Malnutrition and Nutritional Assessment Flashcards
Define malnutrition
A state resulting from lack of uptake or intake of nutrition leading to altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease
Is malnutrition more common in men or women?
Women
What age is malnutrition most common in?
Older people (over 65) Also a bit in younger people
In what patients is malnutrition more common?
Those with long standing or chronic progressive conditions
People who have used drugs/alcohol Gastroenterology patients
Can malnutrition be put down to insufficient or poor quality food provided by hospitals?
No, most hospitals provide nutritional food but patients only intake average 40% of whats given to them (due to eg anorexia, GI symptoms, inactivity, depression, quality of food, belief that medical treatment is the main priority)
Why is malnutrition bad?
There is physical and functional decline and poorer clinical outcomes including increased mortality, septic and post-surgical complications, length of hospital-stay, pressure sores, re-admissions, dependency
What is the first step in diagnosing malnutrition?
Screen the patient via a screening too (bapen tool is used)
After a patient has been screened for malnutrition if they are at risk whats the next step?
Assessment by a dietician involving anthropometry, biochemistry, clinical assessment, dietary assessment, social and physical factors, nutrition requirement
What is anthropometry?
Measuring different compartments of the body
What is useful for measuring body fat instead of BMI and why?
CT it can differentiate between muscle mass and fat while also differentiating visceral from subcutaneous fat
In the dieticians assessment what is included in biochemistry? Are there any limitations?
Tests for nutrient availability in tissues
May be inaccurate due to inflammation so only do if CRP is below the threshold
In the dieticians assessment what is included in clinical assessment?
Past history, signs, symptoms, medications
In the dieticians assessment what is included in dietary?
Allergies, aversions, intolerances, cultural, religious, ethical, restriction
In the dieticians assessment what is included in social and physical factors?
Can they access and afford food
Do they live and eat alone
Who cooks for them
Smoking, drug and alcohol addiction
How is nutrition requirement calculated?
Equations are used
What categories of patients show indications for nutrition support?
Malnourished
Those at risk of malnutrition
What are the criteria for malnutrition?
BMI (< 18.5 kg/m2 )
Unintentional weight loss (>10 % past 3 - 6 / 12)
BMI (< 20 kg/m2 + unintentional weight loss > 5 % past 3 – 6 / 12)
What are the criteria for being at risk of malnutrition?
Have eaten little or nothing for > 5 days and / or are likely to eat little or nothing for the next 5 days or longer
Have a poor absorptive capacity, and / or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism
Define artificial nutrition
The provision of enteral or parenteral nutrients to treat or prevent malnutrition
What are the 2 routes for artificial nutrition?
Enteral nutrition (EN) Parenteral nutrition (PN)
Which route of artificial nutrition is more ideal?
Enteral nutrition
What method of artificial feeding is used if gastric feeding is possible?
Naso-gastric tube (NGT)
What method of artificial feeding is used if gastric feeding is not possible?
Naso-duodenal (NDT) / naso-jejunal tube (NJT)
What method of artificial feeding is used long term?
Gastrostomy/jejunstomy
What are some complications of enteral feeding?
Mechanical= misplacement, blockage, buried bumper Metabolic= hyperglycaemia, deranged electrolytes GI= aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting, diarrhoea
Define parenteral feeding?
The delivery of nutrients, electrolytes and fluid directly into venous blood
What are indications for parenteral feeding?
The delivery of nutrients, electrolytes and fluid directly into venous blood
What are indications for parenteral feeding?
An inadequate or unsafe oral and/or enteral nutritional intake
A non-functioning, inaccessible or perforated gastrointestinal tract
What are the routes of access for parenteral feeding?
Central venous catheter (CVC): tip at superior vena cava and right atrium
Different CVCs for short / long term use
What are some complications of parenteral feeding?
Metabolic= deranged electrolytes, hyperglycaemia, abnormal liver enzymes, oedema, hypertriglyceridemia
Mechanical= pneumo/haemothorax, thrombosis, arrhythmias, thrombus, catheter occlusion, extraversion
Cather related infections
Is nutrition support effective?
Yes, patients receiving support had significantly lower levels of mortality
There was higher energy and protein intake, weight increase and less readmission to hospital, functional status
How are albumin levels useful in relation to malnutrition?
Low plasma albumin = poor prognosis, as inflammation rises albumin synthesis falls
Why do albumin synthesis levels fall when inflammation rises?
Inflammatory stimulus causes activation of monocytes and macrophages lading to cytokine release
Cytokines act on the liver to stimulate production of some proteins whilst down regulating production of others like albumin
Is albumin a valid marker of malnutrition?
Although synthesis falls in inflammation it’s not a good marker, some people may have low albumin despite being overweight due to trauma etc
What is refeeding syndrome?
A group of biochemical shifts & clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition
In starvation what happens to insulin and glucagon levels?
Insulin falls
Glucagon rises
In starvation what happens to water, sodium, potassium, magnesium, phosphate levels?
Increased extracellular water and sodium
Low potassium, magnesium and phospahte
Why does refeeding syndrome arise?
Carbs reduce sodium and fluid excretion causing expansion of extracellular fluid leading to refeeding oedema
What are some consequences of RFS?
Arrhythmia, tachycardia, CHF leading to cardiac arrest, sudden death
Respiratory depression
Encephalopathy, coma, seizures, rhabdomyolysis,
Wernicke’s encephalopathy
What are the categories for RFS?
At risk
High risk
Extremely high risk
Briefly describe how is RFS managed?
Start with very low calorie intake and micronutrients from onset
Correct and monitor electrolytes daily
Administer thiamine from onset
Monitor fluid shifts and minimise risk of fluid or sodium overload
