Malnutrition + Overnutrition Flashcards
what are the 4 disease related caused of malnutrition?
decreased intake
impaired digestion/absorption
increased nutritional requirements
increased nutrient losses
what common symptoms of disease cause increased nutrient losses?
vomiting and diarrhoea
what are the 9 main psychosocial causes of malnutrition?
inapproptiate food provision lack of assistance poor eating environment lack of cooking skills/facilities self neglect bereavement inability to access food deprivation loneliness
what are the 9 major adverse effects of malnutrition?
impaired immune responses impaired wound healing reduced muscle strength and fatigue cardio-resoiratory weakness immobility water and electrolyte disturbances impaired thermoregulation menstrual irregularities psycho-social effects
weight loss is a symptoms for what major 8 GI diseases?
coeliacs diseasse crohns disease colorectal cancer gastric cancer oesophageal cancer intra abdominal infection impaired GI motility acute liver disease
what is the aim of the MUST score?
a screening tool to identify adults who are malnourished or at risk of malnourisment
when must patients be nutritonally screened using MUST?
within 1 day of admission
what is Step 1 of MUST?
BMI score
above 20 = 0
18.5-20 = 1
below 18. 5 = 2
what is Step 2 of MUST?
weight loss score (unexplained weight loss in past 3-6 months) less than 5 percent = 0 5- 10 percent = 1 greater than 10 percent = 2
what is Step 3 of MUST?
if patient is acutely ill AND likely to be no nutritional intake for >5days = 2 points
what is Step 4?
add scores from step 1, 2 and 3 to calculate overall risk of malnutrition
0 = low risk
1 = medium risk
2+ = high risk
how do you calculate BMI?
mass (kg)/
height^2(m)
what is the 4 step pyramid of nutritional support?
food
oral nutritional supplements
enteral nutrition
parenteral nutrition
what is refeeding syndrome?
occurs when previously malnourished are fed with high carbohydate loads
this causes a rapid decline in electrolytes and an increase in extracellular volume which results in organ dysfunction
why is there an increase in extracellular volume (oedema) in patients with refeeding syndrome?
due to salt and water retentsion
what are the main metabolic features of refeeding syndrome?
hypokalaemia hypophosphataemia hypomagnesaemia altered glucose metabolism fluid overload
what are the physiological features of refeeding syndrome?
arrhythmias altered level of consciousness seizures respiratory failure cardiovascular collapse death
how do you prevent refeeding syndrome in moderate risk patients?
introduce nutritional support at a maximum of 50% of requirements for first 8 hours, increase nutritional support after 48 hours if monitoring reveals no problems
what must you do to prevent refeeding syndrome in high risk patients?
rehydrate carefully and supplement potassium, magnesium, phosphate, calcium, thiamine and vit B
start feeding at 5-10kcal/kg/day
what are the BMI categories?
below 18.5 = underweight 18.5- 24.9 = normal 25- 29.9 = overweight 30- 39.9 = obese 40+ = morbidly obese
what are the 9 main consequences of obesity?
diabetes heart disease NAFLD repiratory disease stroke osteoarthriris some cancers (uterus, breast, prostate, colon) gallbladder disease dementia
what s the effect that long-term obesity has on brain-reprogramming?
brain becomes to view extra weight as normal and dieting as a threat to body survival
(so defends new weight by switching on compensatory mechanisms to maintain energy expenditure)
what part of the hypothalamus seems to be associated with decreased energy expenditure?
(ie causes obesity)
lateral hypothalamus
what part of the hypothalamus seems to be associated with increased energy expenditure?
(ie causes leaness)
ventromedial hypothalamus
