NUT - Week 6 Flashcards
Components of a nutritional assessment
- Anthropometry – high, weight, BMI, Malnutrition Universal Screening Tool, bone density scan, waist circumference, waist:height.
- Biochemistry
- Clinical - oral health, swallowing, skin, hair & nail appearance, strength, muscle wasting, appetite, satiety, signs of wasting/weight loss, history of GI, fatigue, sleep.
- Dietary – type of food, quantity, preparation, time of eating, frequency/intake pattern, leftovers, psychological aspects of food, food literacy, dietary restrictions.
- Other factors incl. social situation, financial situation, medical history, food allergies/intolerances, family history, medications, physical activity.
Current national dietary guidelines
- Physically active & choose amounts of nutrition food & drinks to meet energy needs
- Eat a variety of nutritious foods from veg, fruit, grain, lean meats, dairy food groups & drink plenty of water.
- Limit intake of foods containing sat fat, added salt, added sugars, alcohol.
- Promote breastfeeding
- Care for your food.
Advantages & disadvantages of food-based vs nutrient-based approach to healthy eating
Advantages: easier to communicate to those w lower food literacy, no need to translate nutrients into foods/meals.
Disadvantages: variation in nutrient content btw foods in the same group which is not represented, may be considered ‘less sciency’/old-fashioned.
List pts at risk of refeeding syndrome
- Anorexia nervosa
- Major mental illness
- Substance abuse
- Haemodialysis
- Bariatric surgery
- Bowel resection
- Malabsorptive diseases
- Military recruits
- Starvation
- Famine
- Child abuse/neglect
- Critically ill
- ED presentations
Describe basis of refeeding syndrome
Starvation/malnutrition -> glycogenolysis, gluconeogenesis, protein catabolism -> nutrient depletion -> refeeding (switch to anabolism) -> fluid, salt, nutrients -> insulin secretion -> increased protein & glycogen synthesis -> hypokalaemia, hypomagnesaemia, hypophosphataemia, Th deficiency, salt & water retention.
What are NRVs?
Nutrient Reference Values - nutrient amounts req on an average daily basis for:
* adequate physiological function,
* prevention of deficiency disease or excess, or
* chronic disease prevention.
EAR
Estimated average requirement - daily nutritional level needed to meet req of 1/2 healthy people.
RDI
Recommended daily intake - amount needed to meet req of nearly all healthy people.
AI
Adequate intake - adequate average daily amount for nutrients that has insufficient evidence.
EER
Estimated energy requirement - average dietary energy intake predicted to maintain energy balance in healthy people.
UL
Upper limit - highest average amount posing no adverse effects to almost all individuals.
Examples of conditions/situations leading to deficiency via inadequate intake
Poverty, anorexia, food faddism, chronic disease.
Examples of conditions/situations leading to deficiency via decreased absorption
Absorption defect, parasites, malignancies, malabsorption, other nutrients, pharmacological agents.
Examples of conditions/situations leading to deficiency via defective utilisation
Malignancies, acute & chronic illness.
Examples of conditions/situations leading to deficiency via increased requirements
Rapid growth, increased physical activity, pregnancy & lactation, hyperthyroidism.
Examples of conditions/situations leading to deficiency via increased losses.
Drug therapy, diuresis.
Haem sources of iron
Meat & other animal foods.
Non-haem sources of iron
Whole grains, fortified breads & cereals.
Fe reqs for vegetarians/vegans
RDI x 1.8 - as non-haem Fe is poorly absorbed.
Iron-deficiency anaemia appearance of RBCs
Microcytic & hypochromic.
Pts at high-risk of Fe deficiency incl
- Female athletes
- Infants
- Teenagers
- Women of childbearing age
- Pregnancy women
- GI absorption disorders (e.g., Coeliac disease)
Iron depletion
Normal Hb but reduced ferritin (iron stores) - no obvious symptoms.
Iron deficiency changes to Hb and clinical symptoms.
Stored & blood-borne iron stores are low. Hb reduced - some symptoms (e.g., lethargy or fatigue).
Iron deficiency anaemia change in Hb and clinical symptoms.
Significantly reduced Hb - appears pale, breathless, may experience dizziness and fatigue, reduced immune function, impaired growth & cognition.
Pts at high risk of Ca2+ deficiency incl.
- Children/teenagers
- Lactose intolerant pts
- Pts on a vegan diet
- Post-menopausal women
- Older adults (due to higher risk of osteoporosis)
- GI absorption disorders (e.g., Coeliac’s disease).
Pts at high risk of Vit D deficiency incl.
- Infants
- Elderly
- Lack of daylight
- Lack of sun exposure
- Excessive sunscreen use
- Dark pigmented skin.
Complications of Vit D deficiency include
Rickets.
Vit-B12-deficiency anaemia appearance of RBCs
Macrocytic & irregularly-shaped.
Pts at high risk of Vit B12 deficiency incl.
- H. Pylori infection
- Atrophic gastritis
- H2 receptor blocker/PPI use
- Genetic lack of intrinsic factor
- Long term vegan dietary pattern.
Complications of Vit A deficiency
Night blindness, rough skin/keritanisation.
Complications of Vit B1/thiamine deficiency
Dry beriberi w symptoms incl weakness, lethargy, neurodegeneration, wet beriberi w symptoms incl oedema.
Risk factors for Th deficiency
Processed/refined/unfortified grain consumption, alcohol abuse
Complications of Vit B3/niacin deficiency = pellagra
Diarrhoea, dermatitis, dementia, death.
Risk factors of Vit B3/niacin deficiency
Low protein diet (particularly featuring corn as the major starch source).
Complications of scurvy
(Low vit C) incl discoloration around the gums, pinpoint haemorrhages on the skin, dermatitis, poor wound healing.
Risk factors for development of scurvy
Low fruit & veggie intake.
Complications of iodine deficiency
Goitre, impaired brain function in newborn children, fatigue, depression, weight gain, low BMR.
Risk factors for iodine deficiency
Large consumption of goitrogens (e.g., cabbage, spinach, radishes, soybeans, peanuts, peaches, strawberries), consumption of food grown in soil w low iodine content.
Macronutrients vs micronutrients
Macronutrients - carbs, fats, proteins.
Micronutrients - vits, minerals.
Fat-soluble vitamins
A, D, E, K.
Water-soluble vitamins
B, C.
Toxicity of fat-soluble vs water-soluble vitamins
Fat-soluble able to reach toxic levels as less readily excreted than water-soluble vitamins.
Goitre =
I2 deficiency.
Cal = (calories, kCal, kJ)?
1000 calories = 1kCal = 4.164kJ.
Define calorie.
Amount of energy req to raise 1g of food by 1C.
Energy balance =
Energy intake - energy expenditure.
Physical Activity Level =
PAL = Total energy expenditure/BMR.
How can you reduce the energy density of meals?
Increase the water & fiber content - as water & fiber provide little to no energy.
What regulates the absorption of Fe?
Hepcidin.
What regulates the absorption of Vit B12?
Intrinsic factor in the GIT.
Role of Vit B12?
Folate function in DNA & RBC synthesis, cellular production.
Role of Vit D?
Regulates Ca & P absorption, muscle & immune system function, brain development.
Regulation of Vit D absorption?
Activation from 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D.
Regulation of Ca2+ absorption?
GIT absorption & renal excretion, bone mineralisation/demineralisation.
Roles of Ca2+?
Nerve transmission, muscle contraction.
kJ/g of fat, protein, carbohydrates?
- 17.
PAL sedentary, active, vigorously active lifestyle.
1.4. 1.7. 2.0.
