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Year 3 - Met3a > Healthy Eating > Flashcards

Healthy Eating Flashcards

1
Q

how many deaths in the UK are due to non communicable diseases

A

88.8% of all deaths

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2
Q

half of the top risk factors for morbdity …

A

relate to diet

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3
Q

What is the leading cause of cancer

A

Obesity

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4
Q

What is a nutritional assessment

A
  • This is the systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual
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5
Q

What is a nutritional screen

A
  • e.g. MUST
  • which is a brief risk assessment which can be carried out by any healthcare professional and which may lead to a nutritional assessment by a dietician
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6
Q

What is the ABCDE model outlined for performing a nutritional assessment

A
  • A = antropometry (weight and % weight change, BMI, MUAC, skin fold thickness)
  • B = biochemistry - FBC, U&Es, LFT, Ca, B12, Folate, CRP, HBA1C
  • C= Clinical - Disease states or symptoms
  • D = dietary = energy and fluid requirements doing a dietary assessment
  • E = environment - social and physiological factors
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7
Q

What do you ask when taking a dietary history

A
  • what is patients typical food and fluid intake
  • is the patient eating 3 meals a day
  • if they ware unwell are they eating smaller meals than they used to when they were feeling well
  • are they having regular drinks
  • are they having carbohydrate foods and protein foods at each meal time
  • are they eating at least one portion of fruit or vegetable each day
  • are they able to cook for themselves
  • do they have access to essentials such as bread, milk and cheese on a daily basis
  • are they taking any nutritional supplements
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8
Q

What are barriers to loosing wieght

A
  • dont know how to cook
  • cost
  • motivation
  • psychological
  • pain
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9
Q

What are commerical determinants of disease

A

factors that influence health which stem from the profit motive

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10
Q

What is energy expenditure

A

Sum of

  • BMR
  • Thermic effect of food eaten
  • occupational activities
  • non occupational activities
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11
Q

How do you caudate BMR

A
  • can be calculated by measure oxygen consumption and carbon dioxide production
  • usually taken from standardised taels that only require knowledge of the subjects age, weight and sex
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12
Q

What is the physical activity ratio expressed as

A
  • multiples of the BMR for occupational and non occupational activities of varying intensities
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13
Q

What is the total daily energy expenditure

A

BMR X [Time in bed + (time at work x PAR) + (Non-occupational time x PAR)

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14
Q

What is the estimations for the total daily energy expenditure in the UK

A
  • 8100kJ/1940 kCal for a 55 year old female

- 10600kJ/ 2550kCal for a 55 year old male

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15
Q

what can cause energy requirements to increase

A
  • growing period
  • pregnancy and lactation
  • infection and trauma - but in general increased BMR associated with inflammatory or traumatic conditions is counteracted by a decrease in physical activity so that total energy requirements are not increased
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16
Q

What are the energy demands in a basal state

A
  • resting muscle 20% - can be more than 50 fold increase in demand during exercise
  • abdominal viscera - 35-40%
  • brain 20%
  • heart 10%
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17
Q

Vitamin A

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = oily fish, liver, dairy
  • site of absorption = small intestine
  • deficiency syndrome = xerophthalmia
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18
Q

Vitamin B1(thiamine)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source - fortified cereals, flour, bread, grain, nuts, wide range of animal and vegetable products
  • site of absorption = small intestine
  • deficiency syndrome = Beriberi, Wernicke’s encephalopathy
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19
Q

Vitamin B2 (Riboflavin)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = dairy products, cereal grains, meat, fish, broccoli, spinach
  • site of absorption = proximal small intestine
  • deficiency syndrome = angular stomatitis, chellitis
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20
Q

Vitamin B3 ( Niacin)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = meat and cereals
  • site of absorption = jejunum
  • deficiency syndrome = pellagra
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21
Q

Vitamin B6 (Pyridoxine)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = meat and cereals
  • site of absorption = small intestine
  • deficiency syndrome = polyneuropathy
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22
Q

Vitamin B12 (Cobalamin)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = meat, fortified cereals, eggs
  • site of absorption = terminal ileum
  • deficiency syndrome = macrocytic anaemia, neuropathy, glossitis
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23
Q

Vitamin C (ascorbic acid)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = fresh vegetables, citrus fruits, strawberries, spinach, tomatoes
  • site of absorption = proximal ileum
  • deficiency syndrome = scurvy
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24
Q

Vitamin D (Cholecalciferol)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = oily fish, fortified breakfast cereals, margarine, eggs, milk
  • site of absorption = jejunum as free vitamin
  • deficiency syndrome = rickets, osteomalacia
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25
Q

Vitamin E (alpha - tocopherol)

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = plant oils, animal fats, nuts, seeds, vegetables
  • site of absorption = small intestines
  • deficiency syndrome = haemolysis, neurological deficits
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26
Q

Vitamin K

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = leafy green vegetables, liver, cheese, certain fruits
  • site of absorption = small intestine
  • deficiency syndrome = bleeding disorders
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27
Q

Folic acid

  • dietary source
  • site of absorption
  • deficiency syndrome
A
  • dietary source = animal and vegetable products
  • site of absorption = jejunum
  • deficiency syndrome = macrocytic anaemia
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28
Q

When should patients be screened for malnutrition in the hospital

A

All patients should be screened for malnutrition on admission and the findings linked to a care plan under supervision of MDT

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29
Q

Who is nutritional support necessary to provide for

A
  • all severely malnourished patients on admission to hospital
  • moderately malnourished patients who because of their physical illness are not expected to eat for more than 5 days
  • normally nourished patients expected not to eat for more than 5 days or expected to eat less than half their intake for 8-10 days
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30
Q

What is refeeding syndrome

A
  • shifts of water and electrolytes occur during parenteral and enteral feeding and this can be life threatening
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31
Q

Describe the mechanisms of action of refeeding syndrome

A
  • Carbohydrate intake stimulates insulin release, which leads to cellular uptake of phosphate, potassium and magnesium
  • Complications include hypophosphotaemia, hypokalaemia, hypomagnesaemia, fluid overload (because of sodium retention)
  • Can result in arrhythmias, respiratory insufficiency, and is associated with increased mortality
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32
Q

what should patients receive if they have eaten little or nothing for 5 days

A
  • if they have eaten little or nothing for 5 days they should initially receive no more than 50% of their energy requirements
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33
Q

What should patients at high risk of refeeding syndrome be given

A
  • they should be given high potency vitamins daily for 10 days (Pabrinex) and oral and enteral thiamine 50mg 4 times daily for 10 days, along with multivitamins
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34
Q

Why are so many hospital patients malnourished

A
  1. Increased nutritional requirements – eg sepsis, burns, surgery
  2. Increased nutritional losses – eg malabsorption, output from stoma
  3. Decreased intake – eg dysphagia, nausea, sedation, coma
  4. Effect of treatment – eg nausea, diarrhoea
  5. Enforced starvation – eg prolonged periods of NBM
  6. Missing meals – eg due to investigations
  7. Difficulty with feeding – eg loss dentures, no one available to assist
  8. Unappetising food
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35
Q

What are the two ways in which enteral nutrition can be given

A
  • by mouth
  • by fine-bore nasogastric tube
  • by percutaneous endoscopic gastrostomy (PEG) tube
  • by needle catheter jejunostomy
36
Q

how does the procedure of a nasogastric tube work

A
  • Insert fine-bore tube intranasally with a wire stylet
  • Confirm the position of the tube in the stomach by aspiration of gastric contents and check pH
  • Check by X-ray if aspiration is unsuccessful or pH <5.5 is not definitive
37
Q

What is the major problems of a nasogastric tube

A
  • up to 60% of NG tubes fall out of place
38
Q

What are the complications of a nasogastric tube

A
  • regurgitation and aspiration into bronchus
  • blockage of NG tube
  • GI side effects - most commonly diarrhoea
  • metabolic complications - hyperglycaemia, hypokalaemia, as well as low levels of magnesium, calcium and phosphate
39
Q

Who is a PEG tube useful for

A
  • useful for patients who need enteral nutrition for a prolonged period (e.g. >30 days) such as those with swallowing problems
40
Q

How is a PEG tube placed into the stomach

A
  • catheter is placed percutaneously into the stomach under endoscopic control
41
Q

How does needle catheter jejunostomy work

A
  • fine catheter is inserted into the jejunum at laparotomy and brought out through the abdominal wall
42
Q

What makes up a standard enteric diet

A
  • Nitrogen 10-14g/day as whole protein
  • Carbohydrate as glucose polymers (49-53% of total energy)
  • Fat as triglycerides (30-35% of total energy)
  • Other: trace elements, electrolytes, vitamins
43
Q

What are the different ways in which you can do parenteral nutrition

A
  • peripheral parental nutrition

- central venous catheter parenteral nutrition

44
Q

what is peripheral parenteral nutrition

A
  • specially formulated mixtures for peripheral use available: these have a low osmalitiy <800mOsm/L and contain lipid emulsions
45
Q

where can peripheral parenteral nutrition be placed

A
  • peripheral cannula

- peripherally inserted central catheter

46
Q

Where can a peripheral cannula be inserted

A
  • 20cm can be inserted into a mid-arm vein - can be left for up to 5 days
47
Q

Where can peripherally inserted central catheter be inserted

A
  • 60cm - can be placed into an antecubital fossa that has its distal end lying in a central vein
48
Q

What are the benefits of a peripherally inserted central catheter

A
  • less risk of thrombophlebitis
  • hyperosmolar solutions can be given
  • can be used for up to 1 month
49
Q

What is the most appropriate way to give parental nutrition

A
  • central venous catheter parenteral nutrition
50
Q

How does central venous catheter parenteral nutrition work

A
  • Silicone catheter is placed into a central vein, usually adopting an infraclavicular approach to the subclavian vein
  • Skin-entry site should be dressed carefully and not disturbed unless there is a suggestion of catheter-related sepsis
51
Q

What does a central venous catheter for parenteral nutrition contain

A

Administered via 3L bags over 24h – contains 2250kCal

  • 14g nitrogen 1L
  • 50% glucose 0.5L
  • 20% glucose 0.5L
  • 10% lipids 0.5L, fractionated soya oil 100g/L, soya oil 50g, medium-chain triglycerides 50g/L
  • Other: trace elements, electrolytes, water-soluble and fat-soluble vitamins, heparin and insulin if required
52
Q

What are the complications for central venous catheter parenteral nutrition

A
  • catheter related sepsis
  • central vein thrombosis
  • pneumothorax
  • embolism
53
Q

Describe catheter related sepsis causes and when it should be suspected

A
  • Organisms (mainly Staph) enter along the side of the catheter leading to septicaemia
  • Prevented by ensuring careful and sterile placement of the catheter, not removing the dressing, and not giving other substances via the central catheter
  • Should be suspected if patient develops fever and leucocytosis
54
Q

What is the treatment of catheter related sepsis

A
  • removal of the central catheter

- systemic antibiotics

55
Q

How do you monitor parenteral nutrition

A

Blood tests

  • daily = plasma electrolytes and glucose
  • twice weekly = FBC, LFT, Calcium, phosphate
  • Weekly = magnesium, zinc, triglycerides

Nutritional status
- weekly weight and skin fold thickness

Nitrogen balance assessment
- complete collections of urine (grams of protein required = urinary nitrogen x 6.25)

56
Q

What can protein calorie malnutrition lead to

A
  • muscle function
  • delayed hypersensitivity
  • wound healing
  • gondal dysfunction
57
Q

What groups are at risk of under nutrition in the UK

A
  • elderly - particularly if they are living in a care home or in a hospital
  • those that live alone
  • drugs and alcohol
  • people with chronic conditions such as diabetes, kidney disease and chronic lung disease
  • people with progressive illnesses such as cancer
58
Q

What vitamin deficiencies do vegans have

A
  • Vitamin B12
  • Vitamin D
  • Zinc
  • iron
  • omega 3
  • calcium
59
Q

What is anorexia nervosa

A
  • This is an eating disorder
  • patients try to keep their weight down as low as possible by either not eating enough food or exercising too much or both
60
Q

How do you diagnose anorexia nervosa

A

DSM5 or ICD10

61
Q

What is the DSM 5 criteria for anorexia nervosa

A

Must meet all of the current DSM criteria to be diagnosed with anorexia nervosa

  • Restriction of food intake leading to weight loss or a failure to gain weight resulting in a ‘significant low body weight’ of what would be expected for someones age, sex and height
  • fear of becoming fat or gain weight
  • have a distorted view of themselves and of their condition
62
Q

How do you assess someone you suspect of having an eating disorder

A

SCOFF questionnaire - two or more positive answers to the following questions are suggestive of anorexia or bulimia

  • do you ever make yourself sick because you feel uncomfortably full
  • do you worry that you have lost control over how much you eat
  • have you recently lost more than 1 stone in a 3 month period
  • do you believe yourself to be fat when others say you are too thin
  • would you say that food dominates your life

Take a history

  • Symptoms of eating disorder
  • complications of eating disorders
  • co-morbidities and symptoms suggestive of an alternative cause
  • mental health
63
Q

How do you diagnose a patient with short bowel syndrome

A
  • detailed patient history
  • X ray, CT, MRI
  • LAB test - FBC, LFTs, U&Es
64
Q

How do you manage short bowel syndrome

A
  • Replacement of vitamins and minerals depending on the extent and position of the bowel obstruction
  • oral rehydration salts to promote adequate hydration in diarrhoea
  • codeine phosphate to reduce intestinal motility and reduce diarrhoea
  • colestryamine - for patient with an intact colon and less than 100cm of ileum resected - reduce diarrhoea
  • Growth factors
  • be aware when prescribing drugs via the oral route that they might not be able to get absorbed
65
Q

What do you measure in Anthropometry

A
  • BMI/Waist circumference
  • weight history
  • hand grip strength
  • mid arm muscle circumference
  • bioelectrical impedance
66
Q

What do you measure in clinical

A
  • nutritional requirements and stress factor
  • sepsis/infection
  • metabolic response
  • nutrient losses- D&V, fistulas, surgical drains
  • impaired ingestion, digestion or absorption
67
Q

What do you measure in biochemistry

A
  • U&Es
  • serum proteins - albumin, pre-albumin, calcium, albumin, vitamin D, PTH, CRP, WCC, ESR
  • haematological parameters - LFTs
68
Q

what do you measure in dietary

A
  • Assess intake - quality/quantity, diet history, 24 hour recall, FFQ, consider energy/protein intake, micronutrients and electrolytes, cultural/soical considerations
69
Q

Name some types of patients who could experience malnutrition

A
  • elderly
  • sheltered housing
  • low income
  • IV drug users
70
Q

Name some types of patients who could experience vitamin deficiencies

A
  • elderly
  • alcohol excess
  • cultural/ethinic groups
  • restricted diets e.g. veganism, coeliacs
  • cystic fibrosis
71
Q

Name the types of mineral deficiencies

A
  • renal failure
  • weight loss
  • dietary restriction
72
Q

Define osteoporosis

A
  • Osteoporosis is defined as reduced bone mass and micro-architectural deterioration
  • associated sub-optimal levels of calcium and vitamin D and accelerated by increased alcohol consumption
73
Q

What are the signs of scurvy

A
  • haemorrhages
  • receding gums
  • abnormal bone
  • detine formation
74
Q

When does Koilonychia present

A
  • Spoon nails and presents with iron deficiency anaemia
75
Q

What is dermatitis herpetitiformis linked to

A
  • linked to coeliac disease
76
Q

What factors effect protein requirements

A

Inadequate intake of protein
- anorexia or ageing

Reduced ability to use available protein

  • insulin resistance, protein, anabolic resistance, high splanchnic extraction
  • immobility

Greater need for protein

  • inflammatory disease
  • oxidative modification of proteins
77
Q

What are colonic polyps

A
  • these are small non-cancerous growth of cells which form on the inside lining of the colon or rectum
78
Q

What are included in refeeding bloods

A
  • potassium
  • magnesium
  • calcium
  • phosphate
79
Q

How do you manage refeeding syndrome

A
  • IV phosphophates polyfusor (PPF) infusion
  • 1 PPF infusion via a dedicated peripheral IV line in 24 hours
  • measure serum phosphate, magnesium, sodium, potassium, calcium and creatinine at baseline and daily over 3 days
80
Q

What is IBS

A
  • This is a chronic functional disorder of the GI tract in the absence of organic disease
  • defined as recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months with 2 or more of the following: improvement of defectation, onset associated with a chain in the frequency of stool, onset associated with a chance in form of stool
81
Q

What are the types of IBS

A
  • IBS with constipation
  • IBS with diarrhoea
  • Mixed IBS (diarrhoea and constipation)
82
Q

What is the definition of FODMAPs

A

A collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives
- FODMAPS include fructose, fructans, galacto-oligosaccharides, lactose and polyps

83
Q

What is coeliac disease

A
  • Coeliac disease is an autoimmune disease caused by sensitivity to the protein gluten
84
Q

What conditions are linked to coeliac disease

A
  • dermatitis herpetiformis
  • type 1 diabetes
  • autoimmune hepatitis
85
Q

What antibodies do you test for in coeliac disease

A
  • Tissue transglutaminase, Anti-endomysial
86
Q

Name three histology changes in coeliac disease

A
  • Villous atrophy
  • crypt hyperplasia
  • lymphocyte infiltration

Year 3 - Met3a (43 decks)

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