Nutrition and artificial feeding Flashcards
What is EAR in terms of nutrition?
Estimated average requirement, (of nutrients) half the population usually needs more, half needs less
What is LRNI in terms of nutrition?
Lower reference nutrient intake
Sufficient for people with low requirements but 97.5% of the population need more
What is RNI in terms of nutrition?
Reference nutrient intake
Sufficient for about 97.5% of the population
What are the main source of energy in the body and what percentage of our energy do they supply?
Fat stores 80-90%
Can protein be stored? What happens in starvation?
No protein can’t be stored
In starvation muscle tissue is broken down to provide energy
How much protein does an average adult (and a 75kg man) require a day?
0.75g/kg/day
In a 75kg man thats about 50g per day
What should the nitrogen balance be in a healthy adult?
0
As nitrogen intake = nitrogen excretion
What is meant by a negative nitrogen balance and when may this occur?
Intake is less than excretion
Occurs during times of fasting or illness as the body is breaking down proteins for energy
What is meant by a positive nitrogen balance and when may this occur?
Intake is greater than excretion
occurs during periods of growth, pregnancy as the body is building new tissue
What are the nine essential amino acids (many very happy little pigs take iced lemon tea)?
Methionine Histadine Valine Leucine Phenylalanine Tryptophan Isoleucine Lysine Threonine
What 4 amino acids are lacking in plant proteins?
Methionine, Cysteine, Lysine, Tryptophan
1g of fat provides how many kcal compared to carbohydrate and protein?
1g fat = 9kcal
1g carbohydrate and protein = 4kcal
What are the 4 types of fat, what are there characteristics and where are they found?
Saturated - no double bonds - meat and dairy
Mono-unsaturated - 1 double bond - olive and peanut oil
Poly-unsaturated - more than 1 double bond - corn and sunflower oil
Trans (hydrogenated) - trans double bonds - cakes, biscuits, pastries
Has dietary fat improved or not over the last 10 years?
Improved
What percentage of your diet should could from fats and what percentage of this should be made up of saturated /unsaturated/trans fats?
less than 35% ideally 30%
10% saturated
18% unsaturated
less than 2% trans
What are the 2 essential fatty acids?
Omega 3 and 6
What are the 4 types of carbohydrate?
1) Polysaccharides - mainly starch
2) Disaccharides - mainly sucrose
3) Monosaccharide’s - mainly glucose and fructose
4) Non-starch polysaccharide - dietary fibre
What is the recommended intake of total carbohydrate and where should most of that come from?
50% - intrinsic and milk sugars and starch
What is NMEs (non-milk extrinsic sugars)?
Added sugar
What food stuff contributes the most to NMEs intake in the UK?
Sweetened soft drinks
‘Organic compound required for normal metabollic function which cannot be synthesised in the body- deficiency results in disease’ is the definition of what?
Vitamin
‘Inorganic molecules which have a physiological function’ is the definition of what?
Minerals
The majority of vitamins are converted into molecules which act as co enzymes other than which 3 vitamins?
A, D, E
Which vitamin is coblamin?
B12
Which vitamin is folic acid?
B9
Which vitamin is Pyridoxal phsophate?
B6
Which vitamin in pantothenic acid?
B5
Which vitamin is niacin?
B3
Which vitamin is riboflavin?
B2
Which vitamin is Thiamin?
B1
What are the 7 key minerals?
Iodine Fluoride Magnesium Iron Calcium Zinc Phosphate
What is recommended daily salt intake?
less than 6g
What are the 4 most important deficiencies globally?
Iron, Vit A, Iodine and zinc
What happens in vit a deficiency?
Go blind
Other than its implication in osteomalacia and ricketts what else does vit d deficiency put you at increased risk of? 3
1) Autoimmune conditions
2) some cancers (breast, colon, ovarian, rectal and prostate)
3) Muscle weakness in the elderly
Other than B12 deficiency causing anaemia what other effects can it have?
Serious and irreversible neurological damage which if left untreated lead to death
Which UK females are advised to take folic acid supplements?
Those who become pregnant or are in their first 3 months of pregnancy
What effect has inadequate iodine status been shown to have on children?
Affects cognitive outcomes
Children under the age of 5 may be advised to take supplementations of which 3 vitamins?
ADC
Other than folic acid pregnant and breast feeding women are advised to take supplementations of which other vitamin?
D
What percentage of patients are malnourished on acute admission and discharged from hospital?
On acute admission - 40%
At discharge - 70%
How long would a healthy adult survive in complete starvation compared to a patient that has experienced trauma/surgery/infection?
Healthy adults - 2 months
Patient - 1 month
What does the MUST tool measure?
Malnutrition universal screening tool
Assessmant on malnutrition and malnutrition risk
When is an adult malnutrition assessmant undertaken and when must a MUST be undertaken?
Within 24 hours of admission then weekly
If a patient answers yes to any of a series of trigger questions then a MUST is undertaken
What 3 measurements are taken in a MUST assessmant?
1) BMI
2) % recent weight loss
3) Acute illness, with or likely to be no nutritional intake for 5 days
How is a MUST score calculated and what is it out of?
BMI given given a score 0-2 Recent weight loss given a score 0-2 No intake in past 5 days 0 or 2 Out of 6 0 = low 1= medium 2-6 = high
What 3 anthropometric nutritional assessmants can be undertaken?
1) Tricep skinfold thickness
2) Mid arm circumference
3) Mid arm muscle circumference
What 3 types of patient should have artificial nutrition?
1) Can’t eat - (stroke, head and neck surgery)
2) Can’t eat enough - (burns, spesis, pre-operative malnutrition)
3) Shouldn’t eat - (bowel obstruction, leaks after surgery, prolonged ileus)
What are 3 simple methods to encourage the oral route of nutrition if possible?
1) Pureed foods
2) Protected meal times
3) Red trays to indicate patients at risk who may need extra encouragement
What are the 2 main forms of artificial feeding?
1) Enteral - into gut
2) Parenteral - into vein
What are the 2 forms of short term enteral feeding and how long are they used for?
1) Naso-gastric feeds
2) Nasojejunal feeds (if gastric outlet obstruction)
Used for less than 4 weeks
What are the 2 forms of longer term enteral feeding?
1) PEG (percutaneous, endoscopic gastrostomy)
2) RIG (radiologically inserted gastrostomy)
What are the indications for TPN ( total parenteral nutrition)?
Inability to establish any other route of nutrition and inability to meet nutritional requirements via the oral or enteral route such as obstruction, short bowel sydrome, fistulae, complications post surgery (prolonged ileus, anastamotic leaks)
What are the 3 routes for IV feeding and for how many weeks of anticipated feeding would each be used?>
1) Peripheral feeding - less than 2 weeks
2) Central feeding - (peripherally inserted central catheter into heart) - 2-4 weeks
3) Hickmann line (tunnelled line, goes into heart) - more than 4 weeks
What are the 5 possible complications of TPN?
1) infection
2) refeeding syndrome
3) Electrolyte disturbance
4) Abnormal liver tests - fatty liver
5) High blood sugar - may require insulin
What happens in re feeding syndrome?
Fluid shifts
Electrolyte shifts
What are the 3 parts of treatment for re feeding syndrome?
1) Give IV Vit B and C - thiamine (prevent Wernickes/Korsakoffs syndrome)
2) Feed slowly and build up
3) Daily electrolytes
What must be carried out a patient currently receiving TPN?
Daily monitoring
What are the 3 types of eating disorders?
1) Anorexia Nervosa
2) Bulimia Nervosa
3) Eating disorder NOS (binge eating disorder)
What are the 2 diagnostic features of anorexia nervosa and the 2 types?
1) Active maintenance of low body weight ( less than 85% of expected BMI or BMI of less than 17.5
2) Extreme shape and weight concern
Two types: restricting, binge/purging
At what age does the onset on Anorexia nervosa peak?
Age 15-18
What percentage of sufferers of anorexia nervosa and bulimia nervosa are girls?
95%
What is the prevelance of anorexia nervosa amongst girls from 15-18?
0.5%
What are the 3 diagnostic features of bulimia nervosa?
1) Recurrent binge eating - large amounts quickly, loss of control
2) Compensatory behaviour - Vomiting, laxatives, fasting, exercise
3) Extreme weight and shape concern
What is the average age of onset of bulimia nervosa?
Late adolescence, young adulthood
What is the prevelance of bulimia nervosa amongst women aged 18-25?
1-3%
What is eating disorder NOS?
Criteria not met for anorexia or bulimia nervosa but disordered eating characterised by restriction or by binge eating
What are the 4 diagnostic features of eating disorder NOS?
1) Recurrent binge eating
2) Features of binge episodes (to distinguish from overeating)
3) Marked distress regarding binge eating
4) NO compensatory behaviour
What are the 2 types of risk factors for developing an eating disorder?
1) Specific - body dissatisfaction risk factors
2) Non specific - self regulatory risk factors (parental psychopathology/ insensitivity - trauma - temperamental/biological predispositions
What are the 2 functions of stopping eating in AN?
1) Way of feeling in control when external events feel outside of personal control
2) To influence others - to show feelings of distress, defiance, anger
What is the function binge eating and purging in AN or BN?
Regulate emotional states - allows you to escape from an aversive self awareness and is reinforcing and self-maintaining
What percentage of men and women have an obese BMI?
Men 26%
Women 24%
What are the 3 factors of western politics which have contributed to the obesity epidemic?
1) Improved prosperity
2) Food overproduction
3) Major industries benefit from overeating
At what BMI and waist circumference is drug intervention to treat obesity considered?
25-29.9
and high waist circumference and co morbidities
At what BMI is surgery considered as an option to treat obesity?
40 and above
What percentage weight loss is considered a realistic loss of initial weight?
5-10%
How does orlistat medication work and when should it be prescribed?
Changes the way fat is digested and absorbed - gives unpleasant side effects if fat is consumed
A BMI of 28 or more with associated risk factors
A BMI of 30 or more
What are the indications for bariatric surgery?
BMI or 40 or more
Or BMI between 35 and 40 with another significant disease (type 2 DM or hypertension) that would be improved with surgery
What are the 2 types of bariatric surgery?
1) Gastric band
2) Gastric bypass
What are the 4 BMI classifications and values?
less than 18.5 = underweight
18.5 - 25 = healthy weight
25 -30 = overweight
30 or more = obese
