Nutritional Assessment Flashcards
What is the recommended number of servings of fruits and vegetables/day?
6-9
What is the recommended amount of protein per day?
5.5 oz
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]
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
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)
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]
Current recommendations regarding salt intake
Less than 2300 mg/day
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
4 vitamins and minerals required by law to be listed on food labels
Vitamin A
Vitamin C
Calcium
Iron
What does it mean to be salt/sodium-free?
Less than 5 mg sodium per serving
What does it mean to be very low sodium?
Less than 35 mg sodium per serving
What does it mean to be low sodium?
140 mg sodium or less per serving
What does it mean to be “reduced sodium”?
At least 25% less sodium than the original product
What does it mean to be light in sodium or lightly salted?
At least 50% less sodium than regular product
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
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]
What does it mean to be low fat?
3 g of fat or less per serving
What does it mean to be reduced fat or “less fat”
At least 25% less fat than regular produce
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
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)
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
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
Important lab values to assess for possible nutritional deficiency
CBC (MCV) WBC Albumin total protein TSH
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
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
