Clinical Nutrition Flashcards
There are four components to the NCP:
nutrition _______
nutrition ________
nutrition _________
nutrition _________________
assessment
diagnosis
intervention
monitoring and evaluation.
Nutrition _________ is defined as a “systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.”
assessment
The “A–E of Nutrition assessment.”
A— _________________ or _____________
B — ____________ analyses
C— __________ usually performed by the physician
D— __________ analysis and assessment to determine usual ______
E— __________ assessment
anthropometric or body composition measurements
biochemical
clinical examination
dietary; food intake
environmental
Dietary analysis of a patient is generally performed by the ______
Registered dietitian
anthropometric or body composition measurements include:
BMI
_____ circumference
______ thickness,
_______ weighing,
____________(ADP)
______________ (DEXA)
__________________________ (BIA),
Waist
Skinfold
Hydrostatic
Air-displacement plethysmography
Dual energy x-ray absorptiometry
Bioelectrical impedance analysis
Biochemical assessment markers are divided into 2- __________ and _______ markers.
macronutrients and micronutrients
The macronutrients include markers of ________,_________, and _______ metabolism and utilization.
carbohydrate, protein, and fat
Micronutrients measurements are not important.
T/F
F
Micronutrients measurements are also very important.
Liver function will be affected if there is insufficient ______ and excess _____.
protein; fats
An excessive intake of protein may also be harmful to kidney function
T/F
T
due to the excess of non-protein nitrogen compounds formed that must then be removed.
The clinical component of the nutrition assessment
This consists of the _____ (_____,_______, and ________) and ___________
history
present , past and family
physical examination
Metabolic syndrome is defined by utilizing information derived from the ________ components (____) of a nutrition assessment
first three ; A–C
The parameters include for metabolic syndrome include:
- An elevated waist circumference. In women,____ inches (____ cm); in men, ____ inches (____ cm)
- Elevated triglyceride levels > ____ mg/dL (1.7mmoles/L)
- Elevated fasting glucose > ____ mg/dL (____ mmoles/L)
- Reduced HDL cholesterol. In women, ____ mg/dL(1.3mmoles/L); in men, ____ mg/dL(1.03mmoles/L)
- Elevated blood pressure > ___/___ mm Hg
35;88;40;102
150; 110;6.1
50; 40
130/85
There are several ways to assess adequacy of intake
__________________ System.
___________________ [RDA]
___________ [AI]
tolerable __________
the USDA Food Guidance
Recommended Dietary Allowance
adequate intake
upper limits
Examples of tools used by the registered dietitian to determine dietary adequacy include the ________, the _______ record or diary, and/or the ________ questionnaire.
24-hour recall
3-day food
food frequency
The ideal proteins markers have a (short or long?) biologic half-life
Short
Serum albumin half-life??
Serum pre-albumin half life??
20 days
2 days
Serum albumin is a good indicator of short-term protein and energy deprivation
T/F
F
Serum albumin is not a good indicator of short-term protein and energy deprivation
Serum albumin is a good indicator of chronic deficiency.
T/F
T
Albumin’s function as a biochemical marker
1) to identify chronic protein deficiency under conditions of ________________(eg _______)
2) presence of ________ in which metabolic adaptations keeps ________________( eg __________)
adequate non–-protein-calorie intake; kwashiorkor
caloric insufficiency; protein levels within reference range.
marasmus
Serum albumin levels of ___/L are considered normal.
Albumin levels of _____ to ___ g/L indicate mild malnutrition
Levels of _____ to _____ g/L indicate moderate malnutrition Levels
less than ______ g/L indicate severe malnutrition.
35 g
28–30 ; 35
23–25 ; 28–30
23–25
Half-life
Transferrin
Albumin
Prealbumin
RBP
9 days
20days
2days
12hours
Transferrin
It is synthesized in the _____ and binds and transports ____ iron.
liver; ferric
Transferrin synthesis is regulated by ________.
When hepatocyte iron is absent or low, transferrin levels (rise or drops?) in proportion to the deficiency.
iron stores
rise
the (elevated or depressed?) transferrin is the (first or last?) analyte to return to normal when iron deficiency is corrected.
Elevated
Last
Which is most likely to indicate protein depletion first between transferrin, prealbumin and albumin?
Prealbumin
Transferrin
Albumin
________ and _______ are considered the major transport proteins for thyroxine and vitamin A,
Transthyretin and RBP
Concentrations of transthyretin appear to be significantly influenced by fluctuations in the hydration state, liver disease or renal disease.
T/F
F
Concentrations of transthyretin do not appear to be significantly influenced by fluctuations in the hydration state, liver disease or renal disease.
RBP interacts strongly with plasma _______ and circulates in the plasma as a __:___ mol/L
________-________ complex.
transthyretin
1:1
transthyretin–RBP
A potential problem exists in using RBP as a nutritional marker, however. Although RBP has a shorter half-life than transthyretin (_____, compared with __________), it is _______, and its concentration _____eases more significantly than transthyretin in patients with renal failure.
12 hours
2 days
excreted in urine
incr
The molecular size and structure of IGF-1 is similar to proinsulin.
T/F
T
In the healthy adult population, anabolic and catabolic rates are _________, and the nitrogen balance approaches _____.
in equilibrium
zero
Therefore, the determination of ________________ is a method for estimating the amount of nitrogen excretion.
24-hour urinary urea nitrogen (UUN)
Nitrogen balance, as calculated by this equation, is not valid in patients with severe ______ or ______ or in patients with __________
stress or sepsis
renal disease
The two common PEM states are ________ and ________
Marasmus and Kwashiorkor
Marasmus : ______ undernutrition affecting __________ especially insufficiency of ________________________
Generalized
all food nutrients
both protein and CHO.
non-oedematous PEM = _________
Marasmus
In marasmus
______________ causes serum protein and electrolytes to remain within reference range hence no oedema
Starvation adaptation
In marasmus,
Presence or absence of edema
Absence
Absence of oedema with muscle wasting is characteristic of __________
marasmus
Kwashiorkor is a condition caused by severe _______ in individuals with _____ energy intake.
protein deficiency
adequate
Kwashiorkor
Characterised by anorexia, severe _____ with hypoproteinaemia, _______ hair and skin, ________ abdomen due to ______.
odema; depigmented
distended; fatty liver
Kwashiorkor is A disease of weaning.
T/F
T
Biochemistry of Kwashiorkor
(Low or high?) protein to energy ratio causes
-(low or high?) insulin
-(low or high?) cortisol
-increased uptake of amino acid into _____, diverting them from the _____
Low
High
Low
muscle; liver
Biochemistry of Kwashiorkor
- ____eased albumin synthesis
-____eased plasma oncortic pressure leading to _____
-Insulin promotes lipo_____ leading to the storage of ____ in hepatocytes causing ________.
Decr
Decr; odema
genesis; LDL; fatty liver
Parenteral nutritional preparations are usually administered through a _________.
subclavian catheter
TPN administration bypasses normal absorption and circulation routes
T/F
T
