Nutritional Assessment Flashcards
What is useful to know for evaluating CVD risks?
BMI and waist circumference
high BMI and high waist circumference = high risk
Which method of assessing body composition is the gold standard? Which is the current gold standard?
Gold standard= hydrodensitometry
Curent-gold standard= magnetic resonance imaging
What are the techniques for measuring body composition (besides anthropometry)
- BIA (bioelectrical impedance)
- DXA (dual energy X-ray absorptiometry)
- BODPOD (aire displacement plethysmography)
- hydrodensitometry
- MRI (magnetic resonance imaging)
What are subclinical nutrient deficiencies?
Nutritional deficiencies before they become severe and show as clinical signs
What is the uniform system of reporting lab values?
SI units
What is the synonym for prealbumin?
transthyretin (TTR)
Which serum protein has the highest rate of turnover?
TTR, Transferrin, RBP, albumin?
RBP
Why is it important to know the half life time of a protein?
has to do when you implement a nutritional therapy , you want to test if treatment is effective
In QC, which serum proteins are used to assess protein status?
Albumin (and prealbumin if asked)
Not transferrin (is for iron)
A patient has high albumin levels, what does this indicate?
dehydration
A patient has low albumin levels, what does this indicate?
malabsorption, low protein intake, over hydration, edema, inflammation, ageing
A patient has high transferrin levels, what does this indicate?
iron deficiency, pregnancy, chronic loss
A patient has low transferrin levels, what does this indicate?
PEM, infection, acute illness, chronic infection
A patient has high TTR (transthyretin) levels, what does this indicate?
renal disease, Hodgkins disease
A patient has low TTR (transthyretin) levels, what does this indicate?
liver disease, PEM, malabsorption, hyperthyroidism, chronic loss
A patient has high RBP levels, what does this indicate?
renal disease
A patient has low RBP levels, what does this indicate?
vitamin a or zinc deficiency, hyperthyroidism, liver disease
What is the normal range for albumin in the blood?
35g/L
True or False:
CRP is a nutritional marker that can interpret other serum proteins
It is not a nutritional marker, but it is useful to interpret other serum proteins
In the nitrogen balance equation, what is factor 4 from?
4g of protein from N excretion via skin and feces
If the NB is +2 what does this mean?
In reality it is a balance (+5 or +6 would be Positive)
Do errors in NB calculations favour a more positive or negative balance?
A more positive balance
What is creatinine excretion proportional to?
skeletal muscle mass
What do cells look like for an iron-deficiency anaemia?
microcytic, hypochromic
What do cells look like for a folate/B12-deficiency anaemia?
macrocyte, megaloblastic
During dehydration, hematocrits is high or low
high
During water overload and hemorrhage, hematocrits is high or low?
low
What do you measure to make sure it is folate deficiency and not B12 deficiency?
- serum folate (low=def)
- rbc folate (low=def)
- B12 should be normal
Which is a better marker of folate: RBC or serum?
RBC
Which deficiency is easier to measure between folate and vitamin B12?
vitamin B12
What is the biomarker of vitamin B12 deficiency?
High methylmalonic acid
What is the biomarker of B12 and folate deficiency?
High homocysteine
Out of the dietary assessment methods, which data is used for diet counselling?
- 24h recall
- Food records
- food frequency questionnaire
- direct observation
Food records
Out of the dietary assessment methods, which data is used for an epidemiological study?
- 24h recall
- Food records
- food frequency questionnaire
- direct observation
food frequency questionnaire
What is the gold standard to measure REE?
Indirect calorimetry
Which REE prediction equation uses the CURRENT weight of the patient?
Mifflin-St-Jeor
What is the rule of thumb to calculate REE?
25-35 kcal/kg body weight for non-obese adults
Serum protein have __ sensitivity and specificity for nutritional status
LOW
Serum proteins are influenced by
They are influenced by : poor protein intake, altered metabolism and synthesis, hydration, inflammation, pregnancy, medications, exercise
which serum protein binds with RBP ?
TTR (transthyretin)
When do you have a + NB?
growth, pregnancy, athletic training, recovery from illness
When do you have a - NB?
starvation, trauma, surgery, poor quality protein intake or inadequate protein intake
When is creatinine excretion high?
exercise, meat intake, menstruation, infection, fever, trauma
When is creatinine excretion low?
renal failure, age
Which assessment looks at the patient’s social, medical and psychological history?
clinical assessment
What is the best way to measure REE? What is the concept? What does it calculate?
- Indirect calorimetry
- measures quantity of oxygen consumed to burn an energy substrate versus carbon dioxide produced by energy related processes
- it calculates heat production
According to WHO/FAO the protein requirements for healthy individuals is:
0.75g/kg body wt/day
Protein requirements vary depending on what?
physiological or disease status and age
What are methods to estimate fluid requirements?
- weight (100ml first 10kg, 50ml second 10kg, 20ml for rest)
- weight and age
- energy (1mL/kcal)
- fluid balance (urine output + 500mL)
What is a fluid?
Anything that is liquid at body temperature (ice cream, soup, jello)
Sodium, albumin, BUN, creatinine, hematocrits and haemoglobin are increased or decreased during dehydration?
increased
1kg of weight loss = __ mL water
470 mL
What should be considered for elderly?
- have a lower REE
- need more vitamin D and calcium (DRI=1200mg)
- need more protein
- need more fluid
The functional assessment is based on?
handgrip strength measured with a dynamometer (it should be >20kg for W and >30kg for M)
What does handgrip strength not tell?
Muscle mass
What is the prevalence of malnutrition?
15-80% range
highest range = in long term care
What is the only validated tool to detect presence of malnutrition and risk of developing it during hospitalisation?
Nutritional Screening Risk (NSR)
