Nutrition

Question 1

Define cachexia

Answer 1

Severe body weight, fat, muscle loss and increased protein catabolism due to underlying disease(s)

Question 2

Define sarcopenia

Answer 2

Degenerative loss of muscle mass and function associated with ageing

Question 3

Define malnutrition

Answer 3

Inadequate consumption of macro or micronutrients to meet the metabolic demands of the body (under/over nutrition)

Question 4

Define undernutrition

Answer 4

Inadequate intake of dietary energy with features of loss of body weight, muscle and fat

Question 5

Name 10 clinical effects of malnutrition

Answer 5

Fatty liver change, functional decline, necrosis
Impaired wound healing
Impaired gut integrity and immunity
Anorexia
Loss of strength
Hypothermia
Poor renal function
Decreased cardiac output
Poor immune function
Depression and apathy

Question 6

Why would someone have a poor intake?

Answer 6

• Age
• Apathy/depression
• Dementia
• Inability to buy/cook/consume food
• Inability to chew and swallow
• Limited mobility
• Sensory loss (taste/smell)
• Treatment (ventilation/surgery/drain tubes)
• Drug therapy (eg chemotherapy agents)

Question 7

What would give someone increased nutritional requirements?

Answer 7

Burns, fever
Muscle gain
Intense exercise

Question 8

What hospital factors may lead to malnutrition

Answer 8

• Failure to recognise malnutrition
• Lack of nutritional screening/assessment
• Lack of nutritional screening
• Failure to record height and weight
• Lack of staff to assist with feeding

Question 9

What investigations should be done in someone with weight loss/malnutrition

Answer 9

Physical examination (muscle wasting/oedema due to hypoalbuminaemia/dry skin/hair loss)
Dietary history
Anthropometric measurements
Biochemical measurements
INR (for vitamin K levels), vitamin B12 and folic acid levels.

Question 10

How is a MUST score calculated?

Answer 10

BMI (0=>20, 1=18.5-20, 2=<18.5)
Unexplained weight loss in past 3-6 months (5%=0, 5-10%=1, >10%=2)
Acutely ill/likely no nutritional intake for >5 days = 2

Question 11

What counts as high risk for malnutrition?

Answer 11

> 2

Question 12

What does MUST stand for?

Answer 12

Malnutrition Universal Screening Tool

Question 13

How can energy intake be increased?

Answer 13

Fortifying energy content of ordinary food (add cream to mashed potatoes)
Sip feeds (fortisip) and other supplements
Enteral nutrition (PEG/NG)

Question 14

What does PEG stand for?

Answer 14

Percutaneous endoscopic gastrostomy

Question 15

How is a PEG inserted?

Answer 15

Use endoscope to enter stomach
Press on abdomen to show place of needle
Gastric button is kept in with balloon