Nutrition Flashcards
What is malnutrition
A state of nutrition in which a deficiency, excess or imbalance of nutrients causes measurable adverse effects on tissue, body form, function and clinical result
Cause of malnutrition
Decrease intake - Poor appetite, dysphagia
Impaired digestion/absorption
Increased nutritional requirements
Increased nutrient loss - Vomiting, diarrhoea, stoma loss
Impact of malnutrition
GI dysfunction, increase incidence of infection, decrease wound healing. This leads to less food intake which eventually leads to more malnourishment
What happens to water and Na in starvation
There is an initial loss, retention later on
Why should saline be administered carefully to starved patients
Starvation leads to retention of Na and water, hence giving saline could make this worse
Metabolic rate in starvation vs injury
Decrease in starvation, increases in injury
Nitrogen loss in starvation vs injury
Starvation goes down, injury goes up
What happens to insulin in starvation
Decreases as body needs more Glucose in blood
Tool to assess malnutrition risk in patients
MUST - Malnutrition Universal Screening Tool
Common nutritional assessment tools
Mid-arm muscle circumference, triceps fat % and grip
Who needs nutritional support
BMI < 18.5, unintentional weight loss > 10% in last 3-6 months or BMI < 20 with unintentional weight loss > 5% within 3-6 months. Eaten little or nothing past 5 days
Forms of nutritional support available
Food fortification and dietary counselling
Oral nutrient support - snacks/supplements
Enteral feeding - Tube into the gut
Parenteral feeding - Nutrition intravenously
How can nutritional content of food be increased without increasing volume consumed
Fortification of food, adding full cream milk, cheese, butter
Small frequent meals
Example of oral nutritional supplements
Ready made drinks, powders, puddings, fat supplement (Calogen)
Indications for enteral tube feeding
Inadequate or unsafe oral intake due to unconscious patient, neuromuscular swallowing disorder, upper GI obstruction, GI dysfunction or increase nutrition need
Contraindication for enteral tube feeding
Lower GI obstruction, prolonged intestinal ileus, severe diarrhoea or vomiting, intestinal fistula
Type 1 intestinal failure indications for parenteral feeding
Severe malnutrition pre-op, post-op feeding, intestinal fistulae, post chemo mucositis
What is malabsorption
Defective mucosal absorption
Cause of malabsorption
Defective luminal digestion, mucosal disease, structural disorders
Broad types of malabsorption of proteins, lipids, carbs
Digestive or absorptive
Most common vitamin deficiency
Iron
What is tropical sprue
Colonisation of intestine by infectious or alternation in bacterial flora
Treatment for tropical sprue
Tetracycline + Folic acid
Whipples disease
Rare bacterial infection caused by Tropheryma whipplei that interferes with normal digestion by impairing breakdown carbohydrates and fats and hamper ability to absorb nutrients
