CT 1.3 Malnutrition

Question 1

examples of carbs

Answer 1

Polysaccharides – glycogen, starch, cellulose
Disaccharides – sucrose, lactose, maltose
Monosaccharides – glucose, fructose, galactose, deoxyribose, ribose

Question 2

functions of proteins

Answer 2

Structural i.e. Collagen in bone
Regulatory i.e. Hormones like insulin
Contractile i.e. Myosin and actin in muscle cells
Immunological i.e. Antibodies
Transport i.e. Haemoglobin
Catalytic i.e. enzymes

Question 3

types of lipids

Answer 3

Triglycerides
Most plentiful lipid in your body
Provide more than twice as much energy as carbohydrates or protein
Each triglyceride consists of a glycerol molecule (backbone) with 3 fatty acids attached
Further divided into saturated (baddies), polyunsaturated and monounsaturated

Essential fatty acids
which the body can’t produce

Phospholipids
Consist of glycerol backbone but with 2 fatty acid chains and also a phosphate group (this makes it amphipathic – (polar and non-polar portions)
Predominantly found in cell membranes because of its amphipathic properties

Steroids
Such as cholesterol, bile salts, adrenocortical hormones, sex hormones

Eicosanoids
Lipids derived from the fatty acids called arachidonic acid
2 principle subclasses are prostaglandins and leukotrienes
Involved in inflammatory reactions, gastric protection, airway calibre, clotting

Lipoproteins
Carry triglycerides and cholesterol around the body

Question 4

minerals present in the body in quantities greater than 5g

Answer 4

Calcium, phosphorus, potassium, sulphur, sodium, chloride, magnesium, iron and iodide

Question 5

vitamins

Answer 5

Vitamins are divided into 2 groups:
Water soluble vitamins include:
Vitamin B1, B2, B6, B12, C, Folate and Niacin
Absorbed along with water in the GI tract
Fat soluble vitamins include:
Vitamin A, D, E, K
Absorbed with other dietary lipids in small intestine – dependent on bile salts

Vitamins C, E and Beta-carotene act as antioxidants – they inactivate oxygen free radicals which would otherwise damage DNA, cell membranes and structures within a cell

*most vitamins act as coenzymes in metabolic reactions

Question 6

what is BEE

Answer 6

basal energy expenditure

At rest energy is still required for metabolism

Question 7

examples of nutritional assessments

Answer 7

BMI - body mass index (weight (kg)/height (m2))
Mid - arm circumference = muscle mass
Skin - fold thickness = body fat

Question 8

how to identify at risk groups of malnutrition

Answer 8

BMI less than 18.5 kg/m2
Unintentional weight loss greater than 10% within last 3-6 months
BMI less than 20 kg/m2 + unintentional weight loss greater than 5% in last 3-6 months

Question 9

types of enteral feeding

Answer 9

oral
tube

Question 10

indications for enteral feeding

Answer 10

Cannot eat sufficient food
Unconsciousness (tube feed)
Dysphagia (tube feed)
Loss of nutrients from fistulas/stomas
Major illness/postoperatively

Question 11

why is enteral feeding preferred over parenteral

Answer 11

lack of enteral feeding atrophies the intestinal epithelium + may increase bacterial translocation + therefore the risk of sepsis

Question 12

complications of tube feeding

Answer 12

insertion of tube into lungs, aspiration, nasal erosion, refeeding syndrome

Question 13

when is a nasojejunal tube used

Answer 13

gastroparesis
pancreatitis

Question 14

routes for parenteral feeding

Answer 14

Short term feeding (< 14 days) a peripheral cannula can be used if no need for CV access – thrombophlebitis common problem + often limits use

PICC line (peripherally inserted central catheter via basilic vein

Central venous catheters:
Tunnelled subclavian line for use >30 days or Non-tunnelled CVL for use < 30 days

Question 15

what happens in refeeding syndrome

Answer 15

Results from a reduced carbohydrate intake secondary to starvation producing low insulin levels.
Once feeding restarted increased insulin secretion occurs, which increases cellular uptake of PO4.
Phosphate levels fall resulting in rhabdomyolosis, leucocyte dysfunction, respiratory/cardiac failure, muscle weakness, seizures, coma.

occurs around day 4

Question 16

Vit A deficiency leads to

Answer 16

blindness (night)

Question 17

Vitamin D deficiency leads to

Answer 17

osteomalacia/rickets causing proximal weakness of limbs

Question 18

Vitamin E deficiency leads to

Answer 18

anaemia neuropathy

signs = haemolytic anaemia - jaundice

Question 19

Vitamin b1 deficiency leads to

Answer 19

Wet beri beri – oedema, high output left ventricular failure
Dry beri beri – motor/sensory neuropathy

Question 20

Vitamin b2 deficiency leads to

Answer 20

sore tongue and mouth

Question 21

Vitamin b6 deficiency leads to

Answer 21

dermatitis and anaemia

Question 22

Vitamin b12 deficiency leads to

Answer 22

pernicious anaemia - tiredness, pallor

Question 23

Vitamin c deficiency leads to

Answer 23

scurvy - Bent/coiled body hair, bruising, gingivitis

Question 24

folate deficiency leads to

Answer 24

megaloblastic anaemia - fatigue and pallor

Question 25

niacin deficiency leads to

Answer 25

pellagra - Dermatitis, fatigue, insomnia, glossitis, diarrhoea, hallucinations, psychosis