Nutritional Assessment

Question 1

3 standard measurements of nutritional assessment.

Answer 1

Weight: easy to obtain, least measurement error, changes rapidly, trend important, unreliable in fluid overload conditions.
Height/length: accurate technique important, measure at longer intervals, length til age 2-3 years, height >2 years if standing.
Head circumferences: Birth to 36 months when brain growth is most rapid.

Question 2

Standard measurements of nutritional assessment continued

Answer 2

Arm anthropometry: mid-arm circumference, triceps skin fold: technically difficult, can estimate muscle and fat stores, used over time.
Alternative height measurements: arm span/limb lengths: useful when standard measurements cannot be obtained, need previous measurements to trend.

Question 3

WHO growth charts

Answer 3

0-2 years of age

Question 4

CDC growth charts

Answer 4

After 2 years of age

Question 5

BMI >2 years of age

Answer 5

appropriateness of body weight for height, classifying overweight: 85-95 %tile, and obesity >95th %tile or BMI >/= 30.
BMI <10th underweight

Question 6

Weight for length <3 years of age

Answer 6

Assess child’s weight taking into account their length. underweight <5th %tile, overweight >90th %tile.

Question 7

Ideal Body Weight (IBW)

Answer 7

Compare acute weight to median weight for length. Measures short term response to nutritional support or weight reduction therapy.
Waterloos criteria >120% is overweight, 80-90% is mild wasting, 70-80% is moderate wasting, 60-70% severe wasting.
Percent IBW underestimates malnutrition severity in children with short stature

Question 8

zinc, copper and iron metabolism are closely related

Answer 8

if getting zinc therapy, will likely become iron deficient

Question 9

Total Energy Expenditure (TEE)

Answer 9

TEE= BMR+ TEF+ PAL+ energy cost of growth
BMR: Basal metabolic rate: rate at which a person uses energy to maintain the basic function of the body at rest, determined by body mass and composition (60-70% of TEE) and lower than REE (10-20% lower).
TEF: Thermic Effect of Food or energy cost of digesting food (5-10%).
PAL: Physical Activity Level (20-25%).
Energy cost of growth (<5th %).
Affected by age, body size and composition and presence of illness, infection, fever, trauma

Question 10

BMR: Basal Metabolic Rate

Answer 10

Rate at which a person uses energy to maintain the basic function of the body at rest; determined by body mass and composition (60-70% of TEE) and lower than REE (10-20% lower)

Question 11

TEF: Thermic effect of food

Answer 11

energy cost of digesting food (5-10%

Question 12

PAL: Physical Activity Level

Answer 12

20-25%

Question 13

Energy cost of growth

Answer 13

<5 %

Question 14

Equations to determine TEE:

Answer 14

DRI and RDA

Question 15

DRI

Answer 15

DRI: Estimated Energy requirements (TEE +energy deposition)

Question 16

RQ: Respiratory Quotient

Answer 16

ratio of CO2 production to oxygen consumption. varies depending on substrate utilization:
- RQ fat =0.7, RQ protein =0.85, RQ Carbohydrate = 1.0.
- Lipogenesis (conversion of carb to stored fate) occurs when RQ >1.
Ingestion of a carbohydrate rich diet results in increase in CO2 production and worsening respiratory insufficiency

Question 17

Total energy needs = REE x disease activity factor

Answer 17

REE: resting energy expenditure: amount of energy required for a 24 hour period by the body during resting conditions in a thermoneutral environment.
- closely related to, but not identical to the BMR.
Equations to determine REE: WHO and Schofeld.
Measurement of REE: indirect calorimetry (clinical), and doubly labeled water method (research)

Question 18

Energy Expenditure

Answer 18

determined by body size, body composition, food intake and physical activity

Question 19

Higher weight results in higher energy requirement

Answer 19

via a higher REE because of a higher maintenance cost of a larger body weight

Question 20

Larger body size

Answer 20

implies a larger fat free mass or lean body mass. taller subjects have a larger fat free mass than subjects with a short stature and fat free mass is larger in overweight and obese subjects than in lean subjects with the same stature

Question 21

Lean body mass

Answer 21

is metabolically more active than fat mass

Question 23

Severe protein calorie malnutrition

Answer 23

• increased total body water in relation to body weight.
• severe loss of cell mass and body fat
• increased total body Na intracellularly and extracellularly.
• total body potassium is decreased
• increase in extracellular water
• decrease in intravascular volume especially in the face of ongoing diarrhea and vomiting