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MET2 > Nutrition & Diet > Flashcards

Nutrition & Diet Flashcards

1
Q

What is malnutrition?

A

A state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body form and function and clinical outcome

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2
Q

What are some causes of malnutrition?

A

When intake is less than requirements:

  • increase in nutritional requirement
  • decrease in intake due to inadequate availability, quality or presentation of food
  • lack of recognition and treatment (may not realise they have higher requirements and need to eat more)
  • low intake even when food is available
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3
Q

Why may intake be low?

A 
dysphagia
prolonged periods of nil by mouth (cancelled procedures for example)
treatment side effects
pain/constipation
psychological -e.g. depression
social -e.g. low income, isolation
poor dentition
reflux/feeding problems/food intolerance
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4
Q

Why may requirements increase?

A
  • infections
  • involuntary movements
  • wound healing
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5
Q

Why may losses increase?

A
  • gut malabsorption
  • diarrhoea and vomiting
  • high stoma output
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6
Q

What are the main consequences of malnutrition?

A
  • declining respiratory and cardiac function
  • reduced mobility
  • increased risk of pressure sores
  • increased risk of infection
  • reduced wound healing
  • apathy and depression
  • malabsorption increased risk
    all these can be triggers/causes for further malnutrition so get a viscous cycle
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7
Q

What is nutritional screening?

A
  • identify malnutrition/risk of malnutrition
  • completed for all adult patients on hospital admission and weekly thereafter if clinical concern
  • use MUST method
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8
Q

What is MUST?

A 
Barts health method of nutritional screening:
BMI
Weight loss
acute disease effect
add scores
action plan
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9
Q

How is a nutritional assessment done?

A
  • anthropometrics (weight, height, BMI, weight history)
  • biochemistry (pre-existing malnutrition consider evidence of depletion/risk of risk factors)
  • clinical status (diagnosis, medication, will impact nutritional intervention)
  • dietary intake (routes available for feeding, pre-admission nutritional intake, allergies)
  • estimated requirements
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10
Q

How is height measured?

A

surrogate measures - knee height, demispan, ulna length
can be difficult if patient is ill
surrogate measures may overestimate height and so underestimate BMI

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11
Q

What is a demispan?

A

from a point on the midline at their sternal notch to the web between their middle and ring fingers

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12
Q

How is weight measured?

A

difficult to obtain if bedridden unless chair scales or hoist scales
surrogate measures - mid upper arm circumference (measure in supine position)
Can use BMI to estimate weight

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13
Q

What does BMI =?

A

BMI = weight/height^2

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14
Q

What are the ranges for mid upper arm circumference?

A

if <23.5 BMI likely to be <20 = underweight

if >32 BMI likely to be > 30 = overweight

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15
Q

How do you estimate dry weight?

A

Want to take out weight of ascites and peripheral oedema

These weights depend on whether the ascites is tense/moderate/minimal or severe/moderate/mild

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16
Q

What other anthropometric measures are there?

A

Fat mass -> skinfolds (indirectly estimate total adiposity, commonly use triceps site)
Fat free mass -> protein status (arm muscle circumference = mid upper arm circumference - (0.314 X Triceps site)

17
Q

What is the significance of handgrip dynamometry or grip strength?

A

measures muscles strength and endurance
predictor of mortality
can be measured supine or sitting, dominant or non-dominant side, repeated measures

18
Q

What is albumin?

A 
large protein synthesised in the liver
most abundant protein in plasma 
trapped within capillaries usually
normal range is 35-50g/l
function is to maintain oncotic pressure (osmotic effect which helps to stop water leaking out through capillary walls)
19
Q

What are some causes of hypalbuminaemia?

A
  • low albumin arises because of inadequate protein intake
  • inflammation and sepsis associated with infection as increased C reactive protein, WBC = pyrexia
  • capillary walls become more porous and albumin drifts out = low plasma albumin
20
Q

How is albumin relevant to nutrition?

A

good prognostic indicator of mortality risk
albumin levels should normalise over a few weeks as inflammation falls
causes of low albumin should be sought and treated, don’t just assume poor protein intake
- low albumin often occurs in sick/malnourished patients but not caused by poor intake but infection and C reactive protein increase

21
Q

What is refeeding syndrome?

A

potentially fatal condition characterised by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding

22
Q

What levels change during starvation?

A

glucagon levels rise
insulin falls
glycogen used up in first 24-72 hours
shift to protein for energy
fatty acids metabolised to produce ketone bodies which become a major source
loss of fat and lean body mass, water and minerals
intracellular stores of potassium, phosphate and magnesium become depleted

23
Q

How do levels change during refeeding?

A

change from fatty acids to carbohydrates
raised insulin secretion
stimulation of potassium, phosphate, magnesium to return to cells
intracellular stores replenished but at expense of plasma concentrations

24
Q

What are the clinical consequences of hypophosphatemia?

A

neurological - seizures, paraesthesia
musculoskeletal - rhabdomyolysis, weakness, osteomalacia
respiratory - impaired resp muscle function
cardiac - failure
renal - rhabdomyolysis, fluid and salt retention

25
Q

What are the clinical consequences of hypomagnesaemia?

A

neurological - tetany, paraesthesia, seizures, ataxia, tremor
cardiac - arrhythmias
gastrointestinal - anorexia, abdominal pain

26
Q

What are the clinical consequences of hypokalaemia?

A 
neurological - paralysis, paraesthesia
musculoskeletal - rhabdomyolysis
respiratory - respiratory depression
cardiac - arrhythmias, cardiac arrest
gastrointestinal - constipation, paralytic ileus
27
Q

Who is at risk of refeeding syndrome?

A

Risk - any patient with very little food intake > 5 days
High risk - BMI <16, little/no nutritional intake for more than 10 days, low K/PO/Mg levels prior to feeding, unintentional weight loss >15% in last 3-6 months
High risk if 2 of following - BMI <18.5, >10 unintentional weight loss in last 3-6 months, little/no nutrition for more than 5 days, history of alcohol abuse or drug use including chemotherapy, antacids or diuretics

28
Q

Why should nutrition support be provided?

A

Maintain nutritional status and limit catabolism
Preserve lean body mass
maintain immune function
preserve organ function and promote wound healing
enhance recovery and improve patient outcomes

29
Q

What are the 2 main routes for nutrition support?

A

Enteral - oral, nasogastric, orogastric, nasojejunal, gastrostomy, jejunostomy
Parenteral - peripheral, central

30
Q

When should enteral tube nutrition be used?

A

insufficient oral intake but gut function is fine

31
Q

When should parenteral nutrition be used?

A

GIT unable to digest/absorb adequate amount of nutrients (short bowel syndrome, ileus, motility disorders, GI ischemia, bowel perforation, radiation enteritis, pancreatitis)
GIT cannot be accessed (obstruction, enterocutaneous fistulae, severe inflammatory bowel disease)

32
Q

What are the disadvantages of parenteral nutrition?

A
  • risk associated with placement
  • risk of catheter related sepsis
  • disorder liver function
  • risk of gut atrophy
  • psychological
  • cost
33
Q

What is the mechanism of refeeding syndrome?

A

Starvation/malnutrition -> glycogenolysis/gluconeogenesis and protein catabolism -> protein/fat/mineral/electrolyte/vitamin depletion = salt and water intolerance -> switch to anabolism (refeeding) -> fluid/salts/nutrients -> insulin secreted -> increase in protein and glycogen synthesis/glucose uptake/thiamine utilisation/potassium, magnesium, phosphate uptake and use -> hypokalaemia, hypomagnesaemia, hypophosphataemia, thiamine deficiency, salt and water retention (oedema) -> refeeding syndrome

MET2 (26 decks)

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