Clinical Nutrition Flashcards
How is nutritional screening performed?
Calculate BMI
Ask about weight changes, dietary intake, appetite, GI symptoms, history of diabetes and functional impairment
How do you work out BMI
Weight/Height sq
How do you assess for malnutrition clinically
Physical signs: hair changes, mental changes, anaemia, ascites, muscle wasting, loss of subcutaneous fat, loose skin, oedema, diarrhoea, dermatitis, pressure sores, glossitis, sunken eyes, sore red eyes, dry lips
When is nutritional support needed
BMI < 18.5
Unintentional weight loss > 10% in 3-6 months
BMI< 20 with unintentional weight loss > 5% in 3-6 months
why is malnutrition so important
reduced mobility increased risk of falls infections confusion inc hospital admissions dec independence low energy weight loss low mood
what is refeeding syndrome
metabolic disturbances when nutritional support is reinstated in severely malnourished patients
what happens in refeeding syndrome
Fasting = low electrolytes, sodium water intolerance
Patient is fed = inc in insulin
More uptake of glucose, K, Mg, PO4 which have already all been depleted + utilisation of thiamine
Results in: hypokalaemia, magnesaemia, phosphataemia, thiamine def, salt and water retention
Cause cardiac arrhythmia and cardiac failure, convulsions
How do you avoid refeeding syndrome
check urea, electrolytes, bone profile, magnesium
Watch K, Mg, PO4 closely and replace if needed
Provide vitamin preparations
What are the two types of feeding in a clinical setting
Enteral: nutritions fluid past upper GI tract
Paraneteral: bypass GI tract altogether, straight into blood
Describe enteral nutrition
Tube into GI tract: preferred Needed in patients with an upper GI problem Low risk of complications basic training Maintains GI tract Cheap
describe parenteral nutrition
micronutrient rich solution thru venous catheter needed if dysfunction of GI tract can take more than 12 hours high risk of serios complications needs specialist training causes atrophy of GI Expensive
What is short bowel syndrome
significant removal of bowel =less than 100cm of functional intestinal tract
what does loss of bowel lead to
dehydration
malnutrition
malabosprtion
What are the consequences of short bowel syndrome
reduction in absorptive surface area
loss of intestine tissue = inc risk of infection
Management of short bowel syndrome
adequate nutrition for patients
adequate water and electrolytes to maintain homeostasis
correction and prevention of acid base imbalance
What can reduce reliance on parenteral nutrition
Anastamosis of small intestine to the colon
What is healthy eating
developing countries = nutritional security
developed countries = limit development of chronic disease
What is the recommendations for a healthy diet
Fruit and veg x 5 potatoes, bread, rice, pasta milk and dairy meat, fish eggs x 2 small amount of high fat/sugar
has healthy eating been working
obesity inc
chd and diabetes inc
avg cholestrol dec
dietary fat dec
what are the anaerobic sources of energy
phosphocreatine - ADP to ATP
20 seconds max activity
Lactic acid is produced which inhibits enzymes
what are the negative effects of creatine supplements
fluid retention -> inc body mass
inc incidence of muscle cramps
fibre swelling reduced blood flow
what substrate is preferred for high intensity exercise
carbs
what substrate is preferred for low levels of exercise
fat
what are the four types of carb
monosaccharides
dissacharides
oligosaccharides
polysaccharides
what stimulates muscle protein synthesis
protein feeding
resistance exercise
what exercise is recommended for muscle protein synthesis
8-12 reps at 70-80% of 1RM 3 x week
What is crucial to maximising potential hypertrophy
ingesting protein post resistance training
Why are cancer patients malnourished
Iatrogenic: dec food intake and inc energy expenditure
Inadequate symptom control
diff tumor sites
inc metabolic rate
what is cancer cachexia
specific catabolic response due to tumour/metabolites/stimulation of acute or immune response
related to inc inflammatory response (inc CRP and IL1/6/10 tnf alpha
how does cancer cachexia present
weakness
anorexia
weight loss
depletion and derangement of body compartments
