Nutrition Therapeutics Overview Flashcards
What is the NUTRIC score used for?
Used to determine how soon to start enteral/parenteral feeding and risk of refeeding syndrome
Low risk NUTRIC score characteristics
Normal baseline, NUTRIC score <5, can withhold feeding for up to 7 days
High risk NUTRIC score characteristics
Compromised baseline, NUTRIC ≥5, >80% of estimated or calculated goal energy and protein within 48-72 hours, monitor closely for refeeding syndrome
Physical exam: findings suggestive of malnutrition
General appearance, skin and mucous membranes, musculoskeletal, neurologic, hepatic
What does the subjective global assessment do?
Classifies patients subjectively on the basis of data obtained from history and physical examination
What is the subjective global assessment NOT?
It’s not a screening tool for detecting nutritional risk, it’s an assessment tool for malnutrition
Assessment of nutritional status: ways to assess body weight
%IBW, %UBW, BMI
BMI of a healthy weight
19-24.9
BMI of mild malnutrition
17-18.9
BMI of moderate malnutrition
16-16.9
BMI of severe malnutrition
<16
Assessment of nutritional status: ways to measure body composition
Bioelectric impedance, body measurements (triceps skin fold test, midarm muscle circumference, waist circumference), hand-grip strength
Assessment of nutritional status: visceral proteins
Albumin, transferrin, prealbumin
Assessment of nutritional status: ways to assess immune function
Total lymphocyte count, delayed cutaneous hypersensitivity
Assessment of nutritional status: ways to assess nutrient deficiencies
Assessment for signs and symptoms of vitamin, trace mineral, and essential fatty acid deficiency must be included in the physical and evaluated using serum concentrations and surrogates of nutrient function
Starvation-associated malnutrition
Chronic starvation without inflammation
Examples of starvation-associated malnutrition
Anorexia, comprised intake in the setting of depression
Characteristics of chronic disease-associated malnutrition
Inflammation is chronic and mild-moderate
Examples of chronic disease-associated malnutrition
Organ failure, pancreatic cancer, RA
Examples of acute disease or injury-associated malnutrition
Major infection, burns, trauma, closed-head injury
Relationship between severe inflammation and malnutrition
The more severe inflammation there is, the harder it is to reverse the malnutrition
Relationship between severity and energy requirements
The severity determines how much the patient needs in reference to their baseline (ex: burn patients need way more in comparison but starvation needs less)
Ways to estimate energy requirements
Kcal/kg/day
Resting energy expenditure with Harris-Benedict equation
Energy expenditure with indirect calorimetry
Ways to estimate protein requirements
Stress level (g/kg/day), obesity based on BMI, nitrogen turnover studies
g/kg/day of protein needed in critical illness
1.2-2
g/kg/day of protein needed in burn patients
2.5-3.5
g/kg of protein needed for obese patients with a BMI of 30-40
2g/kg
g/kg of protein needed for obese patients with a BMI of >40
2.5g/kg
Conversion between nitrogen and protein
1g nitrogen=6.25g protein
Estimating fat requirements
10-35% of total calories in adults
Predisposing factor of Marasmus malnutrition
Pure starvation (anorexia)
Predisposing factor of Kwashiorkor malnutrition
Acute illness, hypermetabolic states
Predisposing factor of mixed malnutrition
Acute illness with underlying starvation
Characteristics of proteins, tissues, immune function, and substrate abnormality in Marasmus malnutrition
(Reduced or intact for proteins and tissues)
Somatic proteins are reduced Adipose tissues are reduced Visceral proteins are intact Immune function is reduced Substrate abnormality- inadequate intake
Characteristics of proteins, tissues, immune function, and substrate abnormality in Kwashiorkor malnutrition
(Reduced or intact for proteins and tissues)
Somatic proteins are intact Adipose tissues are intact Visceral proteins are reduced Immune function is reduced when severe Substrate abnormality- excessive requirements
Characteristics of proteins, tissues, immune function, and substrate abnormality in mixed malnutrition
All proteins and tissues are reduced
Substrate abnormality is both inadequate intake and needing excessive requirements
