Malnutrition/Obesity Flashcards
Define Marasmus
Severe wasting of fat and muscle mass, due primarily to energy deficiency
Define Kwashiorkor
Edematous PEM, w/o wasting. Related to metabolic stress and inflammation.
Define Cachexia
Wasting associated with inflammatory or neoplastic conditions.
Define sarcopenia
Subnormal amount of skeletal muscle w/o weight loss
When should I use motivational interviewing?
When patient is totally ambivalent.
What is the pathway that insulin and leptin stimulate?
Leptin and insulin inhibit NPY and stimulate POMC-alphaMSH-MCR which leads to decreased food intake.
What is the pathway that ghrelin stimulates?
Ghrelin stimulates NPY and inhibits POMC-alphaMSH-MCR which leads to increased food intake.
What are the criteria for Metabolic Syndrome?
Any 3/5 risk factors:
- high waist circumference
- high Tgs
- low HDL
- BP >130/85
- fasting glucose >100 or on hypoglycemic drug
What are some characteristic clinical findings of Kwashiorkor?
“Flaky paint” skin, “flag sign,” “moon facies.”
Which findings are necessary for diagnosis of Kwashiorkor?
Hypoalbuminemia and edema
What is refeeding syndrome?
Refeeding a starved person quickly can lead to hypokalemia, decrease in serum phosphorus, and higher Mg requirements.
What is a normal value of TC (total cholesterol)?
What is a normal value of Tg (triglycerides)?
What is a normal value of LDL?
What is a normal value of HDL?
> 40 M, > 50 F
How is LDL calculated?
LDL = TC - Tg/5 - HDL
What are risky waist circumference measurements?
> 88cm F, >102cm M
Which four thalamic nuclei are responsible for hunger regulation?
PVN, VMN, Arc, LH
What defines pediatric “overweight?”
BMI 85th - 95th percentile
What defines pediatric “obesity?”
BMI over 95th percentile
What defines pediatric “severe obesity?”
BMI over 99th percentile
When should I use stages of change?
When I am not sure what stage the patient is in in terms pf meeting a health goal.
When should I use the health belief model?
When patient’s actions are inhibited by beliefs that we could help them with.
When should I use values based counseling?
When health is not the primary motivating factor in a patient’s life.
When should I use CBT?
When patients needs specific tools to make a positive change.
When should we start drawing labs in children?
10 YO or Tanner 2; or earlier if severely obese
Which medications are currently available for treatment of obesity?
Phentermine, orlistat, lorcasarin, phentermine/topiramate, naltrexone/bupropion, liraglutide
Which obesity surgery option is the most effective?
Gastric bypass
Which obesity surgery option has the lowest post-op mortality?
Lap band
Which obesity surgery option is currently the most popular?
Gastric sleeve
What are some benefits of bariatric surgery?
Decreased risk of cancer, HTN, GERD, DM, and urinary incontinence. Weight loss.
What is the mechanism of phentermine?
Stimulant
What is the mechanism of orlistat?
Pancreatic lipase inhibitor
What is the mechanism of phentermine/topiramate?
Stimulant + migraine medication.
What is the mechanism of lorcasarin?
Selective serotonin 2C R agonist
What is the mechanism of naltrexone/bupropion?
Opioid R antagonist (naltrexone) + DA/NE reuptake inhibitor (bupropion)
What is the benefit, effectiveness, and cost of phentermine?
$20-40/mo. Limited to 3 mo of use but often prescribe long-term.
What is the benefit, effectiveness, and cost of orlistat?
OTC, safest, $100/mo. Must be taken with a multivitamin. Improves dyslipidemia and DM.
What is the benefit, effectiveness, and cost of phentermine/topiramate?
Big weight loss, little side effects. $150/mo. Teratogenic potential.
What is the benefit, effectiveness, and cost of naltrexone/bupropion?
Moderate effectiveness. $200/mo. Black box warning for suicidal ideation.
What is the benefit, effectiveness, and cost of lorcasarin?
Moderate weight loss. Approved for long-term use. $230/mo.
Which weight loss medication is the safest?
Orlistat
Which weight loss medication is the cheapest?
Phentermine
