Nutrition Assessment Flashcards
What is the Mifflin-St.Jeor equation & what does it measure?
Used to calculate RMR / REE / BMR (all used interchangeably, although RMR / REE are different than BMR)
Males: kcal/day = 10 (wt in kg) + 6.25 (ht in cm) - 5 (age in yrs) + 5
Females: kcal/day = 10 (wt in kg) + 6.25 (ht in cm) - 5 (age in yrs) - 161
(Hark, p. 14)
What is the BMI equation?
Used to measure total body fat (adiposity)
Metric - BMI = weight (kg) / height (m²)
English - BMI = weight (lb) / height (in²) x 703
List the BMI interpretation for:
- Underweight
- Healthy
- Overweight
- Obese class 1 (obese)
- Obese class 2 (severe)
- Obese class 3 (morbid)
- Underweight = < 18.5
- Healthy = 18.5 - 24.9
- Overweight = 25-29
- Obese class 1 (obese) = 30 - 34.9
- Obese class 2 (severe) = 35 - 39.9
- Obese class 3 (morbid) = > 40
What is the formula for TEE?
BMR x activity factor
List the kcal per 1 gram of each macronutrient and alcohol
1 g protein = 4kcal
1 g carb = 4 kcal
1 g fat = 9 kcal
1 g alcohol = 7 kcal
(Hark, p. 13)
List the protein needs for:
- Average healthy person
- Post-surgical
- Highly catabolic
Average: 0.8-1g/kg body wt
Post-surgical: 1.5-2g/kg body wt
Highly catabolic (burns, infection, fever): > 2g/kg body wt
(Hark, p. 14)
List the vital signs
blood pressure
heart rate
respiration rate
temperature
(Also, nutritionally: height, weight, BMI and % weight change, which is usual wt - current wt) / (usual wt) x 100)
(Hark pg 7, 10)
List the waist circumference indications & what is this an predictor of?
Measures visceral adipose tissue. Predictor of mortality and an independent risk factor for diabetes, dyslipidemia, hypertension, CVD.
Recommended in patients with BMI < 35
Increased risk:
> 40 in (102 cm) in men
> 35 in (88 cm) in women
Areas to examine for muscle wasting
temporalis muscles (temples) and the thenar, hypothenar, interosseous muscles on the hands (Hark, p. 8)
Labs for alcoholism
Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Thiamin Folate Vitamin B12 (Hark, p. 11)
Labs for anemia
CBC serum iron serum ferritin total iron binding capacity (TIBC) transferrin sat mean corpuscular volume (MCV) reticulocyte count RBC folate serum B12 (Hark, p. 11)
Labs for diabetes
fasting serum glucose HbA1c insulin CRP serum and urinary ketone bodies (Hark, p. 11)
Labs for eating disorders
potassium albumin serum amylase thyroid panel aspartate aminotransferase (AST) alanine aminotransferase (ALT) anemia labs (Hark, p. 11)
Labs for fluid, electrolyte and renal function
CMP (sodium, potassium, chloride calcium), BUN, creatinine Phosphorus Magnesium Urinary urea nitrogen Urinary and serum - oxalic acid and uric acid (Hark, p. 11)
Labs for hyperlipidemia
Lipid panel - cholesterol, triglycerides, LDL, HDL Lipoprotein A (LPa) Homocysteine TSH (Hark , p. 11)
Labs for musculoskeletal pain, weakness
25(OH) vitamin D
phosphate
parathyroid hormone (PTH)
Labs for malabsorption
24h fecal fat barium imaging studies electrolytes (CMP) albumin serum triglycerides hydrogen breath test (Hark, p. 11)
Labs for metabolic syndrome
Fasting serum glucose
lipid panel
uric acid
(Hark p. 11)
Labs for refeeding syndrome
CMP - albumin, calcium, potassium
Phosphorus
Magnesium
What values are in a CMP?
- glucose
- calcium
- electrolytes - sodium, potassium, bicarbonate, chloride
- kidney function - BUN, creatinine
- liver function - albumin, AST, ALT, bilirubin
- total protein
- alkaline phosphatase (ALP)
https://www.testing.com/tests/comprehensive-metabolic-panel-cmp/
What values are in a CBC?
Basic RBC measures - RBC count, hemoglobin, hematocrit, (may also include: reticulocyte count)
RBC indices (physical features of the RBCS) - mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW)
WBC count
WITH DIFFERENTIAL (includes types of WBCs) - neutrophils, lymphocytes, monocytes, eosinophils, basophils
https://www.testing.com/tests/complete-blood-count-cbc/#:~:text=The%20CBC%20measures%20the%20amount,can%20provide%20important%20health%20information
Labs for protein status
serum albumin - (half life 18-20 dy) protein status over the prev 1-2 mo; not a good indicator of dietary status
serum prealbumin - (half life 2-3 dy) reflects nutritional status/protein intake over prev week
serum transferrin - (half life 8-9 dy) reflects intake over the prev few weeks
(Hark, p. 12)
Serum protein levels can be affected by protein losses in stool/urine as a result of wounds involving blood loss, or by poor intake; protein status is also affection by hydration, disease states, surgery, liver dysfunction, so these tests should be used in conjunction w/ other measures
What are the main causes of malnutrition?
Decreased oral intake
Increased nutrient loss
Increased nutrient requirements
(Hark, p. 14)
What are causes of nutrient loss?
Glycosuria, proteinuria, GI bleeding, diarrhea, malabsorption, draining fistula, protein-losing enteropathy
(Hark, p. 14)
What situations dramatically increase nutrient requirements?
Anything that puts the body into a hypermetabolism / catabolic state: surgery, trauma, fever, burns, hyperthyroidism, severe infectino, malabsorption syndromes, cancer, COPD, cardiac cachexia, critical illness, HIV/AIDS
(Hark, p. 15)
Weight-related markers that put people at risk of malnutrition?
Adults with BMI < 18.5 (consistenly underweight)
Children < 5th %ile for weight-for-age / BMI-for-age
(Hark, p. 15)
In acute malnutrition, what marker declines first in children?
Weight-for-age %ile on the growth chart falls first, followed by decline in height growth…in extreme cases, head circumference growth may plateau
(Hark, p. 15)
Define marasmus & its characteristics
When the body’s requirements for calories and protein are not met by dietary intake
Characterized by: tissue wasting, excessive loss of lean body mass + subcutaneous fat stores, and weight loss
(Hark, p. 15)
Define Kwashiorkor & its characteristics
Predominant protein deficiency
Characterized by: lethargy, apathy, irritability, stunted growth, changes in skin (dermatitis) and hair pigmentation, edema, low serum albumin
(Hark, p. 15)
What populations are most at risk for malnutrition?
Children (esp in developing countries), older adults, hospitalized (regardless of injury/illness), nursing home patients, food insecure
(Hark, p. 15)
Obese individuals have an increased risk of what conditions?
Diabetes, cardiovascular disease, hyperlipidemia, hypertension, stroke, gallbladder disease (cholecystitis)/gallstones, sleep apnea, osteoarthritis, respiratory problems, certain cancers (endometrial, breast, prostate, colon)
Obesity also increases risk during surgery, since subcutaneous fat can make surgery more difficulty/prolongs surgical time; also makes post-op complications more common
(Hark, p. 16)
What biological factors contribute to obesity?
Genetic predisposition, size and number of adipocytes, REE
Hark, p. 17
What is the diagnostic criteria for metabolic syndrome?
National Cholesterol Education Program Adult Treatment Panel Guidelines (NCEPATP III) - dx if have 3 of the 5 conditions:
- abdominal obesity (waist circumference > 40 in men and > 35 in women)
- Pre-hypertension (BP > 130 / > 85 mm Hg)
- Glucose intolerance (fasting blood glucose > 110 mg/dL)
- High triglycerides ( > 150 mg/dL)
- Low HDL ( men < 40 mg/dL and women < 50 mg/dL)
(Hark, p. 25)
How can abdominal obesity be assessed?
By measuring the patient’s waist circumference, in the horizontal plane around the abdomen at the level of the iliac crest
(Hark. p. 25)
What is a safe rate of weight loss per week?
1-2 lbs (or 1% of body weight) per week
Hark, p. 28
Blood pressure indications
How do you calculate Total Energy Expenditure?
Resting Energy Expenditure +Thermal Effect of Activity
**Resting Energy Expenditure (also known as Basal Metabolic Rate/BMR or Resting Metabolic rate/RMR)
What is the Basal Metabolic Rate (BMR) and/or Resting Energy Expenditure (REE)?
This is the energy required to sustain the basic processes of sedentary, inactive life (including normal growth in children and the energy cost of digesting and absorbing food nutrients).
Males: REE (kcal/day) = 66.47 + 13.75W(kg) + 5.0H(cm) – 6.76 A(age)
Females: REE (kcal/day) = 655.10 + 9.56W + 1.85H – 4.68A
What factors can decrease BMR and or REE?
REE declines with increasing age in adults, largely as a result of decreased resting energy expenditure in the brain.
What can increase BMR and/or REE?
Activity of lifestyle (not exercise)- 20-50%
Reversal of Involuntary Weight Loss- 5-15%
Wound healing- 15-30%
Fever- 15%
Burns- 2%
What is the Thermal Effect of food?
The thermal effect of food is an increase in energy expenditure that results from the metabolic cost of food digestion and the absorption and processing of ingested nutrients (typically, an average of 7% to 10% of the energy content of the food consumed).
What is the thermal effect of fats, proteins, and carbohydrates?
Fats: The digestion of dietary fats and the absorption of the products of fat digestion releases 2% to 3% of the energy contained in fats.
Proteins: digestion of dietary protein and the absorption of the products of protein digestion releases 15% to 30% of the energy contained in proteins.
Carbohydrates: digestion of dietary carbohydrates and the absorption of the products of carbohydrate digestion releases 6% to 8% of the energy contained in carbohydrates
What is the Thermal Effect of activity?
is a measure of the heat produced during physical activity and will reflect the type, duration, intensity and frequency of activity.
Optimal protein intake for the first year of life?
On average, the daily dietary protein requirement during the first year of life is about 1.7 g/kg body weight.
What is the optimal protein intake from ages 10-20 yo?
The daily dietary protein requirement decreases to about 1 g/kg at 10 years of age and to about 0.8 g/kg after age 20.
What can chronic protein deficiency lead to?
Chronic protein deficiency (kwashiorkor) produces stunted growth, hypoalbuminemia with edema, muscle wasting, ascites and thinning of hair. The skin of the extremities may exhibit “flaky”desquamation and hyperpigmentation.
Fever increases energy needs by __ percent for each degree above 98.6°F of body temperature
a. 4%
b. 5%
c. 6%
d. 7%
d. 7% (or 12 percent for each degree above 37°C)
Hark, p. 152
True or false?
Illness, trauma, major surgery, extensive burns, recovery from undernutrition, and intensive exercise or manual labor cans double energy requirements.
True
Hark, p. 152
This form of dietary assessment is described as an interviewer prompts the subject to recall all food and beverages eaten over the past 24 hours, estimating intake by ounces, cups, spoons, etc.
A. Food Frequency Questionnaire
B. 24 hour recall
C. Semiquantitative food frequency questionnaire
B. 24 hour recall
A ______________________ on which the subject records all dietary intakes
and the frequency of consumption (from memory) is a form of dietary assessment.
Food frequency questionnaire (FFQ)
True or False. The main difference between an FFQ and a semiquantitative food frequency questionnaire, is that food portions are standardized within the semiquantitative form.
True.
A _________ dietary history during which the subject gives an oral report of the food and beverages consumed recently is a form of dietary assessment.
A. 24 hour recall
B. Burke-type
C. FFQ
B. Burke-type
Prospective methods of obtaining estimates of dietary intakes include use of:
A. weighing and measuring all food that is consumed
B. comprehensive written food log
C. telephone interview recording
D. electronic records obtained via videotape, computer program, or electronic
weighing scale
E. duplicate portion analysis in which a duplicate portion of food is collected and chemically analyzed
F. direct observation (for example, by video recording and trained observers)
A proper nutrition history intake will not only focus on food consumptions and food patterns but will also need to indicate:
A. Surgical history
B. Current medication/supplements
C. history of diagnostic procedures
D. psychosocial history
E. any history of chemotherapy or radiation therapy
F. any history of nutrition related problems including recent weight change
G. All of the above
G. All of the above
__________ is a direct marker of protein mass and energy stores and is an important variable for predicting caloric expenditure and indices of body composition.
A. Body weight
B. BMI
C. waist/hip ratio
A. body weight
The BMI of most adult men and women should be in the range of
A. 18-23 kkg/m2
B. 19-27 kg/m2
C. Less than 30 kg/m2
B. 19-27 kg/m2
True or False. Waist/hip ratio for women should be 0.8 or less while men should have a ratio of 0.95 or less.
True.
True or False. Measurement of the urinary excretion of creatinine and 3-methyl-histidine provide an estimate of total muscle mass.
True.
One of the most common measurements for body composition is:
A. BMI
B. Skinfold
C. None of the above
B. Skinfold
Changes in body composition are reflected in metabolic balances: _______ and _________ balances change with changes in extracellular fluid volume.
A. Potassium and nitrogen
B. Sodium and chloride
B. Sodium and chloride
Changes in _______ and ________ balances reflect changes in body total cell mass.
A. Potassium and nitrogen
B. Sodium and chloride
A. potassium and nitrogen
