Nutritional Assessment Flashcards by Sarah Gillen

What is the recommended number of servings of fruits and vegetables/day?

6-9

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What is the recommended amount of protein per day?

5.5 oz

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Good vs. bad fats

Good fats = Poly and Monounsaturated fat [sources: seafood, sunflower, corn, olive, soybean, cottonseed oil, walnuts, pine nuts, sesame seeds, sunflower seeds, pumpkin seeds, flaxseed]

Bad fats = saturated and trans fats [sources: animal fats (meat, butter, whole milk), solid fats like margarine, coconut and palm kernel oils]

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Describe the mediterranean diet

Plant based — fruits, veggies, nuts, grains, seeds, beans, and olive oil

Eggs, dairy, poultry, and fish are eaten several times per week but the portions are small

Minimal intake of red meat, refined sugar, flour, butter, and fats (except olive oil)

Includes 1-2 glasses of red wine per day

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What 2 food groups are the most different in terms of serving size between healthy american-style eating pattern, healthy mediterranean-style eating pattern, and healthy vegetarian eating pattern?

Dairy and protein

Healthy american diet = 3 C dairy/day, 5.5 oz protein/day

Healthy mediterranean diet = 2 C dairy/day, 6.5 oz protein/day

Healthy vegetarian diet = 3 C dairy/day, 3.5 oz protein/day (most of which comes from eggs, nuts, seeds, and soy products)

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What nutritional deficiency may result in a strict vegetarian or vegan diet?

A. B12 (cobalamin)
B. B3 (niacin)
C. Iron
D. B1 (thiamine)
E. Folic acid

A. B12 (cobalamin)

[there are no plant sources for B12]

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Current recommendations regarding salt intake

Less than 2300 mg/day

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What is the DASH diet and its effect on 2 important health conditions?

DASH diet is based on study limiting sodium to 2300 mg/d

Lowered both blood pressure and LDL cholesterol

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4 vitamins and minerals required by law to be listed on food labels

Vitamin A
Vitamin C
Calcium
Iron

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What does it mean to be salt/sodium-free?

Less than 5 mg sodium per serving

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What does it mean to be very low sodium?

Less than 35 mg sodium per serving

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What does it mean to be low sodium?

140 mg sodium or less per serving

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What does it mean to be “reduced sodium”?

At least 25% less sodium than the original product

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What does it mean to be light in sodium or lightly salted?

At least 50% less sodium than regular product

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What does it mean to be “no-salt-added” or “unsalted”?

No salt is added during processing — it does NOT mean there is no sodium in the product

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What does it mean to be fat-free?

Less than 0.5 g of fat per serving

[same thing for “trans-fat free” — may still contain up to 0.49 grams which can add up with multiple servings]

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What does it mean to be low fat?

3 g of fat or less per serving

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What does it mean to be reduced fat or “less fat”

At least 25% less fat than regular produce

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PMH and PSH clues to nutritional status

PMH — diet related illnessess (CV disease, DM, HTN), psychiatric disorders, seizure disorders, colitis, end-stage chronic disease (COPD, CKD)

PSH — GI surgery: gastrectomy, bariatric surgery, fistula or wound healing concerns

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Medications and allergy-related clues to nutritional status

Antiepileptics, PPIs, supplement use (MVI, herbal remedies)

Allergies: food intolerances (lactose, gluten), true allergies (nuts, seeds, shellfish)

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Social history clues to nutritional status

Chronic alcoholism or recreational drugs

Social isolation (divorce, loss of spouse)

Loss of job (food insecurity, homelessness)

Dietary history

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PE findings suggestive of possible nutritional deficiency in general

Vitals: BMI assessment

Eyes, tongue, teeth, gums, hair, nails, mental status changes

Changes in skin integrity, loss of subcutaneous fat

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Important lab values to assess for possible nutritional deficiency

CBC (MCV)
WBC
Albumin
total protein
TSH

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Integral component of rhodopsin and iodopsin; deficiency is made worse with conditions that have fat malabsorption. Sources include milk, fish oil, liver, eggs, carrots, squash, and greens

Vitamin A

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Which of the following might lead to vitamin A deficiency? ``` A. Crohns disease B. Celiac disease C. Bariatric surgery D. Chronic mineral oil use for constipation E. All of the above ```

E. All of the above

Diarrhea, dementia, pigmented dermatitis in sun-exposed areas, glossitis, stomatitis, vertigo, and BURNING paresthesias are signs of _____ deficiency

Niacin (B3)

Hyperpigmentation in exposed areas, creases and flexures; megaloblastic anemia, thrombocytopenia, weakness, paresthesias, numbness, ataxia, delirium, atrophic patch tongue, weight loss, and fatigue may indicate ___ deficiency

Vitamin B12

Fatigue, depression, widespread abnormalities in CT, inflamed gingiva, petechiae, hemorrhage, impaired wound healing, hyperkeratosis, corkscrew hairs, and bleeding into body cavities indicates possible ____ deficiency

Vitamin C

Vitamin needed for biosynthesis of bile acids, collagen, and norepinephrine

Vitamin C

Niacin (B3) is synthesized in the body from ______; sources include meats, poultry, fish, legumes, and wheat

Tryptophan

Both osteoporosis and sarcopenia have been linked to deficiency in ______

Vitamin D

Which of the following is a risk factor for vitamin D deficiency? ``` A. Elderly nursing home resident B. Treatment for seizure disorders C. Dark-skinned pts living in northern climates D. Pts with milk allergy E. All of the above ```

E. All of the above

Which of the following is most likely in a pt with a strict vegan diet? ``` A. Low total protein B. Low albumin C. Microcytic hypochromic anemia D. Megaloblastic anemia E. Elevated TSH ```

D. Megaloblastic anemia [due to B12 deficiency]

Hyperkeratosis along the arms and lateral thighs may indicate deficiency of: ``` A. Iron B. Vitamin A C. Vitamin D D. Protein E. Vitamin C ```

B. Vitamin A

Hyperpigmentation in creases of hands may indicate deficiency of: ``` A. Vitamin A B. Niacin C. Folate D. Vitamin B12 E. Iron ```

D. Vitamin B12

PE findings reveal shiny, glossy-appearing tongue with loss of normal architecture (papillae). What is the most likely deficiency? ``` A. Riboflavin B. Niacin C. Iron D. Folate E. All of the above ```

E. All of the above [glossitis on its own is not diagnostic, as deficiency in many things including B vitamins and iron can cause it]

Pt presents with hyperpigmentation with thickened irregular skin pattern around the feet and ankles that appears irritated. What is the most likely deficiency? ``` A. Vitamin A B. Niacin C. Folate D. Vitamin C E. Protein ```

B. Niacin

Petechiae, purpura, and bruising may indicate a deficiency in which of the following? ``` A. Vitamin K B. Vitamin A C. Vitamin C D. Iron E. B12 ```

C. Vitamin C

Spoon nail deformity indicates what possible nutritional deficiency?

Iron deficiency

Glossitis and angular cheilitis indicate which of the following deficiencies? ``` A. Riboflavin B. Pyridoxine C. Niacin D. Iron E. All of the above ```

E. All of the above

Resources for pt education regarding diet and nutrition

AAFP: Familydoctor.org AHA: Heart.org ADA: Diabetes.org Academy of Nutrition and Dietetics: Eatright.org Cdc.gov — division of nutrition, physical activity, and obesity Office of disease prevention and health promotion: health.gov/dietaryguidlines Health and human services: www.choosemyplate.gov/dietaryguidelines Pediatrics: healthychildren.org/healthyliving/nutrition

3 options for hospital diet and what diagnoses may require them

Regular/general — healthy person, no restrictions Low salt (1, 2, or 3 g sodium) — CV disease: CHF, HTN, angina [note: potassium salt substitution often given, so monitor for hyperkalemia] Consistent carbohydrate diet — diabetes type 1 or 2

There are 3 components of total energy expenditure: basal energy expenditure (55-65% of total calories), thermal effect of feeding (10% of calories), and activity energy expenditure (25-33%). What are the caloric needs in sedentary hospitalized pts?

In a sedentary hospitalized pt, 30-35 kcal/kg of body weight will maintain weight. However, acutely or severely ill pts (trauma, burn, etc.) may require 35-40 kcal/kg

Risk factors that contribute to malnutrition and obesity

Minority populations — especially African American and Mexican-American Lifestyle factors Neuroendocrine conditions Specific populations: older persons who live alone, chronically ill pts, adolescents who eat and diet erratically, cancer pts undergoing chemotherapy, drug interactions, alcoholics, homelessness, low SES

Define obesity based on BMI and waist circumference

BMI of 30+ is obese (25-29 is overweight) Waist circumference >40 in men and >35 in women [circumference is measured at uppermost lateral border of iliac crest during normal (minimal) respiration]

Older adults should be screened for nutritional status using acronym DETERMINE — what does it stand for?

Disease — any disease that makes it hard to cook, eat, or shop Eating poorly — too much, too little, too much alcohol, excess salt, eating spoiled food Tooth loss or mouth pain — bad dentures, lost teeth, caries Economic hardship Reduced social contact Multiple medications Involuntary weight loss Need for assistance with self care Elderly years: >80 y/o = elderly

Nutrients affected by tetracyclines

Calcium Magnesium Iron Vitamin B12

Nutrients affected by neomycin, kanamycin

Fat-soluble vitamins | B12

Nutrients affected by sulfasalazine

Folate

Nutrients affected by anticonvulsants: phenobarbital, phenytoin

Calcium Vitamin D Folate Niacin

Nutrients affected by hypolipidemics: cholestyramine, colestipol

Fat and fat-soluble vitamins

Nutrients affected by cytotoxic agents: methotrexate

Folate

Nutrients affected by laxatives like mineral oil

Water Electrolytes Fat Fat-soluble vitamins

Nutrients affected by antituberculotics: isoniazid

Pyridoxine (B6) | Niacin (B3)

Nutrients affected by warfarin

Vitamin K

Nutrients affected by diuretics: thiazides, furosemide

Potassium Magnesium Calcium Zinc

Nutrients affected by lithium, amiodarone

Iodine

How to assess the importance of weight loss

Unintentional weight loss of 5% over 6 months or 10% over one year is considered significant %weight change = [(usual weight - current weight)/usual weight] x100 Interview questions should be directed to common areas leading to weight loss: decreased caloric intake, malabsorption, impaired metabolism, increased losses or excretion

Approximately ____ of body fat is subcutaneous. Subcutaneous fat can be assessed using ___________ thickness

50%; tricep skinfold

Deficiencies related to the following skin changes: Dry and scaly, cellophane appearance

Protein

Deficiencies related to the following skin changes: Flaking dermatitis

Zinc

Deficiencies related to the following skin changes: Pallor

Iron Vit B12 Folate

Deficiencies related to the following eye changes: Night blindness, xerosis, keratomalacia, bitot spots

Vitamin A

Deficiencies related to the following eye changes: Conjunctiva pallor

Iron B12 Folate

Deficiencies related to the following mouth changes: Angular stomatitis and cheilosis

Riboflavin Pyridoxine Niacin

Deficiencies related to the following mouth changes: Glossitis

``` Riboflavin Niacin B vitamins Iron Folate ```

Deficiencies related to the following mouth changes: Bleeding gums

Vitamin C | Riboflavin

Deficiencies related to the following muscle changes: tetany

Calcium | Magnesium

Deficiencies related to the following neck changes: Parotid enlargement

Protein

Deficiencies related to the following changes: Corkscrew hairs

Vitamin C

PE maneuvers to assess nutritional status

Appearance: muscle mass, hair texture, nail health, skin texture Muscle strength: grip strength, ambulation/gait, lower extremity strength against resistance, etc

______ <3.5 g/dL is considered to indicate a mild systemic inflammatory response while a value <2.4 g/dL represents severe systemic inflammatory response producing anorexia and increased protein catabolism

Albumin

How are CBC, TSH, and total protein, albumin helpful in determining potential nutritional deficiencies?

CBC — iron, B12, folate TSH — iodine Total protein, albumin — protein calorie malnutrition

The nutrition facts label is based on a _____ calorie per day diet

2000 (may also see 2500)

Less than _____ of your daily calories should be from fat You should try to eat less than ____ cholesterol per day

1/3 300

Recommended fiber daily

20-35 g

If the % DV of saturated fat for 1 serving is ____ or more, the food is considered high fat

25%

Low calorie

40 calories or less per serving

Sugar free

Less than 0.5 g sugar per serving

What does fortified mean

Food provides at least 10% of daily requirement for nutrient the food is fortified with (i.e., iron, calcium, etc.)

“High” or “rich” on food label means ...

Food contains at least 20% the daily value for specific nutrient

Gluten-free means ...

Product contains less than 20 ppm gluten