Ch 9: Malnutrition Screening & Assessment

Question 1

What are some examples of the negative phase reactants?

Answer 1

Albumin, Prealbumin, Transferrin, and RBP

Question 2

What are some examples of the positive phase reactants?

Answer 2

CRP, White blood cell count, cytokines (interleukins, interferons, and TNF)

Question 3

What is the formula to calculate BMI?

Answer 3

BMI = [weight in pounds/height in inches, squared) x 703

Question 4

Which tool to identify malnutrition recognizes three underlying etiologies for malnutrition, and what are they?

Answer 4

ASPEN/AND classification;

• Social/Environmental/behavioral,
• Chronicillness (>3 months)
• Acute illness or injury

Once malnutrition etiology has been identified, the severity of malnutrition can be elucidated as moderate or severe.

ASPEN/AND approach has been criticized for its complexity, and this method has not been validated

Question 5

In which population does the SGA have limited usefulness?

Answer 5

Critical Illness; ASPEN recommends the Nutrition Risk Score (NRS 2003) or Nutrition Risk in Critically Ill (NUTRIC tool) instead

Question 6

ESPEN’s consensus includes

Answer 6

1. All criteria should be objective (wt loss data, BMI, and FFMI based on gender)
2. Visceral proteins are not good prognostic indicators
3. Functional measures are not specific enough to assess nutrition

Has been criticized as being overly restrictive, using parameters that are difficult to apply when assessing the obese, and relying on body composition measure that are not universally available in all settings

Question 7

Why does cachexia not respond to nutrition support?

Answer 7

Because of its multifaceted inflammatory state

Question 8

Which malnutrition tool has been validated in several populations?

Answer 8

Subjective Global Assessment (SGA)

Question 9

The inflammatory response increases what production?

Answer 9

Cytokines

Question 10

Which tool is aimed to characterize malnutrition clearly, without regard for inflammation as an etiology?

Answer 10

ESPEN

Question 11

What are the components of SGA?

Answer 11

Comprised of 5 components (weight change, dietary intake, GI symptoms, functional capacity, and metabolic stress from disease) and 3 components focusing of physical exam (muscle wasting, fat depletion, and nutrition related edema)

Question 12

What is the definition of sarcopenia?

Answer 12

Age related loss of muscle mass. It has been associated with a decline in function.

Question 13

Which situations/diagnosis can present as mild to moderate malnutrition?

Answer 13

The presence of inflammation of mild to moderate degree can result in chronic diseases-related conditions such as organ failure, cancer, rheumatoid arthritis, and sarcopenic obesity.

Marked inflammatory responses can result in acute disease or injury –related malnutrition in conditions such as major infection, burns, trauma, and closed head injury.

Question 14

Use of which substrate is common in both acute illness or injury-related and social or environmental related malnutrition?

Answer 14

Lipolysis; Catabolism of endogenous substrate including fat stored in adipose tissue (lipolysis) is common in both forms of malnutrition. Hypoglycemia and ketosis are characteristic of starvation. Hypermetabolism and hyperglycemia are characteristic of stress-related malnutrition.

Question 15

Which lab value has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients?

Answer 15

Albumin

Question 16

What situation may compromise the reliability of urinary urea nitrogen to calculate nitrogen balance?

Answer 16

Compromised renal function, as indicated by a creatinine clearance <50 mL/min, low urine output, and muscle atrophy can alter urinary urea nitrogen, resulting in unreliable results.

Question 17

The SGA has been found to be a good predictor of complications in which type of patients?

Answer 17

Patients undergoing gastrointestinal surgery, liver transplantation, and dialysis