Nutrient Assessment Flashcards
What are the different types of dietary assessment methods and what are their pros/cons?
24 hour recall:
retrospective for the previous 24 hours
quick, inexpensive, low client burden
likely not their usual intake and memory dependent
Food Records:
prospective for set time period, require recording or weighing intake
Considered actual intake and increasing accuracy with increasing time period - can be used in hospital
higher client burden and behaviour might change
FFQ:
Retrospective, lists food intake over a specific time period
considered usual intake and better for assessing groups
Direct observation:
prospective - can only be done in a controlled setting
frequently used in hospital setting when concerned about pt intake
likely not usual intake - low client burden
What does serum albumin indicate in bloodwork?
What does it mean when high, low, when is it useful?
Better for showing longer term protein status but may be insensitive to acute nutritional changes - a better marker of chronic inflammation
when significantly low - sign of overhydration or an acute illnese influenced by presence of renal or liver disease
Most useful for patients being followed long term with NO acute illness
What are the Albumin cutoff ranges?
- > 35g/L = No protein depletion
- 30-35 = Mild protein depletion
- 24-29.9 = Moderate protein depletion
- <24 = severe protein depleiton
What does thyroxin binding protein indicate?
AKA Prealbumin - what type of patient is it best for?
Due to its shorter half life, may show short term changes in protein status
Gold standard - sensitive to acute nutritional changes
Significant decrease (<0.5) signifies acute illness
Most usefull in pateints being followed in hospital once recovering
What does Nitrogen balance indicate?
Requires a 24 hour urine collection and the urea excreted tells us a measure of protein breakdown when compared aginast intake
What does creatinine excretion tell us?
Reflective of muscle mass and increases with muscle wasting - usefull in bedridden patients
High Creatinine: impaired renal function
Rhabdomyolysis
Meds
Low Creatinine:
decreased hepatic synthesis of creatine
decreased musclemass (wasting etc.)
What does BUN tell us?
High BUN:
Excessive protein intake
dehydration
acute or chronic kidney disease
meds such as corticosteroids
Low BUN:
Malnutrition
profound liver disease
What is hemoglobin?
Essential form of iron - low hemoglobin typically gives a diagnosis of anemia. It is essential iron storage and if low HgB, odds are that the other markers are low and we are at a deficiency stage
What does Ferritin tell us?
Ferritin is the storage iron, typically low in anemia. Must be careful to interpret as it is sensitive to inflammation and infection so may be aritificially elevated
What is transferrin and what does it indicate?
Transport iron, it is typically high when the body is low in iron
What is TIBC?
Surrogate marker of transferrin levels and is typically elevated in iron deficiency.
What is transferrin saturation?
Ratio of serum iron/TIBC which is a reflection of how well free iron binds to the transferrin molecule and how sufficient/deficient free iron is present.
How do you tell if a patient has anemia of chronic diseases or dietary intake?
Explain HCT, MCV etc.
Check B12 and folate - if these are decreased it may indicate chronic disorders (such as liver/kidney disease, alcoholism) or malabsorptive disease such as celiac
Examine CBC:
low hematocrit = hypochromic, low iron content in RBC
MCV - low = microcytic
Increased # of reticulocytes (immature RBC)= compensatory mechanism
Modestly elevated platet counts (mild thrombocytopenia) = compensatory mechanism
