Nutrient utilization Flashcards
Well child nutrient utilization
“basal” needs - respiration, metabolism staying alive
+/- physical activity
Thermic effect of food - energy required to break down food (~10%) of intake
Growth: huge in infants
Sick child nutrient requirements
increased basal needs: High T, HR, RR, increased demand for ATP
reduced physical activity
reduced/no growth
physiology of stress
Burns/Sepsis/Surgery/Trauma
–> stimulation of CNS
ADH: water retention
Catecholamines: Renin, glucagon released
–> hyperglycemia, lypolysis, sodium retention
ACTH: glucocorticoid –> proteolysis, gluconeogenesis
ACTH effects
stimulated by CNS during stress
stimulate hepatic protein synthesis of acute phase reactants
stimulate catabolism of muscle –> aa for gluconeogenesis
Alanine (from muscle) stimulates glucagon
Catecholamine effets
stimulate glycogenolysis in muscle
stimulate gluconeogenesis from aa
decreased insulin relative to glucagon, insulin resistance –> hyperglycemia
Fasting state
cortisol stimulates muscle breakdown
cortisol, glucagon, epinephrine stimulate glucose production
aa are primary source of glucose
very large urinary nitrogen loss
Starvation state
fuel shift from aa –> fat
spares protein for vital functions
fat oxidation: glycerol (glucose) + FFA (energy)
incomplete fat oxidation –> ketone body formation for CNS, body
Protein turnover
increased in stress
reduced in starvation
Insulin during stress
increased to block lipolysis
Insulin during starvation
reduced to promote lipolysis
Nutrients needed in sick child - helpful
Fe P Mg Vitamin C, D folate B12 Se
Adolescence
WHO: 10-19
Period of rapid growth second only to infancy
nutrient requirements high, greatest during peak growht period, especially high for those who are very active
achieve final 20% of adult height and 40% of adult skeletal mass
Physical and sexual maturation
prevention of lifestyle disease
Peak height velocity - boys
longer childhood growth
higher peak velocity
Peak height velocity - girls
2-3 y before boys
Growth spurt
6 y in boys
4 y in girls
Weight growth in adolescence
boys: peak height velocity coindcides with peak weight velocity
Girls: peak weight velocity 6-9 mo before peak height velocity
Pre-pubertal/adult fat % in boys/girls
Pre-pubertal: 15%
Men: 15%, lean mass doubles btw 10-17
Women: 23%
Girls Fe requirements
9-13: 8 mg
14-18: 15 mg (11.4 OCP)
+1.1 if in growth spurt
+2.5 if menstruating
Boys Fe requirements
9-13: 8 mg, +2.9 if in growth spurt
14-18: 11 mg
Fe requirements during adolescence considerations
Vegetarian: multiply by 1.8 to correct for non-heme Fe
Upper level of iron - 45 mg/d based on GI side effects
Semi-vegetarian
no red meat
Pesco-vegetarian
will eat fish
Lacto-ovo-vegetarian risks
may be at risk for energy, protein, iron, zinc
Vegan risks
at risk for energy, protein, iron, zinc, B12
Anorexia N, restricting type
During last 3 mo, individual has not engaged in recurrent episodes of binge eating/purging
Weight loss primarily due to dieting, fasting, and/or excessive exercise
Anorexia N, binge-eating/purging type
During last 3mo, individual has engaged in recurrent episodes of binge eating/purging
Age of onset of anorexia nervosa
early to mid adolescence common, but can occur at any age even in childhood
Primarily seen in girls, but boys are seen more frequently in childhood year
Boys with anorexia nervosa
shape is more of an issue than weight
concern around preventing development of a flabby shape
exercise predominates
small number, but increasing
Bulimia nervosa
Binge eating + extreme wt loss compensatory behaviours (purging/laxative/diuretic, fasting, exercise) at least once a week for 3 mo self evaluation unduly influenced by body shape + wt can be normal or overweight salivary gland enlargement enamel erosion esophagitis arrhythmias blood abnormalities (electrolytes, amylase, etc) finger/back of hand may have callus diarrhea/constipation edema in ankle
Bulimia nervosa age of onset
Later adolescence and young adulthood
Eating disorder in partial remission
full criteria was met, but currently no longer fully meets all criteria
“Eating disorder in full remission
full criteria was met, but now none of criteria has been met for a sustained period of time
Binge eating disorder
regular/sustained binge eating episode
characterized by both eating in a discrete period of time and a sense of lack of control over eating during episode
Binge eating disorder age of onset
young adulthood/midlife disorder
more even gender distribution
Avoidant/restrictive food intake disorder
ARFID
new category
is like anorexia nervosa except without body image disturbance or weight/shape overvaluation
Other Specified and Unspecified Feeding and Eating Disorder
OSFED, UFED, new terminology
Atypical anorexia nervosa: BMI normal
Purge disorder: sub-threshold forms of Bulimia Nervosa + binge eating disorder on basis of insufficient frequency or duration of ED behaviours
Anorexia effect on NS
can't think right fear of gaining weight sad, moody, irritable poor memory fainting changes in brain chemistry
Anorexia effect on skin, connective tissue
thin and brittle hair weak muscles, swollen joints, fractures, osteoporosis easy bruising, dry skin growth of fine hair all over body cold intolerance yellow skin brittle nails
Anorexia effect on CV system
Anemia low BP slow HR palpitations heart failure
Anorexia electrolyte disturbances
Low K, Mg, Na
Anorexia effect on GI/GU
constipation
bloating
kidney stones
kidney failure
Anorexia hormonal changes
Amenorrhea bone loss problems growing infertility higher risk for miscarriage higher risk for C-section baby with low birth weight post-partum depression
Bulimia brain and behavioural changes
depression fear of gaining weight anxiety dizziness shame low self esteem fatigue
Bulimia soft tissue/muscle/bone changes
Cheek swelling, soreness
Mouth: cavities, tooth enamel erosion, gum disease, sensitive teeth
Throat: sore, irritated, can tear and rupture, blood in vomit
Abrasion of knuckles, dry skin
Bulimia CV changes
Arrhythmia heart muscle weakened heart failure low pulse low BP anemia, fatigue
Bulimia GI/GU changes
Problems from diuretic abuse Dehydration, low K, Mg, Na Ulcers, pain, can rupture, delayed stomach emptying Constipation irregular BM bloating, diarrhea, cramping
Bulimia hormonal changes
irregular/absent period
Consequences of eating disorders
Most changes are reversible EXCEPT:
- bone density after a certain age
- growth stunting - catch up growth can sometimes occur but may not be enough
- brain changes not completely reversible, but consequences unknown
- enamel erosion
Eating disorder - criteria for urgent admission
Physiological instability:
- postural hypotension - >20 mm Hg systolic
- resting bradycardia
Other reasons for admission due to eating disorders
Growth arrest and pubertal delay with poor weight gain in outpatient tx (esp for younger adolescents)
failure of outpatient tx
patient/parent not coping at home
lack of local services
Medical reasons for admission in eating disorders
Refeeding syndrome can happen in severely malnourished patients
True phosphate deficiency manifests after 2-3 d of adequate nutrition
Requires close observation, regular blood tests and ECGs with phosphate tx, monitoring
Clinical points in managing patients w/ eating disorders
Correct existing deficiencies, including fluid
Correct vol depletion, check renal function
measure K, Phosphorus, Mg daily, correct deficiencies
Calories: start where the intake is, increase q2-3d until at least 2000cal/D or more
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