Nutritional Disorders Flashcards
1
Q
where does the body get its energy source from?
A
- Carbohydrate
- Indigestible carbohydrate (fiber)
- Nitrogen
- Water
2
Q
RDA (Recommended Dietary Allowances) is the most recognizable what?
A
Most recognizable way nutritional requirements have been expressed in past
-Initially designed to meet the nutritional needs of healthy individuals
3
Q
RDAs (Recommended Dietary Allowances) initially designed to meet what?
A
the nutritional needs of healthy individuals
4
Q
what has replaced RDAs (Recommended Dietary Allowances)?
A
DRI’s (Dietary Reference Intakes)
5
Q
what do the DRI’s do?
A
Broader approach to defining nutritional adequacy
Attempt to include nutritional information as it relates to long term health and reduction of chronic disease
6
Q
what does energy support?
A
normal functions and activity, growth and repair of damaged tissues
7
Q
how is energy provided to the body?
A
by the oxidation of dietary protein, fat, carbohydrate and alcohol
8
Q
what are the 3 factors of energy expenditure?
A
- Basal energy expenditure (BEE)
- Thermic effect of food (TEF)
- Physical activity
9
Q
what is Basal energy expenditure (BEE)?
A
amount of energy required to maintain basic physiologic functions
10
Q
how is the Basal energy expenditure (BEE) measured?
A
in a warm room, not having eaten for 12 hours
11
Q
what equation can you use to estimate Basal energy expenditure (BEE)?
A
Harris-Benedict equation
12
Q
what is thermic effect of food (TEF)?
A
amount of energy expended during and following the ingestion of food
-averages approx. 10% of the BEE
13
Q
what is protein required for?
A
growth and maintenance of body structure and function
14
Q
what is the RDA (Recommended Dietary Allowances) for protein? (in men and women)
A
56g/day for men
45g/day for women
15
Q
how many carbs does an American diet contain?
A
approx 45% carbs
16
Q
what are dietary carbs?
A
- Simple sugars
- Complex carbohydrates (starches)
- Indigestible carbohydrates (dietary fiber)
17
Q
what is the most concentrated course of food energy?
A
fat
18
Q
Average American diet contains how much fat and recommendations to limit it to what?
A
Average American diet contains 35-40% of calories as fat
Current recommendations are to limit this to 20-35%
19
Q
what is fat primarily composed of?
A
fatty acids and dietary cholesterol
20
Q
cholesterol is the major constitute of what?
A
cell membranes
21
Q
cholesterol is synthesized by what?
A
the body - not essential nutrient
22
Q
the assessment of nutritional status is important to what patient populations?
A
patient populations who are at risk for nutritional deficiencies
- Elderly
- Adolescent
- Pregnant or lactating women
- Low socioeconomic status
23
Q
what historical information must be obtained when trying to identify high risk patients who are at risk for nutritional deficiencies?
A
- Regularity and availability of meals
- Grocery shopping and food preparation
- Changes in appetite
- Weight loss or gain
- Food allergies
- Use of drugs, alcohol, medications
- Presence of co-morbidities affecting nutritional needs
24
Q
physical examination when assessing nutritional status?
A
- Body weight
- Muscle wasting
- Fat stores
- Volume status
- Signs of nutritional deficiency
25
what is BMI?
body weight in relation to height
26
what is more of a reliable predictor of nutritional status over BMI?
a recent unintentional change in body weight reported by a patient
27
what does protein-energy malnutrition result from?
from relative or absolute deficiency of energy or protein
28
what are the 2 syndromes of protein-energy malnutrition?
Kwashiorkor
Marasmus
29
what is Kwashiorkor?
Syndrome of protein-energy malnutrition
-deficiency of protein in presence of adequate energy (sufficient caloric intake, insufficient protein deficiency)
30
Kwashiorkor is sufficient in what and insufficient in what?
sufficient caloric intake, insufficient protein consumption
31
what is Marasmus?
Syndrome of protein-energy malnutrition
combined protein and energy deficiency (severe malnutrition, emaciated appearance)
32
Marasmus is severe what?
severe malnutrition (combined protein and energy deficiency)
33
what type of appearance do Marasmus pts have?
emaciated appearance
34
where does primary protein-energy malnutrition pose a health problem?
in developing nations
35
in developing nations, in what areas does Kwashiorkor occur?
in areas where foods containing protein are insufficient
- occurs in areas of famine or poor food supply
- occurs in developing countries in children after women stop breast feeding
36
in who does Kwashiorkor occur in, in developing countries?
children after women stop breast feeding
37
in developing nations, where is Marasmus seen?
where adequate quantities of food are not available
38
protein-energy malnutrition is often what in industrialized societies?
secondary to other disease
39
in industrialized societies, Kwashiorkor-like deficiency syndrome occurs in?
associated with illnesses where the body is in a hypermetabolic state (ex: trauma, sepsis, burns)
40
in industrialized societies, Marasmus-like deficiency syndromes result from what?
chronic disease like heart failure, cancer, COPD, AIDS
41
what organ system doe protein-energy malnutrition affect?
every organ system
42
how much loss of body weight d/t protein-energy malnutrition results in death?
losses of 35-40% of body weight usually results in death
43
how much loss of protein can be tolerated without compromise?
5-10%
44
protein losses begin with what and progress to what?
begin with skeletal muscle and progress to internal organs (liver, GIT, kidneys, heart)
45
when does organ dysfunction develop in protein-energy malnutrition?
with progressive muscle loss
46
what liver dysfunction occurs from protein malnutrition?
hepatic synthesis slows, circulating proteins decrease
47
what heart dysfunction occurs from protein malnutrition?
decreased cardiac output and contractility
48
what respiratory dysfunction occurs from protein malnutrition?
functionality is affected by weakness and muscle atrophy reducing lung volumes
49
what GIT dysfunction occurs from protein malnutrition?
malabsorption occurs with loss of mucosal definition and loss of vili
50
what immune dysfunction occurs from protein malnutrition?
T lymphocytes decrease and B cell function is depressed resulting in infections and impaired wound healing
51
what are the clinical findings of protein-energy malnutrition?
progressive muscle wasting in setting of early weight loss to severe cachexia
-TEMPORAL MUSCLE WASTING
52
progressive muscle wasting in protein-energy malnutrition is typically in what patients?
patients with marasmus-like secondary protein-energy malnutrition
53
who should you call ASAP if pt has protein malnutrition?
nutrition colleagues - call ASAP for protein malnutrition
54
protein malnutrition should be followed by what?
daily by nutrition consultant
55
CHECK THIS CARD-nutrition consultants do what for protein malnutrition?
- Help manage dietary requirements
- Correct electrolyte abnormalities
- Replace vitamins and minerals
- Supplements with enteral or parenteral nutrition
56
obesity definition
excess adipose tissue
57
obesity a direct result of what and in what setting?
excess caloric ingestion in setting of sedentary lifestyle
58
for obese pts, what hx should you obtain when evaluating them?
- Recent weight changes
- Occupation
- Eating behaviors
- Exercise
- Smoking and alcohol consumption
- Medications: OTC, herbal, prescribed, supplemental
59
do many obese pts have an identifiable secondary cause? if concerned, refer to who?
NO!!!
Very small population of patients will have an identifiable secondary cause such as hypothyroidism or Cushing’s syndrome
-if concerned, refer to endocrinologist
60
what is essential to tx of obesity?
close follow-up
61
where do you refer obese motivated pts to?
active tx programs
62
tx programs for obesity emphasize what?
maintenance of weight loss
63
through what do tx programs for obesity emphasize maintenance of weight loss?
- Dietary instruction and education
- Behavior modification
- Exercise
- Medications
- Bariatric surgery
64
anorexia nervosa definition
disturbance in body image and intense fear of weight gain
65
anorexia nervosa is most common in who?
females
66
some anorexia nervosa pts may exhibit features of disease without having what?
severe weight loss
67
important clinical findings of anorexia nervosa
- Weight loss leading to body weight 15% below expected
| - In female patients, amenorrhea is almost always present
68
in female anorexic pts, what is almost always present?
amenorrhea
69
other clinical s/sx's of anorexia nervosa
- Constipation
- Cold intolerance
- Bradycardia
- Hypotension
- Loss of body fat
- Dry and scaly skin
70
dx of anorexia nervosa
Behavioral features such as distorted body image, fear of weight gain and refusal to maintain normal body weight in setting of weight loss to a body weight 15% below expected
in female, absence of at least 3 menstrual cycles
71
what is the goal of tx for anorexia nervosa?
restoration of normal body weight and elimination of psychological features
72
inpatient tx programs for anorexia nervosa may be necessary in what cases of anorexia?
in severe cases for management of volume status and electrolytes
73
does psychotherapy and meds show evidence of improvement for anorexia nervosa?
NO!!!
74
what is essential in tx of anorexia nervosa?
referral to psychiatrist is essential
75
what is bulimia nervosa?
Episodic, uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to avoid weight gain
76
how do bulimia pts avoid weight gain?
- Self-induced vomiting
- Diuretics
- Cathartics
- Strict dieting
- Vigorous exercise
77
bulimia is common in who?
young, white females in middle and upper class
78
is bulimia obvious to the clinician?
NO! less obvious than anorexia
79
are bulimia pts usually within in normal body weight?
Body weight fluctuations but generally within 20% of normal body weight
80
what issues do bulimia pts commonly describe?
family and psychological issues
81
what type of behavior may be present in bulimia pts?
Impulsive or antisocial behavior
82
what is preserved in bulimia that isn't preserved in anorexia?
menstruation
83
what bulimia complications can occur after binges?
Gastric dilatation, pancreatitis
84
what bulimia complications can occur secondary to vomiting?
poor dentition, esophagitis
85
what bulimia complications can occur secondary to diuretics and cathartics?
Electrolyte abnormalities, dehydration secondary
86
bulimia nervosa tx's
Supportive care to include psychotherapy
Antidepressants may be helpful
All patients should be referred to psychiatrist
87
what is worse in bulimia than with anorexia?
long-term psychiatric prognosis
88
are pts usually deficient in one or multiple vitamins?
multiple vitamines
89
do vitamin deficiencies usually exhibit noticeable exam findings?
not until later in the course of the syndrome
90
what is the most common cause of anemia worldwide?
iron deficiency
91
what is a reliable indicator of iron deficiency?
Serum ferritin value < 12 ng/mL without anemia or < 30 ng/mL with anemia
92
iron deficiency developing stages
1. Depletion or iron stores without anemia
2. Anemia with a normal red blood size (MCV)
3. Anemia with low MCV, low reticulocyte count
93
iron deficiency signs and sx's
Fatigue, Tachycardia, Palpitations, Dyspnea on exertion
ALL ARE ANEMIA SX'S
94
severe iron deficiency signs and sx's
- Smooth tongue
- Brittle nails
- Spooning of nails
- Cheilosis
95
what do many iron deficient pts develop?
pica
96
tx for iron deficiency?
First identify cause b/c often d/t blood loss
Treat with PO iron (Ferrous sulfate and continue for 3-6 months after restoration of normal labs)
-use parenteral iron if indicated
97
when is parenteral iron tx indicated for iron deficiency?
- Refractory to PO iron
- GI disease
- Hemodialysis
98
what is thiamine deficiency due to?
chronic alcoholism
99
early sx's of thiamine deficiency
- Anorexia
- Muscle cramps
- Paresthesias
- Irritability
100
late sx's of thiamine deficiency
- Cardiovascular dysfunction – wet beriberi
| - Neurological dysfunction – dry beriberi
101
what is wet beriberi?
cardiovascular dysfunction in thiamine deficiency (late sx)
- Marked peripheral vasodilation caused high output heart failure
- Dyspnea, tachycardia, cardiomegaly, edema
102
what is dry beriberi?
neurological dysfunction in thiamine deficiency (late sx)
Peripheral nerve involvement causing motor and sensory neuropathy, paresthesias and loss of reflexes
103
what is Wernicke – Korsakoff Syndrome?
develops from severe acute thiamine deficiency
dry beriberi
CNS involvement causing encephalopathy, amnesia, and confabulation
104
tx of thiamine deficiency?
replace thiamine, initially IV followed by PO
105
what must you have to absorb vitamin B12?
intrinsic factor
106
what is pernicious anemia?
autoimmune disease where there are autoantibodies against gastric parietal cells that produce intrinsic factor
-no intrinsic factor, no B12 absorption -> B12 deficiency
107
what surgery can cause vitamin B12 deficiency? what does it eliminate?
gastrectomy (abd surgery)
-eliminates site of intrinsic factor production
-surgical resection of ileum eliminates site of B12-intrinsic factor complex
108
B12 deficiency causes what kind of anemia?
moderate-severe anemia of slow onset
has elevated MCV (MCV >100)
109
pts can have what manifestations of B12 deficiency despite having what?
patients can have non-hematologic manifestations of this deficiency despite having a normal CBC
110
sx's of B12 deficiency
Complex neurologic syndrome
- Paresthesias
- Balance difficulty
- Cerebral dysfunction: dementia
111
what is a normal B12 level?
>210 pg/mL
112
Vitamin B12 deficiency anemia and folic acid anemia peripheral smear
megaloblastic and hypersegmented neutrophils
113
tx for B12 deficiency
with parenteral therapy
- IM or subcutaneous injections of 100mcg
- Daily for first week
- Weekly for first month
- Monthly for life
114
folic acid deficiency due to?
lack of dietary intake
115
when do requirements for folic acid increase?
during pregnancy
116
signs and sx's of folic acid deficiency
- GI symptoms
- Swollen, painful tongue
- Neurologic symptoms such as cognitive impairment, dementia, depression
117
what type of anemia is seen in folic acid deficiency?
Megaloblastic anemia is again seen
| -identical in appearance to vitamin B12 deficiency
118
tx of folic acid deficiency
folic acid 1mg PO daily
119
what should you always measure during folic acid deficiency evaluation?
vitamin B12
120
supplementation with large doses of folic acid can improve what but allow what to progress?
Critical to recognize that supplementation with large doses of folic acid can improve anemia seen with vitamin B12 deficiency but allow the neurologic damage to progress
121
where is vitamin D synthesized?
in skin during exposure to UV-B light
122
vitamin D gets converted into what hormone?
1,25 dihydroxyvitamin D
123
what does 1,25 dihydroxyvitamin D do?
increases absorption of dietary calcium in addition to stimulating osteoclasts which release calcium from bone
124
vitamin D deficiency causes what?
decreased bone density from defective mineralization
125
vitamin D deficiency is the most common cause of what?
osteomalacia
126
vitamin D deficiency arises from what?
insufficient sun exposure, malnutrition, or malabsorption
127
what levels may you check with vitamin D deficiency and when do you check it?
calcium levels and check if pt is malnourished
128
vitamin D deficiency tx?
Ergocalciferol (D2) 50,000 units 1x weekly x8 weeks
Cholecalciferol (D3) 2,000 units daily
