Malnutrition Maclary Flashcards
Definition of malnutrition
Insufficient energy and/or protein available to meet metabolic demands
Definition of macronutrient malnutrition
Deficiency in protein energy intake
Definition of micronutrient malnutrition
Deficiency in vitamin and mineral intake
Types of malnutrition
- Macronutrient
- Micronutrient
What is necessary to maintain stable weight?
Energy input = energy output
Standard unit of energy
Calorie or kilocalorie
1 kcal = 1000 cal
How many kcal/gram in carbs, fat, and protein?
- 4.1 kcal/gram of carbs
- 9.3 kcal/gram of fat
- 4.1 kcal/gram of protein
Average energy intake for American male per day
2600 kcal/day
Average energy intake for American female per day
1900 kcal/day
How to estimate caloric need?
Calculate resting energy
- males 900 kcal + 10x kg mass
- females 700 kcal + 7x kg mass
Protein requirement per day
0.6 g/kg
10-14% of calories
Fat requirement per day
No more than 30% calories
Carbs requirement per day
45-55% of calories
Describe carbohydrates
- Main source of fuel
- Easily used for energy
- Stored in liver and muscle for later use
- Found in grains, potatoes, fruits, milk, veggies
What is the main source of fuel?
Carbohydrates
Describe protein
- Needed for growth
- Tissue repair and immune function
- Energy source when carbs are not available
- Preserves lean muscle mass
- Found in meats, fish, cheese
Describe fats
- Some needed for survival
- Needed for normal growth/development
- Absorbs certain vitamins
- Provides cushion for organs
- Found in meat, nuts, dairy
Describe water as a nutrient
- Regulation of core temp
- Transport of nutrients, O2, waste
- Amt decreases w/aging
What contributes to a third of all deaths in children under 5?
Malnutrition
Where are 80% of the world’s undernourished children located?
Just 20 countries around the world
Malnutrition affects which populations?
Both rural and urban
Which developing country has the highest rate of undernourished children?
India
Which developing countries have highest prevalence of undernutrition?
South Asia
Sub-Saharan Africa
Direct etiologies of malnutrition
- Primary (inadequate food intake)
- Secondary (underlying disease)
Indirect causes of malnutrition
Poverty, poor health, war, discrimination, governmental
What percent of weight loss is usually tolerated without loss of physiologic function?
5-10%
What percent of weight loss usually results in death?
35-40%
Which organ systems does malnutrition affect?
Every organ system
Factors to evaluate while screening for malnutrition:
- Underweight
- Poor intake
- Hypermetabolic states
- Alcohol or drug abuse
What screening tool is used for malnutrition?
MUST (5 step screening for adults)
- BMI
- Weight loss
- Acute disease
- Evaluate risk
- Record score and start care plan
Treatment of malnutrition
- Treat underlying process
- Diet modification
- Replenish micronutrients
- Referrals
Types of macronutrient malnutrition
- Marasmus/cachexia
2. Kwashiorkor/protein calorie malnutrition
Define marasmus
- All available body fat stores have been exhausted d/t starvation
- Decreased energy intake
- Can be a chronic state
How long does it take to develop marasmus?
May take months to years
Define cachexia
Involves substantial loss of lean body mass d/t chronic systemic inflammation
Marasmus commonly occurs with what health condition?
Anorexia nervosa
Cachexia commonly occurs with what health condition?
COPD
*Any other chronic disease state
Clinical features of marasmus
- Starved appearance
- Wt less than 80% standard for height
- Triceps skinfold less than 3 mm
- Midarm muscle circumference less than 15 cm
- Absolute weakness
Immunocompetence, wound healing, ability to handle short term stress is well preserved in which condition?
Marasmus
What is low creatinine height index possibly seen in and what does it reflect?
- Marasmus
- Reflects loss of muscle mass
A slightly decreased serum albumin is seen in what condition?
Marasmus
Treatment of marasmus
- Cautious and slow
- Body needs to readapt
- Oral nutritional support is preferred
What nutritional support is preferred in treating marasmus?
Oral
Define kwashiorkor
- Protein malnutrition
- Acute life threatening illness such as sepsis and trauma
Clinical features of kwashiorkor
- May be subtle at first
- Easy hair pluck
- Edema
- Skin breakdown
- Poor wound healing
- Pot belly appearance
Which type of malnutrition usually has drastic lab abnormalities?
Kwashiorkor
Lab findings of kwashiorkor
- Serum albumin less than 2.8
- Total iron binding capacity less than 200
- Lymphocytes less than 1500
Treatment of kwashiorkor
- Aggressive nutritional support
- Restore balance quickly
- Parenteral replacement
Which type of malnutrition requires quick and aggressive nutritional support?
Kwashiorkor
Which type of malnutrition requires slow restoration of nutrition?
Marasmus
What is the prognosis of kwashiorkor?
Poor - high mortality rate
How does metabolic rate change in starvation and semistarvation?
- Falls between 10 and 30%
- Body’s response to energy restriction
- Wt loss is slowed by this process
How is metabolic rate affected by physiologic stress?
- Resting rate rises
- Degree of rise depends on degree of stress (e.g. elective surgery only 10% rise vs. major burns with 110% rise)
Types of metabolic states (define and what malnutrition state are they at risk for)
- Hypermetabolic (stressed from injury/infection, risk for kwashiorkor)
- Hypometabolic (unstressed but chronically starved, risk for marasmus)
Which type of metabolic state causes an increased risk for marasmus?
Hypometabolic state
Which type of metabolic state causes an increased risk for kwashiorkor?
Hypermetabolic state
How is rate of catabolism affected by stress or injury?
Rate increases proportional to degree of injury
What are the major gluconeogenic tissues?
Liver and kidney
Key gluconeogenic enzymes are expressed where?
Small intestine
What is glucose especially necessary for?
- Nervous system
- Erythrocytes
Vit B1 (thiamine) deficiency causes
- Lack of thiamine intake (alcoholic, starvation, gastric bypass)
- Increased depletion (diuretics, diarrhea)
- Decreased absorption (chronic intestinal disease, malnutrition)
Prolonged thiamine deficiency causes:
Beriberi
What causes Wernicke encephalopathy?
Thiamine deficiency
What causes Wernick-Korsakoff syndrome?
Thiamine deficiency
Describe Wernicke encephalopathy
- Occurs in alcoholic pts w/thiamine deficiency
- Acute sequence of vomiting, horizontal nystagmus, fever, ataxia, progressive mental impairment
Describe Wernicke-Korsakoff syndrome
- Chronic thiamine deficiency
- Memory loss
- Confabulatory psychosis
Describe riboflavin and how it is affected
- Vit B2
- Glass milk containers promote degradation of the vitamin from exposure to light
Clinical findings of riboflavin deficiency
- Cheilitis (chapping/fissuring of lips)
- Sore red tongue
- Oily scaly skin
Vitamin B3 is also called
Niacin
Niacin deficiency
- Diarrhea, dermatitis, dementia, death
- Pellagra (scaly sores, mucosal changes)
Vitamin B5 is also called
Pantothenic acid
Clinical findings of Vit B5 deficiency
Nonspecific symptoms
Vit B6 is also called
Pyridoxine
Vit B6 deficiency
Rare bc it is found in a lot of foods
Vit B12 is also called
Cobalamin
Vit B12 deficiency occurs in what pts?
- Inadequate intake (alcoholics, vegetarians)
- Malabsorption (lack of intrinsic factor like in pernicious anemia)
Vit B9 is also called
Folic acid
Causes of Vit B9 deficiency
- Poor diet
- Malabsorption
- Deficiency in B12
- Anticonvulsants
Vit C is also called
Ascorbic acid
Causes of Vit C deficiency
- Poor diet
- Smokers
- Increased consumption states (pregnancy, lactation)
How does scurvy present?
- Easy bruising
- Gingivitis
- Decreased wound healing rate
- Dry, splitting hair
Vit A deficiency
- Uncommon in US
- Caused by poor diet, malabsorption, vegans, alcoholics
Bitot spots occur with what deficiency?
Vit A deficiency
esp young children
What are bitot spots?
- Area of abnormal squamous cell proliferation and keratinization of the conjunctiva
- Can be seen in young children with Vit A deficiency
Clinical presentation of Vit A deficiency
- Bitot spots
- Night blindness
- Xerophthalmia
Causes of Vit E deficiency
- Pts who cannot absorb dietary fat
- Premature infants w/low birth wt
- Rare disorders of fat metabolism
Clinical presentation of Vit E deficiency
- Anemia
- Impairment of immune response
- Male infertility
- Neuromuscular problems
Presentation of acute calcium deficiency
- Convulsions
- Arrhythmias
- Tetany
- Numbness in hands, feet, around mouth and lips
Presentation of long term calcium deficiency
- Rickets
- Osteoporosis
Causes of calcium deficiency
- HypoPTH
- Eating disorders
- Excessive dietary Mg
- CKD
- Absence of Vit D
What is the function of zinc?
- Cell division
- Clotting
- DNA synth
- Protein synth
Define acrodermatitis enteropathica
Autosomal recessive metabolic disorder affecting the uptake of zinc
Function of copper
Bone and CT production
Why is copper deficiency rare?
Body requirements are very low
What causes copper deficiency?
- Bariatric surgery
- Menkes disease
- Wilson’s disease
What is considered clinically significant involuntary weight loss?
10 lbs or 5+% over a 6-12 month timeframe
Main categories of involuntary weight loss
- Malignant neoplasms
- Chronic inflammatory or infectious diseases
- Metabolic disorders (DM)
- Psych
Major manifestations of involuntary weight loss
- Anorexia
- Sarcopenia
- Cachexia
- Dehydration
