Nutrition Therapeutics Overview

Question 1

What is the NUTRIC score used for?

Answer 1

Used to determine how soon to start enteral/parenteral feeding and risk of refeeding syndrome

Question 2

Low risk NUTRIC score characteristics

Answer 2

Normal baseline, NUTRIC score <5, can withhold feeding for up to 7 days

Question 3

High risk NUTRIC score characteristics

Answer 3

Compromised baseline, NUTRIC ≥5, >80% of estimated or calculated goal energy and protein within 48-72 hours, monitor closely for refeeding syndrome

Question 4

Physical exam: findings suggestive of malnutrition

Answer 4

General appearance, skin and mucous membranes, musculoskeletal, neurologic, hepatic

Question 5

What does the subjective global assessment do?

Answer 5

Classifies patients subjectively on the basis of data obtained from history and physical examination

Question 6

What is the subjective global assessment NOT?

Answer 6

It’s not a screening tool for detecting nutritional risk, it’s an assessment tool for malnutrition

Question 7

Assessment of nutritional status: ways to assess body weight

Answer 7

%IBW, %UBW, BMI

Question 8

BMI of a healthy weight

Answer 8

19-24.9

Question 9

BMI of mild malnutrition

Answer 9

17-18.9

Question 10

BMI of moderate malnutrition

Answer 10

16-16.9

Question 11

BMI of severe malnutrition

Answer 11

<16

Question 12

Assessment of nutritional status: ways to measure body composition

Answer 12

Bioelectric impedance, body measurements (triceps skin fold test, midarm muscle circumference, waist circumference), hand-grip strength

Question 13

Assessment of nutritional status: visceral proteins

Answer 13

Albumin, transferrin, prealbumin

Question 14

Assessment of nutritional status: ways to assess immune function

Answer 14

Total lymphocyte count, delayed cutaneous hypersensitivity

Question 15

Assessment of nutritional status: ways to assess nutrient deficiencies

Answer 15

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

Question 16

Starvation-associated malnutrition

Answer 16

Chronic starvation without inflammation

Question 17

Examples of starvation-associated malnutrition

Answer 17

Anorexia, comprised intake in the setting of depression

Question 18

Characteristics of chronic disease-associated malnutrition

Answer 18

Inflammation is chronic and mild-moderate

Question 19

Examples of chronic disease-associated malnutrition

Answer 19

Organ failure, pancreatic cancer, RA

Question 20

Examples of acute disease or injury-associated malnutrition

Answer 20

Major infection, burns, trauma, closed-head injury

Question 21

Relationship between severe inflammation and malnutrition

Answer 21

The more severe inflammation there is, the harder it is to reverse the malnutrition

Question 22

Relationship between severity and energy requirements

Answer 22

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)

Question 23

Ways to estimate energy requirements

Answer 23

Kcal/kg/day
Resting energy expenditure with Harris-Benedict equation
Energy expenditure with indirect calorimetry

Question 24

Ways to estimate protein requirements

Answer 24

Stress level (g/kg/day), obesity based on BMI, nitrogen turnover studies

Question 25

g/kg/day of protein needed in critical illness

Answer 25

1.2-2

Question 26

g/kg/day of protein needed in burn patients

Answer 26

2.5-3.5

Question 27

g/kg of protein needed for obese patients with a BMI of 30-40

Answer 27

2g/kg

Question 28

g/kg of protein needed for obese patients with a BMI of >40

Answer 28

2.5g/kg

Question 29

Conversion between nitrogen and protein

Answer 29

1g nitrogen=6.25g protein

Question 30

Estimating fat requirements

Answer 30

10-35% of total calories in adults

Question 31

Predisposing factor of Marasmus malnutrition

Answer 31

Pure starvation (anorexia)

Question 32

Predisposing factor of Kwashiorkor malnutrition

Answer 32

Acute illness, hypermetabolic states

Question 33

Predisposing factor of mixed malnutrition

Answer 33

Acute illness with underlying starvation

Question 34

Characteristics of proteins, tissues, immune function, and substrate abnormality in Marasmus malnutrition (Reduced or intact for proteins and tissues)

Answer 34

``` Somatic proteins are reduced Adipose tissues are reduced Visceral proteins are intact Immune function is reduced Substrate abnormality- inadequate intake ```

Question 35

Characteristics of proteins, tissues, immune function, and substrate abnormality in Kwashiorkor malnutrition (Reduced or intact for proteins and tissues)

Answer 35

``` Somatic proteins are intact Adipose tissues are intact Visceral proteins are reduced Immune function is reduced when severe Substrate abnormality- excessive requirements ```

Question 36

Characteristics of proteins, tissues, immune function, and substrate abnormality in mixed malnutrition

Answer 36

All proteins and tissues are reduced | Substrate abnormality is both inadequate intake and needing excessive requirements