Nutrition in health and disease Flashcards
diet
sum total of all foods ingested
food
the individual items ingested
nutrients
chemically defined compounds required by the body
what are food choices dependent on
Likes
Dislikes
Religious and ethical considerations
Social and psychological components
what is nutrition a balance between?
intake and demand
what is fixed components of demand?
Basal requirements
Membrane function
Pumps
Transport
Signalling
Mechanical work
Cellular level
Tissue level
Substrate Turnover
what is a variable component of demand?
Cost of processing the dietary intake
Cost of Physical activity
Cost of maintaining body temperature
Cost of growth
what is the basal metabolic rate?
Your basal metabolic rate (BMR) is the number of calories your body needs to accomplish its most basic (basal) life-sustaining functions.
how can basal metabolic rate be calculated?
direct calorimetry
how can basal metabolic rate be calculated?
Depends on lean body mass
Schofield or Harris Benedict, Hernry equations
Various adjustment factors for activity and illness
what is nutritional failure?
Failure to meet the nutritional requirements of the individual
Development of deficiencies
[Weight loss]
Or Excess
[Obesity]
marasmus
a deficiency of all macronutrients: carbohydrates, fats, and protein
Kwashiorkor
The main sign of kwashiorkor is too much fluid in the body’s tissues, which causes swelling under the skin (oedema)
how would you define malnutrition?
As state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients, causes measurable adverse effects on tissue / body form, (body size, shape, composition) body function and clinical outcome.
why is malnutrition a broad term?
Malnutrition is a broad term and can include not only protein energy malnutrition (both over and under) but also malnutrition of other nutrients, such as micronutrients.
what does over nutrition lead to?
Over nutrition leads to obesity, which leads to longer term problems.
These are often hidden and only become apparent over time.
what does under nutrition lead to?
Under nutrition leads to weight loss and impaired function.
It strongly associates with illness
how is BMI calculated
BMI = weight (Kg)/height2(m)
which BMI is classed as overweight?
BMI > 25 overweight
which BMI is classed as obese?
BMI > 30 obese
what can obesity lead to?
metabolic syndrome (hypertension, cardiovascular diseases, type 2 diabetes, fatty liver, NASH, cirrhosis) and cancer (breast and bowel)
what is the current UK estimate of cost on obesity?
£5 billion p.a.
what is the bmi definition of underweight?
BMI less < 20 underweight
what is the bmi definition of physical impairment?
BMI < 18 physical impairment
what is the bmi definition of increasingly severe consequences?
BMI < 16 increasingly severe consequences.
how do we screen for malnutrition?
Malnutrition Universal Screening Tool
Picks up patients at risk of malnutrition
Validated in the community and hospital
Can be carried out by people without special training
step one of MUST?
Height
Weight
BMI
If < 20 Score 1
If < 18 Score 2
step 2 of MUST?
Have you lost weight unintentionally in the last 3 – 6 months?
Yes – 10% Score 2
Yes – 5% Score 1
step 3 of MUST?
Has the patient eaten in the last 5 days
No – Score 2
what do the results of MUST indicate?
A score over 2 suggests a risk of undernutrition
Score 1: supplements and watch
Score 0: Monitor
what does malnutrition associate with?
Illness
Social Isolation
Age
Socially Vulnerable groups
clinical consequences malnutrition?
Impaired immune response
Reduced muscle strength
Impaired wound healing
Impaired psycho-social function
Impaired recovery from illness and surgery
Poorer clinical outcomes
what do you do if you think someones malnourished?
Take a history
Examine the patient
Look at them nutritionally
Analyse what the problem is
Work out their requirements
Difficult method
Easy method
what is the difficult method?
Age
Weight
Sex
Disease 🡩 requirements
🡫 intake
Activity
work out nitrogen requirements
and
Fluids
Vitamins
Minerals
Trace elements
what is the easy method?
Refer the patient to a state registered dietitian
what are causes of undernutrition?
Appetite Failure
Access Failure
Intestinal Failure
apetite failure causes?
Anorexia nervosa
Disease related
access failures
teeth (false, sore teeth)
Stroke
Cancer of head and neck
Head injury (coma)
intestinal failure from surgery disadvantage?
Reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of nutrients
