Malnutrition

Question 1

what is malnutrition?

Answer 1

state of nutrition in which deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (composition), body function, clinical outcome

Question 2

examples of altered nutrient processing?

Answer 2

altered metabolic demands, liver dysfunction

Question 3

traditional paradigm classifying malnutrition?

Answer 3

obesity, marasmus (energy), kwashiorkor (protein)

Question 4

current paradigm of primary etiological origins of malnutrition:

Answer 4

starvation, disease (acute or chronic), advanced aging (>80 years)

Question 5

metabolic response to short starvation (<72h)

Answer 5

v insulin and ^ couterregulatory hormones (glucagon, epinephrine, cortisol), ^glycogenolysis, ^ lipolysis, ^ gluconeogenesis after deplete glyco stores

Question 6

metabolic response to prolonged starvation (>72 hours)

Answer 6

further v insulin, deplete glycogen, ^ beta oxidation of f.a., ^ ketone bodies, adaptation of brain to use ketones as fuel source, reduce net tissue protein catabolism to conserve muscle, v energy expenditure , albumin concentration stays same

Question 7

during adapted (prolonged) starvation, the primary goal of body is to:

Answer 7

conserve body protein

Question 8

preferred substrate for gluconeogenesis that stimulates glucagon secretion and converted to urea in liver

Answer 8

alanine

Question 9

^ _____ excretion reflects myofibrillar protein catabolism

Answer 9

urinary 3-methylhistidine

Question 10

what is cahill cycle?

Answer 10

muscle –> a.a. for energy –> N + pyruvate –>alanine–>urea and pyruvate for glucose

Question 11

what is cori cycle?

Answer 11

lactate produced by anaerobic glycolysis in muscles moves to liver and converted to glucose

Question 12

muscle releases ____

Answer 12

glutamine

Question 13

why decreased kcal needs in adapted (prolonged) starvation?

Answer 13

decrease in cortisol and T3, which v BMR

Question 14

hypermetabolic, catabolic state occurring in response to severe infection/sepsis, injury/trauma, burns, necrosis, presence of tumour cells

Answer 14

metabolic stress

Question 15

what happens in stress state?

Answer 15

normal adaptive response of simple starvation to conserve body protein is overridden by cytokine and neuroendocrine effects of injury

Question 16

what are cytokines?

Answer 16

signalling proteins aiding in cell to cell communication, mediate/regulate immunity, inflammation, hematopoiesis

Question 17

3 different actions of cytokine;

Answer 17

autocrine (binds to receptor of same sell that secretes), paracrine (binds to receptor on celll in close proximity to secreter), endocrine (travels through circ and acts on target cells that are distant)

Question 18

major pro-inflammatory cytokines

Answer 18

TNF, IL-1 and IL-6

Question 19

effects of cytokines during injury and infection

Answer 19

^ blood lipids, fever, ^ glucose synth, ^ plasma copper, v plasma zinc/iron, appetite loss and lethargy, ^ acute phase protein synth, ^ oxidant molecules, loss of lean tissue and fat

Question 20

this protein stimulates phagocytosis, activates complement proteins needed for antibody-induced destruction of microorganisms, concentrations rise greatly when inflamm.

Answer 20

C-reactive protein

Question 21

effects of neuroendocrine stress response:

Answer 21

mobilization of substrates (glucose, glutamine, f.a.), proteolysis in peripheral tissues, gluconeogenesis, insulin/growth hormone resistance, fluid retention, ^ REE

Question 22

what does stress response do?

Answer 22

^ oxygen supply, greater availability of substrates for metabolically active tissues

Question 23

ketone body production is greater in starvation or stress?

Answer 23

starvation

Question 24

resp quotient of starvation is ___ and in stress is ___

Answer 24

0.6-0.7; 0.8-0.9

Question 25

3 internationally recognized malnutrition assessment tools:

Answer 25

SGA, ASPEN/AND, ESPEN

Question 26

components of SGA:

Answer 26

changes in wt, diet intake, GI symptoms, functional capacity, physical assessment, metabolic stress

Question 27

SGA is a ___ system

Answer 27

weighted

Question 28

these 3 components of SGA carry most wt for clinical decision

Answer 28

nutrition intake, net unintended wt loss, evaluation of muscle and fat

Question 29

2 step approach of ASPEN/AND:

Answer 29

identify etiology, determine severity by 6 clinical characteristics (reduced energy intake, wt loss, muscle mass loss, body fat loss, fluid accumulation, decreased HGS)

Question 30

how to identify etiology?

Answer 30

risk identified, is there inflammation? how severe is inflammation if it is present?

Question 31

diagnosis of malnutriton requires id of ____ + characteristics of ASPEN/AND

Answer 31

2

Question 32

ESPEN criteria?

Answer 32

vBMI (<18.5), reduced BMI (<20 if <70, <22 if >70) or low FFM (gender specific) + unintentional wt loss >10% or >5% in last 3 months

Question 33

why ESPEN just look at wt loss, BMI and FFMI?

Answer 33

wt loss=v food intake and imbalance of requirements and intake, BMI commonly accepted, FFMI used evaluate muscle (functional ability, a a pool, energy expenditure and glucose metabolism) ; functional measures not used cuz not nutr specific

Question 34

for GLIM diagnosis malnitrition, at least ______ criterion should be present

Answer 34

1 phenotypic (observable) and 1 etiologic (cause)

Question 35

phenotypic criteria include:

Answer 35

non volitional wt loss, low BMI, reduced muscle mass

Question 36

etiologic criteria include:

Answer 36

reduced food intake, inflammation

Question 37

severity according to GLIM based on ___ criteria

Answer 37

phenotypic

Question 38

GLIM diagnosis categories:

Answer 38

chronic disease w/ inflammation, chronic without inflammation, acute w/ severe inflammation, starvation associated with social/enviro factors

Question 39

approach to identifying micronutrient deficiencies:

Answer 39

condition/disease states associated with deficiencies, physical signs of deficiencies and excess based on body system

Question 40

what is petechiae?

Answer 40

broken blood vessels

Question 41

clubbing of nails caused by:

Answer 41

COPD, cyanotic congenital heart disease

Question 42

corkscrew hair indicative of ___ deficiency

Answer 42

vitamin C

Question 43

bitots spots indicate ____ deficiency

Answer 43

vitamin A

Question 44

pallor conjunctiva indicates ____ deficiency

Answer 44

iron

Question 45

scleral icterus indicates _____

Answer 45

liver disease (circulating bilirubin)

Question 46

cheilities is ____, glossitis is ____ and mucositis is___

Answer 46

cracking on side of mouth/lips; glossy tongue; dead tissue patches common from radiation in chemo

Question 47

jugular venous distension is common in:

Answer 47

fluid overload, disease states (CHF)

Question 48

knock knees and bowing are indicative of ___

Answer 48

rickets

Question 49

nutrition screening is to identify ppl at _____, involves set of standarized criteria to ____ determine whether full nutr assessment/intervention is warranted

Answer 49

nutrition risk; quickly

Question 50

examples of nutr screening tools:

Answer 50

INPAC, MNA-SF, MST, MUST, NRS-2002

Question 51

common indicators in nutrition screening tools

Answer 51

unintentional wt loss, recent dietary intake, appetite/probs with intake

Question 52

INPAC screening:

Answer 52

wt loss in 6 months not trying, eating less than usual

Question 53

MNA screening:

Answer 53

BMI, neuropsych probs, stress/acute disease, mobility, wt loss during last 3 months, food intake decline/digestive probs/dysphagia, calf circumference (point score)

Question 54

MUST screening:

Answer 54

BMI, wt loss, acute disease effect scores