Malnutrition

Question 1

Starvation can be _______ or _________

Answer 1

physiological or pathological

• pahtological is a disease

Question 2

Clinical features of protein energy malnutrition?

Answer 2

• Reduced body weight
• Edema
• Muscle wasting, decreased strengh
• Reduced cardiac and repsiratory muscle capacity
• Apathy
• Immunodeficiency
• Hypothermia
• Skin thinning
• REDUCED METBOLIC RATE

Question 3

What was one effect of the dutch famine?

Answer 3

Intra-uterine growth restricted (IUGR) infants

- For more than one generation!

Question 4

In the starvation experiment from Ancel Keys..
After 6 months, total weight change in % (decreaed or increased):
- Lean tissue mass:
- Fat mass:
- extrwacellular fluid mass

• Rate of fat loss
• Rate of lean tissue loss

Answer 4

Lean tiisue mass: Decreased
Fat mass: Decreased
Extracellular fluid: Increased

Rate of fat loss: zero
Rate of lean tissue loss : zero

After 6 months: equilibrium attained!

Question 5

How is there a reduced protein requirement in starvation?

Answer 5

• Diminish lean tissue mass
• More efficient rtention of dietary protein
• Lean tissue mass stabilizes despite continued low protein intake

Question 6

What are the costs of a successfull adaptation to starvation?

Answer 6

• Immunodifieincy
• Reduced tolerance to stress
• Lean tissue loss
• Fatigue and inactivity

Question 7

What do obese people have to do to loose weight?

Answer 7

• Have to starve! Very mild restriction of energy, though.. objective is not to lose lean mass, but fat mass!

Question 8

What are the characteristics of a safe and effective weight loss? why?

Answer 8

• High protein intake ( avoid loss of muscle mass, resting metabolic energy stays high because no muscle atrophy)
• High level of physical activity (prevent unnecessary muscle loss)
• Micronutrient supplementation
• Cognitive behavioural therapy

Question 9

What is the prevalence of starvation in canadian hospitals?

Answer 9

45%

Question 10

What are the 6 causes of muscle atrophy?

Answer 10

Cancer cachexia - systemic inflammation 
Hormonal excess or deficiency (due to a stress response.. cortisol => protein breakdown) 
Old age- sarcopenia 
Protein- protein energy malnutrition 
Inactivity - disuse atrophy 
Neuromuscular disease

Question 11

How do we measure resting metabolic rate ?

Answer 11

Indirect calorimetry

• to determine minimum energy requirement
• Measure individual’s person need

Question 12

Kwashiorkor or marasmus?

1. 5% prevalence in some countries
2. Caused by infections
3. Severe absorption or deprivation of proteins
4. Loss of appetite
5. Much more difficult to treat
6. Anxiety and apathy
7. Good appetite is possible
8. Infancy, 6-18 months
9. rapid onset
10. Skin and bone appearance
11. Better adaptation to starvation
12. Develops slowly
13. Severely wasted
14. older children 18 months-2 years
15. less than 60% wieght for age
16. • 60-80% weight for age
17. Some muscle wasting, some fat retention

Answer 12

aller voir dans les notes

Question 13

What is edema?

Answer 13

Plasma leaves leaky blood vessels and moves into tissues

Protein attract water, causing swelling

Question 14

What does ERAS stands for? What does it imply?

Answer 14

Enhanced recovering after surgery

• Early feeding and mobility after surgery => enhance recovery
• Avoiding metabolic fasting state before surgery by nutrition intravenous in colon surgery