Lecture 5 Flashcards by Billie Roberts

What can cause malnutrition?

Poor intake
Poor absorption
Increased metabolic needs

How well did you know this?

Not at all

Perfectly

What can cause poor absorption?

GI resection
Inflammatory disease

How well did you know this?

Not at all

Perfectly

What can cause increased metabolic needs?

Cancer
Burns
Aids

How well did you know this?

Not at all

Perfectly

What percent of households have low or very low food security?

10%

How well did you know this?

Not at all

Perfectly

What type of population usually low food security?

Single mothers
Black patients
Low-income households

How well did you know this?

Not at all

Perfectly

What percentage of adults do not get adequate amounts of nutrients?

85%

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How do we calculate percent usual weight?

(actual weight/usual weight) x 100

How well did you know this?

Not at all

Perfectly

How do we screen for malnutrition in young children?

Checking body length and head circumfenrence

How well did you know this?

Not at all

Perfectly

What types of cells does malnutrition especially affect?

Cells with rapid turnover or high metabolic activity such as…
Integumentary
Hematopoiesis
Neurologic

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What percentile in midarm muscle circumference indicates malnutrition

<15th percentile

How well did you know this?

Not at all

Perfectly

What BMI is considered underweight for adults?

<18.5

How well did you know this?

Not at all

Perfectly

What is stunting? Wasting?

Stunting: Low height-for-age
Wasting: low weight-for-age

Underweight individuals may have both

How well did you know this?

Not at all

Perfectly

How do we measure an underweight status in children?

It varies with age/development
but generally you use a Growth chart

How well did you know this?

Not at all

Perfectly

What types of imaging tools can you use for malnutrition?

Dual-energy x-ray absorptiometry (DXA, DEXA) (gold standard)
CT
MRI

How well did you know this?

Not at all

Perfectly

What types of proteins do we access in malnutrition screening?

Somatic proteins
Visceral proteins

How well did you know this?

Not at all

Perfectly

What does somatic proteins assess?

24hour urinary creatinine excretion
Measure state of skeletal muscle mass

How well did you know this?

Not at all

Perfectly

What are examples of visceral proteins?

Albumin
Pre-albumin
Transferrin
Retinol-binding protein

How well did you know this?

Not at all

Perfectly

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