Nutrition assessment 2 Flashcards
Meaning of biochemical assessment
measurement of nutritional markers in blood, urine and other fluids and tissues
what does biochemical assessment detect
detects subclinical nutrient deficiencies
with the biochemicals exams what can we examine
visceral and somatic proteins
hematological assessment
lipid profile
micronutrient assessment
immunocompetent assessment
Protein status assessment
visceral protein status is reflected by serum proteins, red blood cells and white blood cells
malnutrition
decreases organ mass and substrate supply
that will decrease synthesis of serum proteins
what are some of serum proteins
Albumin (3500-5000 mg/dL)
fibronectin (220-400 mg/dL)
transferrin (215-380 mg/dL)
prealbumin (16-35 mg/dL)
retinol (2.1-6.4 mg/dL)
how is serum proteins influenced by
low protein intake
altered metabolism and synthesis
inflammation
hydration
medications
pregnancy
exercise
what is half life in serum proteins
is how much time it takes to replace half of the pool
albumin is 17-21 days
transferring is 8-10 days
prealbumin is 2-3 days
rbp is 10-12h
when you have a high albumin it could mean
dehydration, corticosteroids
when you have a high transferrin
it can means iron deficiency and pregnancy
when you have a high transthyretin it can mean
renal failure or hodgkins disease
when you have a retinol binding protein
renal failure
when serum proteins are low it means
inflammation
what are the proteins that are negative acute phase. What does it mean
albumin, transferrin, TTR and RBP. Their levels decrease by 25% during inflammation, illness or metabolic stress
what are the proteins that are negative acute phase? What does it mean
C reactive protein (CRP). It is used to detect mild or acute inflammation
what does it means if you have a high CRP and a low albumin
it could be due to an inflammation or low protein intake
What is the cutoffs for albumin for a mild deficit in proteins
35 g/L
Nitrogen balances
total protein retention or losses
what is positive nitrogen balance + examples
anabolism > catabolism (more retention)
- pregnancy, growth, recovery
what is negative nitrogen balance
+ examples
anabolism < catabolism (more loss)
starvation, trauma, surgery, inadequate protein intake
Nitrogen balance limitations
- time consuming (24h)
- prone to errors : protein intake estimated vs measured, missed or incomplete urine collection, does not account for losses due to diarrhea, vomiting, wound leaks…
- errors always favor a more + balance
Urinary Creatinine excretion is proportional to what
skeletal muscle mass
urinary creatinine excretion is higher and lower depening of what
higher : exercise, meat, menstruation, infection, fever, trauma
lower: renal failure and age
what is anemia
reduction in the quantity of hemoglobin or in the number of RBC in the blood
decrease oxygen capacity
what is the complete blood count
erythrocytes ( number, size, shape, color) to diagnose anemia
what is the classification of anemia
color: hypochromic, normochromic, hyperchromic
size: microcytic, normocytic, macrocytic
anemias may be due to deficiencies of
iron, folate, vit B12, other micronutrient and chronic diseases
lab tests for anemia
- what is the deficit in women and men for hemoglobin.
<120 g/L women
< 140 men
when can hemoglobin be less
protein energy malnutrition, hemorrhage and other anemias
what is the hematocrit
% of red blood cells in total blood volume
hematocrit is high and low when
high : dehydration
low : hemorrhage
mean corpuscular volume MCV
rbc size: microcytic (<76) vs macrocytic (>100)
mean corpuscular hemoglobin
Hb concentration in RBC
hypochromic (<21) vs hyperchromic (>38)
what is the order of iron status deficiency
1) storage iron (liver, bone marrow)
2) transport iron saturated
3) essential iron
true or false
ferritin deficit is low in early deficiency
true
transferrin saturation (<30%)
decreases with diminished transport iron
serum folate deficiency
4.5-45 nmol/L
vit b12 deficiency
120-500 pmol/L
low in progressing deficiency state
in iron requirement which group needs more
pre menopausal women and pregnancy
what are some excellent sources of heme iron (>3.5 mg)
clams, oysters, liver
what are some excellent sources of non heme iron (>3.5 mg)
cooked legumes, seeds, tofu etc
risk factors for poor iron status
- diet low in meat, fish, poultry
- diet low in vit c
- drink a lot of coffee with meals
- excessive menstrual losses ( menorrhagia)
- 3 or more blood donation
- pregnancy, multiple gestation
- regular use of aspirin
how do we maximize iron supplementation absorption
- take with empty stomach with liquid (orange juice to decrease the pain)
- if you cant take a snack before or with
clinical assessment
- includes the patient’s medical, social and psychological history
- physical examination for clinical signs and symptoms of nutritional deficiencies through visual inspection and palpation
what needs to be examined/asked in the patient history
- primary and secondary diagnosis
- past medical history
- weight history
- factors affecting nutrient intake
- social history (religion socioeconomic, shopping, cooking, family)
what are some physical signs of malnutrition
- hair
- face
- eyes
- lips
- tongue
- gums and teeth
- skin
- nails
- musculoskeletal
- neurological
- abdomen
hair : dry, dull, brittle, early graying
(def in protein, zinc, copper, etc)
face: fullness, puffy (def: protein, energy)
eyes: dryness, pallor (def: vit a, iron, b vit)
lips: angular stomatitis, cheilosis (def: niacin, iron)
tongue: magenta, painful, edema (b vit, zinc, iron)
gums and teeth : caries, stomatitis ( vit c, folate, b12, proteins)
skin: dryenes, scaliness, wound healing (def: vit a, zinc, it c)
nails: spoon nails, egg shell nails (def: iron, vit a)
musculoskeletal: bone pain, weakness (def: protein, energy, thiamin, etc)
neurological: sensory loss, confusion, dementia (def: thiamin, B12, protein)
abdomen: distention, flats (def: protein, energy, lactose, etc)
what are the 5 dietary assessment methods
24h recall
food record or diary
food frequency questionnaire
direct observation
technology based methods
the choices of dietary assessment methods depends on what
individual vs group
nutrients of interest
explain the 24h recall
ask about intake during the previous 24h
multiple ones required to assess usual intake
advantage of 24h recall
- quick and inexpensive
- element of surprise
- low patient burden
- literacy independent
disadvantages of 24h recall
- memory dependent
- overstimation/underestimation
- high inter interviewer variability
Explain food record
recorded or weighed for a given time period (3-7 days)
assesses actual or usual intake
advantage of food record
- greater precision
- not memory dependant
- considered actual intake
disadvantages of food record
- time consuming
- may not reflect “normal” eating patterns, may change behaviour
- must be literate and motivated
explain food frequency questionnaire
survey of intake over specified time
include food list, consumption frequency
what is the advantages of the food frequency questionnaire?
- quick, inexpensive
- can examine specific nutrients
- can be used in large studies
- considered usual intake
disadvantages of food frequency questionnaire
- qualitative information and less accurate
- memory dependant
- diff since not meal based
- must be literate and motivated
explain direct observation
used in controlled setting
does not represent usual intake
advantage of direct observation
- more precise
- not memory or literacy dependent
- patient unaware of assessment
disadvantage of direct observation
- high staff burden
- intrusive
- diff to attain and interpret
what do we need to know in the environmental assessment of a patient
- socio-economic status, food security/access to food
- education, food and nutrition literacy
- ability/time to cook
- working schedule, travelling
- allergies, intolerances, restrictions
- cognitive funciton
functional assessment- handgrip strength
muscle strength correlates with muscle mass. Predicts malnutrition in many patient populations.
with what the handgrip strength is measured
with a dynamometer
what are the 4 steps for the nutrition care process model
- nutrition assessment and requirements
- nutrition diagnosis
- nutrition intervention
- nutrition monitoring and evaluation
how do we do a nutrition diagnosis with the PES statement
Problem: diagnosis
Etiology: cause
Signs and symptoms: evidence
ex: unintended weight loss (p) related to severe diarrhea (e) as evidenced by 7 kg loss in 2 moths (s)
what are the components of total energy expenditure
thermic effect of food
physical activity
REE or BMR
what are some equations to estimate REE
harris-benedict
mifflin-st jeor
fao/who
rule of thumb
true or false
harris-benedict estimation tends to overestimate the REE
true
what is the consensus for protein requirements in healthy adults and older adults
healthy adults 1.0g/kg/d
older adults 1.0-1.2g/kg/d
What are some ways to calculate the fluid requirement
- by weight
the first 10kg 100ml/kg
the next 10kg is 50ml/kg
20 ml/ kg body for each kg above 20 - weight and age
16-30 years: 40 ml/kg body weight - based on energy requirement
1ml/kcal - base on fluid balance: urine output + 500
what are dehydration symptoms
- thirst
- dark urine
- decreased skin turgor
- dry mouth lips
- headache
- tachycardia
- confusion
- rapid weight loss
- lowered body temperature
- increase Na, albumin, BUN, creatinine, Hb, Hct
true or false
older adults don’t know how to detect thrist so people may diagnose with dementia
true
overhydration symptoms
- increased blood pressure
- decreased pulse rate
- edema
- decreased Na, K, albumin, BUN, creatinine, Hb, Hct
- rapid weight gain
what are some special considerations for older adults (nutrients)
nutrients:
- energy reduced
- protein and calcium needs a higher reqt
- vit d is less efficient synthesis by skin, kidney conversion, and exposure
- vit b12 : less efficient absorption due to achlorydia
- fluids : decreased sense of thirst, presence of other diseases
what are some special considerations for older adults (other)
dental status, capacity for mastication
swallow function, dysphagia
GI function
medical diagnosis
polypharmacy
social environment
cognitive function
functional ability
prevalence of malnutrition in
1. community
2. hospitals
3. long term care
community : 15%
hospitals 50%
long term care 80%
element of screening for malnutrition
current condition - bmi
stable condition- involuntary weight loss
will condition deteriorate - less food intake
what are some examples of screening tool
nutritional risk screening and Canadian nutrition tool
canadian nutrition tool (CNST)
- simple tool
- used more
How do we diagnosis malnutrition by Global Leadership initiative on malnutrition (GLIM)
- consensus report
- risk screening (use validated screening tools)
- diagnostic assessment ( phenotypic - what we see weight loss, low BMI, and etiologic - reduced food intake or assimilation disease burden)
- diagnosis - one phenotypic and one etiologic
- determine the severity of malnutrition by he phenotypic criterion (grille)
