MALNUTRITION/REFEEDING SYNDROME & OBESITY Flashcards
what are some consequences of malnutrition?
- increased length of hospital stay
- 2x more likely to be readmitted to hospital
- increased ventilation needs
- surgical complications
- increased hospital costs
- increased mortality rates
- poor wound healing and skin integrity
- increased infections/weakened immune system
- decreased rehabilitation (strength and QOL)
differentiate between the three different types of malnutrition:
1. starvation-related
2. chronic disease-related
3. acute disease or injury related
- starvation: chronic starvation without inflammation (food access and eating disorders)
- chronic disease-related: inflammation is chronic and mild-moderate degree
- acute disease or injury related: inflammation is acute and severe degree (major infections, burns, trauma)
what are the 4 criteria for assessing malnutrition (SGA)
- weight change history (reported) - >10% in 6 months
- dietary intake change (reported) - length and degree of abnormal intake
- GI symptoms (reported) - nausea, vomiting, diarrhea
- pt’s ability to function (reported) - energy level (bedridden, working)
what are some interventions for malnutrition?
- optimize food intake (take food preferences, HPHC diet, liquid calories, add sauces, may need nutrition support)
- reminders posted in patients room
- have family come in to help with meals
- have family bring in food
describe refeeding syndrome
metabolic changes that can occur when refeeding patients who are malnourished or in a starvation state
- increase in glucose and insulin –> phosphorus and thiamin requirements for energy production increase –> massive intake of P, K, Mg into cells –> drop in serum P, K, Mg, and in fluid balance
general guidelines for treating refeeding patients:
- correct electrolyte abnormalities (before feeding)
- feeding: start slow and go slow
- supplement with 100-200mg thiamine and multivitamin x 10 days
- monitor P, K, Mg, glucose, BP, daily until stable while refeeding
how much CHO to start for refeeding?
150-200g/day
what is wasting
loss of body mass without edema or hypoalbuminemia
what is sarcopenia
muscle loss with few biochemical alterations
what is cachexia
under-nutrition with inflammatory component
what is protein-energy malnutrition
loss of body mass related to dietary intake; edema and hypoalbuniemia may occur
what are factors that contribute to PEM
- children’s need for energy and protein
- diet low in nutrients
- inadequate food supply, poverty…
- unsanitary water
describe marasmus
- CHRONIC protein and energy deficiency (never was fed well)
- children often <2 years in developing countries
- no edema, no body fat, stunting, wasting, hair easily pulls out, rib cage showing
- develops slowly, treated slowly, rapid re-feeding causes it to be life threatening
describe kwashiorkor
- ACUTE protein deficiency - rapid onset, often sufficient energy
- usually well fed @ birth and then when there’s another baby, protein drops all of a sudden
- some weight loss, some muscle wasting, retention of fat, edema, fatty liver, hair easily pulls out
- treatment: sanitary water, electrolytes, proteins, carbs, last is fat
when is obesity more prevalent?
lower SES and rural
describe ways to classify obesity
- BMI
- waist circumference
- waist to hip ratio
describe EOSS
Edmonton Obesity Staging System
- stage 0-4
- 0 = high BMI but no other risk factors
- 4 = severe obesity related comorbities/psychological symptoms or functional limitations
what is the role of leptin and how is it related to obesity?
leptin: focuses on feelings of satiety, produce and secrete fat cells and acts on hypothalamus
- obesity: high levels of leptin but hypothalamus does not act on it (leptin resistance)
main organs that regulate appetite
hypothalamus, pancreas, and GI hormones
common nutrition goals during obesity “treatment”
- eating regularly (3 meals + 2-3 snacks per day)
- eating balanced meals and snacks
- eating more vegetables and fruit
- no eating in front of screens
- drinking more water and less sugar beverages
- cooking more at home
- packing lunches
- eating out less
- mindful and intuitive eating
- reshaping attitues and beliefs about food and eating behaviour
what is adjustable gastric band surgery
restrictive bariatric surgery: an inflatable band is used to create a small pouch, limits food consumption
what is vertical sleeve gastrectomy?
restrictive bariatric surgery that permanently removes most of the stomach, leaving a sleeve-shaped pouch - reduction in ghrelin (hunger hormone) secretion
what is roux en y gastric bypass surgery?
restrictive and malabsorptive bariatric surgery
- creates a smaller stomach and bypasses part of the intestine (increase in GLP-1 - satiety hormone)
what are some recommendations post bariatric surgery?
- vitamin and mineral supplementation required for life
- eat 4-6 small meals per day
- chew slowly and thoroughly
- ensure adequate fluid intake
