Malnutrition- Exam 1 Flashcards
______ general state of inadequate nutrient and/or energy intake and absorption to meet metabolic demands.
malnutrition
malnutrition can be defined as ?????
“Not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat
What are the causes of malnutrition?
poor intake
poor absorption
increased metabolic needs
___ of deaths in children worldwide under 5 years of age have been linked to undernutrition
45%
What are some impacts of malnutrition?
low mood
weight loss
low energy
muscle wasting
increased risk of fractures
increased risk of hospital admissions
confusion
infections
reduced independence
increased risk of falls
reduced mobility
About ___ of households had “low” or “very low” food security
Jumps to ____ when looking only at households with children
13%
17%
Estimated that up to ____ of US adults do not consume adequate amounts of the nutrients that they need, on a regular basis, to support optimal health
85%
specially fiber, vitamins, minerals, omega 3 FA
What are some screening tools that screen for malnutrition?
Subjective Global Assessment (SGA)
Malnutrition Universal Screening Tool (MUST)
Malnutrition Screening Tool (MST)
Types of screening tools: ______: combines hx, ROS, and PE findings
Categorizes pts as well-nourished, mild-moderately malnourished, or severely malnourished
Subjective Global Assessment (SGA)
Types of screening tools: ______: Utilizes BMI, unintentional weight loss, and effects of acute disease to determine risk for malnutrition
Offers recommendations based on risk level
Malnutrition Universal Screening Tool (MUST)
Types of screening tools: ______: Simple, 2-question screen to determine risk of malnutrition
Malnutrition Screening Tool (MST)
Name some H&P findings that can help reflect nutritional status
Nutritional habits and intake (“picky eaters”)
Social questions - to determine food security
Psych history
Baseline “usual” weight compared to current
Percent usual weight - (actual weight ➗ usual weight) x 100
How do you screen young children for malnutrition?
body length and head circumference
**Cell with ???? are better ways to check for malnutrition. Give some examples
rapid turnover rate or high metabolism
Integumentary - skin, hair, nails, mucosal membranes
Hematopoiesis - immunosuppression, anemia, bleeding or bruising
What are some physical screening processes that you can do to test for malnutrition?
skinfold thickness
midarm muscle circumference
In men, what does the triceps skinfold thickness need to be? in women?
thickness < 12.5 mm = malnutrition, > 20 mm = overnutrition
thickness < 16.5 mm = malnutrition, > 25 mm = overnutrition
In midarm muscle circumference, the value needs to be ??? in order to be considered malnutrition?
less than 15th percentile
How do you assess underweight in children?
growth charts or failure to thrive
____ is considered low height for age
____ is considered low weight for age
stunting: height
wasting: weight
T/F: Every malnourished pt is underweight
FALSE!! Not every malnourished patient is underweight
______ is considered the gold standard imaging tool for malnutrition. Not used very often
DEXA scan
With labs associated with screening for malnutrition need to assess for ___ and _____
somatic and visceral proteins
Somatic proteins assess ?????. What is a way to test for it?
relative state of skeletal muscle mass
24 hour urinary creatinine excretion
Name 4 visceral proteins
albumin, transferrin, prealbumin, retinol-binding protein
_____ is the most commonly used visceral protein. What is the 1/2 life?
albumin
20 days
Name some clinical scenarios in which albumin might be low?
low in acute sepsis and liver disease
_____ is more useful in a very acute malnourishment. What is the 1/2 life?
prealbumin
also depressed in acute stress states
2 days
_____ is elevated in iron deficiency states. What is the 1/2 life?
transferrin
8-10 days
What labs would you want to order?
CBC, CRP, ESR
Urinalysis +/- Urine culture
order ____ to screen for anemia, chronic infection, inflammation, cancer
CBC, CRP, ESR
order _____ to evaluate for kidney disease and chronic UTI
Urinalysis +/- Urine culture
Order ____ to test for amylase, lipase, +/- C peptide
pancreatic testing
_____ nutrient reference values developed by the Institute of Medicine to quantify recommended levels of a given nutrient necessary for optimal health based on a patient’s individual characteristics (e.g. height, gender, activity level)
Dietary reference Intake (DRI)
_____ average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender group
Recommended Dietary Allowance (RDA)
_____ recommended average daily intake level based on approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate
Adequate Intake (AI)
use _____ with an RDA cannot be determined
Adequate Intake
_______ average daily nutrient intake level estimated to meet the requirement of half (50%) the healthy individuals for a particular life stage and biologic sex
Estimated Average Requirement (EAR)
______ EAR specifically used for energy - average dietary intake predicted to maintain energy balance in healthy individuals of a given age, gender, weight, height, and physical activity level consistent with good health
Estimated Energy Requirement (EER)
EER includes extra metabolic needs during ?????
pregnancy, lactation or childhood
T/F: There is no upper intake level (UL) or recommended dietary allowance (RDA) for energy
True
_____ highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in the general population
Tolerable Upper Intake Level (UL)
_____ energy expenditure needed to sustain the metabolic activities of cells and tissues, blood circulation, respiration, GI and renal processing, and staying awake. How is it determined?
Basal Metabolic Rate (BMR)
subject reclining after a 12 hour fast
What is the difference between BMR and BEE?
Basal energy expenditure (BEE) - BMR extrapolated to 24 hours
______ Similar to BMR; accounts for energy expenditure increases due to recent food intake or recently completed physical activity
Resting Metabolic Rate (RMR)
The RMR is ______ than BMR on average
10-20% higher
What is the difference between RMR and REE?
Resting energy expenditure (REE) - RMR extrapolated to 24 hours
What is the clinical presentation of malnutrition?
iron deficiency, folate, vit D, B vitamins, Vit A, Iodine deficiency
Malnutrition in underdeveloped countries tends to show up as ____ and _____
Vit A and iodine deficiencies
_____ is the most common deficiency in the US
folate deficiencies
_____ state of protein and total energy malnutrition body’s requirements for calories are not met by intake
Marasmus
**Relatively large head with large, staring eyes
Emaciated, weak appearance
Thin, dry skin with thin, sparse hair that is easily plucked
Shrunken arms, thighs, and buttocks with redundant skin folds
Bradycardia, hypotension, hypothermia
Irritable, fretful demeanor
What am I?
marasmus
_____ protein malnutrition in the presence of caloric intake. Classically seen in babies weaned from the breast in low-income countries
Kwashiorkor
Growth retardation
Changes in skin and hair pigmentation, and thin, dry, peeling skin
Low serum albumin
Bradycardia, hypotension, and hypothermia
Distended abdomen with dilated intestinal loops
May see hepatomegaly from fatty liver infiltrates
Lethargic, apathetic, irritable
Classic edematous appearance
What am I?
Kwashiorkor
________: multifactorial wasting syndrome defined by continuous loss of skeletal muscle mass, with or without loss of fat mass
Cachexia
Can cachexia be fully reversed?
Cannot be fully reversed by conventional nutritional support
Cachexia affects ____ of cancer patients
50-80% of cancer patients
Cachexia is thought to be tied to ______
mitochondrial dysfunction
Mitochondrial dysfunction _____ ATP and protein synthesis. ______ oxidative stress in the body. _____ inflammatory markers
Decreases
Increases
Elevated
Enteral feeding includes _____ and _____ tubes. Give some examples
oral and feeding
NG tubes
PEG tubes
How is parenteral nutrition usually delivered? When is it indicated?
usually delivered through a central line
only indicated if the gut is not working
What does parenteral nutrition carry a higher risk of ??
bacteremia and sepsis, poorer weight gain
_____ : fever, HSM, and coagulopathy due to fat sludging
Fat overload syndrome
_____ is associated with bone metabolism disease in children with long-term use
parenteral nutrition
What are some helpful principles of low appetite/anorexic patients?
Frequent spacing of small meals
Prioritize energy-dense foods
Avoid distractions during mealtime
Powdered or liquid nutritional supplementation
Pediasure, Ensure, protein powders
Adding calories and nutrition to preferred foods
T/F: All dietitians recommend powdered or liquid nutritional supplementation to help anorexic patients?
False: Controversial - not always shown to reduce hospitalizations, survival, QOL
_____ sweating, flushing, dizziness, and tachycardia caused by large amounts of foods (especially high intake of simple sugars) moving rapidly from the stomach into the bowel. How do you prevent it?
Dumping syndrome
Slow infusion rate and amount of feeding given at one time
_____ synthetic progestin which has been found to promote appetite
Megestrol acetate (Megace)
_____ is used in anorexic/ cachexia associated with AIDS and cancer related cachexia (off label)
Megestrol acetate (Megace)
_____ 1st generation Antihistamine. Commonly given to pediatric patients.
Cyproheptadine (Periactin)
MAOI therapy; urinary or gastric obstruction (BPH, stenosis, etc.); acute angle-closure glaucoma; gastric ulcer. premature infants, neonates, pregnant or breastfeeding women, elderly or debilitated patients
These are the CI for _____
Cyproheptadine (Periactin)
______ Cannabinoid-derived agent (THC); can suppress N/V and promote appetite
Used mostly in patients AIDS and patients on chemotherapy
Controlled - Schedule III
Dronabinol (Marinol)
use of disulfiram or metronidazole in last 14 d; allergy to alcohol or sesame oil.
These are the CI to ______
Dronabinol (Marinol)
GI upset, headache, insomnia, rash
SE of _____
Megestrol acetate (Megace)
dizziness, drowsiness, anticholinergic
These are the SE of _____
Cyproheptadine (Periactin)
euphoria, GI upset, dizziness, drowsiness, AMS
These are the SE of _____
Dronabinol (Marinol)
**What is the major CI to Dronabinol (Marinol)?
allergy to alcohol or sesame oil
