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MED: Nutrition/GI > Nutrition Assessment > Flashcards

Nutrition Assessment Flashcards

1
Q

What is the goal of nutrition assessment?

A

GOAL: Identify those with pre-existing malnutrition or those most at risk for developing it

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2
Q

What are the ABCDs of nutrition assessment?

A

Anthropometrics
Biochemical Data
Clinical Findings
Dietary Intake

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3
Q

What are Anthropometrics?

A

Height
Weight
Body Composition
Waist Circumference

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4
Q

What are some different ways to measure height?

A

direct:
standing
arm span
semi-arm span

indirect:
knee height

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5
Q

What are the benefits of measuring weight?

A

Provides a crude evaluation of fat and muscle stores

One of the best general parameters used to assess for malnutrition (the exception being obesity)

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6
Q

What are three different ways to measure weight?

A

Metropolitan Weight for Height Tables (1983, 1999)

Hamwi Method/“Rule of Thumb”
Males: 106 lb for 5 feet + 6 lb/inch over 5 feet
Females: 100 lb for 5 feet + 5 lb/inch over 5 feet

Body Mass Index

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7
Q

What is BMI?

A

BMI = weight (kg)/ height (m2)

Indicator of obesity and underweight in adults
Used to screen and monitor a population to detect risk of chronic disease
BMI >27 is associated with increased risk of chronic disease and death

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8
Q

What are the BMI classifications?

A 
Assoc w/ mortality		BMI 14-15
Underweight		BMI < 18.5
Normal			BMI 18.5-24.9
Overweight			BMI 25.0-29.9
Obesity (I)			BMI  30-34.9
Obesity (II)			BMI of 35-39.9
Obesity (III)		BMI > 40
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9
Q

What are the limitations of the BMI?

A

Overestimates body fat in very muscular people

Underestimates body fat in some underweight people with loss of lean tissue (i.e. the elderly)

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10
Q

How can you calculate the percentage of usual body weight and what to the numbers mean?

A

% of usual body weight = current weight/ x 100
usual weight

85 to 95% = mild malnutrition
75 to 84% = moderate malnutrition
< 74% = severe malnutrition

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11
Q

how do we calculate % of recent weight change? What does each percent mean in regards to 1 week, 1 month, 3 months, or 6 months?

A

% of recent weight change = usual weight - current weight x 100
usual weight

      -------------------------------------------------------------------------
      Time	Significant Weight Loss         Severe weight loss
	                (%)		              (%)
      \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
     1 week		1- 2			               > 2
     1 month		   5			                 >5
     3 months	   7.5			         >7.5
     6 months	     10			       >10

Unplanned/unintentional recent weight loss of >10%
is a risk factor for malnutrition

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12
Q

what is the most common site to check skin fold thickness?

A

triceps

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13
Q

what is Bioelectrical Impedance Analysis (BIA)?

A

Estimates body composition
Measures impedance of electrical current passing through the body
Impedance = resistance + reactance of low-electrical current
Estimates total body water, fat mass, fat-free mass (contains electrolytes, acts as electrical conductor), body cell mass

***low impedance = good

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14
Q

What might a microcytic or macorcytic anemia tell you in regards to B vitamin deficiency?

A

Mean Corpuscular Volume (MCV)

100 (macrocytic) Folate, Vit B-12 deficiency

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15
Q

Describe which two hepatic proteins are prognostic indicators of inflammation? How so?

A
  1. albumin and pre-albumin
ALBUMIN: 
Associated with inflammatory process
Improves when inflammation resolves
Prognostic indicator
2-3 week half-life
Decreases colloid oncotic pressure
Impairs carrier function
Protein deficit not primary cause
Not responsive to nutrition intervention
PRE-ALBUMIN:
Associated with inflammatory process
Improves when inflammation resolves
Prognostic indicator
2-3 day half-life
Affected by kidney function
Protein deficit not primary cause
Not responsive to nutrition intervention
Cost $160 (UNMC 2012)
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16
Q

Are hepatic protein changes associated with nutrition or inflammation?

A

inflammation!!!!

NOT NUTRITION DEPENDENT, CANT FIX BY HAVING THEM EAT WELL.

17
Q

What should be done about hepatic protein abnormalities?

A

Metabolic support

Use of acute phase proteins not recommended

18
Q

What are the three malnutrition diagnoses?

A
  1. Starvation-related malnutrition
    - No inflammation
    - Marasmus
  2. Chronic disease-related malnutrition
    - Mild-moderate inflammation
    - Cachexia
  3. Acute disease- or injury-related malnutrition
    - Severe inflammation
    - “Marasmic-kwashiorkor”
19
Q

compare starvation to disease/injury related malnutrition?

A 
STARVATION: 
Serum levels of electrolytes, vitamins, and minerals do not reflect body stores
Ketones/fat for energy
Hypometabolism
Wasted, cachectic appearance
Simple starvation
INJURY/DISEASE RELATED:
Hypermetabolism
Hypercatabolism
Glucose intolerance
Nitrogen losses
Fluid retention
Potential to become malnourished
Inflammation
20
Q

What can nitrogen balance be used for?

A

to estimate how much protein is needed (measures intake nitrogen minus output)

21
Q

Describe PE findings for iron def.?

A

Nails Pale, brittle, ridged

spoon-shaped

22
Q

Describe PE findings for Zinc, protein, copper def:

A

Hair Dry, thin, color &
texture change, dry
easily pluckable

23
Q

Describe PE findings for riboflavin or niacin def:

A

Tongue Swollen, magenta tongue

24
Q

Describe PE findings for Vit c Def:

A

Gums Soft, bleeding, spongy

25
Q

Describe PE findings for Vit A/B def.:

A

Eyes Pale conjunctiva, fissures

at corners of mouth

26
Q

What are four methods of getting a diet history?

A
  1. 24 hour Recall
  2. Information about typical or usual intake
  3. Food frequency questionnaire
  4. Food record (3 to 7 days)
27
Q

What is the subjective global assessment?

A

Well – tested and widely accepted as a practical and reliable tool for nutrition assessment

Easy to perform in a clinic setting

Components include:
Nutrition/Medical Hx
Weight changes, eating habits, GI symptoms, functional capacity, metabolic stress
Physical Exam
Subcutaneous fat, muscle mass, fluid status
Score A, B, C

28
Q

What is indirect calorimetry?

A
  • A method to measure energy expenditure. Uses open circuit spirometry or metabolic cart
  • Results reported as Measured Energy Expenditure (MEE) and Respiratory Quotient (RQ)
  • Food + O2 Heat + CO2 + H2O
  • Uses relationship of oxygen consumed (VO2) to CO2 produced (VCO2)=RQ
  • RQ helps determine the energy substrate used
    1. 7=fat
    2. 85=mixed fuel
    3. 95=CHO
29
Q

What is a general guideline for estimating fluid requirements?

A

16-30 years, active 40ml/kg
20-55 years 35ml/kg
55-75 years 30ml/kg
>75years 25ml/kg

MED: Nutrition/GI (8 decks)

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