Malnutrition

Question 1

define malnutrition

Answer 1

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

Question 2

give some consequences of malnutrition

Answer 2

• impaired immune function
• delayed healing
• pressure sores
• immobility
• muscle weakness
• psychological effects

Question 3

what are the 5 MUST steps i screening A malnutrition?

Answer 3

1. measure height and weight to get BMI
2. note percentage unplanned weight loss
3. establish acute disease effect and score
4. add scores from steps 1, 2 and 3
5. use management guidelines to develop care plan

Question 4

what nutritional assessments can you carry out to assess malnutrition?

Answer 4

• anthropometry (mid-arm muscle circumference and triceps, grip strength

Question 5

what is albumin and why is it assessed?

Answer 5

constitutes around 50% of total protein in plasma. due to reduced synthesis when supply of AA is limited

Question 6

what is transferrin and why is it measured

Answer 6

synthesis reduced in protein restriction. affected by APR, iron deficiency and liver disease

Question 7

what is transthyretin (prealbumin) and why is is assessed?

Answer 7

reflects recent dietary intake rather than overall nutritional status. increased in uraemia and dehydration, decreased by APR, fasting

Question 8

what is retinol binding protein and why is it tested?

Answer 8

reflects recent dietary intake rather than overall nutritional status. affected more by energy than protein restriction. levels increased by increased GFR and alcoholism and decreased by chronic liver disorders and vitamin A and zinc deficiency.

Question 9

what is urinary creatinine and why is it assessed?

Answer 9

if renal function normal, excretion rate reflects muscle mass.

Question 10

what is IGF1 and why is it assessed?

Answer 10

reduced in acute and chronic malnutrition and increased with repletion. levels reduced in liver disease and renal failure. Less affected by APR

Question 11

what are micro-nutrients and why are they assessed?

Answer 11

poor correlation between plasma values and intracellular concentration, especially during illness.

Question 12

what biochemical measures would you assess in the older community?

Answer 12

• vitamins A, C, D and E, albumin and zinc

- all lower

Question 13

who needs nutritional support?

Answer 13

• BMI <18.5
• unintentional weight loss >10% within last 3-6 months
• BMI <20 AND unintentional weight loss >5% within last 3-6 months
• have eaten or likely to eat little or nothing for 5 days or longer
• poor absorptive capacity