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Clin Med II - GI > Malnutrition Maclary > Flashcards

Malnutrition Maclary Flashcards

1
Q

Definition of malnutrition

A

Insufficient energy and/or protein available to meet metabolic demands

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2
Q

Definition of macronutrient malnutrition

A

Deficiency in protein energy intake

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3
Q

Definition of micronutrient malnutrition

A

Deficiency in vitamin and mineral intake

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4
Q

Types of malnutrition

A
  • Macronutrient

- Micronutrient

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5
Q

What is necessary to maintain stable weight?

A

Energy input = energy output

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6
Q

Standard unit of energy

A

Calorie or kilocalorie

1 kcal = 1000 cal

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7
Q

How many kcal/gram in carbs, fat, and protein?

A
  • 4.1 kcal/gram of carbs
  • 9.3 kcal/gram of fat
  • 4.1 kcal/gram of protein
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8
Q

Average energy intake for American male per day

A

2600 kcal/day

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9
Q

Average energy intake for American female per day

A

1900 kcal/day

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10
Q

How to estimate caloric need?

A

Calculate resting energy

  • males 900 kcal + 10x kg mass
  • females 700 kcal + 7x kg mass
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11
Q

Protein requirement per day

A

0.6 g/kg

10-14% of calories

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12
Q

Fat requirement per day

A

No more than 30% calories

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13
Q

Carbs requirement per day

A

45-55% of calories

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14
Q

Describe carbohydrates

A
  • Main source of fuel
  • Easily used for energy
  • Stored in liver and muscle for later use
  • Found in grains, potatoes, fruits, milk, veggies
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15
Q

What is the main source of fuel?

A

Carbohydrates

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16
Q

Describe protein

A
  • Needed for growth
  • Tissue repair and immune function
  • Energy source when carbs are not available
  • Preserves lean muscle mass
  • Found in meats, fish, cheese
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17
Q

Describe fats

A
  • Some needed for survival
  • Needed for normal growth/development
  • Absorbs certain vitamins
  • Provides cushion for organs
  • Found in meat, nuts, dairy
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18
Q

Describe water as a nutrient

A
  • Regulation of core temp
  • Transport of nutrients, O2, waste
  • Amt decreases w/aging
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19
Q

What contributes to a third of all deaths in children under 5?

A

Malnutrition

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20
Q

Where are 80% of the world’s undernourished children located?

A

Just 20 countries around the world

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21
Q

Malnutrition affects which populations?

A

Both rural and urban

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22
Q

Which developing country has the highest rate of undernourished children?

A

India

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23
Q

Which developing countries have highest prevalence of undernutrition?

A

South Asia

Sub-Saharan Africa

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24
Q

Direct etiologies of malnutrition

A
  • Primary (inadequate food intake)

- Secondary (underlying disease)

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25
Q

Indirect causes of malnutrition

A

Poverty, poor health, war, discrimination, governmental

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26
Q

What percent of weight loss is usually tolerated without loss of physiologic function?

A

5-10%

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27
Q

What percent of weight loss usually results in death?

A

35-40%

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28
Q

Which organ systems does malnutrition affect?

A

Every organ system

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29
Q

Factors to evaluate while screening for malnutrition:

A
  • Underweight
  • Poor intake
  • Hypermetabolic states
  • Alcohol or drug abuse
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30
Q

What screening tool is used for malnutrition?

A

MUST (5 step screening for adults)

  1. BMI
  2. Weight loss
  3. Acute disease
  4. Evaluate risk
  5. Record score and start care plan
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31
Q

Treatment of malnutrition

A
  • Treat underlying process
  • Diet modification
  • Replenish micronutrients
  • Referrals
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32
Q

Types of macronutrient malnutrition

A
  1. Marasmus/cachexia

2. Kwashiorkor/protein calorie malnutrition

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33
Q

Define marasmus

A
  • All available body fat stores have been exhausted d/t starvation
  • Decreased energy intake
  • Can be a chronic state
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34
Q

How long does it take to develop marasmus?

A

May take months to years

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35
Q

Define cachexia

A

Involves substantial loss of lean body mass d/t chronic systemic inflammation

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36
Q

Marasmus commonly occurs with what health condition?

A

Anorexia nervosa

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37
Q

Cachexia commonly occurs with what health condition?

A

COPD

*Any other chronic disease state

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38
Q

Clinical features of marasmus

A
  • Starved appearance
  • Wt less than 80% standard for height
  • Triceps skinfold less than 3 mm
  • Midarm muscle circumference less than 15 cm
  • Absolute weakness
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39
Q

Immunocompetence, wound healing, ability to handle short term stress is well preserved in which condition?

A

Marasmus

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40
Q

What is low creatinine height index possibly seen in and what does it reflect?

A
  • Marasmus

- Reflects loss of muscle mass

41
Q

A slightly decreased serum albumin is seen in what condition?

A

Marasmus

42
Q

Treatment of marasmus

A
  • Cautious and slow
  • Body needs to readapt
  • Oral nutritional support is preferred
43
Q

What nutritional support is preferred in treating marasmus?

A

Oral

44
Q

Define kwashiorkor

A
  • Protein malnutrition

- Acute life threatening illness such as sepsis and trauma

45
Q

Clinical features of kwashiorkor

A
  • May be subtle at first
  • Easy hair pluck
  • Edema
  • Skin breakdown
  • Poor wound healing
  • Pot belly appearance
46
Q

Which type of malnutrition usually has drastic lab abnormalities?

A

Kwashiorkor

47
Q

Lab findings of kwashiorkor

A
  • Serum albumin less than 2.8
  • Total iron binding capacity less than 200
  • Lymphocytes less than 1500
48
Q

Treatment of kwashiorkor

A
  • Aggressive nutritional support
  • Restore balance quickly
  • Parenteral replacement
49
Q

Which type of malnutrition requires quick and aggressive nutritional support?

A

Kwashiorkor

50
Q

Which type of malnutrition requires slow restoration of nutrition?

A

Marasmus

51
Q

What is the prognosis of kwashiorkor?

A

Poor - high mortality rate

52
Q

How does metabolic rate change in starvation and semistarvation?

A
  • Falls between 10 and 30%
  • Body’s response to energy restriction
  • Wt loss is slowed by this process
53
Q

How is metabolic rate affected by physiologic stress?

A
  • Resting rate rises

- Degree of rise depends on degree of stress (e.g. elective surgery only 10% rise vs. major burns with 110% rise)

54
Q

Types of metabolic states (define and what malnutrition state are they at risk for)

A
  • Hypermetabolic (stressed from injury/infection, risk for kwashiorkor)
  • Hypometabolic (unstressed but chronically starved, risk for marasmus)
55
Q

Which type of metabolic state causes an increased risk for marasmus?

A

Hypometabolic state

56
Q

Which type of metabolic state causes an increased risk for kwashiorkor?

A

Hypermetabolic state

57
Q

How is rate of catabolism affected by stress or injury?

A

Rate increases proportional to degree of injury

58
Q

What are the major gluconeogenic tissues?

A

Liver and kidney

59
Q

Key gluconeogenic enzymes are expressed where?

A

Small intestine

60
Q

What is glucose especially necessary for?

A
  • Nervous system

- Erythrocytes

61
Q

Vit B1 (thiamine) deficiency causes

A
  • Lack of thiamine intake (alcoholic, starvation, gastric bypass)
  • Increased depletion (diuretics, diarrhea)
  • Decreased absorption (chronic intestinal disease, malnutrition)
62
Q

Prolonged thiamine deficiency causes:

A

Beriberi

63
Q

What causes Wernicke encephalopathy?

A

Thiamine deficiency

64
Q

What causes Wernick-Korsakoff syndrome?

A

Thiamine deficiency

65
Q

Describe Wernicke encephalopathy

A
  • Occurs in alcoholic pts w/thiamine deficiency

- Acute sequence of vomiting, horizontal nystagmus, fever, ataxia, progressive mental impairment

66
Q

Describe Wernicke-Korsakoff syndrome

A
  • Chronic thiamine deficiency
  • Memory loss
  • Confabulatory psychosis
67
Q

Describe riboflavin and how it is affected

A
  • Vit B2

- Glass milk containers promote degradation of the vitamin from exposure to light

68
Q

Clinical findings of riboflavin deficiency

A
  • Cheilitis (chapping/fissuring of lips)
  • Sore red tongue
  • Oily scaly skin
69
Q

Vitamin B3 is also called

A

Niacin

70
Q

Niacin deficiency

A
  • Diarrhea, dermatitis, dementia, death

- Pellagra (scaly sores, mucosal changes)

71
Q

Vitamin B5 is also called

A

Pantothenic acid

72
Q

Clinical findings of Vit B5 deficiency

A

Nonspecific symptoms

73
Q

Vit B6 is also called

A

Pyridoxine

74
Q

Vit B6 deficiency

A

Rare bc it is found in a lot of foods

75
Q

Vit B12 is also called

A

Cobalamin

76
Q

Vit B12 deficiency occurs in what pts?

A
  • Inadequate intake (alcoholics, vegetarians)

- Malabsorption (lack of intrinsic factor like in pernicious anemia)

77
Q

Vit B9 is also called

A

Folic acid

78
Q

Causes of Vit B9 deficiency

A
  • Poor diet
  • Malabsorption
  • Deficiency in B12
  • Anticonvulsants
79
Q

Vit C is also called

A

Ascorbic acid

80
Q

Causes of Vit C deficiency

A
  • Poor diet
  • Smokers
  • Increased consumption states (pregnancy, lactation)
81
Q

How does scurvy present?

A
  • Easy bruising
  • Gingivitis
  • Decreased wound healing rate
  • Dry, splitting hair
82
Q

Vit A deficiency

A
  • Uncommon in US

- Caused by poor diet, malabsorption, vegans, alcoholics

83
Q

Bitot spots occur with what deficiency?

A

Vit A deficiency

esp young children

84
Q

What are bitot spots?

A
  • Area of abnormal squamous cell proliferation and keratinization of the conjunctiva
  • Can be seen in young children with Vit A deficiency
85
Q

Clinical presentation of Vit A deficiency

A
  • Bitot spots
  • Night blindness
  • Xerophthalmia
86
Q

Causes of Vit E deficiency

A
  • Pts who cannot absorb dietary fat
  • Premature infants w/low birth wt
  • Rare disorders of fat metabolism
87
Q

Clinical presentation of Vit E deficiency

A
  • Anemia
  • Impairment of immune response
  • Male infertility
  • Neuromuscular problems
88
Q

Presentation of acute calcium deficiency

A
  • Convulsions
  • Arrhythmias
  • Tetany
  • Numbness in hands, feet, around mouth and lips
89
Q

Presentation of long term calcium deficiency

A
  • Rickets

- Osteoporosis

90
Q

Causes of calcium deficiency

A
  • HypoPTH
  • Eating disorders
  • Excessive dietary Mg
  • CKD
  • Absence of Vit D
91
Q

What is the function of zinc?

A
  • Cell division
  • Clotting
  • DNA synth
  • Protein synth
92
Q

Define acrodermatitis enteropathica

A

Autosomal recessive metabolic disorder affecting the uptake of zinc

93
Q

Function of copper

A

Bone and CT production

94
Q

Why is copper deficiency rare?

A

Body requirements are very low

95
Q

What causes copper deficiency?

A
  • Bariatric surgery
  • Menkes disease
  • Wilson’s disease
96
Q

What is considered clinically significant involuntary weight loss?

A

10 lbs or 5+% over a 6-12 month timeframe

97
Q

Main categories of involuntary weight loss

A
  1. Malignant neoplasms
  2. Chronic inflammatory or infectious diseases
  3. Metabolic disorders (DM)
  4. Psych
98
Q

Major manifestations of involuntary weight loss

A
  1. Anorexia
  2. Sarcopenia
  3. Cachexia
  4. Dehydration

Clin Med II - GI (17 decks)

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