nutrition Flashcards
Describe the constituents of a healthy diet
- fruit and veg - vitamin ,mineral , fibre
- carbohydrates - Good source of fibre, calcium, iron and B-vitamins. Careful about fat, sugar and salt when preparing these foods
- dairy - calcium and protein
- protein -
- fat- unsaturated
- fluid - 6-8 glasses a day
- salt - max 6g a day
what are some diseases of deficiency
scurvy - vitamin c ricket - vitamin d iron deficiency anaemia cardiovascular diseases hypertension renal diet
what is scurvy
lack of Vitamin C (ascorbic acid) From fruit and vegetables Connective tissues can’t form properly Bleeding, corkscrew-shaped hairs Risk factors are EtOH, tobacco, being male, low income, haemodialysis and poor nutritional status
what is ricket
Vitamin D (and calcium)
Made by our skin in response to sunlight
Lighter skins are more efficient than darker skins at making vitamin D
Also found in food e.g. eggs, oily fish, fortified foods like cereal and some spreads
how much calories should men and women have in a day?
Women need 2000 kCal/day
Men require 2500 kCal/day
On average – depends on activity levels!
what are the consequences of obesity
Heart disease
Stroke
Type 2 diabetes
what is the BMI for a normal person, overweight and obese
normal: 18.5 -24.9
overweight : 25 - 29.9
obese 1 : 30 +
how do you work out BMI
For adults
BMI (kg/m2) = Weight (kg)/ (Height)2 (m2)
what is malnutrition
Occurs when diet is insufficient to meet the demands of the body
what is the consequences of malnutrition
Muscle weakness – self care, falls and chest infections
Immune system – fight infections
Wound healing
Kidney function
Metal health – depression, apathy, self-neglect
Reduced fertility and long-term health problems for the baby
what does NICE say about malnutrition?
NICE CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (2006)
Nutrition support should be considered in people who are malnourished:
a BMI of less than 18.5 kg/m2
unintentional weight loss greater than 10% within the last 3–6 months
a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.
Nutrition support should be considered in people at risk of malnutrition who, as defined by any of the following:
have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer
have a poor absorptive capacity, and/or have high nutrient losses and/or have increased nutritional needs from cause such as catabolism.
what is the MUST score
Malnutrition Universal Screening Tool (BAPEN)
Step 1
Measure height and weight and calculate BMI
Step 2
Note percentage of any unplanned weight loss and score using tables provided
Step 3
Establish acute disease effect and score
Step 4
Add scores to obtain overall risk of malnutrition
Step 5
Use management guidelines and/or local policy to develop care plan.
how can you provide nutrition?
Just give them food!
Enteral nutrition: gastro-intestinal (GI) tract
what are the ways in which you can provide nutrition when they cannot swallow
A patient can’t swallow?
Nasrogastric tube
PEG tube
The gut doesn’t work, or cannot be used?
Parenteral nutrition: avoids the GI tract – goes directly into a vein
what happens during starvation
Glycogen stores used first
Then shift to using fat as energy.
Gluconeogenesis occurs and insulin levels are low
Pumps that maintain ion balances across membranes slow down
Electrolyte (phosphate and potassium) levels change
Distribution of body water changes
what is refeeding syndrome
A sudden shift in energy source from fat/protein to CHO
↑insulin secretion
↑glycogen, fat and protein synthesis for which phosphate, magnesium and thiamine are required
Increased absorption of potassium and magnesium into cells
This leads to a decrease in serum levels of K, PO4, Mg
Large shifts in electrolytes and water cause:
rhabdomyolysis
Respiratory or cardiac failure
hypotension
arrhythmias
seizures
coma
sudden death
who is it at risk of malnutrition?
patient has one or more of the following:
BMI(kg/m2) <16
Unintentional weight loss >15% in the past 3-6 months
Little or no nutritional intake for >10 days
Low levels of potassium, phosphate, or magnesium before feeding
Or the patient has two or more of the following:
Body mass index <18.5 kg/m2
Unintentional weight loss >10% in the past 3-6 months
Little or no nutritional intake for >5 days
History of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics
what are the guidelines for management of malnutrition
- patients at risk
- check potassium, calcium, phosphate and magnesium levels
- admister thiamine 200-300mg daily orally
- vitamin B
- multivitamins - start feeding 0.418 mj/kg/day
- increase it over 4-7 days - rehydarate correctly
- monitor potassium, calcium, phosphate and magnesium levels for first 2 weeks and amend treatment if necessary
what is the role of the pharmacist
Integral member of the Nutrition Support Team in hospital
Review enterally and parenterally fed patients in community pharmacy and in hospitals
Prevent and manage risks of refeeding syndrome
Provide dietary advice for all patients /customers
Accessible to public - can influence the dietary habits and poor nutrition
Advise on drug–nutrient interactions
what are some drug to nutrient interactions
Absorption
Tetracyclines chelate with calcium, magnesium and iron (label 6)
Quinolones - ciprofloxacin absorption reduces by 50% if given with enteral feed (label 7)
Metabolism
Grapefruit juice – cytochrome P450 enzyme inhibitor that reduces metabolism of certain drugs hence increasing their plasma concentrations
Examples include amiodarone, ciclosporin, simvastatin
What is a nutraceutical?
Food, or parts of a food, that provide medical or health benefits, including prevention or treatment of disease”
what are some regulations of nutracuetical?
In the EU, supplements are regulated as foods.
Not allowed to make medicinal claims
purpose: supplement the normal diet
‘nutrition claim’ means any claim that a food has particular beneficial nutritional properties due to:
(a) the energy it provides/does not provide
(b) the nutrients or other substances it contains/does not contain
‘health claim’ means any claim that a relationship exists between a food category, a food or one of its constituents, and health.
A health claim goes further than a nutrition claim and relates a food or one of its constituents to health or well-being.
the labeling is regulated as well
why regulate?
Evidence based medicine!
If there is no good evidence of efficacy you may not claim it
Advertising standards!
what is the role of the pharmacist - nutraceutical
Interactions
Vulnerable patients
Right to choose
Informed choice
what is Chondroitin - example of nutraceutical
Part of cartilage, supplement used for arthritis
Usually obtained from animal cartilage
Actual structure may vary depending on origin
Polymer length, sulfate groups
oral bioavailability 15%
what is Glucosamine- example nutraceutical
Found in the human body mostly in joints
Precursor to glycosaminoglycan which forms cartilage
Supplement usually derived from crustaceans
Oral bioavailability 44%
Was thought to be beneficial for arthritis – no evidence
Evidence it may help reduce stroke risk
Does slightly increase INR in patients on warfarin
Fish oils - example of nutraceutical
-good for eyes/ brain Docohexaenoic acid (DHA) Eicosapentaenoic acid (EPA)
co-enzyme Q10 - example of nutraceutical
Antioxidant
Lipid soluble, orally bioavailable
Popular uses
Delay skin aging: evidence that it does penetrate skin
Help muscle pain from statins
Melatonin- example of nutraceutical
A hormone synthesised from tryptophan in the pineal gland
Secretion follows a circadian rhythm: peak is around 2-4am
Light modulates the timing of secretion
Licensed in the UK as a treatment for jet-lag symptoms in adults
Not licensed but used in children with sleep problems
Orally bioavailable
Drug or hormone? Is available from plants e.g. bananas or tomatoes
Cannot buy as food supplement in UK, can in USA
Reasonable evidence for jet-lag
turmeric
Extracted from turmeric root
Active constituent is curcumin
Used for osteoarthritis, prevention of MI, reduce skin irritation post radiation treatment
Efficacy? Shown to be effective in clinical trials
Safety? 4g daily used safely for 30 days
Thought to have antiplatelet effects
Curcumin shown to be antiplatelet in vitro
Case reports of ↑INR when taken with warfarin
One study showed no problem – but only used a low dose
