Nutrition

Question 1

What are micronutrients?

Answer 1

chemical element or substance required in trace amounts (<100 parts per million) for the normal growth and development of living organisms

Question 2

What is malnutrition?

Answer 2

Body Mass Index (BMI) of less than 18.5 or

unintentional weight loss greater than 10% within the last 3-6 months or

a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 3

What is marasmus?

Answer 3

Loss of lean fat due to deficiency of carbohydrates and protein

Question 4

What is Kwashiorkor?

Answer 4

Deficiency in protein but adequate in carbohydrates. Associated with oedema, fatty liver, infection, dematitis and inflammation

Question 5

What are the nutrition screening in patients?

Answer 5

(Clinical) Dietary, nutritional, examination (i.e. muscle weakness, oedema, fluid balance)
(Antropometric measurements) BMI, skin fold measurement, mid-arm circumference, knee-heel length, hand grip strength
(Laboratory assessment) Prealbumin, Nitrogen balance

Question 6

What is the malnutrition universal screening tool (MUST)?

Answer 6

Done on admission to care/nursing homes and hospital, or if there is concern. For example an elderly, thin patient with pressure sores
Takes into account BMI, recent weight change and the presence of acute disease
Categorises patients into low, medium and high risk

Question 7

What are the indications of parenteral support in hospital patients?

Answer 7

Enteral support not feasilbe
Failure of gut function
Intestinal failure
Peri-operative (occurring at same time)

Question 8

What is re-feeding syndrome?

Answer 8

Metabolic abnormalities which occur on feeding a person following a period of starvation, leading to: Hypophosphataemia, Hypokalaemia, Hypomagnesaemia, Abnormal fluid balance

Question 9

What are the risk factors of re-feeding syndrome?

Answer 9

(one or more of following) BMI < 16 kg/m2
Unintentional weight loss >15% over 3-6 months
Little nutritional intake > 10 days
Hypokalaemia, Hypophosphataemia or hypomagnesaemia prior to feeding

(two or more of the following) BMI < 18.5 kg/m2
Unintentional weight loss > 10% over 3-6 months
Little nutritional intake > 5 days
History of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

Question 10

What is the treatment for re-feeding syndrome?

Answer 10

Start at up to 10 kcal/kg/day increasing to full needs over 4-7 days
Start immediately before and during feeding: oral thiamine 200-300mg/day, vitamin B co strong 1 tds and supplements
Give K+ (2-4 mmol/kg/day), phosphate (0.3-0.6 mmol/kg/day), magnesium (0.2-0.4 mmol/kg/day)