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MED V 💗 > 5.05 Malnutrition and Nutrition Assessment > Flashcards

5.05 Malnutrition and Nutrition Assessment Flashcards

1
Q

Classifications of the nutritional status of adults (20 y.o. and above) based on BMI

A

Chronic energy deficient - (x, 18.5)
Normal - [18.5, 25)
Overweight - [25, 30]
Obese - [30, x)

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2
Q

What are nutrients? Where do you get them? What if you don’t get adequate amounts?

A

Nutrients

  • are substances not synthesized in sufficient amts in the body
  • must be supplied in the diet
  • Absence leads to growth impairment, organ dysfunction, and negative nitrogen balance
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3
Q

T or F. Conditionally essential nutrients are required in the diet in normal individuals.

A

F. They are not required in the diet in normal individuals BUT must be supplied to ceratin indivs who do not synthesize them e.g. those w/ genetic defects, pathologies, trauma, infection, etc.

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4
Q

What does the energy balance imply?

A

For the weight to remain stable, energy intake must match energy output. Weight abn are due to imbalance in intake (IN) and OU.

If Energy IN «< Energy OU = Underweight
If Energy IN&raquo_space;> Energy OU = Obese

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5
Q

What are the two major and two minor components/sources of energy output?

A

Energy Output
2 major sources: Resting energy expenditure (REE) and Physical activity (PA)

2 Minor sources: Thermic effect of food and shivering thermogenesis

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6
Q

What formula will you use to assess the energy need of an individual whose weight is stable?

A

Use Estimated Energy Requirement = REE x PA

Estimating REE:
>Male REE = 900 + (10 x weight in kg)
>Female REE = 700 + (7 x weight in kg)

Physical Activity
>1.2 - sedentary
>1.4 - moderately active
>1.8 - very active

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7
Q

How many kcal would it take to gain/lose 1 pound?

A

3500 kcal = 1 lb.

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8
Q

PROTEIN

  1. Recommended Dietary Allowance (assuming energy needs are met and of high biologic value)
  2. % total daily calories
  3. Essential amino acids
  4. When does an increase in protein requirement occur?
  5. When does a decrease in protein requirement occur?
A
  1. 0.8 g/kg desirable body weight per day
  2. 10-14% of total daily calories
  3. PVT TIM HALL (Phe, Val, Trp, Thr, Iso, Met, His, Arg, Leu, Lys)
  4. Growth, pregnancy, lactation, and rehab after malnutrition
  5. Advance renal dse (uremia) and cirrhosis (encephalopathy)
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9
Q
  1. T or F. Fats are the poor sources of energy.
  2. For optimal health, what % should fats be of the total daily calories. How many % should come from PUFAs? Satd fat and trans fat? MUFAs?
A
  1. F F F!! Fats are CONCENTRATED sources of energy
  2. For optimal health, fats should be 30% of the total daily calories
    (PUFAs - less than 10%, Satd fat & trans fat - less than 10%, MUFAs - remainder)
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10
Q
  1. Fatty meat cuts, poultry with skin, whole milk dairy products, coconut oils, palm oil have what type of fats?
  2. What is their state of matter at room temp?
  3. Is there any association to total cholesterol, LDL, or HDL?
A
  1. Saturated fats which are TGs whose FAs have side chains that do not contain any double bonds.
  2. Solid at RT
  3. Satd fats are associated with high levels of total cholesterol and LDL = increased risk of CHD
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11
Q
  1. Vegetable oils and fatty fish have what type of fats?

2. Is there any association to total cholesterol, LDL, or HDL?

A
  1. Mono unsaturated fatty acids (MUFA) which are TGs containing FAs with one double bond.
  2. Lowers TC and LDL but maintain or increase HDL.
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12
Q

In Mediterranean diet, what is the fat composition?

A

Rich in oleic acid

High in MUFA

Low in Satd fat and PUFA

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13
Q
  1. Nuts, avocado, soybean, corn oil have what type of fats?
  2. What is the state of matter of oil containing these at room temp? Chilled?
  3. Is there any association to total cholesterol, LDL, and HDL?
  4. What is an essential FA under this category?
A
  1. N-6 PUFA which are TGs containing FAs with more than one double bond
  2. Liquid at RT, Solid when chilled
  3. Lowers LDL and HDL
  4. Linoleic acid
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14
Q
  1. Fish oils (DHA and EPA) have what type of fats?
  2. What is the state of matter of oil containing these at room temp? Chilled?
  3. Is there any association to total cholesterol, LDL, and HDL?
  4. What is an essential FA under this category?
A
  1. Omega-3 PUFAs which are TGs containing FAs with more than one double bond
  2. Liquid at RT, Solid when chilled
  3. Substantial CV benefits with minimal effect on LDL and HDL
  4. Alpha linolenic
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15
Q
  1. Crackers, cookies, donuts, breads, and food fried in hydrogenated shortening (like french fries and fried chicken) have what type of fats?
  2. Is there any association to total cholesterol, LDL, and HDL?
A
  1. Trans fats which are chemically classified as unsaturated fatty acids but behave more like saturated fatty acids
  2. Elevates LDL but not HDL.
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16
Q

What % of the total calorie should be derived from carbohydrates?

A

At least 45-55%

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17
Q

What type of sugar does these contain?

  1. Fruits, sweet corn, and honey
  2. Table sugar, milk, beer
  3. Starch, wheat, grains, potatoes, vegetables
A
  1. Simple sugars - monosaccharide (glucose and fructose)
  2. Simple sugar - disaccharides (sucrose, lactose, maltose)
  3. Complex sugars - polymers of glucose; do not have a sweet taste
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18
Q

Define the ff:

  1. Fat free
  2. Low saturated fat
  3. Low fat
  4. Reduced fat
  5. Light (in fat)
A

Define the ff:

  1. Fat free - less than 0.5 gm per serving
  2. Low saturated fat - 1 gm or less per serving
  3. Low fat - 3 gm or less
  4. Reduced fat - At least 25% less fat per serving than the regular version
  5. Light (in fat) - Half the fat of the regular version
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19
Q

Define the ff:

  1. Low cholesterol
  2. Low sodium
  3. Lean
  4. Extra Lean
A

Define the ff:

  1. Low cholesterol - 20 mg or less per serving AND 2 gm or less of satd fat per serving
  2. Low sodium - 140 mg or less per serving
  3. Lean - less than 10 gm of fat, 4.5 gm or less of satd fat, and less than 95 mg of cholesterol per serving
  4. Extra Lean - less than 5 gm of fat, 2 gm or less of satd fat, and less than 95 mg of cholesterol per serving
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20
Q

Define the ff:

  1. Calorie free
  2. Low calorie
  3. Reduced or less calories
  4. Light or lite
A

Define the ff:

  1. Calorie free - less than 5 calories per serving
  2. Low calorie - 40 cal or less per serving
  3. Reduced or less calories - at least 25% fewer cal per serving than regular version
  4. Light or lite - Half the fat or a third of the cal of regular version
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21
Q
  1. How much water per kcal of EE is sufficient under usual conditions to allow for normal variation in the PA, sweating, and solute load of the diet?
  2. How do you lose water?
A

1.) 1-1.5 mL per kcal of EE
2.)
Stool - 50 - 100 mL/day
Evaporation/Exhalation - 500 - 1000 mL/day
Urine - 1000 mL/day

22
Q

Adjustments of water intake for:

  1. Fever
  2. Diarrhea
  3. Pregnancy
  4. Lactation
  5. Elderly
  6. Px w/ cardiac or renal problems
A

Adjustments of water intake for:

  1. Fever - 200 mL/day per deg C
  2. Diarrhea - as great as 5 L/day
  3. Pregnancy - 30 mL/day
  4. Lactation - 1000 mL/day
  5. Elderly - may reduced total body water, blunted thirst sensation, taking diuretics
  6. Px w/ cardiac or renal problems - limit water intake
23
Q

Define the following Dietary Reference Intakes

  1. EAR
  2. RDA
  3. DV
  4. AI
  5. UL
A
  1. Estimated Average Requirement
    - Amount of nutrient estimated to be adequate for half of the healthy individuals of a specific age and sex. So median requirement of a group
  2. Recommended Dietary Allowance
    - Average daily dietary intake level that meets the nutrient requirements of nearly all (97-98% of population) healthy persons of a specific age, sex, life stage, or physiologic condition; 2 std. dev above EAR
  3. Daily Value
    - Variant of RDA; Nutrient content in a food is stated as a percentage of the highest RDA for an adult consuming 2000 kcal/day
  4. Adequate Intake
    - For nutrient w/c do not have an established EAR and consequently RDA; nutrients for INFANTS and for chromium, fluoride, manganese, Na, K, H2O, and some vitamins
  5. Tolerable Upper Limit of Nutrient Intakes
    - Highest lvl of CHRONIC nutrient intake (usually daily) that is unlikely to pose a risk of adverse fx for most of the population
24
Q

All the nutritional assessment tools collect which 2 information?

A
  1. Nutritional hx

2. Changes in weight

25
Q

Explain the Subjective Global Assessment.

A

It differentiates if a person is (A) well nourished, (B) moderately malnourished, or (C) severely malnourished.
1. Nutritional Intake
A: No change, B: Decreased, C: Starvation
2. Weight loss
A: Less than 5% for the past 6 mos, B: 5-10% over 6 mos, C: More than 10% over 6 mos
3. Eval of Ms and Fat
A: Normal or improved, B: Mild tissue loss, C: Severe tissue loss
4. Fxnal Capacity
A: No dysfxn, B & C: Dysfxn
5. GI Sx
A: Minimal for less than 2 wks, B & C: Frequent for more than 2 wks
5. Metabolic Demand
A: Minimal, B&C: Increased

“Now, WE Finally Get Malnourished”

26
Q

Differentiate malnutrition brought about by the ff:

(a) Anorexia
(b) Organ failure or pancreatic cancer
(c) Major infection or burns

based on degree of malnutrition and signs of inflammation

A

(a) Anorexia
- Starvation associated malnutrition
- Chronic starvation, NO inflammation

(b) Organ failure or pancreatic cancer
- Chronic Disease associated malnutrition
- Mild to moderate degree of malnutrition, Chronic inflammation

(c) Major infection or burns
- Acute disease or Injury associated malnutrition
- Severe degree of malnutrition, Acute inflammation

27
Q

What could you use to determine the etiology and severity of malnutrition?

A

Using the ASPEN and clinical characteristics

After identifying nutrition risk factor -> Check if inflammation is present
Yes?
-If heightened lvl of inflammation = Acute illness/injury
-If mild to moderate level of inflammation = Chronic illness
No?
-This is pure starvation. = Social or environmental circumstances

For all three:
Is there the presence of 2 or more characteristics of the ff: SMEWFF
dec hand grip Strength, Muscle mass loss, reduced Energy intake, Weight loss, body Fat loss, Fluid accumulation
Yes? -> Malnourished -> Decide if moderate or severe
No? -> Not malnourished

28
Q

Get the Nutritional Hx: Body weight
1. What do you ask?

  1. What if no weighing scale?
A
  1. Ask usual body weight and trend for the past year
    If there’s 4.5 kg weight loss over 6 the past 6 months - noteworthy
    If there’s more than 10% weight loss = prognostic of clinical outcomes
    If there’s more than 30% weight loss = severe and life threatening
  2. If no weighing scale, ask if there are changes in clothes, pants, or belt size.
29
Q

Get the Nutritional Hx: Medical and Surgical conditions

-What do you note here?

A

Look for medical or surgical conditions that can place one at nutritional risk 2’ to increased reqs or compromised intake or assimilation.

30
Q

Severe inflammation produce: RAMuN

  1. REE
  2. Anorexia
  3. Muscle metabolism
  4. Nitrogen content
A
  1. Increased REE
  2. Presence of Anorexia
  3. Muscle catabolism
  4. Nitrogen losses
31
Q

5 Constitutional signs and symptoms to look for in nutritional hx

A

FAT Daw Gurl

  1. Fever or hypothermia - may be a manifestation of active inflammatory response
  2. Anorexia - may be a manifestation or side effect of a medication
  3. Tachycardia presence
  4. poor Dentition or swallowing problems - can compromise oral intake
  5. signs of GI pathology
32
Q

Get the Nutritional Hx: Eating D/o

A
  • Distorted body image
  • Compulsive exercise
  • Amenorrhea - change in mens may significize severe weight loss or chronic malnutrition
  • Tooth loss or dental carries
  • Use of laxatives and diuretics
33
Q

Get the Nutritional Hx: Dietary Practices

A
  • Fad diets, vegetarian diets, imbalanced diets (fad diets before or current diet)
  • Dietary intake: May use ff tools: 24 hr recall, Food frequency, Food diary
  • Supplement intake
34
Q

Nutritional Assessment tool that is a quick way to identify dietary patterns and covers intake over a specific duration. It focuses on key areas correlated with the px’s health concerns. It also reveals excesses and deficiencies (e.g. in fruits, veggies, fish, fiber)

A

Food Frequency Questionnaire

35
Q

Nutritional Assessment Test that consists of writing all food and beverages consumed w/in 3-4 days.

A

Food diary.

The diary itself is an intervention. It makes the px more aware of their eating habits and to encourage compliance w/ recommended dietary changes.

36
Q

-

A

24 hr recall

37
Q

Influences on nutritional status

A
  • Living environment
  • Fxnal status (activities and instrumental activities of daily living)
  • Dependency, caregiver status, resources
  • Dentition
  • Alcohol or substance abuse
  • Mental health (depression or dementia)
  • Lifestyle
38
Q

Lifestyle assessment of nutritional status include?

A
  1. Behavioral factors: Px’s personal stress levels, exercise habits, personal health goals, and motivators
  2. Nature of work: Changes in schedules, time allotment for eating, missed meals during the day then increased intake at night
  3. Home cooked meals vs. Takeout/Restaurant
  4. Who cooks and who buys meals
  5. Health of other members (all overweight?) - may need to address that too. Lifestyle changes are best accomplished w/ support from friends and fam.
39
Q

Nutritional Assessment - Physical Exam

  1. Weight
  2. BMI
  3. Waist Circumference & Waist-Hip Ratio
  4. Skin fold thickness
A
  1. Wt is one of the most useful parameters to follow in px. Has the lowest risk of variability. Measure in a consistent manner and ensure scale is calibrated.
  2. BMI provides an estimate of body fat and is related to risk of dse. If px can’t stand, estimate height by doubling the arm span measurement (from sternal notch to end of longest finger) BMI = kg/m^2 or lbs/inches
  3. WC and WHR
    - Excess abdominal fat, assessed by measurement of WC or WHR, is independently assoc w/ higher risk of DM and CVD
    - WC is a surrogate for visceral adipose tissue
    - Note: ANTHROPOMETRICS INCLUDING SKIN-FOLDS AND CIRCUMFERENCE CAN BE USEFUL BUT REQUIRE TRAINING TO ACHIEVE RELIABILITY.
  4. Skin fold thickness estimate body fat stores (50% of body fat normally loc in the SubQ regions). They permit discrimination of fat mass from ms mass. Triceps skinfold - convenient site generally representative of fat lvl. IF less than 3 mm, suggestive of exhaustion of fat stores.
40
Q

Describe the characteristics of the ms status of patients who are (a) normal, (b) with mild to moderate loss, and (c) with severe loss using the ff parameters:

  1. Temporalis ms
  2. Pectoralis Major and Clavicle
  3. Deltoid ms
  4. Trapezius, supraspinatus, and infraspinatus ms; scapular bones
  5. Interosseous and dorsal side of the thumb ms
A

a. Normal
1. Temporalis ms: Well-defined, easy to see and palpate (*Orbital fat pads: slightly bulged)
2. Pectoralis Major and Clavicle: Pectoralis major, deltoid, trapezius have well-defined ms surrounding bone, clavicle bone typically not visible in males and slightly prominent in females
3. Deltoid ms: Rounded curves at arms, shoulder, and neck
4. Trapezius, supraspinatus, and infraspinatus ms; scapular bones: scapular bones not prominent, no sig depression
5. Interosseous and dorsal side of the thumb ms

b. Mild to Moderate Loss
1. Temporalis ms: Slightly depressed (Orbital FPs: slightly dark circles, somewhat look hollow)
2. Pectoralis Major and Clavicle: Less prominent ms when palpated, more prominent clavicle bone
3. Deltoid ms: Acromion process may slightly protrude
4. Trapezius, supraspinatus, and infraspinatus ms; scapular bones: Mild depression around scapula or bone may slightly show
5. Interosseous and dorsal side of the thumb ms

c. Severe Loss
1. Temporalis ms: Deep hollowing/scooping, lacking ms to the touch, facial bone structures v defined (Orbital FPs: Hollow look, depressions around eye, loose saggy skin)
2. Pectoralis Major and Clavicle: Protruding and prominent bone with low surrounding muscle mass when palpated
3. Deltoid ms: Shoulder to arm joint looks square, bones more prominent, acromion process v prominent
4. Trapezius, supraspinatus, and infraspinatus ms; scapular bones: Prominent, visible scapula bone, notable depressions between ribs, scapula, and/or shoulder/spine
5. Interosseous and dorsal side of the thumb ms

41
Q

Describe the characteristics of the ms status of patients who are (a) normal, (b) with mild to moderate loss, and (c) with severe loss using the ff parameters:

  1. Midaxillary line (fat) in thoracic and lumbar regions
  2. Arm (fat at the area under the triceps muscles)
  3. Hand muscle - (Palmar) Opponens pollicis, adductor pollicis, 1st dorsal interosseous; (Dorsal) Interosseous ms
A

a. Normal
1. Midaxillary line (fat) in thoracic and lumbar regions: Chest is full, ribs do not show, slight to no protrusion of the iliac crest
2. Arm (fat at the area under the triceps muscles): Ample fat tissue obvious between folds of the skin pinched between finger
3. Hand muscle - (Palmar) Opponens pollicis, adductor pollicis, 1st dorsal interosseous; (Dorsal) Interosseous ms: (Palmar) Muscles bulge, could be flat in some well-nourished individuals; (Dorsal) Flat/mild bulge between dorsal bones, bulging/flat ms between index finger and thumb

b. Mild to Moderate loss
1. Midaxillary line (fat) in thoracic and lumbar regions: ribs somewhat more apparent, depressions not v pronounce, iliac crest somewhat prominent
2. Arm (fat at the area under the triceps muscles): Some depth to pinch, not ample
3. Hand muscle - (Palmar) Opponens pollicis, adductor pollicis, 1st dorsal interosseous; (Dorsal) Interosseous ms: (Palmar) slight depression; (Dorsal) Slight depression between dorsal bones

c. Severe loss
1. Midaxillary line (fat) in thoracic and lumbar regions: depression between ribs v apparent, iliac crest is v prominent
2. Arm (fat at the area under the triceps muscles): V little space between folds, fingers practically touching
3. Hand muscle - (Palmar) Opponens pollicis, adductor pollicis, 1st dorsal interosseous; (Dorsal) Interosseous ms: (Palmar) Depressed areas, particularly between thumb and forefinger; (Dorsal) Depressed areas between dorsal bones, particularly between thumb and forefinger, also, bones v prominent

42
Q 
Describe the characteristics of the ms status of patients who are (a) normal, (b) with mild to moderate loss, and (c) with severe loss using the ff parameters:
Ms around the knee
1. Anterior Thigh (Quadriceps)
2. Patellar
3. Posterior Calf (Gastrocnemius ms)
A

a. Normal
Ms around the knee
1. Anterior Thigh (Quadriceps): Well-rounded, well-developed
2. Patellar: Patella not prominent
3. Posterior Calf (Gastrocnemius ms): Well developed bulb of muscle aka rounded; may appear less developed if person is not v active

b. Mild to moderate loss
Ms around the knee
1. Anterior Thigh (Quadriceps): Mild depression on inner thigh
2. Patellar: Slightly prominent yet rounded
3. Posterior Calf (Gastrocnemius ms): Not well developed or look less developed than normal

c. Severe loss
Ms around the knee
1. Anterior Thigh (Quadriceps): Depression/line on thigh, not well-developed, prominent concave between thighs, lack definition
2. Patellar: Sharply prominent with light sign of surrounding muscle
3. Posterior Calf (Gastrocnemius ms): Thin and minimal to no muscle definition

43
Q

Assessing the Degree of Edema vs. Depth and Rebound Time vs. Severity of Edema

A

Edema Classification: 0
Depth and Rebound Time: No distortion occurs after pressure applied; bone structure is readily identifiable
Severity of Edema: None

Edema Classification: 1+
Depth and Rebound Time: Depression is barely noticeable, rebound occurs immediately; 2 mm or less
Severity of Edema: Mild

Edema Classification: 2+
Depth and Rebound Time: Applied pressure causes deeper pit; rebound occurs after a few seconds; 2-4 mm
Severity of Edema: Moderate

Edema Classification: 3+
Depth and Rebound Time: Pitting is even more pronounced; rebound occurs after about 10-12 seconds; 4-6 mm
Severity of Edema: Severe

Edema Classification: 4+
Depth and Rebound Time: Pressure causes v deep pit; rebound generally takes longer than 20 seconds; 6-8 mm
Severity of Edema: Severe

44
Q

Most practical routine clinical assessment with functional outcomes for advance malnutrition?

A

Hand-grip strength

45
Q

Describe the ff indicators of nutritional status

  1. Albumin and prealbumin
  2. C Reactive Protein
A
  1. Albumin and prealbumin have POOR sensitivity and specificity as indicators of nutri status; they are readily reduced by SIRS, dse, or inflammation
  2. C Reactive Protein is a positive acute phase reactant. If CRP is increased and albumin or prealbumin is dec, then inflammation is likely to be a contributing factor
46
Q

Nutrient and Vitamin Deficiency

A

Table

47
Q

Riboflavin b2 deficiency manifestations

A
  1. Mucocutanous lesions: Magenta tongue, angular stomatitis, seborrhea, cheilosis
  2. Corneal vascularization
  3. Anemia
  4. Personality changes
48
Q

Niacin deficiency

A

Pellagra

49
Q

Vitamin C deficiency

A

Scurvy

  • Affected grps: poor and elderly, ROHlics, consumption of macrobiotic diets or severely unbalanced diets
  • Manifestations: generalized fatigue, impaired formation of mature connective tissue (bleeding into skin, inflamed and bleeding gums, bleeding into joints, peritoneal cavity, pericardium, and adrenal glands), Children: impaired bone growth deformity
50
Q

Vit D

A

Rickets

-Bowed legs, rachitic rosary

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