6. Nutrition Flashcards
What does the body require energy for?
- homeostasis
- maintenance of ionic gradients
- transport
- biosynthesis
- heat generation
- locomotion
What are vitamins?
Organic compounds that are required in small amounts for maintenance of normal health and metabolic integrity.
What are the lipid soluble vitamins?
A, D, E and K
What are the sources of Vitamin A?
- liver
- carrots
- kidney
- egg yolk
- butter
What are the signs of Vitamin A deficiency?
- night blindness
- xeropthalmia (dry eyes)
What are the consequences of Vitamin D deficiency?
Rickets (poor mineralisation of bone, affects children)
Osteomalacia (bone demineralisation, affects adults)
What are the sources of Vitamin E?
- olive oil
- meat
- eggs
- leafy vegetables
What are the consequences of Vitamin E deficiency?
Rare - serious neurological dysfunction.
What are the sources of Vitamin K?
Green vegetables:
- broccoli
- brussel sprouts
- kale
- spinach
What are the functions of Vitamin K?
Co-enzyme for FII, FVII, FIX and FX in the clotting cascade.
What are the consequences of Vitamin K deficiency?
- impaired clotting
- haemorrhagic disease
What are the sources of Vitamin B1 (thiamine)?
- legumes
- brown rice
- cereals made from whole grains
What are the consequences of Vitamin B1 deficiency?
- Wernicke-Korsakoff syndrome
- peripheral neuritis
What are the sources of Vitamin B9 (folate)?
- leafy vegetables
- liver
What are the consequences of Vitamin B9 deficiency?
- macrocytic anaemia
- mouth ulcers
What is obesity?
Excess of body fat that is sufficient to affect health adversely (BMI >30kg/m2).
What medical complications are associated with obesity?
- T2DM
- hypertension
- coronary artery disease
- cancers
- osteoarthritis
What are the goals of weight loss?
5-10% reduction in weight from is associated with clinically worthwhile reduction in comorbidities.
What are some potential health benefits from the loss of 10kg from initial body weight in obese patients?
- 25% fall in total mortality
- 50% fall in obesity-related cancer deaths
- 15% fall in HbA1c
How can obesity be managed by diet?
Calculate deficit of 600kCal per day
8% of body weight can be lost within 12 months.
What is the mechanism of action of Orlistat in obesity?
Inhibits pancreatic and gastric lipases, reducing absorption of dietary fat.
What are the side effects of Orlistat?
- liquid stools
- faecal urgency
- oily discharge
What are the surgical options to treat obesity?
- laparoscopic gastric banding
- gastric bypass
Approximately what proportion of adults aged >65years are undernourished?
10%
What screening tool can be used to assess malnutrition risk in patients?
MUST score
What are some causes of malnutrition?
- vegans (lack iron or B12)
- excessive alcohol
- nausea
- medication
- social isolation
- depression
- poverty
What are the clinical features of malnutrition?
- muscle wasting
- concave abdomen
- loose rings on fingers
- prominent cheek bones
What are the indications of artificial nutritional support?
Indicated if oral intake is insufficient to maintain nutrition.
What is enteral artificial nutrition support?
Nutrition support via the gut.
What is parentral nutrition support?
Intravenous administration of nutrition.
a) description
b) uses
c) advantages
d) disadvantages
of nasogastric access.
a) fine-boor tube giving pernasal access.
b) short-to-medium term intragastric feeding, due to inability to swallow.
c) bedside placement without sedation; well tolerated
d) risk of malposition; difficult to manage in confused patients
a) description
b) uses
c) advantages
d) disadvantages
of nasojejunal access.
a) fine-bore tube passed into distal duodenum / proximal jejunum
b) inability to swallow complicated by GORD or gastroparesis; gastric outlet obstruction; acute severe pancreatitis
c) bedise placement; accurate delivery;
d) endoscopy or fluoroscopy for placement; easily displaced
a) description
b) uses
c) advantages
d) disadvantages
of PEG access.
a) tube passed through abdominal wall into stomach, retained internally by a balloon.
b) long-term intragastric feeding;
c) difficult to displace; reliable in long-term;
d) requires endoscopic placement; peritonitis; bleeding; PEG site infection
a) description
b) uses
c) advantages
d) disadvantages
of surgical jejunostomy access.
a) feeding tube placed surgically into jejunum
b) postoperative feeding
c) permits early enteral feeding in post-operative setting
d) not ideal for long-term use due to risk of displacement
What are the options for parenteral nutritional support/
- PICC line
- midline catheter
- Hickman catheter
What is the role of artificial nutrition in palliative care?
Limited evidence to suggest length and quality of life is improved using artificial nutritional support in palliative care settings.
Patients can eat food naturally with accepted risk of aspiration.
How can nutritional services be delivered in hospital?
MDT involving clinician, specialist nurse, dietitian and pharmacist within the hospital service.
Referral of patients to nutritional team.
