Nutrition Flashcards by Alexis B

An eating disorder characterized by abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight

Anorexia Nervosa

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People with anorexia place a high value on controlling WHAT?

Weight and shape using extreme efforts that tend to significantly interfere with their lives

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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

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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?

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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

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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

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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

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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

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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

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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

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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

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What is the lifetime prevalence of bulimia nervosa?

0.9%

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Is bulimia nervosa more common in men or women?

Females > Males

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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

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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

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Eating disturbances, weight loss, and refusal to maintain body weight at 85% of expected weight for height

Amenorrhea ensues

Anorexia Nervosa

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Episodic binge and purge episodes; believed to arise from familial issues, social pressure, low self-esteem, and desire for control

Bulimia nervosa

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What is the common age for eating disorders to emerge?

14-18 years

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What is the mortality for eating disorders?

10%

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What is Russell’s sign?

Bruised knuckles

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What are the differential diagnoses for eating disorders?

Organic disease-producing weight loss

Pregnancy

Depression

Substance abuse

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What BMI counts as obesity?

Greater than or equal to 95%

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What BMI counts as overweight?

85-95%

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What ages do you check hemoglobin for anemia?

9 months, 15 months, 3 years, and every year after that is at risk

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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