Nutrition

Question 1

BMI Classifications

Answer 1

• Underweight <18.5
• Healthy weight <18.5-24.9
• Excessive Weight- 25-29.9
• Obesity >30
• Morbid Obesity >35

Question 2

Macronutrients sources?

Answer 2

Support the energy requirements of the body: Goal is to maintain fluid balance. Demands for macro is affected by activity level, fever, trauma and inflammation

• Carbohydrate- source of energy
• Protein: building blocks, maintain fluid balance, maintain acid-base balance
• Fat: stored energy reserves

Question 3

Estimating Energy Requirement

Answer 3

Energy requirement = ratio of energy intake to energy expenditure

Classic measure is the Basal Metabolic Rate (BMR)

Not used clinically

Clinically, patient’s daily energy requirements is important- daily Resting Energy Expenditure (REE)

Multiple methods to estimate the REE, but Indirect Calorimetry is more accurate

Question 4

COPD nutrition consideration?

Answer 4

Hypercatabolism

• Accessible metabolic breakdown of complex substances like protein
• COPD patients have high work of breathing 10x leading to them burning a lot of calories

Question 5

How is nutrition affected by high WOB?

Answer 5

Increased energy expenditure

• Due to increased work of breathing and difficult to control the energy
• Pulmonary rehab can improve the quality of life and energy can be helpful and maintaining caloric count

Question 6

Marasmus Malnutrition

Answer 6

Elevated energy expenditure + increased WOB + increased systemic inflammation + insufficient caloric intake = marasmus type of malnutrition

• Increasing energy, can be seen in COPD and end stage lung cancer, aids patients
• Protein deficiency
• leads to muscles weakness and dyspnea which further decreases caloric intake

Question 7

Consequences of Cachexia

Answer 7

Peripheral (lower limb) weakness/muscle wasting

Pulmonary rehab and worry about leg muscle strength and encourage exercise usage to increase leg muscles

Respiratory muscle weakness

reduction of lung elasticity and pulmonary function

Loss of respiratory muscle mass

Inability to inhale and exhale because respiratory muscles are wasted

Alteration of pulmonary immune mechanisms and breath control

Suffer from malnutrition and more prone to bacteria viruses that causes exacerbation

Diaphragmatic muscle dysfunction

Due to weakness and muscle wasting of diaphragm

Higher acute exacerbation risk

Pulmonary immune mechanism and ability to cough mucous out of lungs

Poor quality of life

Not a lot of energy to do test and makes it limitiing

Question 8

What is Cachexia?

Answer 8

A complex and debilitating metabolic syndrome associated with an underlying chronic illness, characterized by involuntary and progressive loss of skeletal muscle mass (with variable loss of fat mass)

Question 9

Biomarkers of Inflammation (indicator of nutrition status)

Answer 9

Inflammation increases catabolism and causes albumin leakage out of vascular compartment (CRP/albumin ratio)

• C-reactive protein – increases with infection/inflammation
• Increases in C-reactive protein are linked to increased nutrition risk
• May lead to indirect calorimetry in patients

Question 10

Nutrition goals for a acute patient?

Answer 10

High fat, low Carb diet

• RQ of fats is less than carbs and proteins.
• More CO2 is produced in a high carb or high protein diet
• RQ quotient should be low, not high