Nutrition Assessment and Nutrient Requirements

Question 1

(2) Describe characteristics recommended for the identification of adult malnutrition.

Answer 1

weight loss
energy intake
malnutrition changes on physical exam (muscle mass, fat loss or fluid accumulation)
altered functional assessment

Question 2

(2) What are the limitations of serum proteins to characterize nutritional status?

Answer 2

albumin and pre albumin lack sensitivity and specificity for malnutrition (figures can be fudged by other pathological conditions; can use C-reactive protein for inflammatory prices, CBC for anemia; NO ONE CLINICAL VALUE TELLS YOU SOMEONE IS MALNOURISHED

Question 3

(2) What particular tool might you use when screening an older adult for malnutrition?

Answer 3

the mini nutritional assessment (includes Qs about psychological stress, demential and mobility

Question 4

(3) Describe basic parts of energy expenditure.

Answer 4

basal metabolism (resting metabolic rate)
thermogenesis (temp and digestion)
physical activity
growth
[pregnancy and lactation]

Question 5

(4) How would you measure basal metabolic rate

Answer 5

(min energy to maintain life processes) would require 12-15hr fast, with subject supine, awake and motionless, thermo-neutral environment

Question 6

(4) How would you measure resting metabolic rate (aka resting energy expenditure)

Answer 6

fast for 3-4 hours, not controlled for time of day or physical activity; RMR is 10-20% of BMR and best predicted by fat-free mass

Question 7

(4) What is direct calorimetry?

Answer 7

measure changes in temperature of air or water circulating through insulated walls of an an enclosed chamber holding the subject (research only)

Question 8

(4) What is indirect calorimetry?

Answer 8

an attempt to measure resting energy expenditures by measuring O2 consumption and CO2 production (results shown to correlate with true REE)

Question 9

(5) How would one estimate the energy intake for healthy and hospitalized individuals?

Answer 9

dietary reference intakes are published based on measurements using doubly labeled water; also many equations that calculate on various factors

Question 10

(5) What special considerations are made for obese hospitalized patients’ nutrient needs

Answer 10

recommended hypo caloric, high protein regimen based on ideal body weight

Question 11

(5) What considerations in energy needs would you make for children or older adults?

Answer 11

for children estimated energy requirements must take into account growth, while older adults will see a decline in metabolic rate and activity and require less nutrients

Question 12

(7) List essential amino acids.

Answer 12

isoleucine, leucine, lysine, methionine, phenylalanine, throning, tryptophan, valine and histidine

Question 13

(7) What is the concept of limiting amino acids?

Answer 13

when amino acids are not balanced in a way that reflects dietary needs, the amino acids in short supply are called limiting

Question 14

(7) What is the average amount (g protein/kg) that is recommended for children and adults?

Answer 14

children 1.5 g/kg

adults 0.8g/kg, older adults may require slightly more

Question 15

(8) Name nutrients that are at risk for deficiency across the life cycle. (7)

Answer 15

iron, calcium, zinc, copper, folic acid, vit. D, vit. B12

Question 16

(8) Name 3-5 foods that are a good source of iron.

Answer 16

animal products- meat, nuts, beans, vegetables and fortified grain products

Question 17

(8) Name 3-5 foods that are a good source of calcium (levels tightly regulated)

Answer 17

dairy products, fortified soy milk or OJ, plants in the kale family (broccoli, cabbage, turnip greens)

Question 18

(8) Name 3-5 foods that are a good source of zinc.

Answer 18

meath, pork, poultry, selfish, nuts, legumes (low in fruits, dairy and eggs)

Question 19

(8) Name 3-5 foods that are a good source of copper.

Answer 19

organ meats, shellfish, nuts and seeds, whole grain products

Question 20

(8) Name 3-5 foods that are a good source of folic acid.

Answer 20

green leafy vegetables, citrus fruits, legumes and enriched grains and cereals

Question 21

(8) Name 3-5 foods that are a good source of vitamin D.

Answer 21

fatty fish, eggs, fortified milk, some cereals, breads, and OJs that are fortified

Question 22

(8) Name 3-5 foods that are a good source of vitamin B12.

Answer 22

animal products, fish, meat, poultry, eggs, milk and milk products; fortified cereals (not available in plant foods)