Nutrition Flashcards
An eating disorder characterized by abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight
Anorexia Nervosa
People with anorexia place a high value on controlling WHAT?
Weight and shape using extreme efforts that tend to significantly interfere with their lives
In what ways do people with anorexia prevent weight gain?
Restricting amount of food they eat, misusing laxatives, diet aids, diuretics, or enemas, exercising excessively
Persistent restriction of energy intake that leads to abnormally low body weight
Intense fear of gaining weight or becoming fat or persistent behavior that prevents weight gain
Distorted perception and/or importance of body weight and shape
Clinical features of anorexia nervosa?
Extreme weight loss/not making expected developmental weight gains
Thin appearance
Abnormal blood counts
Fatigue, insomnia, dizziness/fainting
Bluish discoloration of fingers; hair that thins, breaks/falls out
Soft, downy hair covering the body
Absence of menstruation
Constipation and abdominal pain
Dry/yellowish skin; cold intolerance; irregular heart rhythms; low BP; dehydration; swelling of arms or legs
Eroded teeth and calluses on knuckles from induced vomiting
Anorexia Nervosa
Preference for low-calorie foods (low energy density)
Overestimating number of calories consumed
Overusing condiments and/or artificially sweetened products
Food-related rituals
Concerns about eating in public
Social withdrawal
Exercise-related rituals
Anorexia nervosa
Restlessness/hyperactivity
Limited insight into or denial of core clinical features
Resistance to treatment and weight gain
Inhibited expression and dysregulation of emotions
Feelings of ineffectiveness
Poor sleep
Low libido
Dysphoria (depressed/anxious mood)
Inflexible thinking
Perfectionism
Behavioral rigidity
Anorexia nervosa
Anxiety disorders
Obsessive-compulsive disorder
Body dysmorphic disorder
Posttrauamtic stress disorder
Depressive disorders
Substance use disorders
Disruptive, impulse control, and conduct disorders
Anorexia nervosa comorbidity
Restriction of energy intake that leads to low body weight, given the patient’s age, sex, developmental trajectory, and physical health
Intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight
Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of medical seriousness of one’s low body weight
DSM-5 Definition for Anorexia nervosa
May secretly binge (eating large amounts of food with a loss of control over eating) and then purse, trying to get rid of extra calories in an unhealthy way
Bulimia nervosa
In what ways do people with bulimia nervosa prevent weight gain?
Regularly self-induce vomiting
Misuse laxatives
Weight-loss supplements
Diuretics
Enemas after bingeing
Fasting
Strict dieting
Excessive exercise
What is the lifetime prevalence of bulimia nervosa?
0.9%
Is bulimia nervosa more common in men or women?
Females > Males
Feeling a loss of concern during bingeing
Forcing self to vomit or exercising too much to keep from gaining weight
Using dietary supplements
Bulimia Nervosa Clinical Features
What are comorbidities of bulimia nervosa?
Unipolar major depression
Specific phobia
PTSD
Social anxiety disorder
ADHD
Alcohol use disorder
Oppositional defiant disorder
Conduct disorder
Illicit drug use disorder
Premenstrual dysphoric disorder
Eating disturbances, weight loss, and refusal to maintain body weight at 85% of expected weight for height
Amenorrhea ensues
Anorexia Nervosa
Episodic binge and purge episodes; believed to arise from familial issues, social pressure, low self-esteem, and desire for control
Bulimia nervosa
What is the common age for eating disorders to emerge?
14-18 years
What is the mortality for eating disorders?
10%
What is Russell’s sign?
Bruised knuckles
What are the differential diagnoses for eating disorders?
Organic disease-producing weight loss
Pregnancy
Depression
Substance abuse
What BMI counts as obesity?
Greater than or equal to 95%
What BMI counts as overweight?
85-95%
What ages do you check hemoglobin for anemia?
9 months, 15 months, 3 years, and every year after that is at risk
What is the most common cause of iron deficiency anemia?
Poor dietary intake
Who is at increased risk for iron-deficiency anemia?
Lower socioeconomic status patients due to lack of resources of healthy foods
Lack of education of not knowing to feed child higher iron foods
Who has the greatest incidence of iron deficiency anemia?
African Americans and Hispanic children
What are common manifestations of iron deficiency anemia?
Dyspnea, fatigue with exertion, headache, poor concentration, heart palpitations
Cheilosis
Glossitis
What do you treat iron-deficiency anemia?
Elemental iron 3-6 mg/kg/day divided TID
Take on an empty stomach with orange juice
Constipation, dark, tarry stools are side effects
Iron-fortified cereals (40%), red meat, dark green veggies
Continue iron therapy for 2-4 months after anemia has reversed
What percentile counts as failure to thrive?
Less than 5%
What counts as organic failure to thrive?
malabsorption/excessive expenditure of calories
What counts as nonorganic failure to thrive?
inadequate calorie intake
What children should be tested for lead poisoning?
Anemia
Learning or behavioral problems
Treated folk medicines that contain high lead content
Sibling, housemate, or playmate being followed or treated for an elevated lead level
Live in a house built before 1960 (1978)
Living with adult whose job or hobby involves exposure to lead (fisherman, gun range)
Living near environmental sources of lead
What are common symptoms of lead poisoning?
Decreased appetite Stomach ache Sleeplessness Learning problems Constipation Vomiting Diarrhea Tiredness Lowered IQ Anemia
What blood lead level requires chelation therapy?
> 45 mcg/dL
What level of blood lead do you contact the public health department?
> /= 5 mcg/dL
Limited to less than 6 years of age
No body image disturbance and patient lacks cognition associated with anorexia
Avoidant/Restrictive Food Intake Disorder (ARFID)
Eating disturbance cannot be the result of a cultural or religious belief and cannot be explained better by another diagnosis
Avoidant/Restrictive Food Intake Disorder (ARFID)
May be concern about vomiting or choking, either as a result of the patient having such an experience or witnessing an episode; can result from sudden onset of GI symptom with significant fear following episode
Avoidant/Restrictive Food Intake Disorder (ARFID)
History of poor or picky eating, generalized anxiety, or GI problems that interfere with eating over the years
Avoidant/Restrictive Food Intake Disorder (ARFID)
Eating disorder that involves eating items that are not typically thought of as food and that does not contain significant nutritional value (hair, dirt, paint chips)
Pica
What are two of the most common causes of pica?
Iron-deficiency anemia
Malnutrition
What is the common presentation for pica?
Persistent eating over at least 1 month of substances that are not food and do not provide nutritional value
Items may be paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, ice
At what age is it a normal part of development for a child to mouth objects?
Under 2 years
What is the treatment for pica?
Test for nutrients and mineral deficiencies and correcting those
Behavioral therapy
What are risk factors of anorexia nervosa?
Rigid, overprotective families with difficulty with conflict resolution
Fear of sexual maturation; hx of sexual abuse
Social pressure to be thin
Ballet dancers and gymnasts
Psychological profile of low self-esteem despite outward successfulness
What societal class is anorexia more common?
1% white middle/upper-class females
5-10% male with gender identity conflict
What are common physical findings for anorexia nervosa?
Bradycardia, prolonged QTc, dysthymia, lower BP, hypothermia
Osteopenia and osteoporosis
Constipation and reflux esophagitis
Signs of malnutrition, dry or orange-yellow discoloration of skin; brittle nails; muscle weakness; flat affect; bradycardia; hypotension; hypothermia; lanugo; symmetrical parotid gland enlargement; self-harm scars
Anorexia
What are indications for hospitalization for anorexia?
Low median BMI or loss of >20% of body weight in 1 year
Electrolyte abnormalities
Resting HR <50 or <45 at night
Prolonged QTc > 460 mm
Hypotension <95/40 or positive orthostatic signs; pulse increase > 20 beats/min; systolic BP decrease >20 mmHg or diastolic BP decrease > 100 mmHg
Temperature <96F or <75% median body mass index for age and sex
Eating disturbance associated with episodic binge eating followed by compensatory efforts to prevent weight gain (self-induced vomiting, dieting, fasting, excessive exercise or misuse of laxatives, enemas, and/or diuretics)
Bulimia nervosa
Hx of going to the bathroom after eating, feeling out of control after patient eats, eating large amount of food at a time
Can have normal or overweight presentation
Sore throat
Russell’s sign
Loss of tooth enamel or stained/discolored teeth
Electrolyte abnormalities from vomiting (hypochloremia acidosis)
Rectal prolapse
Bulimia nervosa
How do you treat bulimia nervosa?
Family-based therapy
Psychopharmacologic agents are not recommended as sole therapy
Evaluate for comorbidity (bipolar, depression, anxiety)
What do you calculate BMI?
(weight in kilograms)/(higher in meters)^2
Which population has highest rate of obesity
Hispanics and non-Hispanics blacks had higher obesity rate 25.8% and 22.0%
What levels should be checked for obese children?
Thyroid-stimulating hormone (TSH) may be slightly elevated
Insulin levels
Liver function tests
Fasting glucose or 2-hour postprandial glucose tolerance test
Lipid profile
What do you treat obesity?
Increased physical activity
Dietary modifications
Stress healthy sleep patterns
Encourage breastfeeding in infancy
Reserve pharmacotherapy in adolescents
What are the recommended physical activity for obesity?
Vigorous activity at minimum of 20 minutes/day (GOAL 60 minutes per day)
Decreased sedentary activities and max of 1-2 hours of screen time
No screen time for less than 2 years of age
What are the recommended dietary modifications?
Decrease high-fructose corn syrup, table sugar, fast foods, and saturated dietary fat, high-fat, high-sodium, and proceed foods
Decrease in portion size
Use whole fruit rather than fruit juiecs
Regular mealtimes; avoid constant grazing
Male single-portion packages available and clearer labeling
What are the set of symptoms is most characteristics of depression in school-aged child?
Aggression, impulsivity, lack of empathy
What are the set of symptoms most characteristics of conduct disorder in school-aged child?
Aggression, impulsivity, lack of empathy
What are calorie requirements from birth to 6 months?
120 kcal/kg/day
What are calorie requirements from 7 months to 1 year?
100 kcal/kg/day
What are calorie requirements from 2-10 years?
70-100 kcal/kg/day
What are calorie requirements for adolescents?
25 kcal/kg/day
What are calorie requirements for adults?
30 kcal/kg/day
What are the benefits of breastfeeding?
Perfect food for humans that cannot be duplicated
Decreases illness in infants–maternal antibodies are transferred to infants
Decreases GI problems (GERD)
Decreases allergies as breast milk contains anti-inflammatory agents to decrease atrophy; fewer allergies in children
What is adequate weight gain in the first three months?
30 g/day (1 oz/day)
What is adequate weight gain in the next 3 months (3-6 months)?
15-20 g/day
When should you start vitamin D supplements in breastfed infants?
2 months
How much vitamin D supplementation is recommended?
400 IU
When should iron supplementation start in breastfed infants?
6 months
How much iron supplementation for breast-fed infants?
1 mg/kg/day
What does bone age look at?
X-ray of tarsals and carpals to determine extent of ossification
What is the average growth in school-aged children?
5-7 lb/year
2-3 in/year
