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PBL SEM 4 > nutritional status, nutritional screening and assessment > Flashcards

nutritional status, nutritional screening and assessment Flashcards

1
Q

what is malnutrition?

A

a deficiency, excess or imbalance of a wide range of nutrients, resulting in a measurable adverse effect on body composition, function and clinical outcome.

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2
Q

what is nutritional status?

A

intake of a diet sufficient to meet or exceed the need of the individual to keep the body composition and function within the normal range

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3
Q

what is undernutrition?

A
  • insufficient energy and nutrients (lack in energy, protein with an inadequate balance of essential amino acids, vitamins and minerals)
  • inability to meet the requirements of the body to ensure growth, maintenance and specific functions. muscle of the FFM, as well as FM, decreases in size
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4
Q

who makes up the higher risk group for malnutrition?

A
  • elderly (due to natural ageing processes)
  • those with chronic diseases
  • patients with prolonged bed rest
  • people living in institutional care
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5
Q

what is the prevalence of malnutrition in hospital patients in high-income vs low-income countries?

A

high-income = up to 50% hospital patients are undernourished

low-income = up to 70% hospital patients are undernourished

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6
Q

what negative outcomes for patients are associated with malnutrition?

A
  • higher infection and complication rates
  • increased muscle loss
  • impaired wound healing
  • longer length of hospital stay
  • increased morbidity and mortality
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7
Q

what are the 4 causes of malnutrition?

A
  • altered nutrient processing (increased/altered metabolic demands, liver dysfunction)
  • excess losses (vomiting, stomas, surgical drains etc)
  • malabsorption (pathology of stomach, intestine, pancreas and liver)
  • inadequate intake (poor diet/appetite, pain with good, dysphagia, depression, unconsciousness)
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8
Q

what does malnutrition affect?

A
  • muscle function and muscle mass
  • GI function
  • immunity and wound healing
  • endocrine function
  • bone structure
  • psychological
  • micro biome
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9
Q

when energy intake decreases, what does the body go to first? second?

A
  1. stores of glucose in the form of glycogen in the liver — these stores are very limited
  2. then goes to stores of body fat and muscle — get changes of body function with muscle breakdown, not just skeletal muscle, also muscle in heart, lungs etc
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10
Q

how can malnutrition lead to severe diarrhoea?

A

impaired absorption, exocrine function, permeability, enzyme production — decreased ability to retain water and electrolytes in colon — severe diarrhoea

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11
Q

how can endocrine function affect bone structure?

A

decrease in key hormones — inc oestrogen — oestrogen needed for incorporation of calcium into bones — weakening of bone structure

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12
Q

what is the main indicator of malnutrition?

A

unintentional weight loss of 5-10% or more

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13
Q

what does a decrease in energy and nutrients lead to?

A

decrease in fat mass and fat free mass

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14
Q

what is cachexia?

A

a catabolic condition caused by disease-related inflammatory activity and negative nutrient balance due to anorexia and/or a decreased absorption of nutrients. muscle/FFM, as well as FM, decreases in size

(esp FFM dye to protein catabolism)

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15
Q

what is sarcopenia?

A

a multi factorial GERIATRIC syndrome. there is primarily loss of FFM, as well as decline in muscle strength as a result of ageing and physical inactivity, along with the general wear and tear of the normal life course

decreased protein synthesis —> decreased FFM

due to natural ageing processes

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16
Q

what is sarcopenic obesity?

A

a medical condition which is defined as the presence of btoh sarcopenia and obesity

significantly low FFM but still high FM

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17
Q

FFM loss in cachexia vs sarcopenia

A

FFM loss is gradual in sarcopenia, but fast and significant in cachexia

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18
Q

what inflammatory factors cause a deceased in FM and FFM?

A

IL6, TNFa, IGF-1, IFN-y

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19
Q

cachexia <—> sarcopenia ?!

A

cachexic people often become sarcopenic , less likely to be sarcopenic then become cachexic (but it can happen)

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20
Q

what is seen in pre-sarcopenia exam?

A

low muscle mass with normal muscle strength and normal physical performances

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21
Q

what is seen in severe sarcopenia exam?

A

low muscle mass with low muscle strength and poor physical performances

22
Q

what is required to be diagnosed as cachexic?

A

1) weight loss of at least 5% in 12 months or less in the presence of underlining illness

2) 3/5 criteria:
- decreased muscle strength
- fatigue
- anorexia
- low FFM index and/or abnormal biochemistry - increased inflammatory markers (CRP, IL-6)
- anaemia (Hb <12g/dl)
- low serum albumin (<3.2 g/dl)

23
Q

name some of the positive impacts nutritional interventions administered preoperatively have had on postoperative complications

A
  • decreasing infections
  • preventing loss of muscle
  • reducing total weight loss
  • reducing postoperative complications
  • reduce hospital stay
  • decrease mortality
24
Q

nutritional screening vs nutritional assessment

A

nutritional screening:
- general, simple, quick, often performed at first contact with a patient
- detect significant risk of nutritional problems
- can be done by nursing, medical or other staff

nutritional assessment
- specific evaluation, more time consuming
- completed when some serious problems are identified
- can be done by someone with some nutritional expertise — dietitian, specialist nurse, trained clinician

25
Q

what is nutritional screening : SGA?

A

subjective global assessment

  • initially developed for patients with GIT problems to predict clinical outcomes without nutritional intervention
  • not easy performed by untrained person
  • it is subjective and doesn’t involve anthropometric measurements
  • not quite “simple and quick” tool
  • rated A, B or C (A = well nourished, B = moderately (or suspected of being) malnourished, C = severely malnourished)
26
Q

nutritional screening : MUST

A

= malnutrition universal screening tool

  • establishes need for nutritional support based on nutritional status
  • used in different settings
  • quick, easy, doesnt require specific training
27
Q

what is nutritional screening : NRS 2002

A

= nutritional risk screening 2002

  • establishes need for nutrional support based on nutritional status
  • requires specific information that may not always be easily established
  • not as easy
28
Q

what is beriberi?

A

a disease caused by a vitamin B1 deficiency, also known as thiamine deficiency
- 2 forms = wet and dry

29
Q

wet vs dry beriberi symptoms

A

Wet beriberi symptoms include:

shortness of breath during physical activity
waking up short of breath
rapid heart rate
swollen lower legs - OEDEMA

Dry beriberi symptoms include:
decreased muscle function, particularly in both lower legs
tingling or loss of feeling in the feet and hands on both sides
pain
mental confusion
difficulty speaking
vomiting
involuntary eye movement
paralysis
PERIPHERAL NEUROPATHY

30
Q

In extreme cases, what is beriberi associated with?

A

Wernicke-Korsakoff syndrome

31
Q

what are 2 forms of brain damage associated with thiamine deficiency?

A

Wernicke encephalopathy and Korsakoff syndrome

32
Q

what regions of the brain does Wernicke’s encephalopathy damage? symptoms?

A

thalamus and hypothalamus

  • confusion
  • memory loss
  • loss of muscle coordination
  • visual problems such as rapid eye movements and double vision
33
Q

what type of anaemia is folic acid deficiency associated with?

A

megaloblastic and macrocytic

34
Q

in what deficiency can you get an atrophic tongue?

A

folic acid

35
Q

what kind of anaemia is vitamin B12 deficiency associated with?

A

megaloblastic and macrocytic

36
Q

what are some physical signs of vitamin C deficiency?

A

easy bruising, perifollicualr haemorrahges, ecchymosis (positive Hess test), painful legs (due to subperiosteal haemorrhages), corkscrew hair

37
Q

signs of vitamin K def?

A

bleeding and easy bruising (negative Hess test)

38
Q

vitamin C vs vitamin K Hess test

A

c = +ve test
k = -ve test

both easy bruising in deficiency

39
Q

what is a sign of essential FFA def?

A

dry skin

40
Q

what is a sign of Fe and protein def?

A

nails leuconychia

41
Q

what are 2 signs of vitamin A def?

A

keratomalacia (drying and clouding of corneas) and xerophagia

42
Q

what is a sign of vitamin I def?

A

goitre

43
Q

what are some signs of Fe and B vitamins?

A

mouth ulcers, atrophic tongue, angular stomatitis

44
Q

what are albumin levels like in dehydration?

A

elevated

45
Q

when are albumin levels low?

A

inflammation, infections, trauma, heart failure, oedema ,liver dysfunction, nephrotic syndrome

46
Q

when are transferrin levels elevated?

A

renal failure, iron status, acute hepatitis, hypoxia

47
Q

when are transferrin levels decreased?

A

inflammation, chronic infections, hemochromatosis (iron overload), nephrotic syndrome, liver dysfunction

48
Q

anthropometry vs body composition assessment

A

anthropometry — weight and height (BMI), waist and hip circumference, mid-arm muscle circumference (MAMC)
- doesnt differentiate between muslce mass and fat

body composition — bio-impedance analyser (BIA), dual x-ray absorptiometry (DEXA), CT, air displacement plethsmography (ADP)
- basically loads of fancy stuff that is expensive, not always available, adn requires training

49
Q

what has worse outcomes to chemo?

A

sarcopenic obesity

50
Q

body composition has advantages over anthropometry measures in what population?

A

cancer population

PBL SEM 4 (50 decks)

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