Nutrition

Question 1

• Hospital Based:
• Jevity? Need arg for? Glutamine? LCFA?
• Previously well nourished w acute?
• Previously mal or nourished w severe acute?
• Prev mal and serious acute?
• NG risk? Parenteral risk?
• Nutrition perscription: 4 steps?
• Overfeeding risk? Takes how long?
• Underfeeding risk? Measured how? Average need?

Answer 1

• 1 kcal/ml; NO; Gut barrier; LT’s/PG’s
• 10-14d
• 5-7d
• 3-5d
• aspiration pneu; infection
• TEE (30 kcal/kg); multiple by kg; sub D5; Divide by 24
• Hyper; 1-2 days for glycogen buffer to fill
• Protein loss; 24 hour urine N if BUN stable; N grams x 6.25 = catab. protein; 0.5-0.8 healthy; 0.8-1.8 sick

Question 2

• Hospital Based:
  1. ) Pulm: Risks? (2) Do what?
  2. ) Liver failure issues? (3) Do what?
  3. ) Renal failure issue? Do what? (2)
  4. ) Cardiac: Do what? (4)
  5. ) DM: Do what? (2)

Answer 2

1. ) High CO2; weak resp muscles; high fat
2. ) Ammonia, IR, False NT’s with Aromatic AA’s; high branched AA diet
3. ) BUN goes up; low protein or deal with BUN via dialysis
4. ) Low calories, sodium, chol., sat fat
5. ) Monitor insulin and carbs

Question 3

Micronutirents:

• What is a trace element?
  1. ) Iron: Early? (3) Mid? (2) Late? (3)
• 3 functions? Increase abs? (3) Decrease abs? (5) Only way to rid it? (2) 3 effects of deficiency? Epi? Toxicity?
  2. ) Zinc: Physio roles? Source? (2) Decrease abs? (2) Abs. with deficiency? Lost how? Human milk? 3 deficiency effects? Prev? Intervention? Toxicity?

Answer 3

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Question 4

• Malnutrition:
• What trumps all?
• PEM? Due to? Leads to? (2)
  1.) Marismus: Severe wasting of? PA? HR? Temp? Na pump? Inflamm response? GI? High in? Wt loss? Muscle/FM loss?
  2.) Kwashiokor: Leads to? What reserved? (2) Due to?Albumin? Insulin? Hepatic FA’s? Common in? Edema? Anorexia? HM? Infections? Skin/nails?
• Treatment speed? Small and? High in? (2) 5 nutrients?
• ## Refeeding syndrome? (3)

Answer 4

• Energy
• Protein energy malnutirition; neg. N; impaired immune and GI
  1. ) Fat/muscle; Low, Brady, Low, Low, Slow, Impaired, 0-12mo; high; high
  2. ) Edema; fat/protein; protein deficiency; low; high; high; 12-24mos; yes; yes; yes; many; bad
• Slow; frequent; protein/fat diet; K, Mg, P, Zn, Vit. A
• EC –> IC (K, P, Mg)

Question 5

• 2nd most preventable cause of death?
• 3 applications?
• 4 parts of assessment?
• Qualitative (open/closed); Semi quant? quant?
• Nutrient requirement?
• RDA? Focus on? Not?
• Why don’t patients change diets? Not?
• Role of dietary guidelines?
• 4 key messages?
• 4 benefits?

Answer 5

• Low PA/ unhealthy eating
• Public health; Amb. med; Inpatient nutrition
• HPI, Antrho, PE, Labs
• Diet? Fruits/veggies?; Estimates of claories? Diet records
• 50% of a group
• 95-97% of all people; health promotion; deficiency
• Barriers; motivation
• promote health lower chronic illness
• Lower calories; reduce some stuff; increase some stuff; be active
• Vits, minerals, Lower CV disease, Increase bowel health

Question 6

• MDG: 1.) Erdicate what? On track? 2.) Primary ed? 3.) Gender? 4.) Decrease child (5yo) mortality by? So far? 5.) Maternal health? 6.) HIV/AIDS/malaria? 7.) Environment? 8.) Global?
• Focus on? Hunger = ?
  1. ) Basic cause? (2)
  2. ) Underlying cause? (4)
  3. ) Immediate cause? (2)
• Malnutiriton due to inadequate calories?
• 4 interventions?

Answer 6

1. ) Extreme hunger (close) 2.) Universal 3.) Equality 4.) 2/3; 1/3 5.) Improve 6.) Get rid 7.) Ensure 8.) Partnership
   - first 1k days; poverty
2. ) Lack of capital/social/political context
3. ) Income poverty, low food, lack of services/care
4. ) Disease and low intake
   - Myth
   - Supplements, fortification, technology, education

Question 7

• Vitamins: Skin, mouth, neuro, anemia, other?
  1. ) B1 (thiamine) 2.) B2 (Riboflavin) 3.) B3 (Niacin) 4.) Vit C 5.) Folate 6.) B12 7.) A 8.) D 9.) E 10.) K
• Water soluble: Stored? Except? Toxicity? Except? Absorption? Excreted via?
  1. ) B1: 3 types? 2.) B2: Common finding? 3.) B3: Common finding? Carcinoid tumor leads to?
  4. ) Folate (B9): Important for? Conv of? In what food?
  5. ) B12: Imporant for? Lost via? Requires what?
  6. ) Pyroxidine (B6): Cofactor for? Rxn?
  7. ) Vit C: Can lead to lack of vasoactive/neurotropic?

Answer 7

• CHART!
• No; B12; No; B6; High; Urine
  1. ) Dry, wet, Wernickes 2.) Cheilosis somatosis 3.) Pellegra (4 D’s); High seratonin, low tryptophan
  4. ) 1-c transfers; Homo-methionine; foliage
  5. ) 1 C transfer; Bile; IF
  6. ) CBS; Homo –> Cystine
  7. ) Not enough of these NT’s

Question 8

• Fat Soluble Vitamins:
• Stored? Toxicity? More potent D? Vit D must be supplemented in who?
  1. ) D: Helps with absorption of? Can lead to? Can causes?
  2. ) A: No toxicity with?
  3. ) E: Anti oxidant for what? Anemia? Neuro damage? Large dose inihibits?
  4. ) K: Carboxylates what? Synthsis by? Defic can be caused by?

Answer 8

• yes; yes; D3; Infants
  1. ) Ca; Rickets; Hypercalcemia
  2. ) Beta caratine
  3. ) Neurological free radical scavenger; Hemolytic; Irreversibe; Vit K
  4. ) 1972 C,S; Bacteria; Chronic AB’s

Question 9

• Neuroendocrine:
• Short term? Long term signals?
  1.) VMN: Effect? Known as?
  2.) LH: Effect? Voracious eating via? (2)
  3.) Arcuate: 2 Centers? Release? Effect?
  4.) PVN: 2 receptors? Effect?
• Knock out POMC? NPY? MCR?
  Non- homeostatic: Aka? Overrides what? Link b/n NA and? Seratonin effect? Ex? Internal inputs? (3) External? (4)
• Obesity due to?

Answer 9

• Meal; Adipose tissue
  1.) Less hungry; satiety center
  2.) More Hungry; Melanin CH (MCH) and Orexins (hypocretins)
  3/4) NPY/AgRP (NPY (act. NPYR = hungry), AgPR (Blocks MCR)), POMC/CART (a MSH (act. MCR= satiety))
• Increase wt., decrease wt., Increase wt.
• Reward; Homeo; Hypo; Increase hunger; SSRI Increased aMSH; Reward, Crave, Restraint; Environment, Avail., socia, time cues
• Non homeo

Question 10

• Neuroendocrine:
  Homeostatic:
  1.) Gherlin: Location? Effect? Peaks? Stim? (2)
  2.) CCK: Location? Movement? Effect?
  3.) PYY: Location? Inhibits? (2) Effect?
  4.) GLP1: Location? Effect?
  5.) Insulin: Location? Effect?
  6.) Leptin: Location? Activates? Decreases (2) Effect?
  7.) Glucose: Stim? Inhibits?

Answer 10

1. ) Stomach; Hungry; Prior to meal; NPY/AgRP
2. ) Duo; Slows; Satiety
3. ) Ileum; NPY/AgRP; Satiety
4. ) Ileum; Satiety
5. ) Pancreas; Satiety
6. ) Adipose tissue; aMSH; AgRP, NPY; Increase satiety
7. ) VMN; LH

Question 11

• Diet and Exercise Obesity Treatment:
• Ask about what instead of saying obese?
• Best treatment?
• PA good for? (2)
• Next steps after tried first steps? (2)
• PA reccomendation?
• Pedometer: Wear for week to get? Then? Goal?
• NWR: Diet composition? Self monitor? Breakfast? PA? TV?

Answer 11

• Weight
• Lower calories
• Meal replacements; diet logs
• 150 mod or 75 vigorous
• Baseline; increase by 500; work to 10-12k
• 24% fat, 19% protein, 55% carb; yes; yes; 28k/wk; no