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Biochem Exam 2 > L14 Nutritional Assessment > Flashcards

L14 Nutritional Assessment Flashcards

1
Q

What is nutritional assesment?

What determines nutritional status?

A

A means of evaluating current nutritional status is part of the history and physical

Identifies the degree of deficiency and its probable cause

Nutrient stores determines nutritional status

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2
Q

What is the difference between macronutrients and micronutrients?

A

Macronutrients: energy source~lipids (depot fat), proteins, carbs

Micronutrients: iron, calcium, vitamins, minerals

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3
Q

Name two predictors of morbidity and mortality.

A

Quantity of lean body mass and adipose tissue

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4
Q

Why should you do a nutritional assesment?

A
  • to make a diagnosis of either obesity or malnutrition
  • to determine when to screen for disease
  • to establish the adequacy of a diet
  • to start developing a nutritional care plan
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5
Q

What makes up a nutritional assesment?

A

The ABCDs of Nutritional Assessment:
• Anthropometric measurements such as height and weight.
• Biochemical parameters are laboratory tests for compounds such as prealbumin, iron and vitamin B12
• Clinical evaluation
• Dietary history

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6
Q

What does adult height tell us?

How does adult height reflect environmental factors?

What are some environmental factors?

A

a glimpse into society’s well-being

variation mostly genetic

variation between populations is mostly environmental

Height reflects environmental factors that increase or decrease nutrition intake during growth (especially infancy, 6-8 yr old, adolescence)

Environmental factors: missing any of 45 essential nutrients, insufficient calories, iodine deficiency, illness

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7
Q

What does current body weight tell us?

What is the significance of serial weight measurements?

A

Current body weight is a measure of total body energy stores

Most useful when collected in serial fashion

Weight chage over time should be reported as percentage of one’s original weight

Unexplained weight loss of 10% or more maybe considered malnutrition

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8
Q

What is the single most significant measure of nutritional status?

A

Weight change

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9
Q

What is Ideal Body Weight (IBW)?

A

Varies with gender and height

Calculated using Hamwi formula, is a range of values

Male: 106lb +/- (6 lb for every inch above or below 5 ft) +/- 10%

Female: 100lb +/- 5 lb for every inch above or below 5 ft) +/- 10%

Underweight: <85% of IBW

Obese: >120% of IBW

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10
Q

What is the best and most commonly used index of obesity?

A

BMI

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11
Q

What is Body Mass Index (BMI)?

How is it calculated?

What is the advantage of using BMI?

What are the ranges for underweight, normal, overweight, and obese?

A

BMI = weight in kg x height in m^2

BMI = (weight in lb) / (height in inches^2 x 703)

One entity is used to evaluate body weight

Underweight: <18.5

Normal Weight: 18.5-24.9

Overweight: 25-29.9

Obese: > or equal to 30

*these values just for caucasians

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12
Q

What are the criteria for BMI cutoffs based on?

A

increasing risk of premature death

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13
Q

What are some disadvantages of using BMI?

A
  • measures excess weight, not excess fat:(misleading for body-builders, etc) no relation between BMI and precent body fat- factors in with age as body fat increases and muscle mass increases but may have same BMI
  • does not account for gender-women have 10% more body fat than men. for given BI, women have a decreased risk of premature mortality
  • not universal- does not account for ethnicity. target BMI needed to trigger screening for hypertension, heart disease, and diabetes varies with ethnicity
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14
Q

What are two ways for assessing body fat?

Which is the gold standard?

What can we use body fat as a criteria for?

A

Hydrostatic weighing and DXA (dual energy x-ray absorptiometry)-gold standard, but expensive

Bioelectric impedance analysis (BIA): measures body water compartment using electric current. body fat has little water and is resistant to current, more fat = greater electrical resistance. Dehydration will results in over estimating percent body fat

Body fat is another criteria for evaluating obesity

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15
Q

What is the triceps skinfold thickness test?

A

used to estimate body fat as percentage of total weight

based on the fact that 50-80% of adipose tissue is subcutaneous

calipers are used to measure skin folds, multiple sites better

easy, rapid, inexpensive, but variable

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16
Q

Why is fat distribution important?

A

It is not just amount of body fat but the fat distribution that determines disease risk associated with obesity

Central or apple-shaped people carry fat above waist- associated with 2-fold greater risk of hypertension, hyperinsulinemia, diabetes, CV disease

17
Q

How is fat distribution gender dependent?

Where does testosterone favor fat deposition?

A

Non-obese men: fat evenly distributed

Non-obese women: more fat in gluteofemoral area

Women with lower-body obesity (pear-shaped) have to weight about 20 lbs more than comparable men with upper-body obesity to show same health risks

Testosterone favors fat deposition in abdomen

18
Q

What are ways to asses central or abdominal obesity?

Central obesity has more of what type of fat than lower-body obesity?

A

Waist circumference (WC)

Waist-to-hip ratio: fat accumulated on hips is cardioprotective. High risk for men = >1. High risk for women > or equal to 0.86

Central obesity has more visceral fat than lower-body obesity

19
Q

What is the best predictor for risk of CVD and premature death?

A

Waist circumference is more closely associated to the risk of CVD and premature death than BMI or Waist-hip ratio

Male: WC greater than or equal to 40 = visceral obesity

Female: WC greater than or equal to 35 = visceral obesity

Men WC of 34 inches has 70% increased risk of DM

WC of greater or equal to 40 inches has 280% increased risk of DM

20
Q

What is A Body Shape Index (ABSI)?

Why is the ABSI helpful?

A

Combines WC and BMI, but is independent of these factors

ABSI = WC/ (BMI)^2/3 x (height)^1/2

ABSI is helpful because BMI does not deal with fat distribution and normal BMI can mask metabolic abnormalities

25% of people with normal BMI are metabolically unhealthy (skinny fat)

50% of overweight people are metabolically healthy

elevated BMI does not necessarily reflect poor metabolic health

21
Q

What is the most dangerous kind of fat?

A

Abdominal fat over subcutaneous fat

22
Q

What are the two compartments of body protein?

What is used to assess wasting or malnutrition?

What is a marker of malnutrition in the elderly?

A

Somatic protein (skeletal muscle): muscle strength

Visceral protein: prealbumin and albumin

Mid upper arm circumferance (MUAC) assesses wasting or malnutrition. Children 6 months-5 years: <12.5cm = moderate acute malnutrition. <11cm = severe acute malnutrition

Calf circumference (CC) is marker of malnutrition in elderly. measured at point of greatest circumference. cc less than or equal to 30.5cm suggests protein energy malnutrition

23
Q

What are biochemical markers?

What are visceral proteins?

A

Estimate the quantity of specific nutrient stores

eg. protein, iron, vit C, calcium

Prealbumin is used as measure of visceral or organ protein status. useful for screening patients at risk for malnutrition

24
Q

How do you measure thiamin deficiency?

A

measure erythrocyte transketolase activity with and without added thiamin.

if added thiamin results in more than 25% increase in enzymatic activity, thiamin is deficient

25
Q

How is the clinical assessment tailored to specific populations and used to identify individuals that have deficiencies or are at risk for nutrient deficiency?

A

Inner city children: lead exposure

Pregnant women: calcium intake

Elderly: malnutrition (nursing home v. in community)

26
Q

What is a Mini Nutritional Assessment (MNA)?

A

Ranking of nutritional status based on many many factors.

Good = 24-30 MNA score

Risk of malnutrition = 17-23.5

Malnutrition < 17

27
Q

What are the causative factors associated with malnutrition in the elderly?

A

MEALS ON WHEELS

Medication effects

Emotional problems

Anorexia nervosa or alcoholism

Late life paranoia

Swallowing disorders

Oral factors: dentures, etc

No money

Wandering, dementia behaviors

Hyperthyroidism, hypothyroidism

Enteric problems

Eating problems

Low salt, low cholesterol diet

Social problems

28
Q

What are the most common procedures used to determine dietary history?

What are the disadvantages of these methods?

A

Plate diagram: hoard food

24-hour recall: forget snacks

1-3 day record: change of food choices, inaccurate estimates of quantity

food frequency questionnaires: can underestimate usual intakes

Biochem Exam 2 (7 decks)

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