tmg/dL\tchange\tin\tmean\tplasma\tglucose.\tTest\tresults\tare\tuseful\tto\nprovide\n\tfeedback\tto\tpatients\tabout\tchanges\tthey\thave\tmade\tin\ttheir\tnutritional\tintakes\t(\nADA,\t2011\n).\nSee\t\nChapter\t29\n\tfor\tfurther\tdiscussion\tof\tHgb\tA1C\tand\tdiabetes\tmanagement. | [
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] |
BOX\t5.2\nCorrelation\tBetween\tA1C\tand\tMean\tPlasma\tGlucose\t(MPG)\nA1C\nApproximate\tMPG\t(mg/dL)\n4\n65\n5\n100\n6\n135\n7\n170\n8\n205\nInsulin\ttest\tresults\treflect\tboth\tendogenous\tand\texogenous\tinsulin.\tIt\tmay\talso\n\tbe\tused\tin\ndifferentiate\ttype\t1\tand\ttype\t2\tdiabetes,\tto\tdiagnose\ttype\t2\tdiabetes\tin\twhich\tthere\tis\tan\tincreased | [
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production\tof\tinsulin\twith\ta\tconcurrent\tincrease\tin\tblood\tglucose.\tInsulin\ttesting\tis\tused\tto\tidentify\nthe\tetiology\tof\thypoglycemia\t(plasma\tglucose\t<\t55\tmg/dL)\tespecially\tif\tthere\tis\ta\tshortage\tof\tglucose\nto\tthe\tbrain\tdue\tto\thypoglycemia\tand\tthe\tpatient\tis\tunconscious\tdue\tto\thypoglycemia.\n\tConditions | [
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] |
Conditions\nassociated\twith\televated\tinsulin\tlevels\tare\tmetabolic\tsyndrome\t(cluster\tof\tconditions\tassociated\twith\nthe\tdevelopment\tof\ttype\t2\tdiabetes\tand\tcardiovascular\tdisease),\tobesity,\tsteroid\tuse,\tacromegaly\n(abnormal\tgrowth\tof\thand\thands,\tfeet,\tand\tface\tcaused\tby\toverproduction\tof\tgrowth\thormone\tby\tthe | [
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] |
pituitary\tgland),\tCushing’s\tsyndrome\t(complex\thormonal\tcondition\tmanifest\twith\tthinning\tskin,\nweakness,\tweight\tgain,\tbruising,\thypertension,\tdiabetes,\tosteopetrosis,\tfacial\tpuffiness),\ttype\t2\ndiabetes,\tinsulinoma\t(tumor\tof\tpancreas\tthat\tproduces\tan\texcess\tamount\tof\tinsulin).\tConditions | [
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associated\twith\tdecreased\tinsulin\texcretion\tinclude\tsevere\tliver\tdisease,\ttype\t1\tdiabetes,\tand\tsevere\nheart\tfailure\t(\nBuppajarntham,\t2014\n).\nC-peptide\nC-peptide\tis\tan\tinsulin\tprecursor\tthat\tis\treleased\n\tfrom\tthe\tpancreatic\tbeta-cells\tduring\tcleavage\tof | [
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and\tchronic\tkidney\tdisease.\tIt\tis\tsuppressed\tin\ttype\t1\tdiabetes,\tand\tinsulin-independent\nhypoglycemia.\tC-peptide\tshould\tbe\tmeasured\tin\tcombination\n\twith\tinsulin\tand\tproinsulin\tto\ndifferentiate\tbetween\tinsulin-dependent\thypoglycemia\tand\tinsulin-independent\thypoglycemia.\nPhysical\tassessments\nAnthropometry\nAnthropometry | [
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] |
or\tweight\tat\ta\tcertain\tage.\tChildren’s\tgrowth\tat\tevery\tage\tcan\tbe\tmonitored\tby\tmapping\tdata\ton\ngrowth\n\tcurves,\tknown\tas\t\nheight-for-age\n,\t\nlength-for-age\n,\t\nweight-for-age\n,\tand\t\nweight-for-length\ncurves.\t\nAppendix\t4\n\tprovides\tpediatric\tgrowth\tcharts\tand\tpercentile\tinterpretations.\nLength\tand\theight | [
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Length\tand\theight\nThe\tmethodology\tused\tfor\tdetermining\tthe\tlength\tor\theight\tof\tchildren\tis\tdetermined\tby\tthe\tage\tof\nthe\tchild.\tRecumbent\tlength\tmeasurements\tare\tused\tfor\tinfants\tand\tchildren\tyounger\tthan\t2\tor\t3\nyears\tof\tage.\n\tIdeally\tthese\tyoung\tchildren\tshould\tbe\tmeasured\tusing\ta\tlength\tboard\tas\tshown\tin\t\nFig.\n5.3 | [
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Fig.\n5.3\n.\tRecumbent\tlengths\tin\tchildren\tages\t2\tand\tyounger\tshould\tbe\trecorded\ton\tthe\tbirth\tto\t24-month\ngrowth\tgrids.\tStanding\theight\tis\tdetermined\tin\tchildren\tusing\ta\tmeasuring\trod,\tor\t\nstatiometer\n,\tand\nshould\tbe\trecorded\ton\tthe\t2-\tto\t20-year\tgrowth\tgrids,\tas\tin\t\nAppendix\t4\n.\tSitting\theights\tmay\tbe\nmeasured\tin\tchildren\n\twho\tcannot\tstand\t(see | [
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adequacy.\nFIG.\t5.3\nMeasurement\tof\tthe\tlength\tof\tan\tinfant.\nWeight\nWeight\tin\tchildren\tand\tteens\tis\ta\tmore\tsensitive\tmeasure\tof\tnutritional\tadequacy\tthan\theight,\nbecause\tit\treflects\tmore\trecent\tnutritional\tintake\tand\tprovides\ta\trough\testimate\tof\toverall\tfat\tand | [
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be\tconsidered\tin\tthe\tcontext\tof\tother\tgrowth\tassessment\nmeasurements.\tAlthough\tthe\tcalculation\tof\tBMI\tis\tthe\tsame\tfor\tadults\tand\tchildren,\tthe\ninterpretation\tof\tBMI\tis\tdifferent\tin\tchildren\tand\tteens.\tBMI\tis\tplotted\ton\tthe\tCDC\tBMI-for-age\ngrowth\tcharts\tfrom\twhich\ta\tpercentile\tranking\tcan\tbe\tdetermined.\tThese\tpercentiles\tare\tthe\tmost | [
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