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Clinical Nutrition 1 > Nutritional Assessment - Iron, Dietary, Clinical, Functional > Flashcards

Nutritional Assessment - Iron, Dietary, Clinical, Functional Flashcards

1
Q

Name the progression of IDA

A
  • Decreased stores
  • Iron transport increases
  • Degradation of iron
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2
Q

Decreased iron stores is reflected in what lab value?

A

Serum ferritin <20 ug/L

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3
Q

Increased iron transport is reflected in what 2 lab values?

A

Transferrin saturation decreases (<30%)

Total Iron Binding Capacity increases (TIBC) (>4.5 mg/L)

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4
Q

Why does TIBC increase?

A

Because transferring saturation decreases, more possibility for iron to bind

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5
Q

How to calculate transferrin saturation?

A

Serum Iron / TIBC x 100

<30% signals a deficit

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6
Q

Free erythrocyte protoporphoryin increase/decrease during IDA?

A

Increase, since iron will leave heme group to join circulation and will be replaced by zinc. Protoporphoryin is the transport protein of zinc

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7
Q

What decreases in the progression of Fe deficiency?

A
  • Iron stores

- Serum ferritin

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8
Q

What remains unchanged in the progression of Fe deficiency?

A
  • RBC iron
  • Transferrin saturation
  • Free erythrocyte protoporphoryin
  • Hemoglobin concentration
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9
Q

What immediately decreases when Fe deficiency progresses into IDA?

A

Hemoglobin concentration

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10
Q

What will start to decrease when Fe deficiency progresses into IDA? What will increase?

A
  • Transferrin saturation decreases
  • TIBC increases
  • Free erythrocyte protoporphoryin increase
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11
Q

What stays constant at a low level when Fe deficiency progresses into IDA?

A

-Serum ferritin

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12
Q

What is the final indicator of IDA?

A

Decreased RBC iron

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13
Q

IDA is usually identified off of what lab result?

A

Hemoglobin concentration <120 g/L for women and <140 g/L for men

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14
Q

Serum iron reflects ___ and is low in the ____ deficient state

A

the iron bound to transferrin, EARLY (transferrin increases, saturation decreases, TIBC increases)

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15
Q

What is indicative of a progressing deficiency state of folate deficiency? Later state?

A
  • Serum folate

- RBC folate

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16
Q

Lab results indicate megablastic and macrocytic RBCs and an increase in methylmalonic acid, this is indicative of what anemia?

A

B12

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17
Q

Lab results indicate megablastic and macrocytic RBCs and an increase in homocysteine, this is indicative of what anemia?

A

Most likely Folate and B12

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18
Q

Folate deficiency can be suspected when RBCs are megoblastic and macrocytic. What lab results would confirm this?

A

-Low serum folate and RBC folate BUT normal B12 levels

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19
Q

What lab value would indicate B12 deficiency but NOT folate if RBCs are megoblastic and macrocytic?

A

High amounts of methylmalonic acid

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20
Q

What lab value may decrease in the progression of deficiency of B12? What would confirm B12 deficient anemia?

A

Low serum B12

Increased Methylmalonic acid

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21
Q

Iron requirements are increased at what stage of life?

A

Pre-menopausal women

Pregnant women

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22
Q

What are excellent sources of iron?

A

> 3.5 mg

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23
Q

What are good sources of iron?

A

> 2.1 mg

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24
Q

What are sources of iron?

A

> 0.7 mg

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25
Q

Give examples of excellent heme sources of iron

A
  • clams
  • oyster
  • liver
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26
Q

Give examples of good heme sources of iron

A
  • cooked beef
  • blood pudding
  • dark turkey
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27
Q

Give examples of heme sources of iron

A
  • chicken, veal, ham, pork
  • fish
  • shrimp
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28
Q

Give examples of excellent non-heme sources of iron

A
  • Cooked legumes
  • Pumpkin seeds
  • Fortified cereals
  • Tofu
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29
Q

Give examples of good non-heme sources of iron

A
  • Canned legumes
  • enriched egg noodles
  • dried apricots
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30
Q

Give examples of non-heme sources of iron

A
  • Nuts
  • Sunflower seeds
  • Breads
  • Cooked oatmeal
  • Wheat germ
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31
Q

Name some risk factors for poor iron status

A
  • Diet low in heme-iron, vitamin C and fortified foods
  • Diet high in tannins & polyphenols found in coffee and tea
  • Diet high in phytates and oxalates, found in beets and spinach
  • Regular aspirin use (GI bleeding)
  • Mennorhagia
  • > 3 annual blood donations
  • > 3 pregnancies
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32
Q

More that ___ risk factor is grounds for investigating IDA

A

1

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33
Q

Iron supplementation is recommended when __

A

IDA diagnosed or pregnancy

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34
Q

What kind and frequency of supplement is recommended?

A

Ferrous Sulfate, 200 mg for 6 months

35
Q

How quickly will the supplement increase hemoglobin?

A

1 g/L per week

36
Q

How should we advise clients taking iron supplements if they are burning/irritating?

A

Best absorbed on empty stomach BUT could drink with OJ, with small snack or with meal

37
Q

What is included in the clinical assessment?

A
  • Patient medical, social and psychological history

- Physical examination for signs of malnutrition

38
Q

Name the 5 things that are included in the patient history? (PP-W-FS)

A
  • Primary/secondary diagnosis
  • Past medical history
  • Weight history
  • Factors affecting/interfering with nutrient intake
  • Social history
39
Q

Name some examples of signs of malnutrition using the top-to-bottom approach

A
  • dry, brittle hair
  • bleeding gums, gingivitis
  • delayed wound healing
  • egg-shell nails
  • muscle wasting
  • distended abdomen
  • edema
  • depression
40
Q

Name the 4 ways to perform dietary assessment

A
  • 24-hour recall
  • Food records
  • Food frequency
  • Direct observation
41
Q

BEE =

42
Q

What is the best measure of REE? What do we use in clinical settings?

A

Indirect calorimetry

We use REE equations in clinical settings

43
Q

What does indirect calorimetry measure?

A

The quantity of O2 consumes and the amount of CO2 which could provide us with information as to what substate is being used. It also measures the heat (energy) dissipated, where we can plug this into an equation that will accurately give us REE

44
Q

What kinds of energy is measured in indirect calorimetry?

A

Energy as heat dissipated which is based on the energy substrates that are being used (glucose, fat, carbohydrates). If we are at rest, the only energy expended will be this heat, which gives us our REE

45
Q

IS RQ same as indirect calorimetry?

A

RQ is measured via indirect calorimetry but is NOT the same as REE. Using IC we can figure out both the substrate utilization AND the REE by plugging in the O2 and CO2 and heat values measured into different equations.

46
Q

Describe when it is appropriate to use Harris-benedict, what height?

A

For non-obese individuals

height in cm

47
Q

When is it appropriate to use Mifflin-St-Jeor? When should IBW be used? what height?

A

-More appropriate for obese individuals WE ALWAYS USE CBW

Height in cm

48
Q

For simple quick, FAO/WHO and HB, what BW is used if BMI between 16-24.9?

49
Q

For simple quick, FAO/WHO and HB, what BW is used if BMI between 25-29.9? 30-35?

A

IBW at BMI of 25

IBW at BMI of 25-28

50
Q

For simple quick, FAO/WHO and HB, what BW is used if BMI between 35-40? above 40?

A

IBW at BMI 25-28

IBW at BMI of 30

51
Q

What is the rationale for using IBW?

A

As BMI increases, adiposity increases and NOT LBM. Therefore, REE shouldn’t increase.
Use in HB, FAO/WHO and SQ

52
Q

Should HB be used for obese? What equations are appropriate for obese and use CBW?

A

NO

IOM and MFSJ are ok for obese, and use CBW

53
Q

In HB, what will increase REE? Decrease?

A

Increases with height and weight

Decreases with age

54
Q

Simple-quick method for low active, overweight or low appetite

A

25 kcal/kg

55
Q

Simple-quick method for usual moderate activity, non-obese

A

30 kcal/kg

56
Q

Simple-quick method for higher active/higher needs

A

35 kcal/kg

57
Q

FAO/WHO method only integrates weights BUT after the age of 6o y/o will also integrate ______

A

HEIGHT in METRES

58
Q

FAO/WHO method will only integrate weight for those aged 18-60 (T/f)

59
Q

What calculation considers TEE? Should stress factor be multiplies?

A

IOM equations

Recommended not to use if SF is requires, may overestimate TEE

60
Q

How can we obtain TEE?

A

Multiply REE equation by PAL and SF (if needed)

61
Q

When is PA used?

A

In IOM equations

62
Q

What is important about IOM equations?

A

There are many different ones for adults, genders and obese. Be sure to select the right one and include the correct PA.

63
Q

In IOM, height is in __

64
Q

What 2 equations require height in cm?

65
Q

What 2 equations require height in m?

A

FAO/WHO

IOM

66
Q

How can we determine fluid requirements?

A

Urine output + 500ml/day = requirement

67
Q

How is fluid requirement calculated?

A

100ml/kg for first 10 kg
50ml/kg for next 10 kg
20 ml/kg for each kg above 20 kg

68
Q

FR for 16-30 y/o

69
Q

FR for 30-55 y/o

70
Q

FR for 55-75 y/o

71
Q

FR for 75+ y/o

72
Q

Energy-based way to measure fluid requirement?

A

1ml/kcal/day

73
Q

When is thirst detected?

A

When water volume decreased by 1-2%, Specific gravity greater than 1.05

74
Q

What lab values reflect dehydration? (NAB-CHH)

A

Increase in:

  • Na
  • Albumin
  • BUN
  • Creatinine
  • Hemoglobin
  • Hematocrit
  • *all increased in over-hydration
75
Q

Why are some elderly mistaken for dementia?

A

They may be dehydrated, as it causes confusion/restlessness

76
Q

In elderly, what contributes to a lower appetite?

A

Decrease lean mass and PA level

77
Q

Elderly + energy?

A

Decrease EI due to LBM and decrease PA, decreases overall appetite

78
Q

Elderly + protein?

A

1.0-1.2 g/kg/day

Recommend high energy/protein dense foods

79
Q

Elderly + fat?

A

Increase essential FA, no low-fat

80
Q

Elderly + Ca?

A

Decrease Ca absorption as pH has increased in stomach. Vit D status also decrease

81
Q

Elderly + fluids?

A

Decreased sense of thirst especially when hospitalized. Requirements are 25ml/kg/day (lower)

82
Q

How is functional assessment administered?

A

Ideal for elderly - hand-grip strength repeated 3x on dominant hand.

83
Q

What is the hand-grip assessment based on?

A

Muscle mass correlates with muscle strength

Clinical Nutrition 1 (30 decks)

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