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final review Flashcards

1
Q
  1. The two important roles serum proteins play in the body
A

a. Play an important role in water distribution and acid base balance between tissues and blood

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2
Q
  1. How are serum proteins grouped
A

a. Albumin and globulins

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3
Q
  1. The 4 functions of proteins
A

a. Structural functions (collagen and elastin)
b. Regulatory functions (hormones and enzymes)
c. Specific carrier proteins (transport blood components like bilirubin, calcium, lipids, metals, oxygen, steroids, thyroid hormones, and vitamins)
d. Mediators of immune response (antibodies)

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4
Q
  1. Amount of total protein in adult humans and the tissue with the greatest concentration of protein
A

a. Adult human body contains 10-13 kg of protein (70 kg reference man)
b. Muscle has the greatest concentration at 22 g/kg

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5
Q
  1. Body cell mass definition
A

a. The skeletal muscle protein (somatic protein) and the visceral protein together compose the metabolically available protein known as body cell mass
b. *Metabolically active protein in body

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6
Q
  1. Functions of serum proteins
A

a. Maintenance of normal distribution of water between tissues
b. Acid-base balance of blood
c. Transport
d. Immunity
e. **do not have a structural component

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7
Q
  1. Protein quality
A

a. Plant and animal proteins differ as a food source
b. Animal proteins (except gelatin) supply a full complement of 20 amino acids including essential amino acids.
c. Plant protein amino acids (incomplete proteins)
d. Soy protein has a high amino acid score for a plant product
i. Complete protein-only plant that is a comp. protein

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8
Q
  1. Conditions in which serum total protein increase
A

a. Increases
i. During dehydration (vomiting or diarrhea)
ii. During multiple myeloma (presence of myeloma proteins)-a malignant neoplasma of bone marrow

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9
Q
  1. Factors affecting serum protein concentrations
A

a. Inadequate intake
i. Low dietary intake
ii. Anorexia
iii. Unbalanced diet
iv. Hypocaloric intravenous infusions
b. Altered metabolism
i. Trauma
ii. Stress
iii. Sepsis
iv. hypoxia

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10
Q
  1. How is somatic protein status assessed (know all 3 methods)
A

a. Urinary creatine excretion (muscle)
b. Creatine/height ratio (ratio of BUN:creatine)
c. 3-methylhistidine excretion (derived from myosin and actin)

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11
Q
  1. How is visceral protein status assessed
A

a. Total serum protein (TP)
b. Serum albumin
c. Serum transferrin
d. Prealbumin (tranthyretin)
e. C-reactive protein

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12
Q
  1. When is total protein significantly depleted
A

a. Total serum protein concentration is maintained within normal limits despite restricted protein intake
b. TP is only significantly depleted when clinical signs and/or protein malnutrition are present

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13
Q
  1. What are two negative acute-phase responders
A

a. Albumin method-negative acute-phase responder. Long half-life of ~20 days. Used to asses chronic malnutrition and muscle loss
b. Prealbumin method-negative acute-phase responder. Short half life of ~2 days. Used to asses acute changes
c. So…. Albumin and prealbumin are the two neg. acute phase responders

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14
Q
  1. What is the half life of albumin and pre albumin
A

a. Albumin ~ 20 days

b. Prealbumin ~ 2 days

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15
Q

a. PEM

A

i. Deficiency of both protein and energy

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16
Q

b. Marasmus

A

i. Starvation (absolute deprivation of food) results in depletion of skeletal muscle. One extreme of PEM. Albumin shifts intravascularly in marasmus

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17
Q

c. Kwashiorkor

A

i. Low protein intake in relation to energy intake. Results in depletion of visceral protein pool, and edema. Other extreme of PEM. Albumin shifts extravascular in Kwashiorkor

18
Q
  1. Serum ranges for albumin and pre albumin – normal range
A

a. Albumin – 3.5-5.0 g/dL

b. Prealbumin – 19-43 mg/dL

19
Q
  1. All information under “introduction”, Lab 8
A

a. Protein catabolism results in the release of nitrogen in the form of ammonia and other nitrogenous compounds
b. Ammonia must be rapidly converted to a less toxic form to facilitate excretion and maintenance of homeostasis
c. Ammonia is converted to urea through the urea cycle in the liver
d. The rate of production of urea is increased after an intake of a high protein diet or by increased protein catabolism due to starvation or tissue injury.
e. The presence of liver disease will decrease the capacity of the liver to convert ammonia to urea, resulting of an increase in blood ammonia concentration
f. Plasma and urine ammonia should be determined separately if high levels are expected
g. Urea in the blood is referred to as blood urea nitrogen (BUN)
h. Urea in the urine is referred to as urine urea nitrogen (UUN)

20
Q
  1. What is UUN affected by
A

a. Protein intake
b. Kidney function (used to evaluate renal function)
c. Urine volume

21
Q
  1. Know everything about the nitrogen balance equation
A

a. Balance= (protein intake (g)/6.25) – (urinary urea N2 (g)) +4 g
b. Indicates the net change in the total body protein mass
c. In this equation, nitrogen intake is estimated from the protein intake, assuming that protein contains 16% nitrogen in a mixed diet.
d. If parenteral solutions contain free amino acids are used, specific conversion factors should be used to calculate their nitrogen content exactly
e. The constant (4g) in the equation above represents two correction factors:
i. 2 g for dermal and fecal losses of nitrogen, which occur but are not measured
ii. 2 g for the non-urea nitrogen components of the urine (e.g. ammonia, uric acid, and creatine

22
Q
  1. Why does an estimate of the change in nitrogen balance require 3 consecutive, 24 hour urine collections
A

a. An estimate of the change in nitrogen balance, rather than a single measurement, is preferred to monitor the effectiveness of nutritional therapy
b. Requires three consecutive, 24-hour urine collections.
i. Especially for hospital patients
ii. The intra-subjective variation for urinary nitrogen excretion can be large
iii. Care must be taken to avoid spills, discards, or inadvertent omissions of urine during collection, because these lead to a positive effort in the nitrogen balance
iv. Best practice is to avoid any analysis of improperly collected samples and start over

23
Q
  1. “in” nitrogen balance
A

in” nitrogen balance

i. definition: intakes are adequate to replace the endogenous nitrogen losses and for the growth of the hair and nails
ii. healthy adults with adequate energy and nutrient intakes should be “in” nitrogen balance

24
Q
  1. All factors contributing to negative nitrogen balance
A

a. Inadequate protein and/or energy intakes
b. Imbalance in essential amino acid and non-essential amino acid ratio: EAA/NEAA
c. Conditions of accelerated protein catabolism:
i. Trauma
ii. Infection
iii. Sepsis
iv. Burns
v. Excessive losses of nitrogen arising from fistulas or excessive diarrhea

25
Q
  1. Conditions in which the estimated nitrogen balance equation is not appropriate
A

a. Malabsorption
i. When fecal nitrogen losses may be elevated
ii. Making the correction factor of two grams for dermal and fecal losses of nitrogen inappropriate
b. During severe energy restriction or starvation
i. When the production of renal ammonia is increased to such an extent that the non-urea nitrogen correction factor of 2 grams is inadequate
c. When protein intakes are low
i. Urinary urea nitrogen is no longer a valid index of total urinary nitrogen excretion because it accounts for a decreasing percentage of total urinary nitrogen excretion: 61% to 70% compared to more than 80% to 90% on a normal mixed diet
d. During increased excretion of urea (ureagenesis)
i. When diets are based on proteins of low biological value
ii. When parenteral or enteral solutions contacting certain amino acids (e.g. arginine and glutamine) are administered

26
Q
  1. Daily urea urinary excretion values; plasma/serum values of urea; what happens to urea excretion in urine when protein intake increases
A

a. Daily urea urinary excretion: 5-20 g/d
b. Plasma/ serum values of urea: 8-23 g/dL
i. Panic value: >37 mg/dL

27
Q
  1. Definition of anthropometrics
A

a. to evaluate the progress of growth in pregnant women, infants, children, and adolescents
b. to detect under nutrition and over nutrition in all age groups
c. to measure changes in body composition over time

28
Q
  1. 3 main functions of anthropometrics
A

a. to evaluate the progress of growth in pregnant women, infants, children, and adolescents
b. to detect under nutrition and over nutrition in all age groups
c. to measure changes in body composition over time

29
Q
  1. All information under body composition
A

a. Body composition is used in reference to the fat and nonfat components of the human body the fat component is usually referred to as fat mass (FM) or percent body fat (%BF)
b. The nonfat component is referred to as lean body mass (LBM)
c. There are several different procedures whereby body composition can be determined
d. The most common techniques are:
i. Hydrostatic or underwater weighing
ii. Measurement of body volume
iii. Skinfold thickness
iv. Circumference measurements

30
Q
  1. BMI definition and formula
A

a. BMI is an index of a person’s weight in relation to height
b. BMI = kilograms/ meters2
c. BMI = (pounds x 703/ inches2

31
Q
  1. Waist-to-hip ratio definition and formula
A

a. The waist to hip ratio is a valuable indicator of body fat distribution
b. The ratio is determined by dividing the waist circumference in inches by the hip cirvumference in inches
c. Waistline (inches)/ hip (inches)
d. Women with 0.08 or greater, and men with a ratio of 0.95 or greater are at high risk of obesity-related health problem

32
Q
  1. 2 methods used to determine % body fat
A

a. skin fold measurements

b. body fat analyzer

33
Q
  1. How to calculate ideal body weight using the Hamwi equation for males and females
A

a. Males: 106 for 5 ft
i. Add 6lbs for each inch over 5 ft
b. Females:
i. 100 lbs for 5 ft
ii. add 5 lbs for each inch over 5 ft

34
Q
  1. How to calculate % IBW
A

a. % IBW = (current BW/ ideal BW) x 100

35
Q
  1. All information in Table 2: Classification of Body Composition based on BMI (NIH)
A

Classification BMI, kg/m2 Risk
Underweight 25 Increased risk of disease
Obese (classI) >30 Further risk of disease
Obese class II >35 Higher risk of disease
Extremely (morbidly ) obese class III >40 Highest risk of disease

36
Q
  1. All info. in Table 3: Waist to hip ratio
A

Male Female Risk

>0.95 >0.80 Greater risk: obesity-related condiditons

37
Q
  1. All info. in Table 4: Waist circumference
A

Male Female Risk
>40 (122 cm) >35 (88 cm) Independent risk factor for disease when out of proportion to total body fat; may not be as useful for those 35
Apple shape or android obesity weight around the trunk; fat placed in abdominal (truncal) reigion; visceral fat Greater risk: obesity-related conditions like cardiovascular, type 2 diabetes and some cancers
Pear shape or gynoid obesity; weight around the hips Metabolic risks are lower

38
Q
  1. Table 8: Weight as an indicator of nutrition status – know >120 % is obese and <70% is severely undernourished
A

% ideal body weight % usual body weight Nutritional status
>120 - Obese
<75 Severely undernourished

39
Q

“positive” nitrogen balance

A

“positive” nitrogen balance

i. Nitrogen intake exceeds nitrogen output
ii. Occurs during growth, late pregnancy, athletic training, and recovery from illness

40
Q

“negative” nitrogen balance

A

c. “Negative” nitrogen balance
i. Nitrogen output exceeds nitrogen intake
ii. A negative nitrogen balance 1 g/d is equivalent to a reduction in total body protein of 6.25 g/day
iii. If the negative balance persist, the resultant protein depletion may have adverse effect on all organ system

41
Q

Conditions in which serum total protein decrease

A

b. Decreases
i. During nephrotic syndrome (albumin lost in damages kidneys). When albumin is lost from blood there is a movement of water from circulation to intestinal fluid and tissues, resulting in edema. Protein in the urine is a key indicator of renal disorder
ii. During a low protein intake or malabsorption
iii. During starvation
iv. During severe hemorrhage
v. As a result of liver disease, alcoholism

advanced nutrition lab final (1 decks)

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