{"id":668,"date":"2010-10-03T10:51:19","date_gmt":"2010-10-03T08:51:19","guid":{"rendered":"https:\/\/viscojis.cz\/teens\/2010\/10\/03\/129\/"},"modified":"2024-11-07T13:57:14","modified_gmt":"2024-11-07T12:57:14","slug":"129","status":"publish","type":"post","link":"https:\/\/viscojis.cz\/teens\/129\/","title":{"rendered":"Hodnocen\u00ed stavu v\u00fd\u017eivy"},"content":{"rendered":"

O metod\u00e1ch zji\u0161\u0165ov\u00e1n\u00ed na\u0161eho v\u00fd\u017eivov\u00e9ho stavu. N\u011bkter\u00e9 z nich si m\u016f\u017eeme na sob\u011b sami vyzkou\u0161et, jin\u00e9 pat\u0159\u00ed do rukou odborn\u00edk\u016f.<\/span><\/p>\n

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V\u00fd\u017eivov\u00fd stav na\u0161eho organismu je z\u00e1visl\u00fd p\u0159edev\u0161\u00edm na tom, co j\u00edme. Je dan\u00fd rovnov\u00e1hou mezi t\u00edm, co p\u0159ijmeme, a t\u00edm, co vyd\u00e1me. Ne v\u017edy v\u0161ak dostatek potravy znamen\u00e1 dostate\u010dn\u00fd p\u0159\u00edvod v\u0161ech l\u00e1tek pot\u0159ebn\u00fdch ke zdrav\u00e9mu fungov\u00e1n\u00ed na\u0161eho t\u011bla.<\/p>\n

Ke zhodnocen\u00ed v\u00fd\u017eivov\u00e9ho stavu jedince je zapot\u0159eb\u00ed zn\u00e1t ur\u010dit\u00e9 informace. Mezi hlavn\u00ed pat\u0159\u00ed anamn\u00e9za, antropometrick\u00e1 m\u011b\u0159en\u00ed, klinick\u00e9 a biochemick\u00e9 vy\u0161et\u0159en\u00ed, kter\u00e9 m\u016f\u017ee b\u00fdt dopln\u011bno imunologick\u00fdm vy\u0161et\u0159en\u00edm. V ur\u010dit\u00fdch p\u0159\u00edpadech se p\u0159istupuje i k dal\u0161\u00edm vy\u0161et\u0159en\u00edm jako je nap\u0159\u00edklad denzitometrie p\u0159i podez\u0159en\u00ed na k\u0159ivici u d\u011bt\u00ed apod.<\/p>\n

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\"hodnoceni<\/p>\n

Anamn\u00e9za<\/strong><\/p>\n

Anamn\u00e9za poch\u00e1z\u00ed s \u0159eck\u00e9ho slova anamn\u00e9sis <\/em>– rozpom\u00edn\u00e1n\u00ed se. Je to rozhovor l\u00e9ka\u0159e \u010di jin\u00e9ho odborn\u00edka s pacientem, p\u0159i kter\u00e9m l\u00e9ka\u0159 c\u00edlen\u011b klade ot\u00e1zky t\u00fdkaj\u00edc\u00ed se zdrav\u00ed vy\u0161et\u0159ovan\u00e9ho. P\u0159i hodnocen\u00ed nutri\u010dn\u00edho stavu je c\u00edlem zjistit, zda je strava vy\u0161et\u0159ovan\u00e9 osoby vyv\u00e1\u017een\u00e1 a obsahuje v\u0161echny \u017eiviny a jin\u00e9 v\u00fd\u017eivov\u00e9 faktory v pat\u0159i\u010dn\u00e9m mno\u017estv\u00ed a kvalit\u011b (ani hodn\u011b, ani m\u00e1lo). Pt\u00e1me se nap\u0159\u00edklad na onemocn\u011bn\u00ed, kter\u00fdmi osoba trp\u00ed, p\u0159edev\u0161\u00edm onemocn\u011bn\u00ed souvisej\u00edc\u00ed s v\u00fd\u017eivou, zji\u0161\u0165ujeme zp\u011btn\u011b v\u00fd\u017eivov\u00e9 zvyklosti (skladba j\u00eddeln\u00ed\u010dku, kulin\u00e1\u0159sk\u00e1 \u00faprava pokrm\u016f, konzumace alkoholu<\/span>, k\u00e1vy apod.).<\/p>\n

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Antropometrick\u00e9 ukazatele<\/strong><\/p>\n

Pomoc\u00ed antropometrie lze ur\u010dit celkov\u00e9 mno\u017estv\u00ed tuku v t\u011ble, jeho rozlo\u017een\u00ed, a zda m\u00e1 jedinec sn\u00ed\u017eenou nebo zv\u00fd\u0161enou t\u011blesnou hmotnost vzhledem ke sv\u00e9mu v\u011bku a t\u011blesn\u00e9 v\u00fd\u0161ce. Jsou rychl\u00e9 a nevy\u017eaduj\u00ed drahou p\u0159\u00edstrojovou techniku. Ov\u0161em \u017e\u00e1daj\u00ed si profesion\u00e1ln\u00ed zvl\u00e1dnut\u00ed m\u011b\u0159ic\u00edch technik, aby z\u00edskan\u00e9 v\u00fdsledky byly p\u0159esn\u00e9 a objektivn\u00ed. Mezi antropometrick\u00e9 ukazatele stavu v\u00fd\u017eivy pat\u0159\u00ed  t\u011blesn\u00e1 hmotnost a v\u00fd\u0161ka, t\u011blesn\u00e9 obvody a ko\u017en\u00ed \u0159asy.<\/p>\n

K posuzov\u00e1n\u00ed t\u011blesn\u00e9 hmotnosti se nejv\u00edce pou\u017e\u00edv\u00e1 index t\u011blesn\u00e9 hmotnosti, zn\u00e1m\u011bj\u0161\u00ed sp\u00ed\u0161e pod zkratkou BMI<\/span><\/strong> (z angl. Body Mass Index): BMI<\/span> = v\u00e1ha [kg] \/ (v\u00fd\u0161ka[m]) 2. Jde v\u0161ak pouze o p\u0159ibli\u017en\u00e9 hodnoty, nebo\u0165 se nep\u0159ihl\u00ed\u017e\u00ed k v\u011bku, individu\u00e1ln\u00ed dispozici, stupni sportovn\u00ed \u010dinnosti, mohutnosti kostry a mno\u017estv\u00ed svalov\u00e9 a tukov\u00e9 hmoty \u010di p\u0159\u00edpadn\u00e9mu vlivu nemoc\u00ed apod. U d\u011bt\u00ed se hmotnostn\u011b-v\u00fd\u0161kov\u00e1 proporcionalita hodnot\u00ed \u010dast\u011bji na z\u00e1klad\u011b percentilov\u00fdch graf\u016f<\/span><\/strong>.<\/p>\n

T\u011blesn\u00e9 obvody <\/strong>se pou\u017e\u00edvaj\u00ed ke stanoven\u00ed rozlo\u017een\u00ed t\u011blesn\u00e9ho tuku v t\u011ble. Snadno s jejich pomoc\u00ed ur\u010d\u00edme, zda m\u00e1 dan\u00e1 osoba sklon k hromad\u011bn\u00ed tuku v doln\u00ed \u010di horn\u00ed \u010d\u00e1sti t\u011bla. To je d\u016fle\u017eit\u00e9, nebo\u0165 hromad\u011bn\u00ed tuku v b\u0159i\u0161n\u00ed oblasti sebou nese riziko vzniku n\u011bkter\u00fdch onemocn\u011bn\u00ed (nap\u0159. srde\u010dn\u011b-c\u00e9vn\u00ed). Jedn\u00edm z nejpou\u017e\u00edvan\u011bj\u0161\u00edch zp\u016fsob\u016f, jak stanovit rozlo\u017een\u00ed t\u011blesn\u00e9ho tuku v t\u011ble, je pom\u011br obvodu pasu k obvodu bok\u016f (WHR), nebo je\u0161t\u011b l\u00e9pe, samotn\u00fd obvod pasu<\/strong>.<\/p>\n

Celkov\u00e9 mno\u017estv\u00ed tuku<\/strong> v t\u011ble dob\u0159e koreluje s tlou\u0161\u0165kou ko\u017en\u00edch \u0159as<\/strong>. Tlou\u0161\u0165ka ko\u017en\u00edch \u0159as se m\u011b\u0159\u00ed na r\u016fzn\u00fdch m\u00edstech t\u011bla. Vy\u0161\u0161\u00ed hodnoty ko\u017en\u00edch \u0159as b\u00fdvaj\u00ed prov\u00e1zeny vy\u0161\u0161\u00edmi hodnotami cholesterolu<\/span> a tuk\u016f v krvi a u v\u00edce ne\u017e poloviny dosp\u011bl\u00e9 populace souvis\u00ed n\u00e1r\u016fst podko\u017en\u00edho tuku s vy\u0161\u0161\u00edmi hodnotami krevn\u00edho tlaku.<\/p>\n

Celkov\u00e9 mno\u017estv\u00ed tuku v t\u011ble je samoz\u0159ejm\u011b mo\u017en\u00e9 stanovit i mnohem p\u0159esn\u011bj\u0161\u00edmi metodami. Jednou z nejp\u0159esn\u011bj\u0161\u00edch je podvodn\u00ed v\u00e1\u017een\u00ed <\/strong>(hydrodenzitometrie), d\u00e1le jsou to zobrazovac\u00ed metody <\/strong>(po\u010d\u00edta\u010dov\u00e1 tomografie – CT, nukle\u00e1rn\u00ed magnetick\u00e1 rezonance aj.) \u010di bioelektrick\u00e1 impedance. Tyto metody jsou ale technicky n\u00e1ro\u010dn\u00e9 a pro mnoho pracovi\u0161\u0165 nedostupn\u00e9, pou\u017e\u00edvaj\u00ed se sp\u00ed\u0161e ve specializovan\u00fdch centrech k v\u00fdzkumn\u00fdm \u00fa\u010del\u016fm. Proto mezi nejroz\u0161\u00ed\u0159en\u011bj\u0161\u00ed metody stanoven\u00ed celkov\u00e9ho tuku v t\u011ble u n\u00e1s i ve sv\u011bt\u011b pat\u0159\u00ed m\u011b\u0159en\u00ed ko\u017en\u00edch \u0159as, kter\u00e9 je finan\u010dn\u011b, technicky i \u010dasov\u011b a prostorov\u011b nen\u00e1ro\u010dn\u00e9.<\/p>\n

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Klinick\u00e9 vy\u0161et\u0159en\u00ed<\/strong><\/p>\n

Klinick\u00e9 vy\u0161et\u0159en\u00ed se zam\u011b\u0159uje na vy\u0161et\u0159en\u00ed p\u0159\u00edpadn\u00fdch poruch v\u00fd\u017eivy pomoc\u00ed t\u011blesn\u00e9 prohl\u00eddky – somatoskopie, \u010di jednoduch\u00fdmi fyzik\u00e1ln\u00edmi vy\u0161et\u0159en\u00edmi. P\u0159i t\u011blesn\u00e9 prohl\u00eddce l\u00e9ka\u0159 p\u00e1tr\u00e1 po zn\u00e1mk\u00e1ch nespr\u00e1vn\u00e9 v\u00fd\u017eivy nebo p\u0159\u00edpadn\u00e9 podv\u00fd\u017eivy (malnutrice). Nap\u0159. p\u0159\u00ed\u010dn\u00e9 b\u00edl\u00e9 pruhy na nehtech sv\u011bd\u010d\u00ed o t\u011b\u017ek\u00e9m nedostatku b\u00edlkovin, z\u00e1n\u011bty koutk\u016f rt\u016f mohou zna\u010dit nedostatek vitamin\u016f B2, B6 \u010di \u017eeleza, apod.). P\u0159i somatoskopii v\u0161ak mus\u00edme m\u00edt na mysli, \u017ee ne v\u017edy jsou p\u0159\u00edznaky odrazem nespr\u00e1vn\u00e9 v\u00fd\u017eivy. P\u0159\u00ed\u010din m\u016f\u017ee b\u00fdt v\u00edce, nap\u0159\u00edklad p\u016fsoben\u00ed sucha, horka, prachu atd.<\/p>\n

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Biochemick\u00e1 vy\u0161et\u0159en\u00ed<\/strong><\/p>\n

Biochemick\u00e9 metody jsou schopny v\u010das odhalit nedostate\u010dn\u00fd \u010di nadbyte\u010dn\u00fd p\u0159\u00edvod \u017eivin (nutrient\u016f). Mohou se stanovit p\u0159\u00edmo hodnoty nutriet\u016f nebo jejich metabolit\u016f (l\u00e1tek, kter\u00e9 z nich v t\u011ble vznikaj\u00ed), a to v krvi, s\u00e9ru, plazm\u011b, \u010derven\u00fdch krvink\u00e1ch, mo\u010di apod. Nap\u0159\u00edklad nedostatek j\u00f3du<\/span> se zji\u0161\u0165uje podle jeho mno\u017estv\u00ed v mo\u010di (jodurie) nebo podle funkce \u0161t\u00edtn\u00e9 \u017el\u00e1zy. <\/p>\n

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Imunologick\u00e1 vy\u0161et\u0159en\u00ed<\/strong><\/p>\n

Imunologick\u00e1 vy\u0161et\u0159en\u00ed v\u011bt\u0161inou dopl\u0148uj\u00ed vy\u0161et\u0159en\u00ed v\u00fd\u017eivov\u00e9ho stavu, nebo\u0165 p\u0159i poruch\u00e1ch v\u00fd\u017eivy je \u010dasto p\u0159\u00edtomna sn\u00ed\u017een\u00e1 imunita. Stanovuje se nap\u0159\u00edklad po\u010det lymfocyt\u016f (druhu b\u00edl\u00fdch krvinek) nebo se prov\u00e1d\u00ed ko\u017en\u00ed testy.<\/p>\n

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Pou\u017eit\u00e1 literatura:<\/strong><\/em><\/span><\/p>\n

Kleonwachterov\u00e1 H, Br\u00e1zdov\u00e1 Z. V\u00fd\u017eivov\u00fd stav \u010dlov\u011bka a zp\u016fsoby jeho zji\u0161\u0165ov\u00e1n\u00ed. IDVPZ, 2001.<\/em><\/span>
Kubisov\u00e1 D. M\u011b\u0159en\u00ed obvodu pasu a bok\u016f p\u0159i vy\u0161et\u0159ov\u00e1n\u00ed v antropologii a klinick\u00e9 praxi. DMEV. 2003, 4: 209-213.<\/em><\/span>
Kubisov\u00e1 D. Antropometrick\u00e9 ukazatele. Manu\u00e1l prevence v l\u00e9ka\u0159sk\u00e9 praxi – souborn\u00e9 vyd\u00e1n\u00ed, Univerzita Karlova – 3. LF \/ Fortuna, Praha 2004, str. 101-105.<\/em><\/span><\/p>\n

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