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NS Flashcards

1
Q

(Todorovic & Mafrici) Aim: if there is evidence of malnutrition and systemic inflammatory response

A

(Todorovic & Mafrici) Aim: if there is evidence of malnutrition and systemic inflammatory response.
To minimize further losses in nutritional status

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2
Q

(Todorovic & Mafrici) Aim: if there is malnutrition but no evidence of metabolic stress

A

(Todorovic & Mafrici) Aim: if there is malnutrition but no evidence of metabolic stress
To improve nutritional status: via wt gain or wt loss

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3
Q

Ulna limitations

A

Ulna length limitations
* Ethnicity
* Sex
* Bone deformity
* Different equations needed for: sex & ethnicity

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4
Q

Ulna measurement description

A
  • Ulna: alternative measure for height
  • Point of elbow (olecranon process) to prominent bone of wrist (styloid process)
  • Non-dominant arm or left arm (MUST)
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5
Q

Madden et al. 2020 study about ULNA length “Improved prediction equations for estimating height in adults from ethnically diverse backgrounds”

A

Madden et al. 2020 ULNA length study: prediction equations
* Participants: White, Asian, Black. Age: 21-62years
* Ethnicity & sex found to be significant in ulna-height relationship
* Tested proposed new prediction equations using historic data
* Madden et al.’s predicted equations better overall height predictions in non-whites than Elia equation
* MUST: use Elia equations not for ethnically diverse
Study limitations: not measured by same researcher, opportunistic sampling

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6
Q

Gender and body composition

A

Gender and body composition:
* Women more fat than men
* Men have more muscle than women
* There are gender specific skinfold equations

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7
Q

Age & body composition

A

Age & body composition
* Older adults: more likely to have higher fat mass, lower lean mass than younger adults.

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8
Q

BMI limitations

A

BMI limitations:
* There are different ranges for different ethnicities.
* BMI doesn’t differentiate between lean and fat mass. Could indicate concern in athletes who actually have high muscle
* It indicates that there is a linear relationship between height and weight
* Not an indication of how weight is distributed, where is it concentrated
* Doesn’t consider disease state – dehydration, oedema
* Doesn’t consider fluid retention
* Doesn’t measure body compartments

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9
Q

Does a higher body density mean more or less fat?

A

Higher body density = LOWER % of fat

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10
Q

Does a lower body density mean more or less fat?

A

Lower body density= HIGHER % of fat

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11
Q

What % of fat is common in healthy adults?

A

Estimate of healthy % of fat in adults
Men: 10-25%
Women: 15-35%
BUT % is dependent on ethnicity

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12
Q

Which factors affect ENERGY requirements in illness and injury? (PENG)

A

Factors affecting ENERGY requirements in ILLNESS & INJURY
* Age
* Sex
* Body weight/body composition
* Type of illness (ACUTE or CHRONIC)
* Severity & phase of illness
* Metabolic state (metabolically stressed, not stressed or anabolic)
* Nutritional status
* Medical, surgical or pharmalogical inteventions
* Absorptive capacity of the GI tract
* Physical disabilities
* Psychological state
* Physical activity
* Goals of nutritional support
* Likely duration of nutritional support

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13
Q

PALs for PENG requirements

A

PALs for PENG requirements
* In bed & immobile (Acute illness/post surgery): 1.00-1.10
* In bed &/or sitting out (Hospital ward/care home/at home): 1.10-1.20
* Limited mobility (Hospital ward/care home/at home): 1.20-1.25
* Sedentary (care home or at home): 1.25-1.40
* Physically active: >1.40

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14
Q

Why is Mifflin-St Jeor better than Harris-Benedict?

A

Mifflin St-Jeor better than Harris-Benedict:
* developed using more modern populations (1990)
* incorporates sex, changes in age
* it is 5-10% more accurate at estimating REE

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15
Q

What is the gold standard for estimating requirements?
What are its limitations?

A

Indirect calorimetry is the gold standard for estimating requirements however it is not easily accessible, can be taxing to use and is expensive. It is becoming more accessible in clinical settings though.

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16
Q

Considerations for using Mifflin St-Jeor

A

Considerations for using Mifflin St-Jeor
* Based on caucasian populations
* Validated for use in obese populations
* Adjusted body weight may be useful to avoid overestimation/overfeeding
* Easy to use
* PAL needed
* Not as accurate as indirect calorimetry
* Better than Harris-Benedict

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17
Q

What is the SIRI equation? What is its limitations?

A

The SIRI equation estimates body fat % based on body density.
Limitations: young children & elderly as it assumes FFM=1.1g/cm3

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18
Q

What can LBM be modified by?

A

LBM can be modified by physical acitivity & cellular function

18
Q

Jebb & Prentice BMI and Body Fat- The relationship

A

Jebb & Prentice BMI and Body Fat- The relationship:
* BMI is a SURROGATE measure of body fat

18
Q

Mid arm muscle circumference

A

Mid arm muscle circumference:
MAMC (cm)= MUAC (CM)- TSF (mm) x0.3142
* Low value is predictive of worse clinical outcomes
* Can be used to evaluate FFM or lean components

19
Q

Results from a study in Taiwan suggest that calf circumference is better than ? at indicating care needs in older adults

A

Results from a study in Taiwan suggest that calf circumference is better than BMI at indicating care needs in older adults (Hsu et al., 2015)

20
Q

Bioelectrical impedence analysis

A

Bioelectrical impedence analysis:
* Measures FFM and total body water
* Electrical current: not conducted by lipids
* Equations based on HEALTHY individuals to derive FM
* Adequate hydration, rest period and empty stomach is needed
* Result may be over/under estimated in ascites, oedema, dehydration

21
Q

Grip strength

A

Grip strength:
* Functional measure
* Some evidence to support grip strength reflecting overall muscle strength
* Muscle strength responds to earlier nutritional deprivation and nutritional repletion.
* Muscle strength predicts morbidity and mortality independent of muscle mass.
* A reduction of mortality risk for every 1kg increase in handgrip strength has been reported.
* USA and Australian studies – HGS independently predict nutritional status as determined by the PG-SGA score
* Monitoring – better than weight – more accurate compares each successive measurement

22
Q

Trunk measurements are ? used for undernutrition

A

Trunk measurements are not used for undernutrition

23
Q

BMI advantages

A

BMI advantages:
* Applicable to large-scale population studies
* Inexpensive
* Simple to perform – good inter and intra user reliability
* Useful for public health recommendations

24
Q

MUAC

A

MUAC:
* < 23.5cm to identify those with a BMI <20kg/m2
* >32cm to identify those with a BMI >30Kg/m2
* Can’t be used to determine malnutrition with MUST
*

25
Q

Waist to height ratio

A

Waist to Height ratio:
* Indicates adiposity around mid section
A WHtR cut off < 0.5 of recommended. This is a better predictor of diabetes hypertension, dyslipidaemia and metabolic syndrome then BMI

26
Q

Height considerations

A

Height considerations
* Abnormal spinal curvature e.g. Scoliosis , muscular dystrophy, inability to stand, approximation, self reported, observation, inaccuracies, consider what you might want to use the values for, e.g. MUST, self reported height did not make a difference to the overall malnutrition risk Stratton
* Health professionals estimating height were less accurate than self reported heights.

27
Q

Anthropometry relies on:

A

Anthropometry/functional tests relies upon:
* Equipment
* Practitioner expertise
* Predictive equations used – specific to subject
* Are assumptions about the body’s composition being made?
* Standards based on normal population, application to illness

28
Q

Homocysteine indicates a ? in B6, folate or B12

A

Homocysteine indicates a deficiency in B6, folate or B12

29
Q

Serum proteins:

A

Serum proteins:
* Indicator of visceral protein NOT somatic
* Synthesis is compromised in malnutrition
* Non-nutritional factors have a greater influence e.g., fluid status, liver disease, sepsis, trauma
* Half-lives vary: Albumin = 21 days
* Transferrin = 9 days

30
Q

Biochem that is indicative of systemic inflammatory response

A

Biochem indicative of systemic inflammatory response:
* Increased white cell count
* Increased CRP
* Increased serum urea
* Decreased haemoglobin
* Decreased albumin
* Hyperglycaemia

31
Q

Nutritional support should aim to minimise ? losses

A

Nutritional support should aim to minimise nitrogen losses

32
Q

Advantages & disadvantages of Biochemical Markers

A

Advantages
* Specific
* Accurate
* Objective
* Nutrient specific
* Recent and long-term status
* Predictably responsive to corrections of nutritional deficiency

Disadvantages
* Acute phase reactions
* Temporal variations
* Variable tissue growth rates
* Homeostatic control
* Nutrient interaction
* Sample contamination
* Interpretation
* Effects of age, gender, ethnicity
* Reliability and availability of lab analysis

33
Q

Gross assessment of nutritional status

A

GROSS ASSESSMENT OF NUTRITIONAL STATUS
* Appearance – over/under nutrition = energy/protein
* Oedema – poor protein status
* Pressure sores/poor wound healing – poor protein status; vit C
* Breathlessness -anaemia
* Mobility –poor muscle mass/tone = protein depletion
* Mood –depression and apathy = under nutrition

34
Q

How may disease increase the risk of malnutrition?

A

Disease may increase the risk of malnutrition due to:
* Increased energy requirements
* Reduced energy intake
* Increased nutritional losses

Symptoms =
* reduced nutritional intake or increased nutritional losses include
* altered bowel movements e.g., diarrhoea, constipation
* upper gastrointestinal upset e.g., reflux, bloating, nausea, and vomiting.
* early satiety
* dysphagia
* lethargy

35
Q

Advantages and disadvantages of dietary assessment

A

Advantages and disadvantages of dietary assessment
Advantages
* Can give indication of intake
* Can be done without equipment

Disadvantages
* Could be labour intensive: e.g. weighing foods for accuracy
* Relies on recall
* Must be used in conjunction with other assessment methods
* Relies on expertise to interpret assessment
* Doesn’t consider metabolism of foods
* Need to consider how environment/personal preferences/ occupation influence intake

36
Q

What did Burrows et al. (systematic review) find about the validity of dietary assessment methods?

A

Burrows et al:
* Compared the suitability of measurement of energy by various dietary assessment methods such as FFQ, diet histories with varying hours of recall to doubly labelled water.
* Conclusion:
The majority of dietary assessment methods included in the current review were found to significantly under-estimate EI when compared to TEE measured using the DLW technique.The degree of under-reporting was highly variable across all methods, however, 24 h recalls were associated with a lower degree of mis-reporting and less variation in degree of under-reporting compared to other dietary assessment methods.

37
Q

BMI & ethnicity

A

BMI & Ethnicity:
* There are various cut offs for different ethnicities
* Canadian Longitudinal study (nearly 60,000 participants): White (30) people have a higher BMI cut off associated with diabetes risk than South Asian (24), Black (26) or Chinese people (25).

38
Q

BMI and muscle mass

A

BMI and muscle mass:
* Margin for error: estimating those with normal fat free mass as obese: study looked at the relationship between BMI and fat-free mass index (FFMI) 71% of subjects with normal BMI had a normal FFMI. 5 out of 3533 subjects considered obese on the BMI scale had normal range for FFMI.

39
Q

BMI and sex

A

BMI and sex:
* BMI is only weight/ height squared,
* no consideration for variations in fat mass between sexes or the effects of other complexities such as pregnancy, breastfeeding, cancer, or osteoporosis

40
Q

Definition of obesity/overweight

A

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.

41
Q

Critique of definition of overweight/obesity

A

Critique of definition of overweight/obesity:
* Meant to be abnormal or excessive fat accumulation that poses a risk to health however according to the WHO, BMI is used to define it yet BMI isn’t an indication of fat accumulation. It is the ratio of height to weight. It does not differentiate between the different body compartments. There is no way of telling if the measured weight/ BMI score is due to fluid accumulation, fat or lean muscle.

42
Q

What do the centiles show?

A

The centiles show:
- Optimum range of weights and heights
- Describes the percentage expected to be below that line
- 50% below 50th
- 91% below the 91st
- 1 in 250 below 0.4th
- Half of all children should be between 25th-75th centile

CCD (16 decks)

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