Nutrition in Health and Disease

Question 1

Where does our nutriotion demand come form?

Answer 1

Basal Requirements:

Membrane function:

• Pumps
• Transport
• Signalling

Mechanical Work:

• Cellular level
• Tissue level

Substrate turnover

Variable Component:

Cost of processing the dietary intake

Cost of Physical activity

Cost of maintaining body temperature

Cost of growth

Question 2

What is meant by nutritional failure?

Answer 2

Failure to meet the nutritional requirements of the individual

Development of deficiencies

[Weight loss]

Or Excess

[Obesity]

Question 3

What are two clincal examples if malnutrition?

Answer 3

Marasmus

Kwashiorkor

It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein

Question 4

Define malnutrition

Answer 4

When there is an imbalance of energy, protein or other nutrients that results in adverse effect on tissue / body form, body function and clinical outcome

Question 5

How do you calculate BMI?

Answer 5

Weight divided by height squared

Question 6

What BMI is defined as overqeight and obese?

Answer 6

BMI > 25 overweight

BMI > 30 obese.

Question 7

What are the contributing factors to obesity?

Answer 7

Environment

Exercise

Genes

Question 8

What is metabolic syndrome composed of?

(as a result of obesity)

Answer 8

• Hypertension.
• Cardiovascular disease.
• Type II diabetes mellitus.
• Fatty liver.
• NASH
• Cirrhosis

Question 9

What types of cancer are obese people most likely to get?

Answer 9

Breast

Bowel

Question 10

What are the aetiologies for indernutriotion?

Answer 10

Partly environmental

Mostly disease related

Question 11

What are the BMI classifications for those who are malnourished?

Answer 11

BMI less < 20 underweight

BMI < 18 physical impairment

BMI < 16 increasingly severe consequences.

Question 12

Why is BMI insufficient when determining undernutrition?

Answer 12

An obese patient who is experiencing weight loss would be indicative of undernutrition, however BMI would not be able to inform you of this

Question 13

How do we screen for undernutrition?

Answer 13

Malnutrition Universal Screening Tool

Picks up patients at risk of malnutrition

Question 14

What are the aspects of the Malnutrition screening tool?

Answer 14

BMI

If < 20 Score 1

If < 18 Score 2

Unintentional weight loss?

Yes - 10% score 2

Yes - 5% score 1

Patient eaten in the last 5 days or is expected to eat in the next 5 days? No - score 2

Question 15

What do the scores indicate for the malnutrition universal screening tool?

Answer 15

A score over 2 suggests a risk of undernutrition

Score 1: supplements and watch

Score 0: Monitor

Question 16

Which admission source is most likely to have malnourished patients?

Answer 16

Care homes

Other Hospitals

Question 17

Which type of ward has the largest percentage of malnourished patients?

Answer 17

Care of the elderly / Stroke

Question 18

What does malnutriotion associate with?

Answer 18

Illness

Social Isolation

Age

Socially Vulnerable groups

‘Food deserts’ - inability to reach food shops, reliance on conveniance stores

Question 19

What are the clinical consequences of malnutrition?

Answer 19

• Impaired immune response
• Reduced muscle strength
• Impaired wound healing
• Impaired psycho-social function
• Impaired recovery from illness and surgery
• Poorer clinical outcomes

Question 20

What are causes of undernutrition?

Answer 20

Appetite failure

Access failure

Intestinal Failure

Question 21

What are the causes of appetite failure?

Answer 21

Anorexia nervosa

Disease related

Question 22

What are the reasons for access failre?

Answer 22

Teeth

Stroke

Cancer of head and neck

Head injury

Question 23

What is meant by intetinal failure?

Answer 23

Reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of nutrients

Question 24

For patients with access failure, what is the feeding method?

Answer 24

Sip feeding

Fine bore nadogastric tube

PEG - Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient’s stomach through the abdominal wall

Question 25

What causes the fluid build up in Kwashiorkor?

Answer 25

Leaky capillaries, fluid retention.

(Probably as a result of loss of oncotic pressure)

Question 26

Where would you be likely ot find marasmus?

Answer 26

Any Care of the Elderly Ward

General medical admissions

Oncology

Question 27

Where would you be likely to find kwashiorkor?

Answer 27

ITU or HDU