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Module 104: Theme 1 > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

Definition

A

Deficiency of nutrients including:

  • Energy
  • Vitamins
  • Proteins
  • Minerals

This causes measurable adverse on the body composition, function or clinical outcome

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2
Q

Prevalence of malnutrition in children.

A

Becoming an increase problem in the UK with being obese/ overweight:

  • 28% of children 2-15 are overweight/ obese
  • Obese children are increasingly staying obese in adulthood.
  • 21% of 4&5 year olds are overweight/ obese
  • 34% of 10&11 year olds are overweight/ obese.
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3
Q

Global perspective on malnutrition.

A

Despite increasing food availability, 500 mil people in the word still malnourished.

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4
Q

Types of severe malnutrition

A

Severely underweight:

  • Marasmus
  • Kwashiorkor
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5
Q

Marasmus

A

Type of severe malnutrition caused mainly by lack of energy (calorie intake).

Loss of subcutaneous fat and skeletal muscle.

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6
Q

Kwashiorkor

A

Type of severe malnutrition caused predominantly by protein malnutrition but sufficient calorie intake (energy).

Characterised by oedema- pitting oedema and distended abdomen.

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7
Q

Malnutrition in the UK

A

Affects over 3 million people, most commonly in hospitalised patients.

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8
Q

Most common population malnourished in the UK (top 3)

A
  1. Hospital inpatients- 30%
  2. Hospital outpatients- 20%
  3. Children in hospital/ sheltered and elderly at home - 14%
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9
Q

Types of malnutrition

A

Total deficiency:
Protein and energy malnutrition.

Nutrient deficiency:
Lack of specific nutrients such as vitamins, minerals, protein.

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10
Q

Malnutrition and GI/Liver disease.

A

Highly prevalent in diseases of the GI and liver.

  • More than 50% patients with GI/Liver disease are malnourished.
  • Up to 80% with GI malignancy are malnourished, esp. of the pancreas
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11
Q

Malnutrition and surgical patients.

A

Malnutrition can be very prevalent in surgical patients.

87% of patients undergoing general surgery become malnourished.

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12
Q

4 mechanisms of malnutrition.

A
  1. Inadequate intake of nutrients.
  2. Impaired digestion/ processing of nutrients- malabsorption.
  3. Excess loss of nutrients.
  4. Altered requirement of nutrients.
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13
Q

Malabsorption

A

Impaired digestion and processing of nutrients- can lead to malnutrition.

Caused by dysfunction of:

  • Stomach
  • Pancreas
  • Liver
  • Intestines
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14
Q

Causes of excess loss of nutrients [6]

A

XS loss= malnutrition.

Causes:

  • Vomiting
  • Nasogastric (NG) tube drainage.
  • Diarrhoea
  • Surgical drains
  • Fistula
  • Stomas (opening in the body)
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15
Q

Altered requirements [ 5 causes] + malnutrition

A

An increase in metabolic demand causes more energy required via calorie intake.

Insufficient calorie intake = malnutrition.

Causes:
Inflammation
Cancer
Wounds
Burns
Brain injury
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16
Q

Starvation

A

The most extreme of malnutrition that leads to death- a severe deficiency pf calorie intake.

Type types:
Simple starvation
Stress starvation

17
Q

Simple starvation

  • what decreases [4]
  • what stays the same [1]
  • what increases [6]
A

Starvation only due to the lack of calorie intake. No other pathological conditions.

Decreases:

  • Metabolic rate
  • Protein synthesis
  • Nitrogen balance
  • Blood glucose

Increases:

  • Muscle protein breakdown
  • Ketone bodies (significantly)
  • Gluconeogenesis
  • Plasma insulin
  • Insulin resistance.
  • Salt and water retention

Stays the same:
Plasma albumin

18
Q

What happens when we fast 12-24 hours.

  • Liver
  • Brain
  • Fat
  • Muscles.
A

The liver–> gluconeogenesis and glycogenolysis to release glucose.

Glucose released from the liver to the brain and periphery.

Fat –> broken down into fatty acids and glycerol and released to the liver and periphery.

Muscles –> break down to release amino acids to the liver.

19
Q

What happens when we fast for long periods (2-3+ days)

  • Liver
  • Brain
  • Fat
  • Muscles.
A

Lipolysis–> More fat broken down into fatty acids and glycerol and released to periphery and liver.

Liver–> Ketogenesis and glyconeogenesis

  • Ketogenesis releases ketone bodies to the brain and periphery.
  • Gluconeogenesis releases glucose to the brain and periphery.

Less amino acids released from the break down of muscles.

20
Q

Stress starvation

  • what decreases [2]
  • what increases [9]
A

Malnutrition caused by caesation of calorie intake with underlying an underlying pathology such as: trauma, sepsis and critical illness.

Increases:

  • Metabolic rate
  • Muscle protein breakdown (significantly)
  • Protein synthesis
  • Ketone bodies
  • Gluconeogenesis
  • Bood glucose
  • Insulin plasma
  • Insulin resistance (significantly)
  • Salt and water retention (significantly)

Decreases:

  • Plasma albumin
  • Nitrogen balance
21
Q

Differences between simple and stress starvation for:

  • Metabolic rate
  • Muscle protein breakdown
  • Protein synthesis
A
  • Metabolic rate: increases in stress, decreases in simple.
  • Muscle protein breakdown is a lot greater in stressed starvation.
  • Protein synthesis: increases in stress, decreases in simple.
22
Q

Differences between simple and stress starvation for:

  • Plasma albumin
  • Nitrogen balance
  • Ketone bodies
A
  • Plasma albumin: decreases in stress, not affected in simple.
  • Nitrogen balance decreases more in stress.
  • More ketone bodies in simple.
23
Q

Differences between simple and stress starvation for:

  • Gluconeogenesis
  • Blood glucose
  • Insulin plasma concentration
A

Gluconeogenesis: increases more in stress.

Blood glucose: increases in stress, decreases in simple.

Insulin plasma increases the same in both

24
Q

Differences between simple and stress starvation for:

  • Insulin resistance
  • Salt and water retention
A

Insulin resistance is the same in both.

Salt and water retention is significantly greater in stress.

25
Q

Consequences of malnutrition on the body. [9]

A

Psychological- depression, apathy (self neglect= exacerbates condition).

Reduces cardiac output

Impaired renal function

Reduced physical strength

Hypothermia

Impaired wound healing

Impaired gut integrity and immunity

Loss of muscle for ventilation

Impaired liver function and fatty necrosis

26
Q

Reasons for hospital causing malnutrition [4]

A

Food is inadequate/ unpalatable/ unsustainable

Patients cannot reach food or feed themselves

Patients have a poor appetite

Starved before and after surgery

27
Q

Medical causes of inadequate intake [8]

A

Poor diet

Poor appetite/ taste disturbance

NBM for investigations or medical reasons

Pain/ nausea

Dysphagia- difficulty swallowing.

Depression

Physical disability

Unconsciousness

28
Q

Environmental causes of inadequate intake

A

Poor food quality

Poor food availability

Meal times not protected

Inadequate training and knowledge of medical and nursing staff.

29
Q

Patients at risk of malnutrition

A

Patients with:

  • Low weight
  • Weight loss
  • Predicted/ poor intake of food
  • Poor absorptive capacity
  • High nutrient losses
  • Increased nutritional needs, like sepsis, burns.
30
Q

MUST screening tool.

A

Diagnostic tool used to predict the risk of a patient being malnourished.
Score 2 or more = high risk

  1. BMI score:
    >20= 0
    Normal, 18.5-20 = 1
    <18.5 =2

+

  1. Weight loss score: unplanned weight loss in the past 3-6 months.
    <5%= 0
    5-10 =1
    >10 = 2

+

  1. Acute disease effect score:
    If patient is acutely ill and has been or likely to have not nutritional intake for >5 days, score= 2
31
Q

MUAC

A

Mid upper arm circumference

A method of estimating the BMI category

Subject’s left arm is at 90 degrees and the distance between the acromion and olecranon process is measured.

Let the patient’s arm hang loose and measure the circumference of the arm midpoint of the distance.

MUAC< 23.5 = BMI< 20
MUAC >32 = BMI > 30

32
Q

Action taken for someone at low risk of being malnourished.

A

Routine clinical care: Repeated screening

Hospital- weekly
Care home- monthly
Community- annually

33
Q

Action taken for someone at medium risk of being malnourished.

A

Observation:

Document dietary intake for 3 days.

  • Little concern = repeated screening
  • Clinical concern= follow local policy and set goals to increase nutritional intake.
34
Q

Action taken for someone at high risk of being malnourished.

A

Treatment:
Referral to dietitian, nutritional support team or implement local policy.

Set goals and improve overall nutritional intake

Monitor and improve care plan

Module 104: Theme 1 (18 decks)

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