Lecture 5 Flashcards
What can cause malnutrition?
Poor intake
Poor absorption
Increased metabolic needs
What can cause poor absorption?
GI resection
Inflammatory disease
What can cause increased metabolic needs?
Cancer
Burns
Aids
What percent of households have low or very low food security?
10%
What type of population usually low food security?
Single mothers
Black patients
Low-income households
What percentage of adults do not get adequate amounts of nutrients?
85%
What are some screening tools for malnutrition?
Subjective global assessment(GBA):uses hx,ROS, PE
Malnutrition Universal screening tool(Must): uses BMI
Malnutrition screening tool(MST): 2 questions
How do we calculate percent usual weight?
(actual weight/usual weight) x 100
How do we screen for malnutrition in young children?
Checking body length and head circumfenrence
What types of cells does malnutrition especially affect?
Cells with rapid turnover or high metabolic activity such as…
Integumentary
Hematopoiesis
Neurologic
What is considered malnourished or over-nourished when using a skinfold thickness measurement?
Men <12.5mm malnutrition >20mm over nutrition
Women <16.5mm malnutrition >25mm over nutrition
What percentile in midarm muscle circumference indicates malnutrition
<15th percentile
What BMI is considered underweight for adults?
<18.5
What is stunting? Wasting?
Stunting: Low height-for-age
Wasting: low weight-for-age
Underweight individuals may have both
How do we measure an underweight status in children?
It varies with age/development
but generally you use a Growth chart
What types of imaging tools can you use for malnutrition?
Dual-energy x-ray absorptiometry (DXA, DEXA) (gold standard)
CT
MRI
What types of proteins do we access in malnutrition screening?
Somatic proteins
Visceral proteins
What does somatic proteins assess?
24hour urinary creatinine excretion
Measure state of skeletal muscle mass
What are examples of visceral proteins?
Albumin
Pre-albumin
Transferrin
Retinol-binding protein
Half life of albumin?
20 days
Half life of pre albumin? decreased levels on what?
2 days
Decreased in acute stress states
Half life of transferrin? When is it elevated?
8-10 days
Elevated in iron deficient states
Define dietary reference intake(DRI).
Nutrient reference values developed by institute of medicine to quantify recommended levels of a given nutrient for optimal health
Define recommended dietary allowance(RDA).
Average daily nutrient intake to meet the nutrient requirement of nearly all(97-98%) healthy individuals in a particular life stage/gender group
Define adequate intake(AI). When is it used?
Recommended average daily dietary nutrient intake level sufficient by a group of apparently healthy people that assumed to be adequate.
When RDA cannot be determined
Define estimated average requirement(EAR).
Average daily nutrient intake level estimated to meet the requirement of half (50%) the healthy individuals in a particular life stage and gender group
Define estimated energy requirement(EER). What else does it include?
EAR specifically used for energy - average dietary intake predicted to maintain energy balance in healthy individuals of a given age, gender, weight, height, and physical activity level consistent with good health
Includes extrametbolic needs during pregnancy, lactation, or childhood
Define tolerable upper intake level(UL)
Highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in the general population
Define BMR. When is it determined?
Amount of energy needed just to live
Determined after a 12hr fast
How is basal energy expenditure(BEE) different from BMR?
Its the same but after 24hr fast
What is resting metabolic rate(RMR)
BMR and energy expended from food intake and complete physical activity
10-20% higher than BMR on average
What is resting energy expenditure(REE)?
RMR but with a 24hr fast
What are common mineral/nutrient deficiencies in underdeveloped countries?
Vitamin A
Iodine
What are common mineral nutrient deficiencies?
Iron (worldwide)
Folate
Vit D
B vitamins
Vit A
Iodine
How does marasmus present?
Large head with large eyes
Weak appearance
Thin dry skin, sparse hair
Shrunken limbs
Bradycardia, hypotension, hypothermia
Irritable
How does kwashiorkor present?
Growth retardation
Changes in skin and hair pigmentation
Thin dry peeling skin
Rotund bellies
Bradycardia, hypotension, hypothermia
Lethargic
Low serum albumin
Classic edematous appearance
What are features of a classic edematous appearance?
Begins in dependent areas, proceeds cranially
Involves presacral area, genitalia, periorbital area
Muscle atrophy with normal or even increased body fat
Define cachexia.
Multifactorial wasting syndrome define by loss of muscle w or w/o loss of fat mass.
What cachexia be reversed?
CANNOT be fully reversed by conventional nutritional support
Cachexia is usually seen in who?
Cancer patients (50-80%)
Chronic illnesses such as AIDs
Accounts for up to 20% of cancer mortality
What medical condition is thought to be associated with cachexia?
Mitochondrial dysfunction
What are the types of nutritional replacement pathways?
Enteral: NG tubes and PEG tubes
Parenteral: TPN and PPN
When do we use a parenteral feed over enteral?
When the gut is not working
Major bowel resection, lack of GI motility, Severe IBD, obstruction
What are some issues with parenteral feeding?
Higher risk of bacteria, sepsis, poorer weight gain
Fat overload syndrome: Fever, hypersplenomegally, and coagulopathy
Bone metabolism disease in children (if long term use)
What is dumping syndrome? Where is it seen in”
Large amounts of foods moving rapidly from stomach into the bowel
Post-gastric surgery and tube feedings
How do we prevent dumping syndrome?
Slow infusion rate and amount of feeding
What are symptoms of dumping syndrome?
Sweating
Flushing
Dizziness
Tachycardia
What are some issues with parenteral feeding?
Higher risk of bacteria, sepsis, poorer weight gain
Fat overload syndrome: Fever, hypersplenomegally, and coagulopathy
Bone metabolism disease in children (if long term use)
What are features of a classic edematous appearance?
Begins in dependent areas, proceeds cranially
Involves presacral area, genitalia, periorbital area
Muscle atrophy with normal or even increased body fat
