Obesity and Nutrition Flashcards
How do you assess nutritional status? (4)
Intake: diet recall, calorie counts
Digestion
Absorption
Storage/use: Subjective Global Assessment, serum markers (pre-albumin, albumin, transferrin)
How much weight loss is clinically significant?
5-10% body weight loss
What are things you look for in SGA nutritional assessment?
History: weight loss, GI symptoms, metabolic stressors, nutrient intake
Physical exams: height, weight, fat/muscle wasting, hair skin nails, oral cavity, edema
What is ideal body weight?
Men: 5’=106 lbs then +6lbs for each additional inch
Women: 5’=100 lbs then +5lbs for each additional inch
What is the difference between marasmus and Kwashiorkor?
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
What is the difference between maldigestion and malabsorption
Maldigestion: impaired luminal processing of ingested nutrients
Malabsorption: impaired ability of enteric mucosa to absorb ingested nutrients
Where are most nutrients absorbed? What is a notable exception?
Most nutrients are absorbed in duodenum/jejunum; however, B12 is principally absorbed in the terminal ileum
Describe the process of carbohydrate and lipid digestion and absorption
Just do it
Describe B12 Digestion/Absorption
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
What are GI states that affect B12 status? (3)
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
What are GI diseases that affect iron status? (2)
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
What are GI diseases that affect calcium status? (2)
Lactose intolerance: decreased absorption/intake
Small bowel mucosal disease (i.e celiacs and crohns): sloughing of enterocytes disrupt surface area
Zn deficiency presentation: (6)
Anorexia, dysguesia, rash, alopecia, diarrhea, nail dystrophic changes
Vitamin C deficiency presentation (5)
Poor wound healing
Perifollicular hemorrhage, Gingivitis
Anemia
Joint pain
Describe some sources of maldigestion: Gastric (3) Hepaticopancretaticobiliary (3) Small bowel (2) Iatrogenic (2)
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
What is therapy of gastroparesis? (2)
Maintain hydration
Diet: small frequent low fat/protein diets
What are causes of SIBO? (3)
Loss of ileocecal valves
impaired motility
Excessive abx use
What is therapy for SIBO? (2)
Low FODMAP diet
Pancreatic enzyme supplementation
Lactose deficiency: What are primary (1) and secondary (2) causes?
Primary: congenital non-persistence of lactase enzyme
Secondary: loss due to celiac disease or giardiasis
What is primary intestinal lymphangiectasia?
What diseases is it associated with? (5)
Dilated intestinal lacteals lead to lymph leakage into small bowel lumen and PLE
von Recklinghausen, Turner, Noonan, Klippel-Trenaunay, Hennekam
What is the hallmark of primary intestinal lymphangiectasia?
What are other symptoms? (list)
Extremity edema is hallmark
fatigue, abdominal pain, wait loss/inability to gain weight, diarrhea, fat-soluble vitamin deficiencies, lymphopenia, hypoalbuminemia, hypogammaglobulinemia
What is Whipple’s disease?
Describe presentation (4) and treatment
Rare disease caused by
tropheryma whipplei
Px: weight loss, diarrhea, joint pain and/or arthritis
Rx: Prolonged abx
What is the histology for Whipple’s disease?
Distended macrophages in lamina propria with PAS+ granules
What are symptoms of celiac disease? (4)
Describe some of the signs (3)
Symptoms: diarrhea, weight loss, abdominal pain, bloating
Signs: anemia, deficiencies in electrolytes/vitamin/minterals, underweight or stunting in children
What is therapy for celiac disease?
Gluten free diet
What is definition for short bowel syndrome?
50cm small bowel with colon or 150cm without colon
What is treatment strategy for short bowel syndrome?
ORT: water + carbs/salts
GLP2 analog promising
