Maknutrition

Question 1

Does metabolic rate increase or decrease in
1. Starvation
2. Injury

Answer 1

1. Decreases
2. Injury

Question 2

Weight change in
1. Starvation
2. Injury

Answer 2

1. Slow loss, all fat
2. Rapid loss, 80% fat

Question 3

Nitrogen changes in
1. Starvation
2. Injury

Answer 3

1. Losses reduced
2. Losses increased

Question 4

Insulin in
1. Starvation
2. Injury

Answer 4

1. Falls
2. Increases

Question 5

Catecholamines
1. Starvation
2. Injury

Answer 5

1. Early small increase
2. Increase

Question 6

gGH
1. Starvation
2. Injury

Answer 6

1. Early small increase
2. Increase

Question 7

Glucagon
1. Starvation
2. Injury

Answer 7

1. Increase then slow fall
2. Increase

Question 8

Cortisol
1. Starvation
2. Injury

Answer 8

1. Increase, then slow fall
2. Increase

Question 9

Water and sodium
1. Starvation
2. Injury

Answer 9

1. Initial loss
2. Retention

Question 10

How to calculate MUST and interpretation of result

Answer 10

BMI score + weight loss score + acute disease effect score
0 = low risk, routine clinical care
1 = medium risk - observe
2+ = high risk - treat

Question 11

Starvation response

Answer 11

Mobilisation of:
Glycogen scores from liver and muscle
Amino acids, subsequent gluconeogenesis
Fatty acids - produces ketone bodies

Question 12

Stress response
E.g injury, trauma, sepsis

Answer 12

Prioritises mobilising tissue for defence and repair, even in presence of starvation
Involves regulatory and counter-regulatory hormones and cytokines

Question 13

Phases of metabolic response to stress
Describe the ebb stage

Answer 13

First phase
Immediately after injury
Lasts 24-48 hrs
Reduced metabolic activity, O2 consumption, body temp
Energy reserves mobilised but ability to use them is impaired

Question 14

Phases of metabolic response to stress
Catabolic / flow phase

Answer 14

Hypermetabolism
Catabolism
Increased O2 consumption
Mediated by:
cytokines - il-2, il-6, TNFa
Hormones
Catecholamines
Altered nutrient metabolism - energy reserves from fat mobilised, visceral and muscle protein mobilised to provide amino acids, used for gluconeogenesis, providing glucose for the brain

• achievement of energy or nitrogen balance won’t alleviate catabolism

Question 15

Phases of metabolic response to stress
Anabolic stage

Answer 15

Recovery
Catabolism eventually declines
Decreased metabolic rate
Increased appetite
Fluid status and insulin levels return to pre injury levels
Nut therapy now aimed at restoring muscle mass and increasing protein synthesis

Question 16

Define immunonutrition

Answer 16

The potential to modulate the activity of the immune system w specific nutrients
-critically ill and surgical patients

Question 17

Define novel substrates

Answer 17

Specific nutrient substrates suggested as capable of maintaining intestinal mucosa integrity (as a barrier to bacteria and endotoxins)
E.g amino acids - glutamine, Arganine and amithine
Fatty acids - short chain fatty acids and N-3 PUFA nucleotides

Question 18

Polymeric or whole protein feeds - types of formulae

Answer 18

*standard - 1kcal/ml, w or w/o fibre
*high energy: 1.2 - 2 kcal/ml
Especial/disease specific feeds