Obesity and Nutrition

Question 1

How do you assess nutritional status? (4)

Answer 1

Intake: diet recall, calorie counts
Digestion
Absorption
Storage/use: Subjective Global Assessment, serum markers (pre-albumin, albumin, transferrin)

Question 2

How much weight loss is clinically significant?

Answer 2

5-10% body weight loss

Question 3

What are things you look for in SGA nutritional assessment?

Answer 3

History: weight loss, GI symptoms, metabolic stressors, nutrient intake
Physical exams: height, weight, fat/muscle wasting, hair skin nails, oral cavity, edema

Question 4

What is ideal body weight?

Answer 4

Men: 5’=106 lbs then +6lbs for each additional inch
Women: 5’=100 lbs then +5lbs for each additional inch

Question 5

What is the difference between marasmus and Kwashiorkor?

Answer 5

Marasmus: undernutrition with fat and muscle wasting, but preservation of visceral/serum proteins
Kwashiorkor: fat and muscle wasting with low visceral and serum protein (relative protein deficiency) results in ascites and edema

Question 6

What is the difference between maldigestion and malabsorption

Answer 6

Maldigestion: impaired luminal processing of ingested nutrients

Malabsorption: impaired ability of enteric mucosa to absorb ingested nutrients

Question 7

Where are most nutrients absorbed? What is a notable exception?

Answer 7

Most nutrients are absorbed in duodenum/jejunum; however, B12 is principally absorbed in the terminal ileum

Question 8

Describe the process of carbohydrate and lipid digestion and absorption

Answer 8

Just do it

Question 9

Describe B12 Digestion/Absorption

Answer 9

R proteins from saliva liberate B12 from food in stomach with help from acidic environment

In small bowel, intrinsic factor (from enterocytes) binds B12 in context of basic environment and liberates B12 from R-proteins
In terminal ileum, B12 absorption happens and it goes throughout circulation bound to transcobalamin

Question 10

What are GI states that affect B12 status? (3)

Answer 10

Acid hyposecretion (i.e achlorydria): failed liberation from food
Pancreatic insufficiency (chronic pancreatitis): failed liberation from R protein 
Crohn's disease: inflammation/impaired mucosa of terminal ileum==>failed absorption

Question 11

What are GI diseases that affect iron status? (2)

Answer 11

Acid hyposecretion (i.e due to PPI use): Impaired nonheme iron absorption==>cannot convert ferric to ferrous iron

IBD (CD) and Celiac disease: inflammatory process leads to sloughing of enterocytes==>failed absorption, loss of ferritin

Question 12

What are GI diseases that affect calcium status? (2)

Answer 12

Lactose intolerance: decreased absorption/intake

Small bowel mucosal disease (i.e celiacs and crohns): sloughing of enterocytes disrupt surface area

Question 13

Zn deficiency presentation: (6)

Answer 13

Anorexia, dysguesia, rash, alopecia, diarrhea, nail dystrophic changes

Question 14

Vitamin C deficiency presentation (5)

Answer 14

Poor wound healing
Perifollicular hemorrhage, Gingivitis
Anemia
Joint pain

Question 15

Describe some sources of maldigestion:
Gastric (3)
Hepaticopancretaticobiliary (3)
Small bowel (2)
Iatrogenic (2)

Answer 15

Gastric: achlorhydia, delayed gastric emptying, ZE syndrome
HPB: pancreatic insufficiency, bile salt depletion, cholestatic liver disease
Small bowel: SIBO, chronic intestinal pseudo-obstruction
Iatrogenic: meds, bariatric surery

Question 16

What is therapy of gastroparesis? (2)

Answer 16

Maintain hydration

Diet: small frequent low fat/protein diets

Question 17

What are causes of SIBO? (3)

Answer 17

Loss of ileocecal valves
impaired motility
Excessive abx use

Question 18

What is therapy for SIBO? (2)

Answer 18

Low FODMAP diet

Pancreatic enzyme supplementation

Question 19

Lactose deficiency: What are primary (1) and secondary (2) causes?

Answer 19

Primary: congenital non-persistence of lactase enzyme

Secondary: loss due to celiac disease or giardiasis

Question 20

What is primary intestinal lymphangiectasia?

What diseases is it associated with? (5)

Answer 20

Dilated intestinal lacteals lead to lymph leakage into small bowel lumen and PLE

von Recklinghausen, Turner, Noonan, Klippel-Trenaunay, Hennekam

Question 21

What is the hallmark of primary intestinal lymphangiectasia?

What are other symptoms? (list)

Answer 21

Extremity edema is hallmark

fatigue, abdominal pain, wait loss/inability to gain weight, diarrhea, fat-soluble vitamin deficiencies, lymphopenia, hypoalbuminemia, hypogammaglobulinemia

Question 22

What is Whipple’s disease?

Describe presentation (4) and treatment

Answer 22

Rare disease caused by
tropheryma whipplei

Px: weight loss, diarrhea, joint pain and/or arthritis

Rx: Prolonged abx

Question 23

What is the histology for Whipple’s disease?

Answer 23

Distended macrophages in lamina propria with PAS+ granules

Question 24

What are symptoms of celiac disease? (4)

Describe some of the signs (3)

Answer 24

Symptoms: diarrhea, weight loss, abdominal pain, bloating

Signs: anemia, deficiencies in electrolytes/vitamin/minterals, underweight or stunting in children

Question 25

What is therapy for celiac disease?

Answer 25

Gluten free diet

Question 26

What is definition for short bowel syndrome?

Answer 26

50cm small bowel with colon or 150cm without colon

Question 27

What is treatment strategy for short bowel syndrome?

Answer 27

ORT: water + carbs/salts

GLP2 analog promising