Chapter 8 & 9 Flashcards
What is biomarker assessment?
What are characteristics of a nutritional biomarker?
*Involves the use of biologically available chemicals inside the body that perform as objective indicators of health/nutrition status
Involves a nutritional biomarker:
* An organic test used as an indicator of nutritional
status if it relates to the intake or metabolism of dietary components
* Can be a biochemical, functional, or clinical index of the status of an essential nutrient / dietary component
Purpose of biomarker assessment?
*Help clinicians, researchers, and policy makers
make diet and nutrition recommendations to
address disease and improve both individual and public health
*Is more objective and precise for measuring nutritional status than community and dietary
assessments are
Benefits of biomarker assessment?
*Has no bias of self-reported dietary intake errors
*Has no challenge of intra-individual and diet variability
*In the nutrition framework, biomarkers are classified as markers of exposure, status, and function or effect
What is the difference between function and effect biomarkers
*Function biomarkers: help describe the role of specific nutrients and potential interactions between different nutrients in biological
systems.
*They also classify the roles of nutrients across the lifespan and under different physiological
states.
*Effect biomarkers: help us understand the direct and indirect results—that is, those affecting cells and those affecting system function—of a nutrient deficiency.
What does creatinine protein measure?
What does high value indicate?
Measures kidney function, high with muscle wasting or
malnutrition
What does dietary protein measure?
Measures nutrient intake
What does high and low Albumin indicate?
Low with acute infection, trauma
High with dehydration
What do abnormal Prealbumin levels indicate?
high/low with liver disease; inflammation
What does Transferrin do?
What nutritional status does it correlate with?
*Transports iron from absorption centers in the duodenum (intestines) and white-blood-cell
macrophages to all tissues
*Not a reliable indicator of nutritional status alone
What does high Retinol Binding Protein (RBP) indicate?
High with chronic illnesses (i.e. Type 2 Diabetes)
What does low and high serum Ferritin (Iron) indicate?
Low with iron-deficiency anemia
High in autoimmune conditions
What does high Soluble Transferrin Receptor (sTfR) indicate?
High with iron-deficiency anemia
What can an abnormal Hematocrit indicate?
High with sickle-cell anemia, thalassemia, and iron deficiency
What does abnormal Mean Corpuscular Hemoglobin (MCH) indicate?
Low with iron deficiency and thalassemia
High with macrocytosis
What does abnormal Mean Corpuscular Volume (MCV) indicate?
High levels indicate B12 and/or folate deficiency
High/Low indicates iron-deficiency anemia
What does abnormal Hemoglobin (Hgb) indicate? When combined with what other factors?
When low in combination with low HCT & high/low MCV, indicates iron-deficiency anemia
What does abnormal zinc levels indicate?
Low in urine/blood with acute infection/trauma, GI malabsorption, or nutrient deficiency
Often low in combination with low albumin
High in urine indicates too much dietary intake
What does low calcium indicate?
Low levels indicate hypocalcemia
What does abnormal Iodine indicate?
Low in cases of hypothyroidism, mental retardation, goiter, cretinism, developmental irregularities
What does abnormal Phosphorous (P, PO4) levels indicate?
high/low related to phosphorus/calicum-balance related
conditions
What does abnormal Potassium (K) indicate?
High in hypkalemia; low in hypokalemia
What does abnormal sodium (Na) levels indicate)?
Low with hyponatremia (due to diarrhea/vomiting,
diuretics, kidney disease
High with hypernatremia (due to dehydration, Cusher’s Syndrome
What does Vitamin A abnormal levels indicate?
Low with dietary deficiency
May be artificially low with severe protein-calorie malnutrition
What does abnormalities in Vitamin D indicate?
Low with autoimmune conditions, Type II diabetes, rickets, osteopenia, osteoporosis Low with poor dietary intake/low sunlight
What can abnormal vitamin C indicate?
Deficiency rare, low with chronic smoking
What can Vitamin B6 abnormalities indicate?
Rare to be low, unless accompanied with low B12 and folate
Can be low with illness
What does abnormal folate indicate?
May be low with poor dietary intake, excessive alcohol consumption, malabsorption disorders. Often associated with low B12/B6
What can B12 abnormalities indicate?
Low with pernicious anemia, postsurgical malabsorption,
dietary deficiencies
What can Alanine Aminotransferase (ALT) abnormalities indicate?
High indicates liver injury; extremely high indicate acute hepatitis or overwhelming exposure to toxin/drug
What can Bilirubin abnormalities indicate?
Elevated with jaundice, liver cirrhosis, pernicious anemia, acute hepatitis
What does Blood Urea Nitrogen (BUN) indicate?
High or low indicate poor liver or kidney function
What can CO2 test indicate?
high/low indicates imbalance acid-base
What levels of cholesterol indicate what?
Below 200, low risk for CVD
Between 200-239 moderate risk for CVD
Above 240 high risk CVD
What level of triglycerides indicate what?
Less than 150 low risk for CVD
150-199 borderline high risk
200-500 high risk
Greater than 500, very high risk
What levels of HDL are crucial?
Above 40 low risk
Less than 40 moderate-high risk
What level of HDL are good?
Above 40 low risk
Less than 40 moderate-high risk
What is the greatest thing to consider when evaluating lipid profiles?
Note lipid ratio is greatest indicator
of risk!
What blood glucose ranges are good?
0-99 normal; greater than 99 indicates increased risk for type II diabetes. Sometimes elevated with illness
What levels of A1C are important?
Indicates long-term blood sugar status:
5.7-6.4% prediabetes
6.5% or great indicates type II diabetes
What does a NFPE provide?
What does a NFPE include?
What does a NFPE help identify?
What techniques does NFPE use?
What body parts does a NFPE look at?
Nutrition-Focused Physical
Examination (NFPE)
*Provides information that cannot be gleaned from the food- and nutrition-related history, client history, anthropometric measurements,
biochemical data, and medical tests and procedures
*Includes evaluation of physical appearance, muscle and fat wasting, swallowing function, appetite, and affect, which can help determine
nutritional status, signs of malnutrition, and nutrient deficiencies
*Helps identify two general categories for potential nutrient deficiencies: macronutrients (energy, protein, fluids) or micronutrients
(vitamins or minerals)
*Techniques used in the NFPE include
inspection, palpation, percussion and
inspection—the most commonly used
technique.
*Skin, hair and eyes, oral cavity (mouth, lips, and tongue), neck, nails, abdomen, bones, muscles
What is sarcopenia?
What losses does it include?
Time frame of sarcopenia?
How define for diagnostic purposes?
What type of state might it induce?
How can it be described?
- A loss of skeletal muscle mass and strength with aging
- Includes a loss of α-motor neuron input, changes in anabolic hormones, decreased intake of dietary protein, and a decline in physical activity
- Loss of muscle mass can begin as early as the fourth decade of life, with evidence suggesting that skeletal muscle mass and skeletal muscle strength decline in a linear fashion, with as much as 50% of mass being lost by the eighth decade of life.
- For diagnostic purposes, defined as appendicular skeletal muscle mass/height2 (square meters) that
is less than two standard deviations below the mean for young and healthy reference populations - May be a “smoldering” inflammatory state propelled by both cytokines and oxidative stress
- May be described as a condition of both cachexia and failure to thrive
- Sarcopenic obesity
What are characteristics of a subjective global assessment tool?
- Evaluates five components of a patient’s medical history (weight status, dietary-intake changes,
gastrointestinal symptoms, functional capacity, and metabolic stress from disease) - Evaluates three components of physical examination (muscle wasting, fat depletion, and nutrition-related edema
- Seven-point scale
- Patient-generated subjective global assessment
(PG-SGA) for individuals with cancer
What is anthropometry?
What measurements does it include?
Why are these chosen?
*The study of the measurement of the human body in terms of the dimensions of bone, muscle, and adipose (fat) tissue
*Includes the measurement of weight, height, weight changes, and body composition, including body mass index (BMI)
*Some measurements are easy, noninvasive, and inexpensive.
*Others require specialized equipment and training.
Weight:
What does it monitor?
What does it not do?
How do be accurate?
*Used to monitor the patient’s or individual’s nutritional status and as a rough estimate of
energy stores
*Does not provide information on actual body composition
*Accuracy is important; adjust for casts, clothing, etc.
*Weight(s) and weight changes are part of the assessment
Height:
Why accuracy?
Estimates?
*Accuracy needed, because body weight is compared to height
*Estimations: Arm span, knee height, forearm or ulnar length, segmental measurement
Who is there recommendations for BMI and by who?
BMI recommendations per the Centers for Disease Control and Prevention (CDC) for adults 20 years of age and older, both male and female:
What are other tools for anthropometry?
Skinfold
Circumference (calf, arm, waist, hip)
BIA
DXA
Air-Displacement Plethysmography
How skinfold good?
*Skinfold measures: Relatively easy to measure and noninvasive. Unlike body weight, they are also less affected by hydration status.
Waist measure standards?
Note: At BMIs equal to or more than 35, waist circumference has little additional predictive power
of disease risk beyond that of BMI
High risk of disease: men >102 cm (>40 inches), women > 88 cm (>35 inches)
Waist-to-hip ratio standards?
Waist-to-hip ratio:
* For men, normal risk is a ratio of 0.90 or less
* For women, 0.80 or less
* For both men and women, a WTH ratio above 1.0 is
considered at risk for cardiovascular and other
chronic diseases
What have studies shown in waist and waist-to-hip measures?
- Studies show that waist circumference is more predictive of cardiovascular disease risk, while
others have reported that WTH ratio is a more sensitive indicator of disease risk. - Both measurements have been found to be predictive of cardiovascular events.
What is BIA?
Bioelectrical Impedance
Analysis (BIA)
*A relatively quick, simple, and noninvasive method to measure body composition (lean
body mass and fat mass)
*Electrical conductivity of lean mass vs. fat mass
What is DXA
Dual-Energy X-Ray
Absorptiometry (DXA)
* Measures body composition as well as bone-mineral density to assess the risk of osteoporosis
What is Air-Displacement Plethysmography?
Air-Displacement
Plethysmography
*Gold standard for getting fat mass vs. lean mass
*Underwater weighing (i.e., BODPOD)
What general things does a client history provide?
*Provides information regarding acute and chronic medical conditions that can have an impact on nutrition status
*Personal history
* Medical, health, and family history
*Treatments and complementary or alternative medicine use
*Social history
What is included in personal history?
- Age; gender; race or ethnicity; language spoken and written; literacy factors such as a language barrier or low literacy; educational level;
physical disability, including impaired vision, hearing, or other; and mobility - These data are important to the nutritional assessment, as the delivery of nutrition care and nutrition education and counseling may be
affected by these factors.
What is included in Medical, health, and family history?
- Includes current and past medical diagnoses, conditions, and illnesses that can have an effect on nutritional status
What does social history include?
- Nonmedical factors can affect nutrition intake and the retention of nutrition education.
- Socioeconomic factors, living or housing situations, domestic issues, social and medical support systems, geographic location of the home,
occupation, religion, history of recent crisis, and daily stress level
What does a nutrition and food related history include?
*Identifies current eating patterns and types and amounts of foods and beverages consumed
Information about a typical day’s eating pattern:
* Meals
* Beverages
* Snacks
* Occasional alternative foods consumed
* Usual portion sizes
Information about a typical day’s eating pattern:
* Past changes in eating patterns
* Food preferences and dislikes
* Food allergies
* Food intolerances or aversions
* Ethnic, cultural, and religious food practices and preferences
What should be assessed in a food and nutrition related history?
When should data be collected?
What types of questions?
Can the histories be modified?
*Assess food security, transportation availability, cooking facilities, and health-related dietary restrictions.
*Assess medication regimen, alcohol
consumption, and nutritional and
non-nutritional supplement use.
*The diet history can be taken for a three-day period, with one weekend day, or for one day if time is a limiting factor.
*Questions should be specific and not
judgmental about food-intake behaviors, to promote open and honest answers.
*Food histories can be modified based on the presenting medical condition(s) of the client or patient to obtain additional information to aid in
planning for nutritional care
What is 24 hour recall?
*Trained interviewer
*Generally takes about 20 minutes to 60 minutes to complete
*In person or by telephone
*Examples: USDA’s Automated Multiple-Pass Method, National Cancer Institute’s Automated
Self-Administered 24-hour (ASA24) dietary assessment tool
Daily food checklist what is it?
Benefits?
*Provides a list of foods
*Over a one-day period, the respondent makes a check beside the food each time he or she
eats it.
Benefits:
* The individual does not need to recall foods eaten the previous day.
* Little effort is required to complete the list.
What is a food frequency questionnaire?
*A defined list of foods and beverages, with response categories to indicate usual intake of food over a certain time period
*Approximately 80–120 foods and beverages included
*Usual portion size queried
*Can also include questions regarding
supplement intake
*Typically self-administered and can be completed in 30 to 60 minutes
*Used for large population studies
*Variations based on ethnic groups
