Nutrition in health and disease

Question 1

diet

Answer 1

sum total of all foods ingested

Question 2

food

Answer 2

the individual items ingested

Question 3

nutrients

Answer 3

chemically defined compounds required by the body

Question 4

what are food choices dependent on

Answer 4

Likes

Dislikes

Religious and ethical considerations

Social and psychological components

Question 5

what is nutrition a balance between?

Answer 5

intake and demand

Question 6

what is fixed components of demand?

Answer 6

Basal requirements
Membrane function
Pumps
Transport
Signalling

Mechanical work
Cellular level
Tissue level

Substrate Turnover

Question 7

what is a variable component of demand?

Answer 7

Cost of processing the dietary intake
Cost of Physical activity
Cost of maintaining body temperature
Cost of growth

Question 8

what is the basal metabolic rate?

Answer 8

Your basal metabolic rate (BMR) is the number of calories your body needs to accomplish its most basic (basal) life-sustaining functions.

Question 9

how can basal metabolic rate be calculated?

Answer 9

direct calorimetry

Question 10

how can basal metabolic rate be calculated?

Answer 10

Depends on lean body mass

Schofield or Harris Benedict, Hernry equations

Various adjustment factors for activity and illness

Question 11

what is nutritional failure?

Answer 11

Failure to meet the nutritional requirements of the individual

Development of deficiencies

[Weight loss]
Or Excess
[Obesity]

Question 12

marasmus

Answer 12

a deficiency of all macronutrients: carbohydrates, fats, and protein

Question 13

Kwashiorkor

Answer 13

The main sign of kwashiorkor is too much fluid in the body’s tissues, which causes swelling under the skin (oedema)

Question 14

how would you define malnutrition?

Answer 14

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.

Question 15

why is malnutrition a broad term?

Answer 15

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.

Question 16

what does over nutrition lead to?

Answer 16

Over nutrition leads to obesity, which leads to longer term problems.
These are often hidden and only become apparent over time.

Question 17

what does under nutrition lead to?

Answer 17

Under nutrition leads to weight loss and impaired function.
It strongly associates with illness

Question 18

how is BMI calculated

Answer 18

BMI = weight (Kg)/height2(m)

Question 19

which BMI is classed as overweight?

Answer 19

BMI > 25 overweight

Question 20

which BMI is classed as obese?

Answer 20

BMI > 30 obese

Question 21

what can obesity lead to?

Answer 21

metabolic syndrome (hypertension, cardiovascular diseases, type 2 diabetes, fatty liver, NASH, cirrhosis) and cancer (breast and bowel)

Question 22

what is the current UK estimate of cost on obesity?

Answer 22

£5 billion p.a.

Question 23

what is the bmi definition of underweight?

Answer 23

BMI less < 20 underweight

Question 24

what is the bmi definition of physical impairment?

Answer 24

BMI < 18 physical impairment

Question 25

what is the bmi definition of increasingly severe consequences?

Answer 25

BMI < 16 increasingly severe consequences.

Question 26

how do we screen for malnutrition?

Answer 26

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

Question 27

step one of MUST?

Answer 27

Height Weight BMI If < 20 Score 1 If < 18 Score 2

Question 28

step 2 of MUST?

Answer 28

Have you lost weight unintentionally in the last 3 – 6 months? Yes – 10% Score 2 Yes – 5% Score 1

Question 29

step 3 of MUST?

Answer 29

Has the patient eaten in the last 5 days No – Score 2

Question 30

what do the results of MUST indicate?

Answer 30

A score over 2 suggests a risk of undernutrition Score 1: supplements and watch Score 0: Monitor

Question 31

what does malnutrition associate with?

Answer 31

Illness Social Isolation Age Socially Vulnerable groups

Question 32

clinical consequences malnutrition?

Answer 32

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

Question 33

what do you do if you think someones malnourished?

Answer 33

Take a history Examine the patient Look at them nutritionally Analyse what the problem is Work out their requirements Difficult method Easy method

Question 34

what is the difficult method?

Answer 34

Age Weight Sex Disease 🡩 requirements 🡫 intake Activity work out nitrogen requirements and Fluids Vitamins Minerals Trace elements

Question 35

what is the easy method?

Answer 35

Refer the patient to a state registered dietitian

Question 36

what are causes of undernutrition?

Answer 36

Appetite Failure Access Failure Intestinal Failure

Question 37

apetite failure causes?

Answer 37

Anorexia nervosa Disease related

Question 38

access failures

Answer 38

teeth (false, sore teeth) Stroke Cancer of head and neck Head injury (coma)

Question 39

intestinal failure from surgery disadvantage?

Answer 39

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