Nutrition and diet Flashcards
what is the definition of malnutrition
- this is a state of nurtion in which a deficiency or excess of energy, protein, and other nutrients causes adverse effects on tissue form and function
what is the annual cost of malnutrition
19.6bn increase in obesity and malnutrition
what are the causes of malnutrition
- Decreased intake when food available
- Increased intake due to inadequate availability quality or presentation of food
- Lack of recognition and treatment
- Increase in nutritional requirements e.g. if you are pregnant
what can cause decreased intake of food
Dysphagia – tend to be in elderly – after stroke, or brain damage
Prolonged periods NBM – patients fast and then there procedure gets cancelled
Side effects of treatment
Pain/constipation
Psychological e.g. depression
Social e.g. low income, isolation
Poor dentition – in children and adults, older people will loose there teeth and end up with dentures – effect the ability to chew food and the consistency of the food that they can have
Reflux/feeding problems/food intolerance’s – this can effect there intake –
what requires you to increase nutritional requirements
- Infection
- Involuntary movements
- Wound healing
what causes increase losses of nutrition
- Malabsorption from gut
- Diarrhoea and vomiting
- High stoma output
what are the consequences of malnutrition
Respiratory function Cardiac function Mobility risk of pressure sores risk of infection wound healing risk of malabsorption Apathy and depression
what two things can identify the risk of malnutrition
MUST
STAMP
what are the 5 steps of MUST
- Body mass index BMI
- Weight loss
- Acute disease effect
- Add scores for steps 1-3
- Action plan
- 0 – low risk
- 1 medium risk
- 2 or more is high risk
how do you assess malnutrition in terms of ABCDE
A - anthropometrics B - biochemistry C - clinical status D - dietary intake E - stilted requirements
describe anthropometrics of the ABCDE assessment tool
- Weight (Dry/Oedema/Ascites)
- Height (ulna, knee length, full body length),
- BMI (Actual or estimate)
- Weight history (?recent weight loss)
- Other measurements – MUAC, MUAMC
describe biochemistry of the ABCDE assessment tool
• Pre-existing malnutrition consider evidence of depletion/risk of RFS
what is the clinical status of the ABCDE assessment tool
• Diagnosis, medications, PMH will impact on nutritional intervention
what is the dietary intake of the ABCDE assessment tool
- Routes available for feeding
- Pre-admission nutritional intake
- Allergies
what are the BMI levels for
- underweight
- normal
- overweight
- Less than 19 is underweight
- 20-24.9 normal
- Over 25 is overweight
how can you measure height
Can be difficult to measure for example if they are bedbound
Surrogate measures;
-Knee height
-Demispan
-Ulna length
- reported height form the patient is a better measure than this
how can you measure weight
- Difficult to obtain unless chair scales or hoist scales
- instead of measuring there weight you can use a mid upper arm circumference as a surrogate
what can you use as a surrogate measure instead of weight
Mid upper arm circumference (MUAC)
how do you measure mid upper arm circumference
o Can measure in supine position
o Obtain height or surrogate height
o Can then estimate weight from BMI
o (Weight (kg) = BMI x Height (m2)
name some mid arm circumference numbers and how they link to BMI
- If MUAC is less than 23.5 BMI is likely to be less than 20 likley to be underweight
- If MUAC is greater than 32 BMI is likely to be greater than 30 so overweight
what are the different levels of ascites
tense 14Kg,
moderate 6Kg
minimal 2.2Kg
what are the different levels of peripheral oedema
Severe 10kg(up to sacrum), moderate 5kg(up to knee), mild 1kg (ankle)
you need an increase in body water off at least….
increase in body water of at least 1kg before can see visual oedema
how much unintentional weight loss do you have to have before you have predicted death
34% weight loss
what can you use to measure fat mass
- skinfolds, commonly use triceps sit
how do you measure fat free mass (ie protein synthesis)
Arm Muscle Circumference (AMC)
Derive from MUAC & TSF
AMC = MUAC (cm) – (0.314 x TSF
what does handgrip dynamometry (HGD) measure
- measures muscle strength and endurance
- t has a positive correlation with functional ability
how can you measure handgrip dynamometry
- supine or sitting position
- dominant or non-dominant side
- repeated measures to mirror original position
what is albumin
- Large protein synthesised in the liver
* Most abundant protein found in plasma and is usually trapped within capillaries
what is the normal range of albumin
35-50g/l
what is the function of albumin
maintains oncotic pressure
what are the causes of hypalbuminaemia
- arises because inadequate protein intake
- can also be due it inflammation and sepsis associated with infection
- this would result in an increase in C reactive protein, white cell count, pyrexia
- then axillary walls become more porous and albumin moves out leading to a low plasma albumin
what is a good prognostic indicator of mortality risk
albumin
define referring syndrome
A potentially fatal condition characterized by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding (via the oral, enteral or parenteral routes
what happens in starvation to
- glucagon
- insulin
- glycogen
- protein
- fatty acids
- intracellular stores of potassium, phosphate, magnesium
- Glucagon levels rises
- Insulin levels fall
- Glycogen used up in the first 24-72 hrs of starvation
- Shifts to protein for energy
- Fatty acids are metabolised to produce ketone bodies – become the major source of energy
- Loss of fat and lean body mass, water and minerals.
- Intracellular stores of K+, P04-, Mg2 become depleted
what source is used in the brain
- ketone bodies are used in the brain, they can diffuse into the CSF whereas the others cannot be used in the brain
- it is still 50;50 with glucose in the brain in starvation
what happens in refeeding syndrome
• Metabolism changes from fatty acids to carbohydrates
• Raised insulin secretion
• Insulin stimulates K+, P04-, Mg2+ to return to cells
- intracellular stores are replenished but at the expense of plasma concentrations this leads to hypokalamia, hypomagnesaemia, hypophosphataemia, thiamine deficiency, salt and water rentention
what are the three clinical consequences of refeeding syndrome
hypophosphataemia
hypomagnesaemia
hypokalameia
what are the - neurological - musculoskeletal - respiratory - cardiac - renal signs of the three clinical consequences of refeeding syndrome
Hypophosphataemia
Neurological—Seizures, paraesthesia
Musculoskeletal—Rhabdomyolysis, weakness, osteomalacia
Respiratory—Impaired respiratory muscle function
Cardiac—Cardiac failure
Renal—Rhabdomyolysis, fluid and salt retention
Hypomagnesaemia
Neurological—Tetany, paraesthesia, seizures, ataxia, tremor
Cardiac—Arrhythmias
Gastrointestinal—Anorexia, abdominal pain
Hypokalaemia Neurological—Paralysis, paraesthesia Musculoskeletal—Rhabdomyolysis Respiratory—Respiratory depression Cardiac—Arrhythmias, cardiac arrest
who is at risk of refeeding syndrome
- any patient with very little food intake for greater than 5 days
who is at high risk of refeeding syndrome
Any one the following;
– BMI <16
– Unintentional weight loss >15% in last 3-6 months
– Little or no nutritional intake for more than 10 days
– Low levels of K, PO, Mg prior to feeding
OR Any 2 of the following
– BMI <18.5
– Unintentional weight loss >10% in last 3-6 months
– Little or no nutrition for more than 5 days
– A history of alcohol abuse or drug use including chemotherapy, antacids or diuretics
why do we provide nutrition support
• Increased nutritional requirements are associated with the metabolic response to stress/trauma/sepsis
Maintain nutritional status and limit catabolism
Preserve lean body mass (LBM)
• Maintain immune function
• Preserve organ function and promote wound healing
• Enhance recovery and improve patient outcomes
what are enteral routes for nutrition support
- Oral
- Nasogastric
- Orogastric
- Nasojejunal
- Gastrostomy
- Jejunostomy
what are parenteral routes for nutrition support
Peripheral
Central
name some oral nutritional support supplement drinks
Milkshake style • Calorie content varies • Ready made Juice based • Fat free Powdered • Not nutritionally complete • Is the patient able to mix it
what are the nutritional supplements in dysphagia
- Pre-thickened drinks
- Thickening of supplement drinks with a thickener
- Yoghurt style drinks
- Smoothie style drinks
- Yoghurt/dessert pot type supplements
when do you use enternal tube nutrition
Insufficient oral intake
-options exhausted
Oral intake is not possible
If Gut is functioning – Use it
when do you use parental nutrition
GIT unable to digest or absorb adequate amount of nutrients (e.g. short bowel syndrome, ileus, motility disorders, gastrointestinal ischaemia, bowel perforation, radiation enteritis, pancreatitis)
GIT cannot be accessed (e.g. obstruction, enterocutaneous fistulae, severe inflammatory bowel disease)
what are the disadvantages of parental nutrition
Risk associated with placement Risk of catheter related sepsis Disordered liver function (long term) Risk of gut atrophy Psychological Cost
