Malnutrition Flashcards

1
Q

What are the fixed and variable influences on dietary demand?

A

Fixed (basal metabolic rate):
- Membrane pumps, transport and signalling
- Mechanical work at a cellular and tissue level
- Substrate turnover

Variable:
- Physical Activity
- Maintaining body temp
- Growth
- Processing dietary intake

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2
Q

How do we calculate basal metabolic rate?

A

We can use direct calorimetry

Or more commonly use equations adjusted for illness, age, acqtivity etc.

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3
Q

Define malnutrition

A

A state where an imbalance of energy, protein & other nutrients causes measurable adverse effects on body form, function and clinical outcome.

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4
Q

What are the major signs of malnutrition?

A

Severe under-nutrition causes marasmus and kwashiorkor.

Over nutrition leads to obesity

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5
Q

Define marasmus and kwashiorkor

A

significantly lower than expcted weiht

Salt and fluid retention brought on by under nutrition leading to oedema & Ascites

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6
Q

How do we calculate BMI?

A

Weight in K
Divided by Height squared in metres

So for me roughly 75/1.8squared = 23

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7
Q

Define overweight in terms of BMI?

A

Overweight = BMI>25

Obese = BMI > 30

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8
Q

What are some conditions obesity predisposes you to?

A

Breast and bowel cancer
Hypertension, CVD disease, Diabetes, Fatty liver, NASH, Cirrhosis etc.

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9
Q

Define underweight in terms of BMI?

A

Underweight = BMI <20
Physical impairment tends to occur <18 and conseqeunces get severe <16

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10
Q

What are the clinical consequences of undernutrition?

A
  • Impaired immune response
  • Reduced muscle strength
  • Impaired wound healing
  • Impaired recovery from illness/surgery
  • Impaired psycho-social function
  • Poor clinical outcomes
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11
Q

What can cause under nutrition and how do we classify them?

A

Split into:
Appetite Failure:
- E.g. Anorexia or Flu

Access Failure:
- Teeth problems
- Head injury
- Cancer of head/neck

Intestinal failure
- Loss of functioning gut mass below minimum required for digestion/absorption
- E.g. Short bowel syndrome
- Very Rare

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12
Q

How do we screen for patients at risk of undernutrition?

A

With the Malnutrition Universal Screening Tool! (MUST)
It can be carried out by anyone, no training required

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13
Q

What are the questions of MUST?

A

BMI:
- <20 = 1 point
- <18.5 = 2 points

Weight Loss:
Unplanned in last 3-6 months
- 5-10% of body mass = 1 point
- >10% = 2 points

Eating:
Have you eaten in last 5 days? (also if the patient is acutely ill and is likely to have no nutrional intake for more than 5 days)
- No = 2 points

Total score is from 0-6

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14
Q

How do we respond to a MUST Score?

A

0 - Review in the future, i.e. monitoring. This is done for patients and people in care homes + other risk groups

1 - Supplements, dietary advice and close monitoring

2 or more - Dietary advice, supplements, refer to a dietician

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15
Q

What are the high risk groups for malnutrition?

A
  • The ill
  • Socially isolated
  • Old age
  • Socially vulnerable groups
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16
Q

How do we treat malnutrition?

A

Call a state registered dietician

17
Q

What types of feeding are available for the undernourised in hospital?

A

Fine Bore NG tube

Percutaneous Endoscopic Gastrostomy (PEG) tube
- I.e. a tube passes into stomach through abdominal wall

IV feeding
- For people with intestinal failuer

Sip feeds:
- Oral nutritional supplements