Nutrition and Malnutrition

Question 1

Malnutrition

Answer 1

State of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes adverse effects on body etc and clinical outcome

Question 2

Disease-related malnutrition

Answer 2

Under nutrition caused by disease or illness

Question 3

Psychosocial causes

Answer 3

Inappropriate food provision
Self neglect
Bereavement
Inability to access food
Deprivation
Loneliness
...

Question 4

Effects of malnutrition

Answer 4

Impaired immune response
Impaired wound healing
Reduced muscle strength
Reduced resp muscles
inactivity 
Impaired thermoreg
Depression, apathy

Question 5

What tool is used for screening of malabsorption?

Answer 5

MUST (Malnu. Universal Screening Tool)

5 steps

1. BMI
2. Unplanned weight loss?
3. Acute disease effect?
4. Add up scores
5. Management guidelines

Question 6

If weight and height cannot be measured, what is an alternative method to measure BMI?

Answer 6

Mid Upper Arm Circumference

bent at the elbow at a 90 degree angle, with the upper arm held parallel to the side of the body

Question 7

What can be used for height?

Answer 7

Ulna length

Question 8

MUST score

Answer 8

0 = low risk
1 = medium risk
2+ = high risk

Question 9

What strength test can also be used?

Answer 9

Hand grip test

Question 10

“ABCDE” of malnutrition?

Answer 10

Anthropometry, biochemistry, clinical condition, dietary intake, economic/psychosocial issues

Question 11

Enteral tube feeding

Answer 11

delivery of nutritionally complete feed directly into gut via a tube

Stomach
Duodenum
Jejunum

NG
NJ
Percutaneous endoscopic gastrostomy
Surgical jejunostomy

Question 12

Parenteral nutrition

Answer 12

Intravenous nutrition
Central or peripheral vein

People who need it//

• inadequate/unsafe oral intake
• non functional, inaccessible GI tract

> PICC - Peripherally Inserted Central Catheter
Tunnelled catheter (Hickman line)
US guided

Question 13

Who needs nutritional support?

Answer 13

BMI < 18.5
>10% unintentional weight loss

BMI < 20 and 5% unintentional weight loss >5%

Likely to eat little or nothing for more than 5 days or longer

Question 14

Oral nutritional supplements

Answer 14

Ready made drinks
Powders (milkshake)
Puddings
Carb supplements 
Fat supplements
Fat and protein supplements

Question 15

Enteral Tube Feeding - contraindications

Answer 15

> Lower GI obstruction
Severe diarrhoea or vom
High enter-cutaneous Fistula
Intestinal ischaemia

Question 16

Estimating energy requirements

Answer 16

Calculate BMR

Add factor to account for increased requirements caused by disease

Add/subtract energy to allow weight gain/loss

Question 17

Refeeding syndrome

Answer 17

Potentially fatal shifts in fluids and electrolytes

Insulin release

Up take of electrolytes and glucose

Blood concs go down –> big problems

esp. by parenteral or enteral

Question 18

Preventing referring syndrome

Answer 18

Introduce nutrition support at a max of 50% for first 48 hours

Provide supplements

Monitor

Increase nutrition support to meet full requirements and monitor

Question 19

Intestinal Failure (IF)

Types

Answer 19

Type 1 - self limiting, short term post op/paralytic ileus

Type2 - prolonged. Sepsis. Abdo surgery w/complications*** , weeks/months of care

Type 1 and 2 are ACUTE

Type 3 - long term but stable. Home parenteral nutrition CHRONIC IF

Question 20

Type 1

Answer 20

> Replace fluid, correct electrolytes

> Parenteral nutrition if unable to tolerate oral food/fluids

> PPIs

Question 21

Devices for venous access for parenteral nutrition

Answer 21

Portocath

PICC

Central venous catheter

Question 22

Parenteral Nutrition - complications

Answer 22

Sepsis
SVC thrombosis
Line fracture
Line leakage
Line migration
Liver disease
Endocarditis

Question 23

Type 3 IF (Chronic)

Answer 23

Home parenteral nutrition

Bowel lengthening for short bowel syndrome

Question 24

Short bowel syndrome

Answer 24

< 200cm = short bowel

Insufficient length of small bowel to meet nutritional needs without artificial nutritional support

(normal = 250-850cm)

Most common indication home parenteral nutrition

Question 25

Small bowel transplantation

Answer 25

> Surgery well described
Immune-suppression
Last resort

Question 26

Nutritional support team

Answer 26

Best care
Multidisciplinary teams

DRs
Specialist 
Dietician 
Pharmacist
Biochemist