- Entire leg: 16% of BW - lower leg with foot: 6% of BW - entire arm: 5% of BW - forearm with hand: 2.3% of BW

- independent risk factor for disease when out of proportion to total body fat - M > 40, F > 35

3. 5-5 g/dL - high levels likely due to dehydration - does NOT reflect current protein intake --> long half life

- related to muscle mass - measures somatic protein - high: renal disease - low: muscle wasting - lean body mass; somatic protein

10-20mg/dL - related to protein intake; and best indicator for renal disease - BUN:Creat ratio 10-15:1 - renal pts should keep BUN under 100

Nutrition Assessment & Screening Flashcards by Natalie Navarre

4 steps of Nutrition care process

Assessment
Diagnosis
Intervention
Monitoring and Evaliation

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ABCDH of Nutritional Assessment

Anthropometrics
Biochemical labs
Clinical findings
Diet
History

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% weight change

-stresses significance of change in weight

= (UBW-ABW) / (UBW) x100

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Measure of skeletal muscle mass (somatic protein

AMA= arm muscle area

use TSF and Arm circumference
male: 25.3 cm, female: 23.2 cm
useful in growing children
useful in identifying possible pro-energy malnutrition

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Normal range BMI for healthy adult

18.5-24.9

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HIGH Waist to hip ratio (WHR) for men and women

-indicative of android obesity

>/= to 1.0 for men and >/= to 0.8 for women –> increased risk for obesity related diseases (i.e. diabetes, HTN)

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Clearly defined markers that can be observed and measured; compared against nutrition care criteria

indicators

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Food frequency lists

community setting; quick way to determine intakes on large numbers of people

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Amputations

Entire leg: 16% of BW
lower leg with foot: 6% of BW
entire arm: 5% of BW
forearm with hand: 2.3% of BW

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Formula for Estimated IBW with amputations

(100-%amputation)/100 x IBW for original ht

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Triceps skinfold thickness (TSF)

Measures body fat reserves and calorie reserves

-male: 12.5 mm, female: 16.5 mm

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Waist Circumference

independent risk factor for disease when out of proportion to total body fat
M > 40, F > 35

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Hair: thin, sparse, easily pluckable

protein deficiency

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Pale dry scaly skin

iron, folic acid, zinc deficiency

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Pale, dry eyes, poor vision

vitamin A, zinc, or riboflavin deficiency

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Visceral protein markers

serum albumin
serum transferring
transthyretin -shorter half life
prealbumin - shorter half life

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Best visceral protein marker

transthyretin (TTHY)

-norm range: 16-40 mg/dL

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Albumin

5-5 g/dL
- high levels likely due to dehydration
- does NOT reflect current protein intake –> long half life

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Serum ferritin

indicates size of iron STORAGE pool

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Serum creatinine

related to muscle mass
measures somatic protein
high: renal disease
low: muscle wasting
lean body mass; somatic protein

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Blood urea nitrogen

10-20mg/dL

related to protein intake; and best indicator for renal disease
BUN:Creat ratio 10-15:1
renal pts should keep BUN under 100

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Total lymphocyte count

> 2700 cells/cu mm

measures immunocompetency; ability to fight off infection
decreased in protein-energy malnutrition

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C-Reactive protein

marker of acute inflammatory stress

-indicates when nutritional therapy would be beneficial as it declines

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Free Erythrocyte Protoporphyrn (FEP)

Increased during lead poisoning

-lead depletes iron leading to anemia; displaces Ca in bone leading to Zn deficiency

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Prothrombin Time (PT)

11-12.5 seconds; anticoagulants prolong PT

Activity factors and BEE

BEE x 1.2 = sedentary x1. 3= active x1. 5= stressed

Megace

appetite stimulant

oral contraceptives

decreases folate, b6, and Vit C

Loop diuretics

deplete K, Mg, Ca, Na, and Cl

Thiazide diuretics

decreases K and Mg; absorb Ca

Methotrexate (chemo agent)

decreases folate

lithium carbonate (antidepressant)

increased appetite | -maintain consistent Na and caffeine intake; if restricted, lithium excretion decreases leading to toxicity

anticoagulants (warfarin)

antagonizes Vit K -- need to maintain consistent Vit K intake

Propofol (diprivan)

administered in oil -- need to consider fat calories (1.1kcal/cc)

Isoniazid (treats TB)

Depletes pyridoxine; interferes with vitamin D --> leading to decreased Ca

Vitamin B6 and protein

decreases effectiveness of levodopa --> controls symptoms of parkinsons Disease -rec: take drug in AM with < 10gm protein

nutrient that bind tetracycline

calcium

Nutrient that can cause HTN if taken with MAOI (monoamine oxidase inhibitor)

Tyramine | -eliminate dopamine and restrict tyramine if taking MAO inhibitors

Tyramine restriction if on MAO inhibitors

Restrict: aged, fermented, dried, pickled, smoked, spoiled foods Avoid: hard aged cheeses, sauerkraut, lunch meat -The more aged or fermented the cheese, the more tyramine in the product ADVICE PT to Buy, cook, and eat fresh foods

Community and group nutrition status indicators

- Are available nutrition resources adequate? - What groups at at potentially high risk? - Are health needs being met by existing programs?

Morbidity

disease rates

MORTALity

death rates

number of NEW cases of a disease over a period of time

incidence

TOTAL number of EXISTING people with a disease during a period of time

prevalence

Access to sufficient foods by all people at all times to lead a healthy and active lifestyle

Food security

Limited ability to acquire/consume the quality or quantity of food needed in socially acceptable ways

Food INsecurity - food insecurity without hunger - food insecurity WITh hunger

Development of sustainable and community based strategies to ensure all individuals have access to adeqaute food

Community Food Security Initiative

Examination of a group at a particular point in time; cross-sectional exam; identified PREVALENCE at a specific time

Nutrition survey

Continuous collection of data to identify a problem, set baseline and priorities, and detect trends * uses ht, wt, hct, hgb, and serum chol - identifies needs and intervention needed

Nutritional surveillance

Program to promote nutrition and improve nutritional care for the ELDERLY to identify nutritional problems early

NSI: Nutrition Screening Initiatve - DETERMINE Checklist: increases awareness of factors that influence nutritional health - LEVEL I: identifies those who need more comprehensive assessments - LEVEL II: for possible greater medical or nutritional problems

5-12 ppl group to talk about concerns, beliefs, problems to obtain insight and advice; contributes attitudinal data

focus groups

Program that includes all data collection and analysis activities of the govt r/t measuring the health and nutritional status, food consumption, and attitudes about diet and health

NNMRRP: National Nutrition Monitoring and Related Research Program

PedNSS

Pediatric Nutrition Surveillance System - Dept HHS - low income, high risk children birth-17 yrs - monitors growth and nutritional status

PNSS

Pregnancy Nutrition Surveillance System - Dept HHS - identify and reduce pregnancy related risks - Counts # of wmn who breastfeed

NHANES

National Health and Nutrition Examination Survey - ongoing survey to obtain info on health of Americans - Clinical, chem, anthro, nutritional data (24hr recalls, FFQ)

NHANES III

First time with a LARGE sample over 65 with NO age limit --> study of aging related to nutrition

NFCS: Nationwide Food Consumption Surveys

To obtain info on food intake of individuals and total households from entire US -USDA

Behavioral Risk Factor Surveillance System (BRFSS)

Adults 18 yrs and older residing in houses with phones -- phone interviews on ht, wt, smoking, alcohol, FFQ for fat, F+V, diabetes -Dept HHS

Youth Risk Behavior Survey (YRBS)

Grades 9-12 surveyed on smoking, wt control, alc use, exercise and eating habits -Dept HHS

Emergency food programs

-I.E. soup kitchens; don't provide balanced meals because all food is given in donations

Native american and alaskin native obesity epidemic

Adds to increased prevalence of heart disease and hypertension -they depend heavily on federal food assistance programs

High levels of which vitamin interfere with Levodopa?

Pyridoxine