Essentials of nutrition

Question 1

What is nutrition?

Answer 1

The sum of all processes involved in how organisms use nutrients to support body function

Question 2

What are the 6 nutrients that must be obtained from the diet?

Answer 2

Protein
Carbohydrates
Fats 
Vitamins
Minerals 
Water

Question 3

What are the 5 main functions of carbohydrates?

How many Kcal/g ?

Answer 3

• Energy storage
• Energy production
• Building macromolecules
• Lipid metabolism
• Sparing protein

4Kcal/g

Question 4

What are the main functions of protein?

How many Kcal/g?

Answer 4

• Enzymes + hormones
• Wound healing + inflammation ( clotting factors + acute phase proteins)
• Protection : Keratinised skin layer
• Transport
• Acid base balance
• Energy production ( amino acids used in gluconeogenesis)

4Kcal/g

Question 5

What are the main functions of fat?

How many kcal/g?

Answer 5

Insulation + protection
Energy storage
Regulating signalling ( e.g menstrual cycle)
Aiding digestion: Some substances are only lipid soluble

9Kcal/g

Question 6

What are the main functions of water?

Answer 6

Shock absorber + lubricant
Transport
Medium for chemical rxns
Temperature regulator

Question 7

What is a calorie?

Answer 7

The amount of energy in the form of heat needed to heat one gram of water by one degree celcius

Question 8

What are vitamins and what 2 classes may they be?

Answer 8

Complex organic structures

Can be water soluble or fat ( lipid) soluble

Question 9

What are minerals? ( ions)

Answer 9

Inorganic substances not directly used for making energy

Examples: calcium, phosphorus, potassium, sodium, chloride

Question 10

What factors affect nutritional requirements?

Answer 10

Age
Weight 
Activity level 
Disease/pathology 
Physical and psychological health 
Metabolic state ( catabolic, normal, anabolic)
Absorptive capacity
Goals + duration of nutritional support : Undernourishment/over nourishment

Question 11

How is TEE calculated?

How is REE calculated in the acutely unwell?

Answer 11

BMR/REE + DIT + energy expended in activity

In the acutely unwell REE = BMR + Stress

Question 12

What is REE?

Answer 12

The energy expended lying still at complete mental and physical rest after an overnight hour fast with no prior stimulants in the last 24 hours

Question 13

What is BMR?

Answer 13

The rate at which the body uses energy to maintain basic functions AT REST

Question 14

Based on PENG guidance what is the range of Kcal/kg ?

Answer 14

20 - 35 Kcal / kg of body weight or free fat mass

Question 15

What about for those at risk of refeeding syndrome?

Answer 15

10 Kcal/kg body weight/FFM to reach full needs by 4-7 days

In extreme cases only 5Kcal/Kg

Question 16

What are PAL factors?

Answer 16

Combine DIT + energy expended in activity ( physical activity)

Question 17

How do we calculate TEE?

How do we calculate REE ?

Answer 17

BMR/REE + DIT + Energy expended in activity

TEE = REE X PAL 
REE = Body weight/FFA X Kcal/kg ( 20-35)

Question 18

What are typical protein requirements?

Answer 18

1.0-1.5g/Kg/day
Up to 1.9g/Kg/day for anabolism after injury
Lower protein diet in those with CKD of 0.8-1.0 g/Kg/day

Question 19

What are typical fluid requirements?

Answer 19

Pyrexic patients require an additional 2.0-2.5ml/kg for each degree > 37

18-60 = 35ml/Kg/day
>60 = 30ml/Kg/day
20-25 ml/kg/day in the elderly and those with renal or cardiac disease

Question 20

What does PENG guidance generally suggest?

Answer 20

20-25Kcal/Kg
- 25-30 for ICU patients

0. 75g/Kg
   - 1-1.5 for malnourished

Question 21

What is re feeding?
What is re feeding syndrome?

What are some consequences of re feeding syndrome?

How do we treat re feeding syndrome?

Answer 21

Process of re introducing food after malnourishment or starvation

Potentially fatal shifts in fluid and electrolytes that occur when re feeding occurs

Arrhythmias, death

Slow calorie increase 10-20 Kcal/kg/day
Monitoring electrolytes
Vitamin supplements

Question 22

Who is at risk of re feeding syndrome?

Answer 22

Any patient who has had little or no food intake for 5 days

Question 23

What are the main feeding routes?

Answer 23

Food - as long as functioning gut
Oral nutritional supplement
Enteral feeding tube
Parenteral nutrition: Peripheral or central vein. Used when the GI tract is non viable or if oral/enteral intake is insufficient to sustain life. Also when complete bowel rest is needed after surgery