Chapter 5: Nutritional Needs Flashcards
Chronic disease related malnutrition with inflammation is also known as
Cachexia
Effect of systemic inflammation on protein metabolism
-changes in protein synthesis & degradation
-loss of fat & muscle mass
-increase in acute-phase proteins (aka CRP)
Effect of systemic inflammation on carbohydrate metabolism
Insulin resistance and impaired glucose tolerence
Effect of systemic inflammation on lipid metabolism
maintained or increased lipid oxidation (d/t free radicals), particularly in the presence of weight loss
Individuals with cancer are at risk for loss of muscle mass resulting from two conditions
- Sarcopenia (age related muscle breakdown)
- Cachexia
These 7 cancers have found to be hypermetabolic
- pancreatic
- gastric
- bile duct
- kidney
- adrenal
- NSCL
- H&N
There is controversy amongst advanced cancers and if they may be hypermetabolic or hypometabolic. What about metastatic cancer to the liver?
Hypermtabolic
These 3 cancers are considered normometabolic
- breast
- colorectal
- bladder
The Dietary Reference Intakes are developed for ___________ but cannot be used to ensure adequacy for __________
Groups
Individuals
*Use a reference point or approximation
Protein needs for individual with cancer
1-1.5 g/kg
Protein needs for cancer cachexia
1.5-2.5 g/kg
Protein needs for hematopoietic stem cell transplant
1.5 g/kg
Protein needs for healthy young adult
0.8 g/kg
ADMR: 10-35%
Protein needs for healthy older adult
1.0-1.2 g/kg
Protein needs for acutely ill or chronically ill older adult
1.2-1.5 g/kg
Nitrogen balance can be used to assess
Adequacy of recommended protein values
RDA for carbohydrates
130 g/day
ADMR: 45-65%
RDA for fats
None set, but need for essential fatty acids can usually be met when linoleic & linolenic acid provide 2-4% of total intake
ADMR: 20-35%
Cisplatin in a ______toxic chemotherapy
Nephrotoxic
3 methods used to calculate fluid needs
- Weight (Holliday-Segar)
- Body surface area
- RDA
RDA method for calculating fluid needs
1 mL/kcal
Body surface area calculation
1500 mL x BSA
Weight (Holliday-Segar) method calculation
0-10 kg = 100 mL/kg
10-20 kg= 1000 mL + 50 mL for each kg over 50
>20 kg
- </= 50 years old, 1500 mL + 20 mL for each kg over 20 kg
- > 50 years old, 1500 mL + 15 mL for each over 20 kg
5 conditions that increase fluid requirements
- Fever
- Sweating
- Hyperventilation
- Hyperthyroidism
- Gastric or renal losses
Levels of these 4 nutrients are not usually lowered in the presence of inflammation (thus low levels may = deficiency)
*b strong
- Thiamine
- Riboflavin
- Folate (B9)
- Vitamin B12
Levels of these 4 nutrients are lowered during the inflammatory process
- Selenium
- Copper
- Iron
- Zinc
These are the 2 primary methods for assessing energy requirements
- Predictive equations - predicted REE
- Indirect calorimetry - measured REE
BEE
Basal Energy Expenditure
Minimum amount of energy expended to be compatible with life
BMR
Basal Metabolic Rate
measurement made early in the morning before activity & 10-12 hours after ingestion of food, beverage, or nicotine
rate = measurement
RMR
Resting Metabolic Rate
measurement taken when any requirement for BMI is not met, also in the fasting state (at least 5 hours); generally 10-20% higher than BMR
REE
Resting Energy Expenditure
Energy needed to maintain normal body functions measured after 30 minutes of recumbent rest
EEE
Estimated Energy Expenditure
Energy needed per day to maintain normal body functions
*Equations
EER
Estimated Energy Requirement
Average predicted nutrition intake for maintenance of energy based on age, sex, weight, height, activity level
4 physical activity levels defined by the National Academy of Medicine
Sedentary - ADLS
Low active - ADLS + 30 mins moderate
Active - ADLs + 60 mins moderate
Very active - ADLS + 60 mins vigorous or 120 mins moderate
What is the Respiratory Quotient?
Derived from Indirect Calorimetry (metabolic cart)
CO2 produced (VCO2)/Oxygen consumed (VO2)
What are inaccurate RQ values?
<0.7 or >1.0
<0.7 = hypoventillation or prolonged fasting
(low slow)
> 1 = hyperventilation or inaccurate gas collection
(high fast)
What is interpretation of RQ?
0.7 = using mostly lipids
0.8 = using mostly protein (normal)
1.0 = using mostly carbs
What is the Weir Formula?
Formula to determine REE using indirect calorimetry
REE = (4VO2 + 1 VCO2) x 1.44
Cistplatin causes a decrease in the mineral
Magnesium
Critical illness causes a decrease in vitamin
C despite supplementation
Gastrectomy or terminal ileum resection causes a decrease in
Iron & vitamin B12
Pancreatitis causes a decrease in absorption of vitamin
B12
Alcoholic liver causes a decrease in these 4 nutrients
Folate, thiamine, pyridoxine, vitamin A
Renal failure causes a decrease in these 3 nutrients
pyridoxine, folate, vitamin c
Loss of bile cause a decrease in ___________________ while chyle leaks/fistulas cause a decrease in _______________
Fat soluble vitamins (ADEK)
Micronutrients
This predictive equation has been shown to be the best predictive value in healthy (not critically ill) oncology patients ages 20-82, either obese or not-obese
Mifflin St Jeor
(10 x kg) + (6.25 x cm) - (5 x years) + 5 for men
- 161 for wome
What formula should be used for critically ill patients not appropriate for hypcaloric feedings under 60?
Pennstate 2003b
These equations are used for critically ill obese patients that ARE appropriate for hypocaloric regimens
22-25 kcal/kg IBW
11-14 kcal/kg ABW
What equation should be used for critically ill patients over 60 not appropriate for hypocaloric feedings?
Penn State 2010
Penn State 2003b Equation
RMR = (Mifflin x 0.96) + (ventilation in L/min x 31) + (max daily body temp in Celsius x167) -6212
Penn State 2010 Equation
RMR = (Mifflin x 0.71) + (ventilation in L/min x 64) + (max daily body temp in C x 85) - 3085
What 3 components do the Penn state Equations utilize
Max body temp
Ventilation rate (L/min)
Mifflin
Cancer, inactive, nonstressed
25-30 kcal/kg
Cancer, repletion or wt gain energy needs
30-35 kcal/kg
Cancer, hypermetabolic, stressed
35 kcal/kg
Sepsis
25-30 kcal/kg
Hematopoietic cell transplant
30-35 kcal/kg
Obese, critically ill & non-critically ill obese
11-14 kcal/kg ABW
22-25 kcal/kg IBW
What are hypocaloric feeds?
Calorie-reduced, high protein diets
Often used in critically ill overweight or obese patients, which can positively affect protein anabolism, reduce HLD/hyperglycemia
Hypocaloric feeds should not exceed _____-_____% estimated energy needs
Should not provide less than ______ kcal/kg
Should provide at least _____ g/kg pro ABW OR _____-______ g/kg IBW
65-70%
14 kcal
1.2 g
2-2.5 g
kcal/kg for healthy older women (64-84)
25-35 kcal/kg
kcal/kg for healthy older men (64-84)
30-40 kcal/kg
During refeeding syndrome, reintroduction of CHO triggers insulin which forces K+, Phos, Mg back from the serum to the cells. Low phos usually occurs within ____ days of starting nutrition intervention
3 days
Supplementation of this vitamin may reduce risk for refeeding syndrome
Thiamine
For those at risk for refeeding syndrome, start at _____% estimated needs and advance to the target goal over _____-______ days while monitoring electrolyte imbalances
25%
3-5 days
