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(C) Nutrition > Lecture 5: Malnutrition & Cachexia > Flashcards

Lecture 5: Malnutrition & Cachexia Flashcards

1
Q

What is malnutrition?

A

The general state of inadequate nutrient and/or energy intake and absorption to meet metabolic demands.

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2
Q

What are the 3 main causes of malnutrition?

A

Poor intake

Poor absorption

Increased metabolic needs.

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3
Q

How much of US adults do not consume adequate amounts of nutrients on a regular basis?

A

85%!

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4
Q

How many households in the US were considered low or very low in terms of food security?

A

10%

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5
Q

What tools can we use to screen for malnutrition?

A

Subjective Global Assessment (SGA)

Malnutrition Universal Screening Tool (MUST)

Malnutrition Screening Tool (MST)

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6
Q

What is the SGA?

A

Combines hs, ROS, and PE findings.

It is mainly to categorize pts by their nourishment status.

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7
Q

What is the MUST?

A

Utilizes BMI, unintentional weight loss, and effect sof acute disease to measure RISK OF MALNUTRITION.

Offers recommendations.

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8
Q

What is the MST?

A

2-question screen, also helps determine RISK OF MALNUTRITION.

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9
Q

How do we check nutritional status in adults vs children?

A

Adults: generally weight

Children: Body length and head circumference.

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10
Q

What specific organs would show nutrient malnutrition and how?

A

Integumentary: skin, hair, nails, mucosal membranes.
Hematopoiesis: immunosuppression, anemia, bleeding or bruising.
Neurologic: Paresthesia, weakness, cognitive delay or impairment.

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11
Q

Where do we measure skinfold thickness? How?

A

Triceps
Using calipers

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12
Q

What skinfold thickness are men usually at? Women?

A

Men: 12.5-20mm
Women: 16.5-25mm

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13
Q

What midarm muscle circumference % is suggestive of malnutrition?

A

< 15th percentile.

Measured with a tape measure.

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14
Q

What is underweight for adults?

A

BMI <18.5

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15
Q

What is underweight for children?

A

Depends on growth charts.

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16
Q

What is the difference between stunting and wasting?

A

Stunting has to do with low HEIGHT for age.

Wasting has to do with low WEIGHT for age.

Note:
Stunted trees are SHORT.

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17
Q

Is an underweight patient malnourished?

A

Not always!

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18
Q

What is the gold standard to screen for malnutrition?

A

DEXA scan (Dual-energy XRAY absorptiometry)

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19
Q

What proteins do we measure for malnutrition?

A

Somatic and visceral proteins.

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20
Q

How do we assess somatic proteins?

A

24 hour urinary creatinine excretion.

This assesses the relative state of skeletal muscle mass.

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21
Q

What are the visceral proteins?

A

Albumin, transferrin, prealbumin, and retinol-binding protein.

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22
Q

Which visceral protein do we commonly measure? Why?

A

Albumin. It has the longest half-life at 20 days.
However, it can be decreased in any septic state

Normal range is about 3.5-5.5

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23
Q

When do we measure prealbumin?

A

Acute malnourishment (t1/2 is 2d)

Depressed in acute stress states as well.

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24
Q

When do we measure transferrin?

A

Iron deficiency elevates it.

T1/2 is 8-10d

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25
Q

What is dietary reference intake?

A

Nutrient reference values developed by the institute of medicine to quantify recommended levels of a given nutrient necessary for optimal health based on a patient’s individual characteristics.

Includes:
RDA
AI
EAR
EER
UL

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26
Q

What are all the things included in a DRI?

A

RDA: Recommended dietary allowance
AI: Adequate intake
EAR: Estimated Average Requirement
EER: Estimated Energy Requirement
UL: Tolerable upper level intake

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27
Q

What is RDA/recommended dietary allowance?

A

The average amount of nutrient sufficient to meet the requirements of 97-98% of health individuals.

28
Q

What is AI/adequate intake?

A

Recommended average daily intake level based on health individuals.

Used when RDA cannot be determined!!

29
Q

What is EAR/estimated average requirement?

A

Average nutrient level needed to meet 50% of individuals.

Often known as the threshold/minimum.

30
Q

What is EER/estimated energy requirement?

A

Average dietary intake predicted to maintain energy balance.

It includes extra needs such as pregnancy, lactation, or childhood.

It is only the minimum, no upper level.

31
Q

What is UL/tolerable upper intake level?

A

Highest average daily nutrient intake level that won’t cause adverse effects.

AKA the most you can consume in nutrients without consequences.

32
Q

What is BMR and how do we determine it?

A

Basal Metabolic Rate
Energy spent to maintain basic metabolic processes.

Determined by subject reclining after a 12 hour fast.

33
Q

What is Basal energy expenditure/BEE?

A

BMR extrapolated to 24 hours.

34
Q

What is RMR and how do we determine it?

A

Resting Metabolic Rate
Includes BMR + recent eating or exercise.

10-20% higher than BMR on avg.

35
Q

What is Resting energy expenditure/REE?

A

RMR extrapolated to 24 hours.

36
Q

What equation is used to estimate energy requirements for an individual?

A

Harris-benedict equation

37
Q

What information does the Harris-Benedict Equation need?

A

Weight in kg
Height in cm
Age

38
Q

How is EER calculated from BMR?

A

BMR is multipled to adjust for a person’s physical activity level.

39
Q

What equation is the most current one to calculate EER now?

A

Institute of Medicine equation.

40
Q

What is the most common nutrition deficiency in the world?

A

Iron Deficiency.

41
Q

What are two common nutrient deficiencies in underdeveloped countries?

A

Vitamin A
Iodine deficiency

42
Q

What is marasmus?

A

A state of BOTH protein and total energy malnutrition.

Results in massive wasting and weight loss.

43
Q

How does someone with maramus appear?

A

Relatively large head with large, staring eyes.

Emaciated, weak appearance.

Thin skin and hair that is easily plucked.

Bradycardia, hypotensive, hypothermic

Like gollum

44
Q

What is kwashiorkor?

A

A state of PROTEIN malnutrition with normal caloric intake.

45
Q

What demographic often presents with kawshiorkor?

A

Babies weaned from the breast in low-income countries.

46
Q

What are some PE findings in someone with kwashiorkor?

A

Growth retardation

Distended abdomen with dilated intestinal loops.

Classic edematous appearance with pitting edema.

47
Q

Why does kwashiorkor present with pitting edema?

A

Hypoalbumenia leads to low osmotic colloid pressure.

Lack of protein = lower production of albumin.

48
Q

What is cachexia?

A

Multifactorial wasting syndrome with continuous loss of skeletal muscle mass, with or w/o loss of fat.

49
Q

What is significant about cachexia?

A

Not fully reversible by nutritional support.

Progressive functional impairment.

50
Q

What kind of pts are most commonly cachetic?

A

50-80% of cancer patients.

Accounts for up to 20% of cancer mortality.

Also appears in pts with AIDS.

51
Q

What is the suspected cause of cachexia?

A

Mitochondrial dysfunction.

Leading to…
Decreased ATP and protein synthesis
Increased oxidative stress in the body
Elevated inflammatory markers

52
Q

What are the two general ways we can provide nutrients to a patient?

A

Enteral

Parenteral

53
Q

What are the enteral nutritional options?

A

Oral and feeding tubes:
Nasogastric/NG tubes for short-term.
Percutaneous endoscopic gastrostomy tube/PEG for long-term feeding.

Jejunal tubes as well for high aspiration risk patients.

54
Q

What are the parenteral nutritional options?

A

Central line delivery

TPN: Total parenteral nutrition
PPN: Partial parenteral nutrition.

PPN is only used in situations where the gut is not working properly.

55
Q

What are the concerns with parenteral nutrition treatment?

A

Higher risks of bacteremia and sepsis, poor weight gain.

Fat overload syndrome: fever, HSM, and coagulopathy

Bone metabolism disease in children with long-term use.

56
Q

What is fat overload syndrome specifically a complication of?

A

Intravenous lipid emulsion therapy (ILE)

57
Q

What are the general treatment principles for an anorexic patient?

A

Frequent spacing of small meals.

Prioritize energy-dense foods.

Powdered/liquid supplementation

Adding calories/nutrients to preferred foods.

58
Q

What is dumping syndrome?

A

Sweating, flushing, dizziness, and tachycardia caused by large amounts of food moving rapidly from the stomach to the bowel.

59
Q

When is dumping syndrome commonly seen? What do we do to treat it?

A

Tube feeding and post-gastric surgery.

Slowing infusion rate and amount of feeding given at one time.

60
Q

What is megestrol acetate/megace? Indications?

A

A synthetic progestin used as an appetite stimulant.

Indicated for:
Anorexia or cachexia associated with AIDS.

Off-label: Cancer-related cachexia

61
Q

What are the SEs and CI of megace?

A

SE: GI upset, HA, insomnia, rash
CI: Allergy

62
Q

What is cyproheptadine/periactin?

A

1st gen antihistamine used as appetite stimulant.

Can be given to adults or peds.

63
Q

What are the SEs and CIs of periactin?

A

SE: dizziness, drowsiness, anticholinergic.

CIs: Allergy, MAOI use, gastric or urinary obstructions, acute angle-closure glaucoma, and gastric ulcer.

NOT FOR USE IN:
preemies
neonates
Pregnant or breastfeeding
elderly or debilitated

64
Q

What is dronabinol/marinol? Indications?

A

Cannabinoid-derived agent (THC).
Schedule 3 drug.

Indicated for anorexia/cachexia associated with AIDS

65
Q

What are the SEs and CIs of marinol?

A

SE: euphoria, GI upset, dizziness, drowsiness, AMS

CI: allergy, use of disulfiram or metronidazole in past 2 weeks, allergy to alcohol or SESAME OIL

(C) Nutrition (12 decks)

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