Nutrition in Medicine

Question 1

What is undernutrition?

Answer 1

A form of malnutrition resulting from reduced supply of food or inability to digest/assimilate and utilise the necessary nutrients

Question 2

What are the 2 classes of nutrients?

Answer 2

Macronutrients

Micronutrients

Question 3

Who is most vulnerable to undernutrition?

Answer 3

Chronically diseased
elderly
recently discharged from hospital
low income
socially isolated

Question 4

What are the consequences of undernutrition?

Answer 4

In the community - falls (weak bones from undernutrition), depression (symptoms of depression is loss of appetite - viscous circle), infection risk (immunodeficient as little energy), dependency
In hospitals - increased morbidity, length of stay, dependency, mortality and costs of care

Question 5

What are some causes of reduced nutritional intake?

Answer 5

anorexia
side effects of treatment
pain
dysphagia
physical disability
nil by mouth (should not eat for a period of time)

Question 6

What are some causes of increased nutritional requirements?

Answer 6

inflammation/infection
pyrexia
tissue healing
metabolic effects

Question 7

What are some causes of increased nutritional losses?

Answer 7

malabsorption

would exudate/burns

Question 8

What are the consequences of undernutrition?

Answer 8

decreased muscle mass, decreased visceral proteins, impaired immune response, impaired wound healing and response to trauma, multiple organ failure,
fatigue, lack of initiative, bedridden, apathy, depression, behavioural changes, complete exhaustion

(if ill these things will happen faster)

Question 9

How can we assess nutritional status?

Answer 9

• history: weight and BMI, diet history, weight changes, appetite/taste changes, GI symptoms, energy and activity levels
• physical: muscle wasting, fat stores, ascites, oedema

Question 10

What specific clinical investigations regarding nutritional assessment can we do?

Answer 10

• clinical anthropometrics (skinfold thickness -fat, mid upper arm circumference - muscle)
• imaging procedures (DEXA)
• bioelectrical impedence analysis
• handgrip dynamometry

Question 11

How can you do a nutritional assessment in the lab?

Answer 11

Check albumin/transferrin/pre-albumin/retinol binding protein (for anaemia and plasma proteins)
Check vitamin & mineral concentrations
Check lymphocyte count/delayed hypersensitivity reaction for immune response

Question 12

What is total energy expenditure made up of?

Answer 12

• basic metabolic rate
• thermic effect of food (energy required to process food)
• physical activity
• stress factors (if they are ill for example)

Question 13

How do you estimate volume requirements?

Answer 13

• non urinary output (stoma, fistula)
• insensible loss (sweat) and add 10% for every degree Celsius temperature rise
• 1-1.5L urine daily

Question 14

What nutritional support should be given and at what stage?

Answer 14

early levels for the majority:
increased intake of normal diet
prescribed supplements
specialist enteral feeds (via mouth to the stomach as patients cannot eat themselves)
nasogastric tube
gastrostomy tube (through abdominal wall)
parenteral nutrition (IV directly into bloodstream)

Question 15

What are some indications for gastrostomy feeding?

Answer 15

• reduced consciousness (brain injury)
• unsafe swallowing (Parkinsons, motor neurone disease, CVA)
• pre head and neck cancer surgery/radiotherapy
• special situations (cystic fibrosis)
  (through abdominal wall, use endoscope)

Question 16

What are some indicates for parenteral nutrition?

Answer 16

Prolonged postoperative ileus
Intestinal obstruction - ongoing
Short bowel
Small bowel fistula
Acute pancreatitis
GI motility disorders

Question 17

How is parenteral nutrition carried out?

Answer 17

Calculate nutrient need
Compound in a large IV bag
Usually central vein access
Pump infusion 24-10 hours
ASEPSIS  ASEPSIS
Monitor especially Water and
	Electrolytes
Stop when Enteral working

Question 18

What are the problems with nasogastric feeding?

Answer 18

aspiration, discomfort, diarrhoea

Question 19

What are the problems with percutaneous endoscopic gastrostomy?

Answer 19

peritonitis, infection, discomfort, diarrhoea

Question 20

What are the problems with parenteral nutrition?

Answer 20

infection, thrombosis, electrolyte disturbances, hepatic dysfunction, hyperglycaemia

Question 21

What are some causes of disease-related undernutrition?

Answer 21

Reduced nutritional intake
Increased nutritional losses
increased nutritional requirements

Question 22

What is nil by mouth?

Answer 22

Someone who cannot eat anything because of : operations, investigations, certain treatments and drugs

Question 23

What is MUST?

Answer 23

Malnutrition Universal Screening Tool
Measure weight and BMI
Decide if they have lost weight
Give each a score
If 1 or below -> don’t need to take action
If score 2 or above -> take to dietician
Happens in every hospital in the UK and every week after that according to NICE guidelines

Question 24

What is basic metabolic rate?

Answer 24

Energy required to run the basic metabolic systems

Can be estimated based on individual’s information

Question 25

What are the protein requirements?

Answer 25

0. 75g/kg/day for healthy adults

52. 5g/day for 70kg