Ger 2 Nutrition Flashcards
In which direction are the figures of “% elderly classified as malnourished” trending over the next 30 years?
These figures are predicted to rise dramatically
Why is it difficult to get an accurate measurement of the effects on one’s digestive system from aging alone?
Because of pathological factors that might come into play such as diabetes, pancreatitis, liver disesase, and malignancies
What has been proven to be associated with reduced body weight and reduced intake of micronutrients? And what causes this?
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)
The physiological age-related reduction in appetite and energy intake has been termed _____ __ ______
Anorexia of Aging
In a pt > 65 y/o, what is the negative consequence of having a BMI <22?
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
In elderly, what does reduced physical activity, reduced growth hormone, diminished sex hormones, and a decreasing metabolic rate all lead to?
Increase in body fat (15% in a 20 y/o @18 kg, 29% in a 75 y/o @ same weight)
As you age a greater proportion of fat is intra-hepatic and intra-abdominal. What does this lead to?
Insulin resistance; higher risk of ischemic heart disease and stroke
What three distinct mechanisms of weight loss have been ID’d in eldery?
Wasting, Cachexia, and Sarcopenia
involuntary loss of weight due to disease
Wasting
How does cachexia lead to a loss in muscle (free-fat body mass)?
Chronic disease -> cytokines released->alter hormone production->shifts albumin production to acute phase proteins->negative nitrogen balance formed->muscle mass is lost
Decline is skeletal muscle mass is known as___________ and is caused by what factors
Sarcopenia, reduced physical activity, cytokine production, decline in endocrine messengers, and neuronal loss
Diminished sense of smell and taste, increased cytokine activity, delayed gastric emptying, altered gastric distention all contribute to what?
Physiological Anorexia
What are some things that can contribute to a change in you sense of taste as you age?
Reduced number of taste buds, Parkinsons medications, and antidepressants
What is an increase in circulating cytokines associated with?
Loss of muscle mass
Do older people respond to undernutrition the same way younger people do?
No, older people did not overcompensate like the younger group, and instead only returned to their baseline eating
what neuropeptide mediates hunger and inhibits satiety? and what neuropeptide is released in the distal intestines to inhibit this in order to stimulate satiety?
NPY, PPY
Satiety neuropeptide released from the proximal bowel? What are the relative levels in elderly?
CCK, increased (contributes to loss of appetite)
Older people tend to have _____ levels of leptin. What does this mean for them?
Leptin, signals that body that there is adequate fat stores and no further intake of food is needed (decreased appetite)
What condition contributes to the elderly having an increased leptin signal and inhibition of gherlin?
Glucose intolerance with an increase in insulin which amplifies leptin and inhibits gherlin
what is the only only peripheral hormone known to stimulate appetite?
Gherlin
What is the best predictor of worst clinical outcome and is associated with morbidity and mortality in elderly?
Unintentional Weight Loss
What is the single best biochemical marker for malnutrition?
There is none, main value of markers is in using them in a detailed assessment and monitoring
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?
0.8 g protein/kg body weight per day; 1.5 g protein/kg body weight per day
Deficiency can cause osteomalacia, rickets, and myopathy
Vitamin D
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
Deficiency causes cognitive impairment, depression, risk of colorectal cancer, macrocytic anemia, and increased homocystine levels
Folate
What mineral levels are unchanged with aging?
Zinc, selenium, chromium, copper, and manganese
what leads to a prolonged satiety and slowed antral emptying?
High levels of fasting and postprandial CCK and PPY
What tool has been well validated and is easy to use for nutritional screening?
MUST
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
Hair:
Thin/depigmented
Easy pluckability
Thin/depigmented Protein
Easy pluckability Protein/zinc
Nail:
Transverse depigmentation
Spooned
Transverse depigmentation Albumin
Spooned Iron
Eyes:
Night blindness
Conjunctival inflammation
Keratomalacia
Night blindness Vitamin A
Conjunctival inflammation Riboflavin
Keratomalacia Vitamin A
Mouth: Bleeding gums Glossitis Atrophic papillae Hypogeusia
Bleeding gums Vitamin C, riboflavin
Glossitis Niacin, pyridoxine, riboflavin
Atrophic papillae Iron
Hypogeusia Zinc, vitamin A
Neck:
Thyroid enlargement
Parotid enlargement
Thyroid enlargement Iodine
Parotid enlargement Protein
