Nutrition

Question 1

What are the particular nutritional issues in CKD? (3)

Answer 1

Catabolic state – Pts need more calories and protein per Kg, esp when on dialysis

Impaired K and PO4 excretion – need low K diet, phosphate binders and modified supplements

Anorexia due to uraemia

Question 2

What are the particular nutritional issues in chronic liver disease? (3)

Answer 2

Catabolic state – need HEHP diet

Anorexia, nausea and diarrhea are common (due to disease or treatments)

Low sodium diet essential – can reduce palatability

Question 3

What nutritional issues are unique to Parkinson’s disease? (3)

Answer 3

High-calorie requirements due to tremor and dyskinesias

Dysphagia is very common in late disease

Treatments can induce significant nausea (all dopaminergics)

Question 4

If you suspect malnutrition, how do you confirm the diagnosis? (3)

Answer 4

• Anthropometry, inc. BMI (<18.5) and waist circumference
• Subjective Global Assessment
• Historical weights
• Food diary
• Collateral Hx

Question 5

What are the 5 elements of assessing the SGA?

Answer 5

1. Weight changes in last 2 weeks + last 6 months
2. Dietary assessment - adequacy and change
3. GI symptoms
4. Functional change
5. Examination findings

Question 6

What are three components of the examination in SGA?

Answer 6

Basically fat + muscle loss + oedema

Subcutaneous fat loss (eyes, biceps, triceps)

Muscle wasting

Oedema

Ascites

Question 7

We advise patients to have a varied diet. How should we quantify this recommendation?

Answer 7

Pts should aim for, per day (1-2-3-4-5-1 rule)

• ≥1 serves of protein
• 2 serves of fruit
• 3 serves of dairy (or calcium-rich non-dairy)
• 4-6 serves of carbs
• 5 serves of vegetables
• No more than 1 ‘discretionary’ item

The focus should be on fresh/less processed food

Question 8

What are some medical therapies that could be used to help with renourishment? (4)

Answer 8

Mirtazapine (remember - Mass in patients with low mood)

Olanzapine (Obese - causes increase in appetite and weight gain. Can use in psychotics/bipolars)

Steroids (when anorexia is due to cancer)

Medical marijuana (also for cancer, limited data)

Question 9

What are some of the non-pharmacological measures to improve malnutrition? (5)

Answer 9

Always rule out an organic cause first (e.g. malabsorption)

Educate (1-2-3-4-5-1 diet)

Dietician assessment

Meal plans

Consider meal services (“Meals on Wheels)

Supervised or Assisted feeding

Hand & visual aids (if impaired vision/dexterity)

Supplements

Last resort PEG/PEJ feeding.