nutritional status, nutritional screening and assessment Flashcards
what is malnutrition?
a deficiency, excess or imbalance of a wide range of nutrients, resulting in a measurable adverse effect on body composition, function and clinical outcome.
what is nutritional status?
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
what is undernutrition?
- 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
who makes up the higher risk group for malnutrition?
- elderly (due to natural ageing processes)
- those with chronic diseases
- patients with prolonged bed rest
- people living in institutional care
what is the prevalence of malnutrition in hospital patients in high-income vs low-income countries?
high-income = up to 50% hospital patients are undernourished
low-income = up to 70% hospital patients are undernourished
what negative outcomes for patients are associated with malnutrition?
- higher infection and complication rates
- increased muscle loss
- impaired wound healing
- longer length of hospital stay
- increased morbidity and mortality
what are the 4 causes of malnutrition?
- 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)
what does malnutrition affect?
- muscle function and muscle mass
- GI function
- immunity and wound healing
- endocrine function
- bone structure
- psychological
- micro biome
when energy intake decreases, what does the body go to first? second?
- stores of glucose in the form of glycogen in the liver — these stores are very limited
- 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
how can malnutrition lead to severe diarrhoea?
impaired absorption, exocrine function, permeability, enzyme production — decreased ability to retain water and electrolytes in colon — severe diarrhoea
how can endocrine function affect bone structure?
decrease in key hormones — inc oestrogen — oestrogen needed for incorporation of calcium into bones — weakening of bone structure
what is the main indicator of malnutrition?
unintentional weight loss of 5-10% or more
what does a decrease in energy and nutrients lead to?
decrease in fat mass and fat free mass
what is cachexia?
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)
what is sarcopenia?
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
what is sarcopenic obesity?
a medical condition which is defined as the presence of btoh sarcopenia and obesity
significantly low FFM but still high FM
FFM loss in cachexia vs sarcopenia
FFM loss is gradual in sarcopenia, but fast and significant in cachexia
what inflammatory factors cause a deceased in FM and FFM?
IL6, TNFa, IGF-1, IFN-y
cachexia <—> sarcopenia ?!
cachexic people often become sarcopenic , less likely to be sarcopenic then become cachexic (but it can happen)
what is seen in pre-sarcopenia exam?
low muscle mass with normal muscle strength and normal physical performances
what is seen in severe sarcopenia exam?
low muscle mass with low muscle strength and poor physical performances
what is required to be diagnosed as cachexic?
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)
name some of the positive impacts nutritional interventions administered preoperatively have had on postoperative complications
- decreasing infections
- preventing loss of muscle
- reducing total weight loss
- reducing postoperative complications
- reduce hospital stay
- decrease mortality
nutritional screening vs nutritional assessment
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
what is nutritional screening : SGA?
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)
nutritional screening : MUST
= malnutrition universal screening tool
- establishes need for nutritional support based on nutritional status
- used in different settings
- quick, easy, doesnt require specific training
what is nutritional screening : NRS 2002
= 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
what is beriberi?
a disease caused by a vitamin B1 deficiency, also known as thiamine deficiency
- 2 forms = wet and dry
wet vs dry beriberi symptoms
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
In extreme cases, what is beriberi associated with?
Wernicke-Korsakoff syndrome
what are 2 forms of brain damage associated with thiamine deficiency?
Wernicke encephalopathy and Korsakoff syndrome
what regions of the brain does Wernicke’s encephalopathy damage? symptoms?
thalamus and hypothalamus
- confusion
- memory loss
- loss of muscle coordination
- visual problems such as rapid eye movements and double vision
what type of anaemia is folic acid deficiency associated with?
megaloblastic and macrocytic
in what deficiency can you get an atrophic tongue?
folic acid
what kind of anaemia is vitamin B12 deficiency associated with?
megaloblastic and macrocytic
what are some physical signs of vitamin C deficiency?
easy bruising, perifollicualr haemorrahges, ecchymosis (positive Hess test), painful legs (due to subperiosteal haemorrhages), corkscrew hair
signs of vitamin K def?
bleeding and easy bruising (negative Hess test)
vitamin C vs vitamin K Hess test
c = +ve test
k = -ve test
both easy bruising in deficiency
what is a sign of essential FFA def?
dry skin
what is a sign of Fe and protein def?
nails leuconychia
what are 2 signs of vitamin A def?
keratomalacia (drying and clouding of corneas) and xerophagia
what is a sign of vitamin I def?
goitre
what are some signs of Fe and B vitamins?
mouth ulcers, atrophic tongue, angular stomatitis
what are albumin levels like in dehydration?
elevated
when are albumin levels low?
inflammation, infections, trauma, heart failure, oedema ,liver dysfunction, nephrotic syndrome
when are transferrin levels elevated?
renal failure, iron status, acute hepatitis, hypoxia
when are transferrin levels decreased?
inflammation, chronic infections, hemochromatosis (iron overload), nephrotic syndrome, liver dysfunction
anthropometry vs body composition assessment
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
what has worse outcomes to chemo?
sarcopenic obesity
body composition has advantages over anthropometry measures in what population?
cancer population
