nutrient malabsorption Flashcards
what issues are present in the UK population
Generally population is nourished but concerns about marginalised groups, minority groups, the very young and the very old
what can lead to concerns of malnutrition in marginalised groups
Poor dietary intake Excessive energy dense/nutrient light diets Extreme diets (removal of one or more food groups)
what are the concerns about malnutrition in people in care/hospital
Being malnourished due to age, long term ill health Being housebound Disease related malnutrition – (in hospital & LTC) Food poverty
how does malabsorption link to disease
maldigestion inadequate absorptive surface bile salt deficiency lymphatic obstruction vascular obstruction mucosal disease
what can cause maldigestion
Chronic pancreatitis, cystic fibrosis, pancreatic carcinoma
what can cause inadequate absorptive surface
ntestinal resection, gastro colic fistula, jejuno-ileal bypass
what can cause bile salt deficiency
Cirrhosis, cholestasis, bacterial overgrowth, impaired ileal reabsorption, bile salt binders
what causes lymphatic obstruction
Lymphoma, Whipple’s disease, intestinal lymphangiectasia
what can cause vascular disease
Constructive pericarditis, right sided heart failure, mesenteric arterial or venous insufficiency
what can cause mucosal disease
Infection, giardia, Whipple’s disease, tropical sprue, Inflammatory diseases, radiation enteritis, eosinophilic enteritis, ulcerative jejunitis
what is energy balance determined by
size, sex and age physical activity thermogenesis basal metabolism thermion effect of food digestion, absorption and utilisation heat generated glucose primary fuel for this
how does energy balance change in disease
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
how does energy expenditure link to disease
cancer inc the most
acute renal can inc or dec
liver failure, lung (COPD), GI (Crohn’s)
what is the acute illness- stress response
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)
how does acute illness link to growth hormones
increase synthesis of growth hormones (decrease in receptors and synthesis of GH binding protein to reduce sensitivity inc by negative feedback)
what are the effects of increased growth hormone
dec insulin sensitivity, glycogen synthesis, protein synthesis
inc lipolysis, glycogenolysis, protein catabolism
clinical manifestations of growth hormone dysregulation
hyperglycaemia hyperlipidaemia hyperbolic state poor response to exercise muscle wasting
What do patients with an acute illness need?
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
risk factors for referring syndrome
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
how can those with chronic illness be fed
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
how can those with acute illness be fed
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
