Ger 2 Nutrition Flashcards

1
Q

In which direction are the figures of “% elderly classified as malnourished” trending over the next 30 years?

A

These figures are predicted to rise dramatically

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2
Q

Why is it difficult to get an accurate measurement of the effects on one’s digestive system from aging alone?

A

Because of pathological factors that might come into play such as diabetes, pancreatitis, liver disesase, and malignancies

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3
Q

What has been proven to be associated with reduced body weight and reduced intake of micronutrients? And what causes this?

A

Bacterial Overgrowth (71% have it and 11% of them are malnourished). Caused by prolonged use of PPIs leading to suppressed acid secretion (typically prescribed to patients with chronic gastritis to prevent hyperchlorydia)

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4
Q

The physiological age-related reduction in appetite and energy intake has been termed _____ __ ______

A

Anorexia of Aging

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5
Q

In a pt > 65 y/o, what is the negative consequence of having a BMI <22?

A

At a BMI <22 there is a steady increase in mortality and the combined effect of being underweight with increasing age has a deleterious effect on mortality

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6
Q

In elderly, what does reduced physical activity, reduced growth hormone, diminished sex hormones, and a decreasing metabolic rate all lead to?

A

Increase in body fat (15% in a 20 y/o @18 kg, 29% in a 75 y/o @ same weight)

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7
Q

As you age a greater proportion of fat is intra-hepatic and intra-abdominal. What does this lead to?

A

Insulin resistance; higher risk of ischemic heart disease and stroke

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8
Q

What three distinct mechanisms of weight loss have been ID’d in eldery?

A

Wasting, Cachexia, and Sarcopenia

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9
Q

involuntary loss of weight due to disease

A

Wasting

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10
Q

How does cachexia lead to a loss in muscle (free-fat body mass)?

A

Chronic disease -> cytokines released->alter hormone production->shifts albumin production to acute phase proteins->negative nitrogen balance formed->muscle mass is lost

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11
Q

Decline is skeletal muscle mass is known as___________ and is caused by what factors

A

Sarcopenia, reduced physical activity, cytokine production, decline in endocrine messengers, and neuronal loss

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12
Q

Diminished sense of smell and taste, increased cytokine activity, delayed gastric emptying, altered gastric distention all contribute to what?

A

Physiological Anorexia

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13
Q

What are some things that can contribute to a change in you sense of taste as you age?

A

Reduced number of taste buds, Parkinsons medications, and antidepressants

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14
Q

What is an increase in circulating cytokines associated with?

A

Loss of muscle mass

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15
Q

Do older people respond to undernutrition the same way younger people do?

A

No, older people did not overcompensate like the younger group, and instead only returned to their baseline eating

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16
Q

what neuropeptide mediates hunger and inhibits satiety? and what neuropeptide is released in the distal intestines to inhibit this in order to stimulate satiety?

17
Q

Satiety neuropeptide released from the proximal bowel? What are the relative levels in elderly?

A

CCK, increased (contributes to loss of appetite)

18
Q

Older people tend to have _____ levels of leptin. What does this mean for them?

A

Leptin, signals that body that there is adequate fat stores and no further intake of food is needed (decreased appetite)

19
Q

What condition contributes to the elderly having an increased leptin signal and inhibition of gherlin?

A

Glucose intolerance with an increase in insulin which amplifies leptin and inhibits gherlin

20
Q

what is the only only peripheral hormone known to stimulate appetite?

21
Q

What is the best predictor of worst clinical outcome and is associated with morbidity and mortality in elderly?

A

Unintentional Weight Loss

22
Q

What is the single best biochemical marker for malnutrition?

A

There is none, main value of markers is in using them in a detailed assessment and monitoring

23
Q

What is the minimum amount of protein intake required to prevent progressive loss of mean body mass? what is perhaps a better reccomendation for elderly?

A

0.8 g protein/kg body weight per day; 1.5 g protein/kg body weight per day

24
Q

Deficiency can cause osteomalacia, rickets, and myopathy

25
Deficiency can cause macrocytic anemia, subacute combined degeneration of the spinal cord, neuropathies, ataxia, glossitis, and dementia; as well as increased homocystine (CVD risk)
Vitamin B12
26
Deficiency causes cognitive impairment, depression, risk of colorectal cancer, macrocytic anemia, and increased homocystine levels
Folate
27
What mineral levels are unchanged with aging?
Zinc, selenium, chromium, copper, and manganese
28
what leads to a prolonged satiety and slowed antral emptying?
High levels of fasting and postprandial CCK and PPY
29
What tool has been well validated and is easy to use for nutritional screening?
MUST
30
``` Skin: Dry scaly skin Follicular hyperkeratosis Petechiae Photosensitive dermatitis Poor wound healing Scrotal dermatitis ```
Dry scaly skin Zinc/essential fatty acids Follicular hyperkeratosis Vitamin A, C Petechiae Vitamin C, K Photosensitive dermatitis Niacin Poor wound healing Zinc, vitamin C Scrotal dermatitis Riboflavin
31
Hair: Thin/depigmented Easy pluckability
Thin/depigmented Protein | Easy pluckability Protein/zinc
32
Nail: Transverse depigmentation Spooned
Transverse depigmentation Albumin | Spooned Iron
33
Eyes: Night blindness Conjunctival inflammation Keratomalacia
Night blindness Vitamin A Conjunctival inflammation Riboflavin Keratomalacia Vitamin A
34
``` Mouth: Bleeding gums Glossitis Atrophic papillae Hypogeusia ```
Bleeding gums Vitamin C, riboflavin Glossitis Niacin, pyridoxine, riboflavin Atrophic papillae Iron Hypogeusia Zinc, vitamin A
35
Neck: Thyroid enlargement Parotid enlargement
Thyroid enlargement Iodine | Parotid enlargement Protein