nutrient malabsorption

Question 1

what issues are present in the UK population

Answer 1

Generally population is nourished but concerns about marginalised groups, minority groups, the very young and the very old

Question 2

what can lead to concerns of malnutrition in marginalised groups

Answer 2

Poor dietary intake 
Excessive energy dense/nutrient light diets
Extreme diets (removal of one or more food groups)

Question 3

what are the concerns about malnutrition in people in care/hospital

Answer 3

Being malnourished due to age, long term ill health
Being housebound
Disease related malnutrition – 
(in hospital & LTC)
Food poverty

Question 4

how does malabsorption link to disease

Answer 4

maldigestion
inadequate absorptive surface
bile salt deficiency
lymphatic obstruction
vascular obstruction
mucosal disease

Question 5

what can cause maldigestion

Answer 5

Chronic pancreatitis, cystic fibrosis, pancreatic carcinoma

Question 6

what can cause inadequate absorptive surface

Answer 6

ntestinal resection, gastro colic fistula, jejuno-ileal bypass

Question 7

what can cause bile salt deficiency

Answer 7

Cirrhosis, cholestasis, bacterial overgrowth, impaired ileal reabsorption, bile salt binders

Question 8

what causes lymphatic obstruction

Answer 8

Lymphoma, Whipple’s disease, intestinal lymphangiectasia

Question 9

what can cause vascular disease

Answer 9

Constructive pericarditis, right sided heart failure, mesenteric arterial or venous insufficiency

Question 10

what can cause mucosal disease

Answer 10

Infection, giardia, Whipple’s disease, tropical sprue, Inflammatory diseases, radiation enteritis, eosinophilic enteritis, ulcerative jejunitis

Question 11

what is energy balance determined by

Answer 11

size, sex and age
physical activity
thermogenesis
basal metabolism 
thermion effect of food
digestion, absorption and utilisation
heat generated
glucose primary fuel for this

Question 12

how does energy balance change in disease

Answer 12

basal metabolism increases 
appetite and activity decrease
inflammatory response via cytokines 
TNFα Insulin resistance, glycolysis
IL2 glucose metabolism
IL4 lipid & glucose metabolism
IL6 lipolysis
activity and appetite reduced

Question 13

how does energy expenditure link to disease

Answer 13

cancer inc the most
acute renal can inc or dec
liver failure, lung (COPD), GI (Crohn’s)

Question 14

what is the acute illness- stress response

Answer 14

sepsis, trauma, shock, reperfusion to
catabolic signals to TNF/IL-1
pancreas to release insulin
adrenal glands to relese cortisol and catecholamines
immobilisation
glucagon to adipose tissue (lipolysis), muscle (protein breakdown and synthesis), liver (gluconeogenesis, glycogenolysis)

Question 15

how does acute illness link to growth hormones

Answer 15

increase synthesis of growth hormones (decrease in receptors and synthesis of GH binding protein to reduce sensitivity inc by negative feedback)

Question 16

what are the effects of increased growth hormone

Answer 16

dec insulin sensitivity, glycogen synthesis, protein synthesis
inc lipolysis, glycogenolysis, protein catabolism

Question 17

clinical manifestations of growth hormone dysregulation

Answer 17

hyperglycaemia 
hyperlipidaemia
hyperbolic state
poor response to exercise 
muscle wasting

Question 18

What do patients with an acute illness need?

Answer 18

meet energy demand
conserve muscle mass – avoid negative nitrogen balance
Manage blood glucose Current feeding issues
Poor appetite or inability to eat
Extended periods of time nil by mouth
Not a priority
Unclear roles and responsibilities
Be cautious with severely malnourished patients – risk of refeeding syndrome

Question 19

risk factors for referring syndrome

Answer 19

BMI <16 kg/m2
unintentional weight loss greater than 15% in last 3-6 months
little/no nutrient intake in >10 days
low levels of K, PO3 4-, Mg prior to feeding
(or 2 of 18.5kg/m2, 10%, 5 days, history of alcohol abuse or drugs inc insulin, chemo, antacids and diuretics)
check urea and electrolytes prior to feeding

Question 20

how can those with chronic illness be fed

Answer 20

start with food – may have long term enteral feeding
Focus on balanced diet
Diet to increase energy  intake 
Diet to manage blood glucose
Diet to reduce workload of kidney
Diet to reduce inflammation
Diet to support treatment

Question 21

how can those with acute illness be fed

Answer 21

start with food but consider other routes such as enteral/parenteral
Diet to meet energy demand and reduce catabolism
Diet to support recovery – micronutrients & macronutrients