1/22 Medical Disorder of Nutrition Flashcards by Zach Overgaard

What is the medical consensus for the meaning of Cachexia?

Presence of a chronic disease PLUS
Loss of body weight > or = to 5%, within previous year or less, PLUS
Presence of at least 3 of the following:
a. Reduced Muscle Strength
b. Fatigue
c. Anorexia
d. Low fat-free mass index
e. Abnormal biochemistry (inflammation, Anemia, Low albumen)

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What is the overall prevalence of cachexia in industrialized countries?

1% or about 9 million people. 5 million people in the USA.

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What is the prevalence of death from cachexia in cancer patients?

> 30% of patients who have cancer die from cachexia. >50% of patients who die from CA have cachexia present. Other chronic illnesses causing death have >30% w/ cachexia present.

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What are the top 4 conditions where cachexia is present but underestimated or under-recognized?

COPD, Chronic heart failure, malignant cancer, chronic kidney disease.

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What are 3 main contributors to cachexia?

1) anorexia and/or malnourishment
2) immune overactivity and systemic inflammation
3) endocrine disorders

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2 general causes of anorexia?

1) decreased desire to eat

2) persistent nausea / GI inhibitors to eating

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4 general causes of malnutrition?

1) medications
2) effects of radiation treatment
3) Cancers
4) Food intolerance

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Basic inflammatory response leading to cachexia?

up regulation of pro-inflammatory cytokines –> increases C-reactive protein –> chronic inflammation –> anemia from chronic disease and decreased body weight.

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In endocrine disorder, what is the consequence of anabolic/ catabolic imbalance?

favors protein degradation
inhibits protein synthesis
resistance to growth hormone

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There is no specific treatment for cachexia now, but what treatments are under development?

anabolics, anti-catabolic therapies, appetite stimulants, nutritional interventions.

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What a 4 symptoms/signs related to cancer cachexia?

anorexia, insulin resistance, hypogonadism, inflammation.

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how is cancer cachexia treated?

1) best = treat cancer
2 )appetite stimulants, progestins, herbal medicine.
3) diet modification & exercise

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What are possible benefits for exercise in cancer cachexia?

increased: insulin sensitivity, protein synthesis rate, anti-oxidant enzyme activity, immune function.
decreased: CRP (inflammatory response).

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What are some modes of exercise for cancer cachexia?

endurance exercise (reduces CA related fatigue),
resistance training (may decrease effects of muscle wasting)

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How does COPD contribute to cachexia?

increases protein degradation pathways. Decreases physical activity and possibly causes arterial hypoxemia.

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What is the prevalence of cachexia in COPD patients?

20-40% of COPD patients. Very predictive of increased mortality.

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Can patients with COPD and cachexia increase their peripheral skeletal muscle mass and increase exercise capacity as much as someone who has COPD alone?

can still gain some peripheral skeletal muscle, and they CAN increase exercise capacity as much. High intensity cycle training, 45min/day, 3x/week, X 10 weeks.

How are chronic heart failure and cachexia related?

worse outcomes assoc. w/ low BMI. BMI is an independent predictor of survival. Cachexia most likely in NYHA Class 4.

why is it difficult to identify cachexia in patients with RA?

because loss of fat free mass is offset by increase in fat mass.

what percentage of patients with RA have cachexia?

> 50%

What are signs and symptoms of cachexia in pt w/ RA?

Joint pain, restricted mobility, fatigue, reduced muscle mass, strength & endurance. Type II muscle fibers affected more.

What are factors leading to cachexia in the ICU, and how quickly is muscle mass lost in the ICU? ICUAW = ?

multi-factorial (multiple organ failure, immobilization, hyperglycemia, corticosteroids, neuromuscular blockers). protein degradation > protein synth. Can lose over 3lbs per day! ICU acquired weakness.

In 2 weeks in the ICU how much muscle mass can be lost compared to admission?

up to HALF

list some examples of ICU conditions and percent metabolism increases?

postop ~10% metabolism increase. bone fracture ~15%. Sepsis ~ 40%. 40% body burn ~ 80%. 70% body burn ~ 120% metab. increase.

What is parenteral feeding?

nutrients enter blood directly. Uses IV pump. risk of catheter injection. expensive.

Why do they try to use the gut if it works compared to parenteral feeding?

maintains mucosal integrity. restores immune function (70% of body immune globulin production in gut). decreases morbidity in pts with critical illness.

why is enteral feeding not used sometimes?

if gut does not have adequate perfusion. if patient is severely malnurished

What do they give in the ICU to help prevent wasting?

insulin, which decreases wasting by stimulating protein synthesis.

what is a normal Albumen level? abnormal?

3.5-5 g/dL. decreased is <3.2 g/dL.

What is normal C-reactive protein level? abnormal?

norm 5.

Normal hemoglobin level? Men? Women? abnormal?

men 14-18 g/dL. Women 12-16 g/dL. decrease <12 g/dL.

normal phosphorus level? abnormal?

2.4-4.1 mg/dL. decreased <2.

What is refeeding syndrome?

if someone loses 20-30% of body weight they are at risk of mortality. in this case, the body makes everything smaller, smaller heart, organs etc. so when team tries to bring back food, the phosphate starts going back into skeletal muscle, but now smaller heart may not handle new load. So is something we have to watch someone for first 5 days to 2 weeks after refeeding has started.

In eating disorders, which macro nutrient leads to the greatest amount of wasting, when restricted,?

protein. Though usually fat restricted > carbohydrate >protein.

What is the psychiatric criteria for diagnosing anorexia nervosa?

1) self induced weight loss, usually ~85% of normal weight. 2) duration > 3 months. 3) intense drive for fitness/ irrational fear of fat 4) body image distortion 5) signs consistent w/ medical starvation >3 mo. (esp. amenorrhea or decreased testosterone in men.)

What are some physical signs of anorexia nervosa?

emaciation, hypothermia, cold hands/feet, hyperactivity. Bradycardia (< 90), heart murmur. hypoactive bowel sounds, pressure sores, brittle hair & nails, scalp hair loss, edema at ankles.

What is the PT's goal for working with a pt w/ anorexia?

maximize function, while minimizing calorie burning.

What are some PT precautions for working with a pt w/ anorexia?

don't share the pt's weight with them. osteoporosis precautions: avoid spinal flexion, encourage weight bearing activities), closely monitor heart rate and BP.

What BMI is recommended to start PT treatment for a pt w/ anorexia?

14 (though at UCH they usually have pts with BMI 9-12, and get them started)

What are keys to the Norway "body awareness" anorexia treatment?

>sensing and interpreting body signals. > improving emotional awareness. >"body as one's own"

What are impairements observed in the Norway "body awareness" anorexia treatment?

pts have poor body awareness. >restricted breathing pattern. >significant muscular tension. > compulsive physical activity.

What does the PT need to consider concerning bone density for pts w/ anorexia?

in early recovery, when bones are brittle, bone loading is risky. But as they recover bone loading will increase bone recovery.