24) Nutrition & vitamins Flashcards
Major components of energy output
Resting Energy Expenditure (REE)
physical activity
Average energy intake
American women is approximately 1800 kcal/d
American males is approximately 2600 kcal/d
Recommended dietary allowance (RDA) for protein
approximately 0.6 g/kg body mass per day
Dietary requirements for a healthy diet are ——% of calories from protein.
10-15
Contribution of carbohydrates to total caloric intake should be at least ——–%.
45-55
Brain requires approximately —– g/dL carbohydrate in order to function properly.
100
Benchmark recommendations for nutrient intakes developed to guide clinicians.
Replaced RDA
Dietary Reference Intakes (DRI)
DRI includes ———— for protein, fat, and carbohydrates
acceptable macronutrient distribution ranges (AMDRs)
Science of measuring the human body
Anthropometry
Anthropometry includes…
Craniometry
Osteometry
Skin-fold evaluation for subcutaneous fat estimation
Height and weight measurements
BMI
Body mass index < ——– and/or recent loss of ≥ ——- of usual body mass puts pt at risk for nutritional deficiency
18.5
10%
Hypermetabolic states
sepsis, protracted fever, extensive trauma or burns
serum albumin RR
3.5-5.0 g/dL
Serum prealbumin (transthyretin) RR
20-40 mg/dL
TIBC RR
240-450 ug/dL
Prolonged shows Vitamin K deficiency
PT
>15.5 sec
—– mg/dL serum creatinine reflects muscle wasting
< 0.6
24hr urine creatinine RR
500-1200 mg/d
reflects catabolism
Levels of >15 g/d severe catabolism
24 hr urinary urea nitrogen (UUN)
Protein Balance = Protein Intake - Protein Loss, where protein loss (protein catabolic rate) =
[24h UUN (g) + 4] x 6.25
——- mg/dL BUN = inadequate protein intake
< 6 mg/dL
adequate intake: 12-20 mg/dL
2 reasons for providing specialized nutrition support (SNS)
- Provide appropriate nutritional substances to maintain or replenish the nutritional status of patients unable to voluntarily ingest or absorb sufficient amounts of food
- Maintain the nutritional and metabolic status of sufficiently nourished patients who may have a health issue such as severe inflammation, injury, or infection
TPN
Direct infusion of complete mixtures of crystalline amino acids, dextrose, triglyceride emulsions, and micronutrients into the circulatory system through a central venous catheter.
TPN should be considered if…
energy intake has been or is anticipated to be inadequate for more than 10 days and enteral feeding is not feasible
3 techniques for functional/indirect vitamin assays
- Increased or decreased activity of reactions
- Cell response to inhibitors
- Activators that will reflect alteration in vitamin concentrations
direct vitamin assays
Immunoassays, colorimetric, fluorescent, separation techniques, spectrophotometers, fluorometers, gas and liquid chromatographs, and mass spec.
Erythrocyte transketolase activation
B1/thiamine
Thiamine concentration in blood as thiamine pyrophosphate
B1/thiamine
Measure F A D-dependent glutathione reductase activity in freshly lysed erythrocytes
B2/riboflavin
(1) Measure two urine metabolites, Nmethyl nicotinamide and ‘N-methyl-2-pyridone-5’carboxyamide
(2) Determine ratio of
N A D/N A D P in erythrocyte and plasma tryptophan
B3/niacin
Measure activity of erythrocytes
B6/pyridoxine
Measure plasma levels of pyridoxal-5-phosphate
B6/pyridoxine