2. Nutrition

Question 1

What symptoms can selective neurodegeneration of the aging enteric nervous system lead to?

Answer 1

GI Sx such as dysphagia, GI reflux, and constipation

Question 2

How are gastric motility and the small intestine affected with aging?

Answer 2

gastric motility is impaired but the small intestine is unaffected

Question 3

What happens to gastric acid secretion with aging and what is the consequence?

Answer 3

Gastric acid secretion declines with aging which can lead to small bowel bacterial growth. This is associated wtih reduced body weight and reduced intake of micronutrients

Question 4

If people are more sedentary as they age, why do they still lose weight?

Answer 4

The decrease in their energy intake is greater than the decrease in their energy expenditure

Question 5

What age does body weight and BMI start to decline?

Answer 5

50-60

Question 6

What is the relationship between BMI and mortality in the elderly?

Answer 6

J-shaped curve: increased mortality with low and high BMIs

Question 7

What is cachexia and what does it lead to the release of?

Answer 7

Cachexia is an involuntary loss of fat-free mass or body cells caused by catabolism. It leads to release of cytokines such as IL-1, IL-6, and TNF-a which increases the resting energy expenditure

Question 8

What is the major age-related physiological change in older people?

Answer 8

Sarcopenia: decline in skeletal muscle mass

Question 9

What drugs may affect the sense of taste in the elderly?

Answer 9

Parkinson medications and antidepressants

Question 10

What changes in the stomach allow the elderly to feel fuller earlier?

Answer 10

Receptive relaxation of the gastric fundus is impaired which causes rapid antral filling, distension, and early satiety

Question 11

What 3 elevated hormones may cause early satiety in the elderly?

Answer 11

1. CCK
2. PPY
3. Leptin

Question 12

If the elderly patients have a lower body mass than before, why do they have elevated leptin levels?

Answer 12

Aging is associated wtih reduced glucose tolerance and elevated insulin levels which may amplify the leptin signal and inhibit ghrelin

Question 13

What is a 5-step screening tool that is used to identify adults who are malnourished or at risk of malnutrition and what three components does it measure?

Answer 13

MUST - Malnutrition Universal Screening Tool
measures:
1. BMI
2. Hx of unexplained weight loss
3. acute illness effect

Question 14

What does the SCALES test measure and who is it used for?

Answer 14

SCALES identifies:

1. sadness
2. cholesterol
3. albumin
4. loss of weight
5. eating problem physical/cognitive
6. shopping problems
   - used for outpatient screening

Question 15

What are 5 things that may contribute to physiological anorexia?

Answer 15

1. diminished sense of smell and taste
2. increased cytokine activity
3. delayed gastric emptying
4. altered gastric distension
5. hormonal

Question 16

What 3 cytokines are associated with reduced muscle mass?

Answer 16

IL-1, IL-6, and TNF-a

Question 17

What did the study comparing underfed diets of older and younger men demonstrate?

Answer 17

Older people did not return to their baseline weight, indicating that older people do not respond to acute undernutrition compared with younger men.

Question 18

What are the WHO categories of BMI?

Answer 18

< 18.5 --> underweight
18.5-24.9 --> normal
25-29.9 --> overweight
30-39.9 --> obese
>40 --> EXTREME obesity

Question 19

What skinfold measurement is a helpful indicator of malnutrition in ill patients?

Answer 19

mid-upper arm circumference

normal 23cm in males, >22cm in females

Question 20

What tool is a simple, non-invasive and inespensive method to estimate total body water, extracellular water, fat-free mass, and body cell mass?

Answer 20

biometric mpedance analysis

Question 21

What is the most commonly used marker to predict mortality in older people and why is its use limited?

Answer 21

Albumin - it has a long half life, so it is not useful for short-term changes in protein and energy intake. Also, it can be affected by inflammation and infection which makes it less specific.

Question 22

What is a more sensitive marker of early protein-energy malnutrition?

Answer 22

Transferrin

Question 23

What is the RDA intake of protein for elderly individuals to optimize health and function?

Answer 23

1.5 g protein/kg body weight per day (as opposed to 0.8 g protein/kg body weight per day in younger adults)

Question 24

Why are elderly patients susceptible to hypervitaminosis?

Answer 24

They do not clear vitamin A well

Question 25

What are the most common causes of vitamin B12 deficiency in older people?

Answer 25

atrophic gastritis and pernicious anemia

Question 26

What are some consequences of folate deficiency in older patients?

Answer 26

1. macrocytic anemia
2. increased homocysteine level
3. increased risk of colorectal cancer and possibly cervical cancer
4. cognitive impairment
5. depression

Question 27

Why are older people more susceptible to develop problems with fluid and electrolyte balance?

Answer 27

They are likely to have more physiological renal impairment and changes in thirst perception

Question 28

What eneteral feeding methods are indicated in short and long term respectively, if a patient is severely malnourished or suffers from a medical condition such a stroke?

Answer 28

short term: nasogastric tube

long term: PEG (percutaneous endoscopic gastrostomy)