Nutrition in health and disease

Question 1

what is the definition of a nutrient requirement

Answer 1

that amount required to sustain life and prevent a deficiency

intake must = demand

Question 2

what are the fixed components of nutrient demand

Answer 2

basal requirements
- membrane functions (pumps, transport, signalling)

mechanical work

• cellular level
• tissue level

Question 3

what are the variable components of nutrient demand

Answer 3

Cost of processing the dietary intake

Cost of Physical activity

Cost of maintaining body temperature

Cost of growth

Question 4

what is the basal metabolic rate

Answer 4

the rate of energy expenditure per unit time

i.e. the amount of energy per unit time that a person needs to keep the body functioning at rest

Question 5

how can we measure basal metabolic rate

Answer 5

calorimetry

usually calculated on lean body mass - various adjustments for activity and illness

BUT easy to over estimate requirements

Question 6

what can failure to meet nutritional requirements lead to

Answer 6

development of deficiencies
weight loss
development of excess
obesity

Question 7

define malnutrition

Answer 7

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

also includes micronutrients

Question 8

how can malnutrition be identified clinically

Answer 8

marasmus

kwashiorkor

obesity

Question 9

what is marasmus

Answer 9

form of severe malnutrition characterised by protein deficiency - look emaciated

Question 10

what is kwashiorkor

Answer 10

form of severe protein-energy malnutrition characterized by edema, and an enlarged liver with fatty infiltrates - enlarged abdomen

different from marasmus because of sufficient calorie intake but insufficient protein consumption

Question 11

what does over nutrition lead to

Answer 11

obesity - leads to longer term health problems that are often hidden and only become apparent over time

**trouble in store

Question 12

what does under nutrition lead to

Answer 12

weight loss and impaired function - strongly associates with illness

i.e. cause of under nutrition frequently disease related

**trouble right now

Question 13

what BMI classifies you as overweight

Answer 13

> 25

Question 14

what BMI classifies you as obese

Answer 14

> 30

Question 15

what are three causes of obesity

Answer 15

environment
lack of exercise
genes

Question 16

what metabolic syndromes can develop from obesity

Answer 16

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

Question 17

what cancers can develop from obesity

Answer 17

breast

bowel

Question 18

what BMI classifies you as underweight

Answer 18

<20

Question 19

what BMI classifies you as having a physical impairment

Answer 19

<18

Question 20

what BMI is associated with increasing severe consequences

Answer 20

<16

Question 21

what factors can cause undernutrition

Answer 21

environmental 
appetite failure
access failure 
disease
intestinal failure

Question 22

why is BMI not enough to determine if someone has under or over nutrition

Answer 22

an obese patient can become undernourished as weight loss is a hallmark of undernutrition

5% loss of body mass (unintentionally ) can occur quickly

10% loss of body mass becomes associated with increasing morbidity

Question 23

what is used to screen for undernutrition

Answer 23

MUST - malnutrition universal screening tool

picks up patients at risk

Question 24

what is the first step in MUST

Answer 24

height
weight
BMI 
- <20 score 1
- <18 score 2

Question 25

what is the second step in MUST

Answer 25

have you lost weight unintentionally in the last 3-6 months

yes 5% score 1
yes - 10% score 2

Question 26

what is the third and final step in MUST

Answer 26

has the patient eaten in the last 5 days

no - score 2

Question 27

how do you interpret MUST scores and

Answer 27

score over 2 suggests a risk of undernutrition

score 1: supplements and watch

score 0: Monitor

Question 28

what are other factors that can be associated with malnutrition aside from illness

Answer 28

social isolation
age
socially vulnerable groups

Question 29

what are the clinical consequences of malnutrition

Answer 29

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

Question 30

what should be done once an at patient risk has been identified

Answer 30

Take a history

Examine the patient
- Look at them nutritionally

Analyse what the problem is

Work out their requirements
- nitrogen, fluids, vitamins, minerals, trace elements

Refer to dietician

Question 31

what are reasons for appetite failure in undernutrition

Answer 31

anorexia nervosa

disease related

Question 32

what are reasons for access failure in undernutrition

Answer 32

teeth
stroke
cancer of head and neck
head injury

Question 33

how can intestinal failure cause undernutrition

Answer 33

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

Question 34

if a patient has access failure malnutrition how can this be managed

Answer 34

help with eating
- purees, soups, yogurt, juices, liquids, etc

Fine bore nasogastric tube

Percutaneous Endoscopic Gastostomy

Question 35

if a patient has intestinal failure malnutrition how can this be managed

Answer 35

assess nutritional requirements

establish IV feeding

deal with sepsis urgently

? small amounts enteral feeding