nutritional assessment W4

Question 1

most vulnerable groups for malnutrition?

Answer 1

those with acute and chronic diseases, those recently discharged from hospital, older people, poor or socially isolated people

Question 2

clinical consequences of malnutrition

Answer 2

reduced cardiac output
impaired liver function and fatty change/fibrosis/necrosis
impaired gut integrity and immunity
impaired wound healing
depression and apathy
ventilation - loss of muscle and hypoxic responses
impaired renal function
sarcopenia - loss of muscle strength

Question 3

important features of nutritional screening tools

Answer 3

practical (quick and easy)
universal
reliable
valid and evidence based
linked to a care plan for treatment
acceptable to patients and health care team

Question 4

MUST (malnutrition universal screening tool) features?

Answer 4

BMI - where the patient is now
recent weight loss - where the patient has come from
starvation in presence of acute disease - where the patient is going

Question 5

MUST: BMI scoring?

Answer 5

> 20 (>30 obese) = 0
18.5-20 = 1
<18.5 = 2

Question 6

MUST: weight loss scoring?

Answer 6

unplanned weight loss in past 3-6 months:
<5% = 0
5-10% = 1
>10% = 2

Question 7

MUST: acute disease effect scoring?

Answer 7

if patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days = 2

Question 8

MUST: calculating overall risk of malnutrition

Answer 8

add scores together:
0 = low risk
1 = medium risk
2 or more = high risk

Question 9

minimal/moderate/severe ascites?

Answer 9

minimal = 2.2kg
moderate = 6.0kg
severe = 14.0kg

Question 10

minimal/moderate/severe oedema?

Answer 10

minimal = 1.0kg
moderate = 5.0kg
severe = 10.0kg

Question 11

how to calculate percentage weight loss?

Answer 11

(usual weight - current weight) / usual weight

x100

Question 12

MUST: management guidelines?

Answer 12

adapt to local policy. should include:
-frequency of repeat screening
-recording of dietary intake
-measures to improve dietary intake
-referral for specialist advice

Question 13

nutritional assessment: ABCDE?

Answer 13

anthropometry
biochemical data
clinical presentation
diet history and dietary intake
environmental/social factors

Question 14

anthropometric data?

Answer 14

BMI
waist, mid arm circumference
weight history
body composition
skinfold thickness measurements
handgrip strength
bioelectrical impendence analysis (BIA)
dual energy x-ray absorptiometry (Dexa)

Question 15

4 sites of skinfold thickness measurements?

Answer 15

triceps, biceps, subscapular, supra iliac

Question 16

measuring weight?

Answer 16

light clothing, without shoes
diurnal variation - 2kg within a day
take account of hydration status

Question 17

BMI equation?

Answer 17

weight / height (m^2)

Question 18

BMI ranges?

Answer 18

<20 = underweight
20-25 = desirable weight
25-30 = overweight
>30 = obese

Question 19

factors affecting BMI interpretation

Answer 19

ethnicity
age
body composition

Question 20

in which patients is adiposity a better measure than BMI for? who is it not reliable for? how is it measured?

Answer 20

measured as waist circumference

older people
non-white ethnicity

not reliable in those with ascites, colostomy, ileostomy

Question 21

surrogate height measures?

Answer 21

demi-span
knee height
ulnar length (olecranon and midpoint of styloid process)

Question 22

surrogate weight measures? when are these useful?

Answer 22

mid-upper arm circumference
useful for when weight is distorted by fluid overload

Question 23

how to estimate BMI category from mid upper arm circumference?

Answer 23

bend subjects left arm at a 90 degree angle. measure distance from bony protrusion on the shoulder (acromion) and the point of the elbow (olecranon process). mark the midpoint and measure circumference.

MUAC <23.5cm -> BMI <20
MUAC >32.0cm -> BMI >30

Question 24

accuracy of reported height and weight?

Answer 24

height overestimated by older people, shorter men and heavier women

weight underestimated by heavier people, not affected by age or height

Question 25

triceps skinfold thickness features?

Answer 25

estimate of total body fat
assumes constant relationship between subcutaneous and internal fat but varies with sex, body weight, ethnicity, age

Question 26

MUAMC?

Answer 26

mid upper arm muscle circumference
calculated from MUAC and TSF
used to assess total body muscle mass
can be used to assess PEM (protein energy malnutrition) as is an index of protein reserves

Question 27

handgrip strength features

Answer 27

assesses upper extremity muscle strength
measured by hand grip dynamometer
reflects physical function
affected by motivation, medication
some patients unable to perform technique

Question 28

biochemistry for nutritional assessment?

Answer 28

used to assess body stores
albumin (half life 14-21 days), prealbumin (half life 2 days)

Question 29

how is biochemistry altered/affected?

Answer 29

altered by inadequate intake of nutrients, medications, metabolic changes during illness or stressed state, fluid status

affected by protein deficiency but also renal and hepatic disease, wounds, burns, infections, cancer, inflammation, hydration status, stress

Question 30

nutritional assessment - clinical examination

Answer 30

physical appearance
emancipation (pale skin, hair loss?)
loose clothing, rings, dentures
sunken eyes, dry mouth, fragile skin
oedema (underlying disease)
poor wound healing (impaired immune function)
physical problems affecting eating

Question 31

dietary assessment techniques

Answer 31

food diary
food frequency questionnaire
24-hr recall

Question 32

24-hr recall benefits?

Answer 32

doesn’t rely on patients perception of usual diet
culturally sensitive
doesn’t require literacy
less likely to alter eating behaviour since information is collected afterwards
minimal patient burden

Question 33

environmental/social aspects?

Answer 33

cooking/storage, shopping facilities and ability
family commitments and support
social isolation/loneliness
employment and income
psychological status
alcohol or drug addiction