2. Nutrition Flashcards
What symptoms can selective neurodegeneration of the aging enteric nervous system lead to?
GI Sx such as dysphagia, GI reflux, and constipation
How are gastric motility and the small intestine affected with aging?
gastric motility is impaired but the small intestine is unaffected
What happens to gastric acid secretion with aging and what is the consequence?
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
If people are more sedentary as they age, why do they still lose weight?
The decrease in their energy intake is greater than the decrease in their energy expenditure
What age does body weight and BMI start to decline?
50-60
What is the relationship between BMI and mortality in the elderly?
J-shaped curve: increased mortality with low and high BMIs
What is cachexia and what does it lead to the release of?
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
What is the major age-related physiological change in older people?
Sarcopenia: decline in skeletal muscle mass
What drugs may affect the sense of taste in the elderly?
Parkinson medications and antidepressants
What changes in the stomach allow the elderly to feel fuller earlier?
Receptive relaxation of the gastric fundus is impaired which causes rapid antral filling, distension, and early satiety
What 3 elevated hormones may cause early satiety in the elderly?
- CCK
- PPY
- Leptin
If the elderly patients have a lower body mass than before, why do they have elevated leptin levels?
Aging is associated wtih reduced glucose tolerance and elevated insulin levels which may amplify the leptin signal and inhibit ghrelin
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?
MUST - Malnutrition Universal Screening Tool measures: 1. BMI 2. Hx of unexplained weight loss 3. acute illness effect
What does the SCALES test measure and who is it used for?
SCALES identifies:
- sadness
- cholesterol
- albumin
- loss of weight
- eating problem physical/cognitive
- shopping problems
- used for outpatient screening
What are 5 things that may contribute to physiological anorexia?
- diminished sense of smell and taste
- increased cytokine activity
- delayed gastric emptying
- altered gastric distension
- hormonal
What 3 cytokines are associated with reduced muscle mass?
IL-1, IL-6, and TNF-a
What did the study comparing underfed diets of older and younger men demonstrate?
Older people did not return to their baseline weight, indicating that older people do not respond to acute undernutrition compared with younger men.
What are the WHO categories of BMI?
< 18.5 --> underweight 18.5-24.9 --> normal 25-29.9 --> overweight 30-39.9 --> obese >40 --> EXTREME obesity
What skinfold measurement is a helpful indicator of malnutrition in ill patients?
mid-upper arm circumference
normal 23cm in males, >22cm in females
What tool is a simple, non-invasive and inespensive method to estimate total body water, extracellular water, fat-free mass, and body cell mass?
biometric mpedance analysis
What is the most commonly used marker to predict mortality in older people and why is its use limited?
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.
What is a more sensitive marker of early protein-energy malnutrition?
Transferrin
What is the RDA intake of protein for elderly individuals to optimize health and function?
1.5 g protein/kg body weight per day (as opposed to 0.8 g protein/kg body weight per day in younger adults)
Why are elderly patients susceptible to hypervitaminosis?
They do not clear vitamin A well
