{"id":11385546,"date":"2010-04-15T00:00:00","date_gmt":"2010-04-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/slozeni-tela\/"},"modified":"2010-04-15T00:00:00","modified_gmt":"2010-04-14T22:00:00","slug":"slozeni-tela","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/slozeni-tela\/","title":{"rendered":"Slo\u017een\u00ed t\u011bla"},"content":{"rendered":"

Slo\u017een\u00ed t\u011bla: Hodnocen\u00ed a v\u00fdklad<\/strong>
Slo\u017een\u00ed t\u011bla m\u00e1 velk\u00fd praktick\u00fd i funk\u010dn\u00ed v\u00fdznam pro mnoh\u00e9 z n\u00e1s: v\u011bdce, klinick\u00e9 pracovn\u00edky i ve\u0159ejnost. Obzvl\u00e1\u0161t\u011b d\u016fle\u017eit\u00e9 je v\u0161ak pro pot\u00e1p\u011b\u010de, proto\u017ee v\u00e1hu si mus\u00ed vyhodnotit p\u0159ed ka\u017ed\u00fdm pot\u00e1p\u011bn\u00edm a z\u00e1rove\u0148 p\u0159itom vz\u00edt v \u00favahu, zdali se pot\u00e1p\u011bn\u00ed uskute\u010dn\u00ed ve slan\u00e9 nebo sladk\u00e9 vod\u011b.
Nespr\u00e1vn\u00e9 slo\u017een\u00ed t\u011bla m\u016f\u017ee m\u00edt nep\u0159\u00edzniv\u00fd dopad na schopnost \u010dlov\u011bka splnit sv\u00e9 denn\u00ed pracovn\u00ed \u00fakoly a tak\u00e9 na vyu\u017eit\u00ed mo\u017enosti zrekreovat se.
 <\/p>\n

Nadm\u011brn\u00fd t\u011blesn\u00fd tuk souvis\u00ed se zv\u00fd\u0161enou n\u00e1chylnost\u00ed ke kardiovaskul\u00e1rn\u00edm onemocn\u011bn\u00edm, vysok\u00e9mu krevn\u00edmu tlaku, mozkov\u00e9 mrtvici, cukrovce, r\u016fzn\u00fdm ortopedick\u00fdm pot\u00ed\u017e\u00edm a mnoha dal\u0161\u00edm zdravotn\u00edm probl\u00e9m\u016fm.
Slo\u017een\u00ed t\u011bla se zji\u0161\u0165uje mnoha r\u016fzn\u00fdmi metodami. Ty se od sebe li\u0161\u00ed p\u0159esnost\u00ed dosa\u017een\u00fdch v\u00fdsledk\u016f i cenou. V tomto \u010dl\u00e1nku se chceme zam\u011b\u0159it na v\u00fdhody a nedostatky n\u011bkolika zn\u00e1m\u00fdch a zaveden\u00fdch zp\u016fsob\u016f. Pot\u00e9 nab\u00eddneme ur\u010dit\u00e1 doporu\u010den\u00ed, jak interpretovat z\u00edskan\u00e9 hodnoty.<\/p>\n

Index t\u011blesn\u00e9 hmotnosti<\/strong>
Index t\u011blesn\u00e9 hmotnosti (ve zkratce BMI z anglick\u00e9ho Body Mass Index), n\u011bkdy tak\u00e9 naz\u00fdvan\u00fd jako Quetelet\u016fv index, je nejjednodu\u0161\u0161\u00edm n\u00e1strojem pro odhadov\u00e1n\u00ed slo\u017een\u00ed t\u011bla. Slovo “odhadov\u00e1n\u00ed” je zde pou\u017eito z\u00e1m\u011brn\u011b, nebo\u0165 BMI vlastn\u011b nen\u00ed m\u011b\u0159\u00edtkem slo\u017een\u00ed t\u011bla, je to pouze jednoduch\u00fd v\u00fdpo\u010det zalo\u017een\u00fd na vzr\u016fstu (v\u00fd\u0161ce) postavy a jej\u00ed hmotnosti (v\u00e1ze) a tento v\u00fdpo\u010det se pou\u017e\u00edv\u00e1 pro za\u0159azov\u00e1n\u00ed lid\u00ed do r\u016fzn\u00fdch kategori\u00ed podle jejich t\u011blesn\u00e9ho tuku.
 <\/p>\n

Odhady podle BMI jsou u\u017eite\u010dn\u00e9 pro rozs\u00e1hl\u00e9 v\u00fdzkumy, kdy nen\u00ed mo\u017eno pou\u017e\u00edvat slo\u017eit\u011bj\u0161\u00ed a p\u0159esn\u011bj\u0161\u00ed m\u011b\u0159ic\u00ed postupy a metody, ale tyto odhady jsou u mnoh\u00fdch jedinc\u016f velmi nep\u0159esn\u00e9.
P\u0159edpoklad, \u017ee zv\u00fd\u0161en\u00e9 hodnoty BMI automaticky znamenaj\u00ed v\u011bt\u0161\u00ed mno\u017estv\u00ed tuku \u010dasto neplat\u00ed – hodnoty BMI se zvy\u0161uj\u00ed,  a\u0165 je v\u011bt\u0161\u00ed hmotnost zp\u016fsobena tukem nebo svalovinou. Pro jednotlivce s velmi vyvinutou svalovinou je tato metoda velmi nelichotiv\u00e1.
Hodnoty BMI se snadno vypo\u010d\u00edt\u00e1vaj\u00ed jednoduchou kalkula\u010dkou. BMI se uv\u00e1d\u00ed v kilogramech na \u010dtvere\u010dn\u00fd metr (kg•m2). Vypo\u010dte se tak, \u017ee t\u011blesn\u00e1 v\u00e1ha v kilogramech se vyd\u011bl\u00ed mocninou v\u00fd\u0161ky v metrech:
 <\/p>\n

BMI {v (kg•m2)} = v\u00e1ha {v kg} ÷ (v\u00fd\u0161ka)2 {v m}<\/span>
 <\/p>\n

Upozor\u0148ujeme, \u017ee pro v\u00fdpo\u010det BMI se pou\u017e\u00edvaj\u00ed metrick\u00e9 m\u00edry. Dal\u0161\u00ed metody, kter\u00e9 zde uvedeme, zji\u0161\u0165uj\u00ed procento t\u011blesn\u00e9ho tuku p\u0159esn\u011bji.<\/p>\n

Kalibrovac\u00ed antropometrie<\/strong>
Tlou\u0161\u0165ka podko\u017en\u00edho tuku se dlouho pova\u017eovala za ukazatel celkov\u00e9ho obsahu tuku v t\u011ble. Tlou\u0161\u0165ka ko\u017en\u00ed \u0159asy a pod n\u00ed ulo\u017een\u00e9 tukov\u00e9 tk\u00e1n\u011b se jednodu\u0161e m\u011b\u0159\u00ed ru\u010dn\u00edm m\u011b\u0159idlem (viz doprovodn\u00e1 fotografie). Hodnoty nam\u011b\u0159en\u00e9 na n\u011bkolika m\u00edstech se pou\u017eij\u00ed v regresn\u00ed rovnici, pomoc\u00ed kter\u00e9 se vypo\u010dte odhadovan\u00e9 mno\u017estv\u00ed t\u011blesn\u00e9ho tuku. Ve v\u011bdeck\u00e9 literatu\u0159e existuje ohromn\u00e9 mno\u017estv\u00ed p\u0159\u00edklad\u016f a metod pro dosa\u017een\u00ed v\u00fdsledn\u00e9ho v\u00fdpo\u010dtu, n\u011bkter\u00e9 doporu\u010duj\u00ed m\u011b\u0159it na 2, jin\u00e9 a\u017e na 12 m\u00edstech. Odhady jsou nejp\u0159esn\u011bj\u0161\u00ed tam, kde m\u011b\u0159en\u00e1 osoba nejp\u0159esn\u011bji odpov\u00edd\u00e1 typu t\u011bla a ukl\u00e1d\u00e1n\u00ed tuku referen\u010dn\u00ed skupiny pou\u017eit\u00e9 pro vytvo\u0159en\u00ed regresn\u00ed rovnice. P\u0159esnost odhadu se m\u016f\u017ee u r\u016fzn\u00fdch lid\u00ed v\u00fdznamn\u011b li\u0161it. A ani pou\u017eit\u00ed rovnice, kter\u00e1 vy\u017eaduje m\u011b\u0159en\u00ed na v\u00edce m\u00edstech, nezaru\u010duje p\u0159esn\u011bj\u0161\u00ed v\u00fdsledek.
 <\/p>\n

St\u00e1le se nejv\u00edce pou\u017e\u00edvaj\u00ed jednoduch\u00e9 p\u016fvodn\u00ed rovnice. Ty byly sestaveny na z\u00e1klad\u011b vyhodnocen\u00ed velk\u00fdch po\u010dt\u016f testovan\u00fdch osob a jsou pom\u011brn\u011b dobr\u00fdmi ukazately pro odhady u ur\u010dit\u00fdch skupin (typ\u016f) lid\u00ed (znovu p\u0159ipom\u00edn\u00e1me, \u017ee nemus\u00ed p\u0159esn\u011b platit pro ka\u017ed\u00e9ho jednotlivce). Nej\u010dast\u011bji pou\u017e\u00edvan\u00e9 rovnice p\u0159edpov\u00eddaj\u00ed t\u011blesnou hustotu rozd\u00edln\u011b pro ka\u017ed\u00e9 pohlav\u00ed (Jackson a Pollock, 1978; Jackson et al., 1980). Vypo\u010dten\u00e9 hustoty se dosad\u00ed pro v\u00fdpo\u010det odhadu dvou slo\u017eek skladby t\u011bla – t\u011blesn\u00e9 hmoty bez tuku a tukov\u00e9 hmoty (i kdy\u017e tento dvojslo\u017ekov\u00fd model nen\u00ed anatomicky p\u0159esn\u00fd, pou\u017e\u00edv\u00e1 se velmi snadno a p\u0159in\u00e1\u0161\u00ed pom\u011brn\u011b validn\u00ed v\u00fdsledky).<\/p>\n

Pro osoby b\u011blo\u0161sk\u00e9ho (tzv. kavkazsk\u00e9ho) typu se zpravidla pou\u017e\u00edv\u00e1 rovnice zn\u00e1m\u00e1 jako Siriho rovnice (Siri, 1956). A proto\u017ee se zjistilo, \u017ee beztukov\u00e1 hmota u dosp\u011bl\u00e9ho \u010derno\u0161sk\u00e9ho obyvatelstva je v\u00fdznamn\u011b vy\u0161\u0161\u00ed ne\u017e u odpov\u00eddaj\u00edc\u00ed skupiny b\u011bloch\u016f (1 113 g•cm3 oproti 1 100 g•cm3), n\u011bkdy se u t\u011bchto jednotlivc\u016f pou\u017e\u00edv\u00e1 upraven\u00fd vzorec – tzv. Schutteho rovnice (Schutte et al., 1984).<\/p>\n

Hydrodenzitometrie<\/strong>
Vztah mezi t\u011blesnou hustotou zji\u0161t\u011bnou vzpl\u00fdvavost\u00ed ve vod\u011b a slo\u017een\u00edm t\u011bla dal vzniknout dal\u0161\u00ed praktick\u00e9 metod\u011b, kterou vyvinulo n\u00e1mo\u0159nictvo Spojen\u00fdch st\u00e1t\u016f na z\u00e1klad\u011b v\u00fdzkum\u016f prov\u00e1d\u011bn\u00fdch b\u011bhem druh\u00e9 sv\u011btov\u00e9 v\u00e1lky (Behnke et al., 1942).
Tato metoda byla pozd\u011bji je\u0161t\u011b zdokonalena kv\u016fli snadn\u00e9 aplikaci (Katch et al., 1967). Pot\u00e1p\u011b\u010di jist\u011b ocen\u00ed skute\u010dnost, \u017ee doktor Albert Behnke je pova\u017eov\u00e1n za jednoho z otc\u016f modern\u00ed pot\u00e1p\u011b\u010dsk\u00e9 fyziologie a mediciny. Metodu hydrostatick\u00e9ho v\u00e1\u017een\u00ed \u00fadajn\u011b vyvinul pot\u00e9, co jej frustrovalo, \u017ee jeho velice zdatn\u00ed pot\u00e1p\u011b\u010di byli tehdy pou\u017e\u00edvan\u00fdmi standardn\u00edmi rovnicemi klasifikov\u00e1ni jako osoby s nadv\u00e1hou.<\/p>\n

Tak\u00e9 hydrodenzitometrie vych\u00e1z\u00ed z dvojslo\u017ekov\u00e9ho modelu (t.j. z hmoty bez tuku a hmoty tukov\u00e9). Odhaduj\u00ed se procenta ka\u017ed\u00e9 z t\u011bchto dvou slo\u017eek v\u016f\u010di pr\u016fm\u011brn\u00e9 hustot\u011b t\u011bla. Porovn\u00e1vac\u00edm standardem pro hustotu je destilovan\u00e1 voda (tzv. “specifick\u00e1 v\u00e1ha”, t.j. v\u00e1ha na jednotku hmoty), jej\u00ed\u017e hodnota je 1,000 g•cm3.
 <\/p>\n

Tuk m\u00e1 specifickou v\u00e1hu p\u0159ibli\u017en\u011b 0,9 g•cm3 a svalovina p\u0159ibli\u017en\u011b 1,1 g•cm3. Hlavn\u00edm probl\u00e9mem p\u0159i odhadov\u00e1n\u00ed pr\u016fm\u011brn\u00e9 hustoty tk\u00e1n\u011b osoby pono\u0159en\u00e9 do sladk\u00e9 vody je ovliv\u0148ov\u00e1n\u00ed zji\u0161t\u011bn\u00e9ho v\u00fdsledku plynem obsa\u017een\u00fdm v d\u00fdchac\u00edm a tr\u00e1vic\u00edm traktu. Tato p\u0159\u00ed\u010dina nep\u0159esnost\u00ed a chyb se d\u00e1 sn\u00ed\u017eit co nejd\u016fkladn\u011bj\u0161\u00edm v\u00fddechem p\u0159ed spo\u010dinut\u00edm na v\u00e1ze, kterou m\u011b\u0159en\u00e1 osoba mus\u00ed zat\u00ed\u017eit pod vodou. Zbytkov\u00fd objem plic lze vypo\u010d\u00edtat nez\u00e1visl\u00fdm testem, na z\u00e1klad\u011b kter\u00e9ho se oprav\u00ed nadn\u00e1\u0161ej\u00edc\u00ed \u00fa\u010dinek plynu (Wilmore et al., 1980).<\/p>\n

Objem plynu zachycen\u00e9ho v tr\u00e1vic\u00edm traktu se pova\u017euje za pom\u011brn\u011b mal\u00fd a p\u0159\u00edslu\u0161n\u00e1 korekce se prov\u00e1d\u00ed odhadem. Rovn\u011b\u017e se prov\u00e1d\u011bj\u00ed ur\u010dit\u00e9 korekce hustoty vody zp\u016fsoben\u00e9 jej\u00ed r\u016fznou teplotou. Navzdory r\u016fzn\u00fdm omezen\u00edm a nutnosti pouze odhadovat n\u011bkter\u00e9 opravn\u00e9 \u00fadaje (nap\u0159. plyn v tr\u00e1vic\u00edm traktu), hydrodenzitometrie se pova\u017euje za dobrou referen\u010dn\u00ed metodu pro zji\u0161\u0165ov\u00e1n\u00ed slo\u017een\u00ed t\u011bla, zvl\u00e1\u0161t\u011b p\u0159i srovn\u00e1n\u00ed s n\u011bkter\u00fdmi nov\u00fdmi postupy. Jej\u00ed hlavn\u00ed nev\u00fdhodou je skute\u010dnost, \u017ee testovan\u00e1 osoba mus\u00ed vydr\u017eet pod vodou v klidov\u00e9m stavu s pr\u00e1zdn\u00fdmi pl\u00edcemi (a samoz\u0159ejm\u011b s pono\u0159enou celou hlavou). Sice se objevily i n\u011bkter\u00e9 alternativn\u00ed metody, p\u0159i kter\u00fdch se nevy\u017eaduje d\u016fkladn\u00fd v\u00fddech, ale ty se pou\u017e\u00edvaj\u00ed m\u00e9n\u011b \u010dasto.<\/p>\n

Pletysmografie<\/strong>
Jedn\u00e1 se o suchou metodu, kter\u00e1 napodobuje hydrodenzitometrii a posledn\u00ed dobou se stala dosti popul\u00e1rn\u00ed. Pletysmografie s v\u00fdtlakem vzduchu (anglick\u00e1 zkratka ADP) se pou\u017e\u00edv\u00e1 v za\u0159\u00edzen\u00ed nazvan\u00e9m Bod Pod (v\u00fdrobce: Life Measurements Instruments, Concord, Kalifornie), p\u0159i\u010dem\u017e p\u0159i stanovov\u00e1n\u00ed pr\u016fm\u011brn\u00e9 t\u011blesn\u00e9 hustoty odpad\u00e1 nutnost pono\u0159en\u00ed se pod vodu a vyt\u011bsn\u011bn\u00ed vzduchu z plic.
 <\/p>\n

Princip je n\u00e1sleduj\u00edc\u00ed: testovan\u00e1 osoba sed\u00ed v mal\u00e9 such\u00e9 komo\u0159e, kde se pomoc\u00ed po\u010d\u00edta\u010dem \u0159\u00edzen\u00fdch n\u00e1stroj\u016f p\u0159esn\u011b zm\u011b\u0159\u00ed hmotnost a objem t\u011bla. Potom se vypo\u010dte celkov\u00e1 t\u011blesn\u00e1 hustota a odhadne hmotnost bez tuku i tukov\u00e1 hmotnost stejn\u011b jako v p\u0159\u00edpad\u011b hydrostatick\u00fdch m\u011b\u0159en\u00ed. Rozd\u00edly mezi hodnotami nam\u011b\u0159en\u00fdmi hydrostaticky a metodou ADP se u r\u016fzn\u00fdch skupin li\u0161\u00ed a rovn\u011b\u017e mohou b\u00fdt zna\u010dn\u011b rozd\u00edln\u00e9 v\u00fdsledky (co se t\u00fd\u010de p\u0159esnosti) mezi jednotlivci (Collins et al., 2004), nicm\u00e9n\u011b metoda ADP nab\u00edz\u00ed velkou v\u00fdhodu d\u00edky snadnosti prov\u00e1d\u011bn\u00e9ho m\u011b\u0159en\u00ed. Zvl\u00e1\u0161t\u011b to plat\u00ed pro jedince, kter\u00fdm \u010din\u00ed pot\u00ed\u017ee zcela vydechnout a pak se v klidu udr\u017eet celkov\u011b pono\u0159en pod vodu. ADP se naopak nehod\u00ed pro osoby trp\u00edc\u00ed klaustrofobi\u00ed.<\/p>\n

Bioelektrick\u00e1 impedance<\/strong>
Bioelektrick\u00e1 impedan\u010dn\u00ed anal\u00fdza (BIA) je bezesporu nejpohodln\u011bj\u0161\u00ed metodou pro zji\u0161\u0165ov\u00e1n\u00ed slo\u017een\u00ed t\u011bla. M\u011b\u0159\u00edc\u00ed p\u0159\u00edstroj p\u0159ipom\u00edn\u00e1 b\u011b\u017enou v\u00e1hu po\u017e\u00edvanou v koupeln\u011b nebo jakousi malou krabici se dv\u011bma dr\u017eadly. Princip, jak to funguje, je jednoduch\u00fd: lidsk\u00e9 t\u011blo je vlastn\u011b vodi\u010dem elektrick\u00e9ho proudu. BIA vych\u00e1z\u00ed ze skute\u010dnosti, \u017ee celkov\u00e1 vodivost t\u011bla se zvy\u0161uje rostouc\u00edm procentem svaloviny a sni\u017euje rostouc\u00edm pod\u00edlem tukov\u00e9 hmoty.
P\u0159i pou\u017eit\u00ed tohoto m\u011b\u0159\u00edc\u00edho za\u0159\u00edzen\u00ed je pot\u0159eba um\u00edstit na t\u011ble dva kontakty v ur\u010dit\u00e9 vzd\u00e1lenosti od sebe (zpravidla jeden na ka\u017ed\u00e9 noze nebo ruce). Pot\u00e9 se mezi ob\u011bma kontakty vy\u0161le velmi slab\u00fd el. sign\u00e1l o vysok\u00e9 frekvenci (testovan\u00e1 osoba nic nepoc\u00edt\u00ed). P\u0159itom se zm\u011b\u0159\u00ed rychlost pr\u016fchodu el. proudu t\u011blem a na z\u00e1klad\u011b zm\u011b\u0159en\u00e9 rychlosti se vypo\u010dte relativn\u00ed procento beztukov\u00e9 a tukov\u00e9 hmoty.
 <\/p>\n

I kdy\u017e toto za\u0159\u00edzen\u00ed v\u011bt\u0161inou poskytuje pom\u011brn\u011b p\u0159esn\u00e9 odhady slo\u017een\u00ed t\u011bla, mohou b\u00fdt v\u00fdsledky siln\u011b ovlivn\u011bn\u00e9 moment\u00e1ln\u00edm stavem hydratace, zm\u011bnami vlastnost\u00ed elektrolytu a dokonce i posledn\u00edm j\u00eddlem. \u00da\u010dinek zm\u011bny elektrolytu je z\u0159ejm\u00fd, jestli\u017ee se za\u0159\u00edzen\u00ed pou\u017eije t\u011bsn\u011b p\u0159ed a ihned po t\u0159icetiminutov\u00e9m b\u011bhu. Validitu hodnot nam\u011b\u0159en\u00fdch metodou BIA n\u011bkte\u0159\u00ed odborn\u00edci ost\u0159e krizuj\u00ed (Gelbrich et al., 2005). I kdy\u017e jsou tato m\u011b\u0159ic\u00ed za\u0159\u00edzen\u00ed n\u011bkdy nep\u0159esn\u00e1, sv\u00e9 opodstatn\u011bn\u00ed pro m\u011b\u0159en\u00ed slo\u017een\u00ed t\u011bla si zachov\u00e1vaj\u00ed d\u00edky tomu, \u017ee jsou levn\u00e1 a snadno pou\u017eiteln\u00e1. Pohodln\u00e1 m\u011b\u0159en\u00ed prov\u00e1d\u011bn\u00e1 doma pravideln\u011b r\u00e1no hned po procitnut\u00ed mohou poskytovat dosti spolehliv\u00e9 informace o tom, jak\u00fdm sm\u011brem se vyv\u00edj\u00ed slo\u017een\u00ed t\u011bla.<\/p>\n

Ultrazvuk<\/strong>
Pro m\u011b\u0159en\u00ed slo\u017een\u00ed t\u011bla lze pou\u017e\u00edvat (na r\u016fzn\u00fdch \u010d\u00e1stech t\u011bla) i ultrazvuk. Oproti jin\u00fdm zde zm\u00edn\u011bn\u00fdm metod\u00e1m to je v\u0161ak pon\u011bkud komplikovan\u011bj\u0161\u00ed a m\u00e9n\u011b ov\u011b\u0159en\u00e9. Jako neju\u017eite\u010dn\u011bj\u0161\u00ed se tato metoda jev\u00ed p\u0159i m\u011b\u0159en\u00ed ob\u00e9zn\u00edch jedinc\u016f, pro kter\u00e9 jsou jin\u00e9 techniky pou\u017eiteln\u00e9 jen s obt\u00ed\u017eemi. Ultrazvukovou metodou se n\u011bkdy odhaduje i tzv. viscer\u00e1ln\u00ed (\u00fatrobn\u00ed) obsah tuku, co\u017e m\u016f\u017ee b\u00fdt ukazatelem nebezpe\u010d\u00ed kardiovaskul\u00e1rn\u00edho onemocn\u011bn\u00ed (Kim et al., 2004).<\/p>\n

Dvojenergetick\u00e1 rentgenov\u00e1 absorpciometrie <\/strong>
P\u0159\u00edstroje ur\u010den\u00e9 k aplikaci tzv. dvojenergetick\u00e9 rentgenov\u00e9 absorpciometrie (DEXA) vyu\u017e\u00edvaj\u00ed dvoj\u00ed rentgenovou energii pro m\u011b\u0159en\u00ed obsahu tuku, svaloviny a kost\u00ed p\u0159i skenov\u00e1n\u00ed cel\u00e9ho t\u011bla nebo jeho r\u016fzn\u00fdch \u010d\u00e1st\u00ed. DEXA je oproti tradi\u010dn\u00edm metod\u00e1m zji\u0161\u0165ov\u00e1n\u00ed tlou\u0161\u0165ky tukov\u00e9 \u0159asy a hydrodenzitometrii v\u00fdhodn\u011bj\u0161\u00ed – p\u0159i odhadov\u00e1n\u00ed beztukov\u00e9 i tukov\u00e9 hmoty se m\u016f\u017ee p\u0159i n\u00ed zohlednit i hustota kost\u00ed (\u010d\u00edm\u017e se sni\u017euje chyba vyskytuj\u00edc\u00ed se p\u0159i dvojslo\u017ekov\u00e9m modelu). I kdy\u017e se pomoc\u00ed t\u00e9to techniky dosahuje pom\u011brn\u011b p\u0159esn\u00fdch odhad\u016f t\u011blesn\u00e9 hustoty (Prior et al., 1997), jej\u00ed finan\u010dn\u00ed n\u00e1ro\u010dnost zat\u00edm zabr\u00e1nila, aby se stala novou standardn\u011b pou\u017e\u00edvanou metodou (k jej\u00ed aplikaci doch\u00e1z\u00ed t\u00e9m\u011b\u0159 v\u00fdhradn\u011b ve v\u011bdeckov\u00fdzkumn\u00e9m prost\u0159ed\u00ed).<\/p>\n

Zobrazen\u00ed magnetick\u00e9 rezonance<\/strong>
P\u0159i zobrazen\u00ed magnetickou rezonanc\u00ed (MRI) se vyu\u017e\u00edv\u00e1 magnetick\u00e9 pole pro aktivaci vybran\u00fdch jader v t\u011ble tak, \u017ee se jeho prost\u0159ednictv\u00edm vytv\u00e1\u0159ej\u00ed p\u0159esn\u00e1 vyobrazen\u00ed t\u011blesn\u00fdch tk\u00e1n\u00ed, ani\u017e by se t\u011blo vystavovalo ioniza\u010dn\u00edmu oz\u00e1\u0159en\u00ed. T\u00edmto zp\u016fsobem lze velmi p\u0159esn\u011b stanovit rozlo\u017een\u00ed tuku v t\u011ble (Ross et al., 2000). Jedn\u00e1 se o bezpe\u010dnou metodu, jej\u00ed\u017e pou\u017eit\u00ed je v\u0161ak omezen\u00e9 kv\u016fli vysok\u00fdm n\u00e1klad\u016fm na pot\u0159ebn\u00e9 za\u0159\u00edzen\u00ed a po\u010d\u00edta\u010dem prov\u00e1d\u011bnou anal\u00fdzu.<\/p>\n

V\u00fdklad v\u00fdsledk\u016f z\u00edskan\u00fdch vy\u0161et\u0159en\u00edm<\/strong>
slo\u017een\u00ed t\u011bla Informace z\u00edskan\u00e9 p\u0159i zji\u0161\u0165ov\u00e1n\u00ed indexu t\u011blesn\u00e9 hmotnosti (BMI) se mus\u00ed vyhodnocovat s pou\u017eit\u00edm velk\u00e9 d\u00e1vky selsk\u00e9ho rozumu. Nejlep\u0161\u00edm zp\u016fsobem, jak tuto metodu pou\u017e\u00edvat, je jednodu\u0161e ji \u010das od \u010dasu opakovat. Lidem s hodnotami BMI p\u0159ekra\u010duj\u00edc\u00edmi doporu\u010den\u00fd r\u00e1mec, nebo jedinc\u016fm, jejich\u017e hodnoty se b\u011bhem jejich dosp\u011blosti nep\u0159etr\u017eit\u011b zvy\u0161uj\u00ed (bez patrn\u00e9ho n\u00e1r\u016fstu svaloviny) m\u016f\u017ee tato metoda pomoci k p\u0159ehodnocen\u00ed stravy a fyzick\u00fdch \u010dinnost\u00ed (cvi\u010den\u00ed).<\/p>\n

Klasifikace BMI je dosti libovoln\u00e1 a n\u00e1zor na \u017e\u00e1douc\u00ed a\u017e ide\u00e1ln\u00ed hodnoty se st\u00e1le vyv\u00edj\u00ed. V sou\u010dasnosti se jako nejpou\u017e\u00edvan\u011bj\u0161\u00ed norma pou\u017e\u00edv\u00e1 stupnice uzn\u00e1van\u00e1 Americk\u00fdm n\u00e1rodn\u00edm institutem pro v\u00fdzkum srdce, plic a krve (U.S. National Heart, Lung and Blood Institute = NHLB) a Sv\u011btovou zdravotnickou organizac\u00ed (World Health Organization = WHO) z roku 1998 (viz tab. 1).<\/p>\n

Kategorizace podle NHLB\/WHO v\u0161ak nen\u00ed jedin\u00fdm platn\u00fdm v\u00fdkladem. Definice “norm\u00e1lnosti” je klasick\u00fdm jablkem sv\u00e1ru. Nap\u0159. mnoz\u00ed odborn\u00edci doporu\u010duj\u00ed, \u017ee by se hodnoty, kter\u00e9 ji\u017e sice pat\u0159\u00ed do kategorie “nadv\u00e1ha”, ale jen nev\u00fdznamn\u011b, m\u011bly st\u00e1le je\u0161t\u011b pova\u017eovat za norm\u00e1ln\u00ed. Jestli\u017ee se pou\u017e\u00edv\u00e1 tak jednoduch\u00fd a potenci\u00e1ln\u011b zav\u00e1d\u011bj\u00edc\u00ed ukazatel, jak\u00fdm je BMI, je stanoven\u00ed jedin\u00e9ho platn\u00e9ho syst\u00e9mu klasifikace pro r\u016fznorod\u00e9 obyvatelstvo velmi obt\u00ed\u017en\u00e9.
 <\/p>\n

I v\u00fdsledky o zji\u0161t\u011bn\u00e9m mno\u017estv\u00ed tuku v t\u011ble se mus\u00ed vykl\u00e1dat racion\u00e1ln\u011b. U ka\u017ed\u00e9 metody je t\u0159eba m\u00edt st\u00e1le na mysli mo\u017enost potenci\u00e1ln\u00edho zkreslen\u00ed a\u017e omylu. Nejv\u00edce zav\u00e1d\u011bj\u00edc\u00ed mohou b\u00fdt odhady z\u00edskan\u00e9 m\u011b\u0159en\u00edm tukov\u00e9 \u0159asy nebo bioelektrickou impedan\u010dn\u00ed anal\u00fdzou. V\u00fdsledky dosa\u017een\u00e9 pomoci hydrodenzitometrie nebo dal\u0161\u00edch slo\u017eit\u011bj\u0161\u00edch metod jsou zpravidla p\u0159esn\u011bj\u0161\u00ed. Bez ohledu na pou\u017eit\u00e9 za\u0159\u00edzen\u00ed je v\u0161ak d\u016fle\u017eit\u00e9 zachovat si rozumn\u00fd p\u0159\u00edstup. Pro n\u00e1s pro v\u0161echny je typick\u00e9, \u017ee bychom cht\u011bli v\u00e1\u017eit m\u00e9n\u011b. Nezapom\u00ednejme v\u0161ak, \u017ee pro zdrav\u00ed je zapot\u0159eb\u00ed i ur\u010dit\u00e9 mno\u017estv\u00ed tuku.
 <\/p>\n

Kategoriza\u010dn\u00edch syst\u00e9m\u016f zalo\u017een\u00fdch na vyhodnocov\u00e1n\u00ed procentu\u00e1ln\u00edho obsahu tuku v t\u011ble existuje cel\u00e1 \u0159ada. Stupnice, kterou up\u0159ednost\u0148uje Americk\u00e1 rada pro t\u011blesn\u00e1 cvi\u010den\u00ed, nab\u00edz\u00ed velmi rozumn\u00e9 a p\u0159im\u011b\u0159en\u00e9 rozsahy jednotliv\u00fdch kategori\u00ed (viz tab. 2). N\u011bkter\u00e9 jin\u00e9 syst\u00e9my nab\u00edzej\u00ed je\u0161t\u011b v\u011bt\u0161\u00ed rezervy, v\u011bt\u0161inou s rostouc\u00edm v\u011bkem.<\/p>\n

Doporu\u010den\u00ed pro sni\u017eov\u00e1n\u00ed tuku<\/strong>
Je-li pot\u0159eba sn\u00ed\u017eit nadbyte\u010dn\u00fd tuk v t\u011ble, nejlep\u0161\u00edm zp\u016fsobem, jak toho dos\u00e1hnout, je kombinovat dietu s programem fyzick\u00fdch cvi\u010den\u00ed. Samotn\u00e1 dieta toti\u017e p\u0159inese ztr\u00e1tu jak tukov\u00fdch, tak i svalov\u00fdch tk\u00e1n\u00ed. Sn\u00ed\u017een\u00ed rychlosti metabolismu, kter\u00e9 v p\u0159\u00edpad\u011b ztr\u00e1ty svaloviny n\u00e1sleduje, pak znamen\u00e1, \u017ee se nadm\u011brn\u00e1 v\u00e1ha vrac\u00ed rychleji zp\u011bt. Hlavn\u00edm c\u00edlem by nem\u011bl b\u00fdt \u00fabytek na v\u00e1ze s\u00e1m o sob\u011b: c\u00edlem je zlep\u0161it pom\u011br mezi netukov\u00fdmi a tukov\u00fdmi tk\u00e1n\u011bmi.
 <\/p>\n

V\u0161ichni, kdo se rozhodli vstoupit do n\u011bjak\u00e9ho programu sni\u017eov\u00e1n\u00ed t\u011blesn\u00e9 v\u00e1hy, by m\u011bli po celou dobu tohoto procesu pravideln\u011b sledovat a kontrolovat slo\u017een\u00ed sv\u00e9ho t\u011bla. Absolutn\u00ed \u010d\u00edsla jsou mnohem m\u00e9n\u011b d\u016fle\u017eit\u00e1, ne\u017e zm\u011bny, kter\u00e9 se d\u011bj\u00ed a zji\u0161\u0165uj\u00ed po del\u0161\u00ed dobu. A i kdy\u017e jednotliv\u00e9 nam\u011b\u0159en\u00e9 absolutn\u00ed hodnoty nemus\u00ed b\u00fdt p\u0159esn\u00e9, opakovan\u00e1 m\u011b\u0159en\u00ed se daj\u00ed pou\u017e\u00edt pro pom\u011brn\u011b spolehliv\u00e9 zji\u0161t\u011bn\u00ed zm\u011bn, kter\u00e9 se d\u011bj\u00ed b\u011bhem del\u0161\u00ed doby – pokud se pou\u017e\u00edvaj\u00ed stejn\u00e9 postupy a metody v\u00fdpo\u010dtu.
 <\/p>\n

Ka\u017ed\u00fd program by m\u011bl b\u00fdt koncipov\u00e1n jako dlouhodob\u00fd: c\u00edle by m\u011bly b\u00fdt stanoveny p\u0159im\u011b\u0159en\u011b a m\u011blo by se jich dosahovat kr\u00e1tkodob\u00fdmi “kr\u016f\u010dky” sm\u011brem ke vzd\u00e1len\u011bj\u0161\u00edmu a trval\u00e9mu v\u00fdsledku. N\u011bjak\u00e9 moment\u00e1ln\u00ed zastaven\u00ed nebo p\u0159eru\u0161en\u00ed \u00fasp\u011b\u0161n\u00e9ho procesu by nem\u011blo odradit od pokra\u010dov\u00e1n\u00ed v dlouhodob\u00e9m sna\u017een\u00ed.<\/p>\n

Tabulka 1: Klasifikace nadv\u00e1hy a obezity pomoci indexu t\u011blesn\u00e9 hmotnosti (BMI)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Klasifikace<\/strong><\/td>\nBMI (kg • m-2)<\/strong><\/td>\n<\/tr>\n
Podv\u00e1ha<\/td>\n<18.5<\/td>\n<\/tr>\n
Norm\u00e1ln\u00ed v\u00e1ha<\/td>\n18.5 – <25.0<\/td>\n<\/tr>\n
Nadv\u00e1ha<\/td>\n25.0 – <30.0<\/td>\n<\/tr>\n
1. stupe\u0148 obezity<\/td>\n30.0 – <35.0<\/td>\n<\/tr>\n
2. stupe\u0148 obezity<\/td>\n35.0 – 40.0<\/td>\n<\/tr>\n
Extr\u00e9mn\u00ed obezita<\/td>\n>40.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

(US NHLB, 1998; WHO, 1998)<\/p>\n

Tabulka 2:<\/a>: Klasifikace nadv\u00e1hy obezity podle procenta t\u011blesn\u00e9ho tuku
<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Klasifikace
<\/strong><\/td>\n		\u017deny (% tuku)<\/strong><\/td>\nMu\u017ei (% tuku)<\/strong><\/td>\n<\/tr>\n
Z\u00e1kladn\u00ed tuk<\/td>\n10-12<\/td>\n2-4<\/td>\n<\/tr>\n
Atleti<\/td>\n14-20<\/td>\n6-13<\/td>\n<\/tr>\n
Zdatn\u00ed<\/td>\n21-24<\/td>\n14-17<\/td>\n<\/tr>\n
P\u0159ijateln\u00ed<\/td>\n25-31<\/td>\n18-25<\/td>\n<\/tr>\n
Ob\u00e9zn\u00ed<\/td>\n32+<\/td>\n25+<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Slo\u017een\u00ed t\u011bla: Hodnocen\u00ed a v\u00fdkladSlo\u017een\u00ed t\u011bla m\u00e1 velk\u00fd praktick\u00fd i funk\u010dn\u00ed v\u00fdznam pro mnoh\u00e9 z n\u00e1s: v\u011bdce, klinick\u00e9 pracovn\u00edky i ve\u0159ejnost. Obzvl\u00e1\u0161t\u011b d\u016fle\u017eit\u00e9 je v\u0161ak…<\/p>\n","protected":false},"author":1,"featured_media":11374011,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[384],"tags":[],"authors":[1521],"class_list":["post-11385546","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","authors-neal-pollock-ph-d-cs_cz"],"acf":[],"yoast_head":"\nSlo\u017een\u00ed t\u011bla - Alert Diver<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/slozeni-tela\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Slo\u017een\u00ed t\u011bla - Alert Diver\" \/>\n<meta property=\"og:description\" content=\"Slo\u017een\u00ed t\u011bla: Hodnocen\u00ed a v\u00fdkladSlo\u017een\u00ed t\u011bla m\u00e1 velk\u00fd praktick\u00fd i funk\u010dn\u00ed v\u00fdznam pro mnoh\u00e9 z n\u00e1s: v\u011bdce, klinick\u00e9 pracovn\u00edky i ve\u0159ejnost. 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