Lecture 25: Malnutrition Flashcards
___ is the science that studies the interaction between nutrients, and other substances in food in relation to maintenance, growth, reproduction, health, and disease of an organism
Nutrition
___ is defined as a disease state in which an organism is not receiving required nutrients for it to be able to grow and reproduce
Malnutrition
___is a disease state in which an organism is not consuming the minimum amount of various nutrients and/or enough calories for growth and reproduction. Also known as protein-energy malnutrition (PEM)
Undernutrition
_____is a disease state in which an individual’s diet results in serious protein deprivation, but still significant caloric intake (carbohydrate-based diets)
Kwashiokor
What are the clinical symptoms of Kwashiokor?
-Immune system compromised
-NO significant muscle wasting/loss of fat
-Edema (stomach)
-Poor wound healing
-Stunted growth
-Loss of hair/pigment
-Fatty liver
-Decreased serum albumin
Marasmus is a disease state in which an individual’s _____ is greater than the individual’s protein deprivation
caloric deprivation (restriction; starvation conditions)
What are the symptoms of Marasmus (chronic state)?
-Anemia
-No edema
-Low mortality
-Extreme muscle wasting (cachexia) and extreme loss of body fat
-Immune system preserved
What is an example of non-adaptive malnutrition?
Kwashiokor
(high mortality pathological state)
True or False: individuals with Marasmus display anemia and edema
False - individuals with Marasmus display anemia but NOT edema
____ is a disease state in which an individual’s caloric deprivation is greater than the individual’s protein deprivation
Marasmus
True or False: Extreme muscle wasting and extreme loss of body fat (cachexia) are seen in Kwashiorkor
False - extreme muscle wasting and extreme loss of body fat (cachexia) are seen in Marasmus
How are the albumin levels of patients with Marasmus compare to those with kwashiorkor?
Albumin levels are normal in people with Marasmus
Albumin levels are elevated in people with Kwashiorkor
True or False: The immune system is compromised in patients with marasmus
False - The immune system is compromised in patients with Kwashiorkor
Cachexia is an adaptive response to ____
undernourishment
True or False: Marasmus is a low mortality pathological state
True
Under starvation conditions, individuals will lose ___ mass to adjust to reduced energy intake. The body uses ___ acids as a source of energy.
muscle; amino
One physiological response to starvation is decreased energy expenditure (also known as: BMR_ due to decreased energy ___, decreased body __. This can lead to lethargy.
intake; mass
Physiological fasting triggers oxidation of _____ and ___ to provide energy
oxidation of fatty acids and ketosis
What mediates the physiological response to starvation?
Endocrine systems (insulin, glucagon, thyroid, adrenal)
Hematological changes (hemoglobin)
True or False: During starvation conditions, insulin will be high and glucagon will be low
False
There will be low insulin levels and high glucagon levels (mediates breakdown of fats, proteins, breakdown of glycogen)
True or False:
During starvation conditions, (adrenal glands) epinephrine will become elevated while thyroid hormone will decline
True
True or False: During starvation conditions, individuals may develop anemia
True
Glycogen can be broken down into ____ while protein can be broken down into amino acids, which can be used for the process of ____ in the liver.
glucose; gluconeogenesis
During starvation conditions, adipose tissue can be broken into free fatty acids. These can either provide energy (muscle) or make ___ in the liver and provide energy to brain and muscle
ketones
How does the physiological response to starvation change when starvation is acute (1-3 days) vs. chronic (10-15 days)?
Under chronic conditions:
-more ketogenesis in liver to supply brain and muscle w ketones
-more break down of fat
Under acute condtions:
-gluconeogenesis predominates in liver
-brain is supplied w glucose
-muscle broken down to get amino acids for gluconeogenesis
How can you calculate BMI?
BMI = 703 x (weight)/(height)^2
BMI less than 25 is considered ___ weight while over 25 is considered ___
normal; overweight
BMI greater than 30 indicates ___ while BMI greater than 40 indicates ___
obesity; morbid obesity
If patient is older than 70 years of age, has BMI greater than 20.5, is critically ill, or had a reduced food intake in past week, you should screen them for _____
malnutrition
True or False: Albumin, Pre-Albumin, Tranferrin, and CRP are made in the liver
True
Can you use albumin as nutritional marker in patient with infection/inflammation or liver/renal failure?
No
Why could someone who is malnourished have normal looking albumin levels?
Dehydration
What is a good clinical marker for malnutrition?
Albumin (unless inflammation/infection/kidney or liver failure)
How do you treat PEM?
1) slow increase in food intake (enteral or parenteral)
2) slow increase in protein intake
3) monitor/reintroduce electrolytes
4) avoid re-feeding syndrome (hypophosphatemia)
____syndrome is re-introduction of nutrients in a malnourished individuals trigger the synthesis of proteins, fats, and glycogen, which depletes the serum of potassium, magnesium, and phosphorus (hypophosphatemia)
Re-feeding Syndrome
What can be the consequences of malnutrition?
cardiac, pulmonary, and neurological consequences (can be fatal!)
