Malnutrition Flashcards
what is malnutrition?
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
examples of altered nutrient processing?
altered metabolic demands, liver dysfunction
traditional paradigm classifying malnutrition?
obesity, marasmus (energy), kwashiorkor (protein)
current paradigm of primary etiological origins of malnutrition:
starvation, disease (acute or chronic), advanced aging (>80 years)
metabolic response to short starvation (<72h)
v insulin and ^ couterregulatory hormones (glucagon, epinephrine, cortisol), ^glycogenolysis, ^ lipolysis, ^ gluconeogenesis after deplete glyco stores
metabolic response to prolonged starvation (>72 hours)
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
during adapted (prolonged) starvation, the primary goal of body is to:
conserve body protein
preferred substrate for gluconeogenesis that stimulates glucagon secretion and converted to urea in liver
alanine
^ _____ excretion reflects myofibrillar protein catabolism
urinary 3-methylhistidine
what is cahill cycle?
muscle –> a.a. for energy –> N + pyruvate –>alanine–>urea and pyruvate for glucose
what is cori cycle?
lactate produced by anaerobic glycolysis in muscles moves to liver and converted to glucose
muscle releases ____
glutamine
why decreased kcal needs in adapted (prolonged) starvation?
decrease in cortisol and T3, which v BMR
hypermetabolic, catabolic state occurring in response to severe infection/sepsis, injury/trauma, burns, necrosis, presence of tumour cells
metabolic stress
what happens in stress state?
normal adaptive response of simple starvation to conserve body protein is overridden by cytokine and neuroendocrine effects of injury
what are cytokines?
signalling proteins aiding in cell to cell communication, mediate/regulate immunity, inflammation, hematopoiesis
3 different actions of cytokine;
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)
major pro-inflammatory cytokines
TNF, IL-1 and IL-6
effects of cytokines during injury and infection
^ 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
this protein stimulates phagocytosis, activates complement proteins needed for antibody-induced destruction of microorganisms, concentrations rise greatly when inflamm.
C-reactive protein
effects of neuroendocrine stress response:
mobilization of substrates (glucose, glutamine, f.a.), proteolysis in peripheral tissues, gluconeogenesis, insulin/growth hormone resistance, fluid retention, ^ REE
what does stress response do?
^ oxygen supply, greater availability of substrates for metabolically active tissues
ketone body production is greater in starvation or stress?
starvation
resp quotient of starvation is ___ and in stress is ___
0.6-0.7; 0.8-0.9
3 internationally recognized malnutrition assessment tools:
SGA, ASPEN/AND, ESPEN
components of SGA:
changes in wt, diet intake, GI symptoms, functional capacity, physical assessment, metabolic stress
SGA is a ___ system
weighted
these 3 components of SGA carry most wt for clinical decision
nutrition intake, net unintended wt loss, evaluation of muscle and fat
2 step approach of ASPEN/AND:
identify etiology, determine severity by 6 clinical characteristics (reduced energy intake, wt loss, muscle mass loss, body fat loss, fluid accumulation, decreased HGS)
how to identify etiology?
risk identified, is there inflammation? how severe is inflammation if it is present?
diagnosis of malnutriton requires id of ____ + characteristics of ASPEN/AND
2
ESPEN criteria?
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
why ESPEN just look at wt loss, BMI and FFMI?
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
for GLIM diagnosis malnitrition, at least ______ criterion should be present
1 phenotypic (observable) and 1 etiologic (cause)
phenotypic criteria include:
non volitional wt loss, low BMI, reduced muscle mass
etiologic criteria include:
reduced food intake, inflammation
severity according to GLIM based on ___ criteria
phenotypic
GLIM diagnosis categories:
chronic disease w/ inflammation, chronic without inflammation, acute w/ severe inflammation, starvation associated with social/enviro factors
approach to identifying micronutrient deficiencies:
condition/disease states associated with deficiencies, physical signs of deficiencies and excess based on body system
what is petechiae?
broken blood vessels
clubbing of nails caused by:
COPD, cyanotic congenital heart disease
corkscrew hair indicative of ___ deficiency
vitamin C
bitots spots indicate ____ deficiency
vitamin A
pallor conjunctiva indicates ____ deficiency
iron
scleral icterus indicates _____
liver disease (circulating bilirubin)
cheilities is ____, glossitis is ____ and mucositis is___
cracking on side of mouth/lips; glossy tongue; dead tissue patches common from radiation in chemo
jugular venous distension is common in:
fluid overload, disease states (CHF)
knock knees and bowing are indicative of ___
rickets
nutrition screening is to identify ppl at _____, involves set of standarized criteria to ____ determine whether full nutr assessment/intervention is warranted
nutrition risk; quickly
examples of nutr screening tools:
INPAC, MNA-SF, MST, MUST, NRS-2002
common indicators in nutrition screening tools
unintentional wt loss, recent dietary intake, appetite/probs with intake
INPAC screening:
wt loss in 6 months not trying, eating less than usual
MNA screening:
BMI, neuropsych probs, stress/acute disease, mobility, wt loss during last 3 months, food intake decline/digestive probs/dysphagia, calf circumference (point score)
MUST screening:
BMI, wt loss, acute disease effect scores
