FFMI and MAMC assessment in COPD patients – anthropometry

Apart from decreased lung function, patients with COPD have many systemic complications, such as malnutrition and cachexia, which may lead to development of other comorbidities, e.g., muscle depletion, osteoporosis, diabetes mellitus etc. Muscle loss is considered as a better predictor of mortality than BMI (Rutten et al., 2010).

Fat free mass index (FFMI) and mid arm muscle circumference (MAMC) can be used for the assessment of muscle mass after pre-and post-therapeutic intervention. Muscle loss can be quantified using FFMI as well. Muscle mass is calculated through skinfold caliper measurement, which was shown to be second best to DEXA (Hronek et al., 2013).

Body density is calculated using the Durnin and Womersley equation (Durnin and Womersley, 1974), using the data from skinfold measurement in 4 locations on the body. Fat mass (FM) and fat free mass (FFM) is calculated using the Siri equation (Siri, 1961). FFMI is the proportion of FFM to the height squared in kg/m².

Patient’s muscle reserves and muscle loss can be evaluated by MAMC on the non-dominant side. It is calculated using upper arm circumference and thickness of skinfold above the triceps muscle, both on the non-dominant side of the body (Hronek, 2011).

Table1. Patient condition according to FFMI a BMI

FFMI	BMI
FFMI	< 21	21-25	25-30	> 30
♂ <16; ♀ <15	cachexia	muscle atrophy	muscle atrophy	not possible
♂ >16; ♀ >15	underweight	normal	overweight	obesity

(Schols, 2009)

Table 2. Muscle loss evaluation according to MAMC

		Patient condition
		Physiologic		Muscle loss		Significant muscle loss
% of standard		100	90	80	70	60	50	40
MAMC	♂	25,5	23,0	20,0	18,0	15,0	12,5	10,0
MAMC	♀	23,0	21,0	18,5	16,0	14,0	11,5	9,0

(Hronek et al., 2011)

Doc. PharmDr. Miloslav Hronek, Ph.D.
PharmDr. Miroslav Kovařík, Ph.D.
Charles University, Faculty of Pharmacy and University Hospital in Hradec Králové

Sex	female male
Age	years
Height	cm
Weight	kg
Note: The dominant side in right handed patients is right and non-dominant side is on the left (vice versa in left handed patients).
Biceps – dominant side
Skinfold above the biceps muscle on the dominant side - 1 (mm)
Skinfold above the biceps muscle on the dominant side - 2 (mm)
Skinfold above the biceps muscle on the dominant side - 3 (mm)
Skinfold above the biceps muscle on the dominant side - mean (mm)
Triceps – dominant side
Skinfold above the triceps muscle on the dominant side - 1 (mm)
Skinfold above the triceps muscle on the dominant side - 2 (mm)
Skinfold above the triceps muscle on the dominant side - 3 (mm)
Skinfold above the triceps muscle on the dominant side - mean (mm)
Subscapular skinfold – dominant side
Subscapular skinfold on the dominant side - 1 (mm)
Subscapular skinfold on the dominant side - 2 (mm)
Subscapular skinfold on the dominant side - 3 (mm)
Subscapular skinfold on the dominant side - mean (mm)
Suprailiac skinfold – dominant side
Suprailiac skinfold on the dominant side - 1 (mm)
Suprailiac skinfold on the dominant side - 2 (mm)
Suprailiac skinfold on the dominant side - 3 (mm)
Suprailiac skinfold on the dominant side - mean (mm)
Triceps – non-dominant side
Skinfold above the triceps muscle on the non-dominant side - 1 (mm)
Skinfold above the triceps muscle on the non-dominant side - 2 (mm)
Skinfold above the triceps muscle on the non-dominant side - 3 (mm)
Skinfold above the triceps muscle on the non-dominant side - mean (mm)
Upper arm circumference – non-dominant side
Upper arm circumference on the non-dominant side (cm)
Results
% FM Siri
Kg FM Siri
kg FFM Siri
FFMI
FMI
Mid-arm muscle circumference (cm)

References

Durnin JVGA, Womersley J. Body fat assessed from the total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition, 1974; 32(1): 77-97.

Hronek M, Kovarik M, Aimova P, Koblizek V, Pavlikova L, Salajka F, Zadak Z. Skinfold Anthropometry – The Accurate Method for Fat Free Mass Measurement in COPD. COPD, 2013; 10(5): 597-603. doi:10.3109/15412555.2013.781151

Rutten EP, Spruit MA, Wouters EF. Critical view on diagnosing muscle wasting by single-frequency bio-electrical impedance in COPD. Respiratory Medicine, 2010; 104(1): 91-8.

Schols A. Nutritional Assessment and Support. In: Hodgkin JE, Celli BR, Connors GL (eds.). Pulmonary Rehabilitation, Guidelines to Success 2009.

Siri WE. Body composition from fluid space and density. Brozek J, Hanschel A (eds.). Techniques for measuring body composition (pp. 223-244). Washington, DC: National Academy of Science. 1961.