Malnutrition Flashcards
what is malnutrtion?
defieicnies, excesses or imbalances in a person intake of energy or nutrients- WHO
what are the different types of undernutrition and define
stunting, wasting, underweight
stunting- low height for age
wasting- low weight for height
underweight- low weight for age
what are the types of overnutriton?
overweight
obesity
diet-relared non-communicabel diseases (Heart disease, stroke, diabetes, cancer)
how can we define types of malnutrtion
specific (nutrient missing)
long stadning ( after period of inadequate eating)
sudden ( sudden marked change in food intake- bereavemet)
recurrent (cycles of inadeuqate nutritona —> malnutiriton)
what are the causes of severe undeniutrtion globally?
lack of dietary education (inapproproate weaning)
limited or unstabel food supply (war/famine/poverty)
presence of infection (poor hygiene- reduced appeitie/aborpsiton/ increased nutrition loss)
what is Kwashiorkor?
pure protein deficiency without energy deficiency (lack of protein but normal calorie intake?
- stunting
- suceptibilioty to infections
- hair colour changes (melanin not made)
- flaking skin
- impaired nutrietn absorption
- bloated abdomin (fat accumualitng in liver and fluid in abdomen)
- lethargic
- poor appetite
what is this?
Marasmsus- Protein-energy malnutrtion
emaciated (body fat stores used for energy)
ketosis
lack of energy AND protein itnake
- ribs very prominent
- alert and irritable
- severe muscle wasting
- Voracious feeder
why might individuals become malnourished?
inadeuqate nutrient intake
increased metabolic requirmeents
excessive nutrient losses
what are the consequences to the indivdual of malnutriton
- infertility
- skin and chest infections
- would complications
- DVT and embolisms
- hypothermia
- pressure ulver
- repsiatory failure
loss of earning/ employment
psychological
what Tool can we use to asses Malnutriton?
MUST
MUST- malnutriton universals creening
- BMI (below 18.5kgm2 2 points, 18.520kg/m2- 1 point)
- unplanned weight loss over 3-6 months ( 5-10% bodyweight 1 point) (> 10% 2)
- acute disease effect- ill and no nutritonal itnake for >5 days - 2 points
- overall risk fo malnutrtion
- 2 or more hgih risk, 1 medium risk
- action
what is a nutrtional assesment - ABCDE?
- Antropology
- wight, BMI, % weight change, Mid upper arm cirucmference
- bloods
- Hb- albumin, C reactive protien, WCC< HB1ac, soidum, urea, calcium and phosphate (baseline used when assessing risk of refeeding sydnrome), magneisum (GI losses), micronutrients
- CLinical
- disease state may increase risk of malnutriton, symptoms caused by disease . altered bowel movements, Upper gastrointrsintal upset, early satiety, dyshgaia , letharyg
- dietary
- dietary assment, and nutritonal requirments of patient
- Envuronment
- social- ability to cook, shop, eocnomic afford food, storage
- physical- appetie, dntures, dexterity, use of cutlery, diarrhoea, pain, dyshagia
how is nutrtional requirmenets different to dietary assesment?
nutrtional screening- simple rapdi genrrla procedure- enegry, protien fluid, macor balcne, micronutirents
nutritonal asssment- more detialed, specif, indepth evaluation- wauntiy, uwiuality of food, poriton sizesm cooking methofs
what are the risk factros for refeeding syndrome?
one or more of- high risk
BMI- less than 16kg/2
unintentional weight loss greater than 15%
little to no nutritonal itnake for 10 dyas
low levels of pottaisdum, poshopsahte or magenisum priot to feeding
conditom hisotyr or drugs
what is the treatment for undernutriton
FOOD
what is oral nutritoanl support?
additiona snakc, fotritified food, oral nutritonal supplemnts, sip food
how can food be foritfied clinically?
fat- cream, butter, cheese, creme fraiche- fat is best 1g= 9Kcal comapred to 4g carbs and protiens
carbs- suagr, jam
Protien- skimmed milk pwoder, peantu butter
what are 3 differen types of fortification of food in scoiety?
mass fortifciaiton (breakf aste cerals -iron)- generla public
targeted fortifiication- specific populations
Market drive fortificiaiton- business oreintaeted intiaitve
what should milkshake type oral nutritoanl supplements contain ideally ?
nutritioanl completet
better with fibre
centrla route or peripheral route for parentenral nutrtion?
central route0 longer term acess- and for concentrated feeds which can be toxic for smaller veins
Peripheral for shorter term use,
what is the use of enteral nutrtion if we havev Parenteral routes?
soem eneterla nutriton maintiend- for the health of the gut
feeds thoug nose
- __Gastric
- nasogastric- short term
- gastrosotmy tubes- logn term
- posy pyloric
- nasoduodenal tube- short term
- nasojejeunal tube- long term
- jejeunostoym- tube long erm
what happens in starvation? that leads to state that is suscpetibel to refeeding sydorme?
consequence of strvation
- levels of gluocse fall withn 24-72 hours
- gluocse maiantiend by glycogenoloysus
- gluconeogeneiss
- then meabolsim will shit to ketone
- this sapres skeltla msucle from breakdowmn and fat free mass is prsereces
- in effort to reduce cellular expendiutire action of cellular pumps is reduced- electorlytes leak across mmebrane
- increas ein extracelelular water and depletion of total body pottasium, magnesium and phopshate stores
- Loss of body fat and protein sitll occur- atrphy of guts
Why does rapid reeding after starvation- on a electorlyte/cellular level?
- in the presecne of food (oral, enteral and parenteral)
- conversion backt o glucose as energy supply
- rapdid celine in gluconeogeneis and anareobi metbalosim
- insulin satrts to increase
- ATPase pumps K+ back into cells and water and sodium further into extracellular space
- Potasisum, phosphate, mageniusm
- shift back into cells, strogn cocn gradidnet
- thiamine deficiency b1 (co-enzyme in carb metabolism)
wwhat does refeeding sydnrome reuslt in- in the body?
hypophosphataem
hypokal;aemai
hypomagnesaemia
reduced sodium and water excretion-nextracelelula fluid complarmetn expands- refeeding oedema
Ctimain defificney- B1 thiamine
how do we define Refeeding sydrome?
refeeding syndrom is not a singlular codntion- but a grouop of biochemical shifts and clinical sympotms that occur in the lamnoruished or starved indivudal- upon reintroduction of oral, enteral or parenterl nutrtion
how does Refeeding syndrome manifest clinically?
Cardiac- altered mycodracial fuction, cardiac arrest, arythmia, tachycardia
Respiratory- acute ventilatory failure, dsypnea, respriaotyr depression
renal- acute kidney injudtr, decrease urnry concentrating abiliyt, increase Potaasium loss secondayr to hypojalaemia
Gastro- anorexia, nausa, vommitingm constipation, vommiting
hametaolgical- anemai, dysfunction
MEtabolic- reduced oxygen release to tissues, glucose intolerane.
what does thiamine deficinecy in refeeding syndrome manifest as clinically?
congestive heart fialure, cardiomegalty, pulmonary oedema, pleural efuffison, ataxia, coma
How is refeeding syndrome prevented and managed?
restortiaon of cirulatory volume
oral thimaine 200-300mg dialy
Vitamin B co
addition balancing of multivitamin/trace supplements
Low dose- slow introduciton of nutrients
- and potasdium, phsopahte and maneisum supplementation
- top tsop electorylet shift
- full requirements of fluid, elctorylets , vtimaina nd minerals form the onset
- steady increase in nutrients- consider GI tolerance (diarrhoea if too fats, spread thoughtou day)
describe the steady increase in nutriiton in refeeding
day 1- 10Kcal/kg/day
mainly carbs 50-60%, fat 30-40%, protein 15-20|%
day 2-4 increase by 5Kcal if low tolerance stop or go back lower
day 5-7 20-30 Kcal ‘kg’day
day 8-10 20Kcal/Kg/day or increase to full requirement
