Ger 2 Nutrition

Question 1

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

Answer 1

These figures are predicted to rise dramatically

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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)

Question 4

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

Answer 4

Anorexia of Aging

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Insulin resistance; higher risk of ischemic heart disease and stroke

Question 8

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

Answer 8

Wasting, Cachexia, and Sarcopenia

Question 9

involuntary loss of weight due to disease

Answer 9

Wasting

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

Physiological Anorexia

Question 13

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

Answer 13

Reduced number of taste buds, Parkinsons medications, and antidepressants

Question 14

What is an increase in circulating cytokines associated with?

Answer 14

Loss of muscle mass

Question 15

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

Answer 15

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

Question 16

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

Answer 16

NPY, PPY

Question 17

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

Answer 17

CCK, increased (contributes to loss of appetite)

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

Gherlin

Question 21

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

Answer 21

Unintentional Weight Loss

Question 22

What is the single best biochemical marker for malnutrition?

Answer 22

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

Question 23

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?

Answer 23

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

Question 24

Deficiency can cause osteomalacia, rickets, and myopathy

Answer 24

Vitamin D

Question 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)

Answer 25

Vitamin B12

Question 26

Deficiency causes cognitive impairment, depression, risk of colorectal cancer, macrocytic anemia, and increased homocystine levels

Answer 26

Folate

Question 27

What mineral levels are unchanged with aging?

Answer 27

Zinc, selenium, chromium, copper, and manganese

Question 28

what leads to a prolonged satiety and slowed antral emptying?

Answer 28

High levels of fasting and postprandial CCK and PPY

Question 29

What tool has been well validated and is easy to use for nutritional screening?

Answer 29

MUST

Question 30

Skin: 
Dry scaly skin
Follicular hyperkeratosis
Petechiae
Photosensitive dermatitis
Poor wound healing
Scrotal dermatitis

Answer 30

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

Question 31

Hair:
Thin/depigmented
Easy pluckability

Answer 31

Thin/depigmented Protein

Easy pluckability Protein/zinc

Question 32

Nail:
Transverse depigmentation
Spooned

Answer 32

Transverse depigmentation Albumin

Spooned Iron

Question 33

Eyes:
Night blindness
Conjunctival inflammation
Keratomalacia

Answer 33

Night blindness Vitamin A
Conjunctival inflammation Riboflavin
Keratomalacia Vitamin A

Question 34

Mouth:
Bleeding gums
Glossitis
Atrophic papillae
Hypogeusia

Answer 34

Bleeding gums Vitamin C, riboflavin
Glossitis Niacin, pyridoxine, riboflavin
Atrophic papillae Iron
Hypogeusia Zinc, vitamin A

Question 35

Neck:
Thyroid enlargement
Parotid enlargement

Answer 35

Thyroid enlargement Iodine

Parotid enlargement Protein