Nutrition Flashcards
Energy comes from
o Carbohydrate
o Fiber
o Nitrogen
o Water
Energy supports
normal functions and activity, growth and repair of damaged tissues
Three factors for Energy Expenditure
o Basal energy expenditure (BEE)
o Thermic effect of food (TEF)
o Physical activity
Basal energy expenditure (BEE)
amount of energy required to maintain basic physiologic functions
Thermic effect of food (TEF)
amount of energy expended during and following the ingestion of food
Of the energy expenditures, which has the largest effect
physical activity
Why do we need protein
growth and maintenance of body structure and function
How much protein a day
56g/day for men and 45g/day women
Carbs include
o Simple sugars
o Complex carbohydrates (starches)
o Indigestible carbohydrates (dietary fiber)
What is the most concentrated source of food energy
fat
What is major part of cell membranes
cholesterol
Patient populations at risk of nutritional deficiencies
o Elderly
o Adolescent
o Pregnant or lactating women
o Low socioeconomic status
BMI
body weight in relation to height
Most important lab in evaluation of protein-calorie undernutrition
albumin
2 distinct syndromes of protein- energy malnutrition
Kwashiorkor
Marasmus
Kwashiorkor
- deficiency of protein in presence of adequate energy
- Sufficient caloric intake, insufficient protein consumption
Marasmus
- combined protein and energy deficiency
- Severe malnutrition, emaciated appearance
In developing countries where is Kwashiorkor found
- where foods containing protein are insufficient
- Occurs in areas of famine or poor food supply
In developing countries where is Marasmus found
seen where adequate quantities of food are not available
In developed countries where is Kwashiorkor found
associated with illnesses where the body is in a hypermetabolic state, i.e. trauma, sepsis, burns
In developed countries where is Marasmus found
results from chronic diseases like heart failure, cancer, COPD, AIDS Protein-Energy Malnutrition
Tx protein energy malnutrition
Call your nutrition colleagues ASAP
Should be followed daily by nutrition consultant
o Help manage dietary requirements
o Correct electrolyte abnormalities
o Replace vitamins and minerals
o Supplements with enteral or parenteral nutrition
obesity is
excess adipose tissue
Tx obesity
- Close follow-up is essential
- Identify and refer those patients who are motivated to active treatment programs
- Programs are multifactorial and emphasize maintenance of weight loss
o Dietary instruction and education
o Behavior modification
o Exercise
o Medications
o Bariatric surgery
Def anorexia
a disturbance in body image and intense fear of weight gain
Clinical anorexia
- Weight loss leading to body weight 15% below expected
- In female patients, amenorrhea is almost always present
- Other clinical signs and symptoms:
o Constipation
o Cold intolerance
o Bradycardia
o Hypotension
o Loss of body fat
o Dry and scaly skin
Dx anorexia
- Behavioral features such as distorted body image, fear of weight gain and refusal to maintain normal body weight in setting of weight loss to a body weight 15% below expected
- In female, absence of at least 3 menstrual cycles
Tx anorexia
- Goal is restoration of normal body weight and elimination of psychological features
- Inpatient treatment programs are available but may also be necessary in severe cases for management of volume status and electrolytes
- Referral to psychiatrist is essential
Def bulimia nervosa
Episodic, uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to avoid weight gain o Self-induced vomiting o Diuretics o Cathartics o Strict dieting o Vigorous exercise
Clinical bulimia nervosa
- Body weight fluctuations but generally within 20% of normal body weight
- Commonly describe family and psychological issues
- Impulsive or antisocial behavior may be present
- Menstruation is typically preserved
- Medical complications such as:
o Gastric dilatation, pancreatitis after binges
o Poor dentition, esophagitis secondary to vomiting
o Electrolyte abnormalities, dehydration secondary to diuretics and cathartics
o Constipation
Tx bulimia
- Supportive care to include psychotherapy
- Antidepressants may be helpful
- All patients should be referred to psychiatrist
- Long term psychiatric prognosis is worse with bulimia nervosa
Serum ferritin levels in iron deficiency
Serum ferritin value <12 ng/mL without anemia or <30 ng/mL with anemia
Stage of iron deficient anemia
- Depletion of iron stores without anemia
- Anemia with a normal red blood size (MCV)
- Anemia with low MCV (microcytic), low reticulocyte count , low serum ferritin
Clinical iron deficient anemia
- Fatigue
- Tachycardia
- Palpitations
- Dyspnea on exertion
- Skin and mucosal changes
- Smooth tongue
- Brittle nails
- Spooning of nails
- Cheilosis
- pica
Tx iron deficient anemia
- Identify cause of iron deficiency anemia as often this can be a result of occult blood loss
- Oral iron
o Ferrous sulfate 325 mg PO one-three times daily
o Continue 3-6 months after restoration of normal labs
Who get parenteral iron
Refractory to PO iron
GI disease
Hemodialysis
Thiamine deficiency due to
chronic alcoholism
Clinical thiamine deficiency
- Anorexia
- Muscle cramps
- Paresthesias
- Irritability
- Cardiovascular dysfunction – wet beriberi
- Neurological dysfunction – dry beriberi
Wet beriberi
- Marked peripheral vasodilation caused high output heart failure
- Dyspnea, tachycardia, cardiomegaly, edema
Dry beriberi
- Peripheral nerve involvement causing motor and sensory neuropathy, paresthesias and loss of reflexes
- Wernicke - Korsakoff Syndrome
Tx thiamine deficiency
replace thiamine, initially IV followed by PO
Where is B12 from?
animal sources
How is B12 absorbed
intrinsic factor in the intestine and stored in liver
B12 deficiency in
vegans, alcoholics, elderly
Pernicious anemia
autoimmune disease where there are autoantibodies against gastric parietal cells that produce intrinsic factor
What surgery eliminates intrinsic factor
Gastrectomy
B12 anemia
- elevated MCV (MCV >100) (macrocytic)
- megaloblastic and hypersegmented neutrophils
Tx B12
IM or subcutaneous injections of 100 mcg
• Daily for first week
• Weekly for first month
• Monthly for life
Folic acid found
fruit and vegetable
Folic acid deficiency due to
lack of intake
Clinical B12 and folate
- GI symptoms
- Swollen, painful tongue
- Neurologic symptoms such as cognitive impairment, dementia, depression
Diagnostic level folic acid
less than 150
Tx folic acid deficiency
folic acid 1mg PO daily
Vit D found
ultraviolet B light, plants, animals, fish
Vit D converted into
Hormone 1,25- dihydroxyvitamin D
Hormone 1,25- dihydroxyvitamin D does what
increases absorption of dietary calcium and stimulate osteoclast to release calcium
MC manifestation of Vit D deficiency
osteomalacia
Tx Vit D
o Ergocalciferol (D2) 50,000 units once weekly x8 weeks o Cholecalciferol (D3) 2,000 units daily
