PRINCIPLES OF MALNUTRITION

Question 1

MALNUTRITION GROUPS WHICH 2 CONDITIONS?

Answer 1

UNDER AND OVERNUTRITION

Question 2

HOW MANY PEOPLE IN EUROPE ARE AFFECTED BY MALNUTRITION?

Answer 2

33 MILLION

Question 3

HOW MANY PEOPLE IN THE UK ARE AFFECTED BY MALNUTRITION?

Answer 3

3 MILLION

Question 4

ANNUAL COST OF MALNUTRITION IN THE UK?

Answer 4

23.5 BILLION POUNDS

Question 5

WHAT IS ‘STUNTING’?

Answer 5

GROWTH RETARDATION

Question 6

WHAT IS ‘WASTING’ AND WHAT IS THE OTHER NAME FOR IT?

Answer 6

CACHEXIA

SEVERE WEIGHT LOSS WITH MUSCLE WASTING TO MAKE ENRGY

Question 7

WHICH HEALTH PROBLEMS RELATED TO MALNUTRITION CONTRIBUTE TO 45% OF CHILD DEATHS WORLDWIDE?

Answer 7

WASTING, STUNTING, ZINC AND VIT A DEFICIENCIES

Question 8

POSSIBLE CAUSES OF UNDERNUTRITION?

Answer 8

MALABSOPRTION, IMPAIRED METABOLISM, CANCER (CELLS VERY METABOLICALLY ACTIVE, REQUIRE A LOT OF GLUCOSE), INFECTION, LACK OF ACCESS TO FOOD

Question 9

WHICH POPULATION IS AT PARTICULAR RISK OF VIT K DEFICIENCY AND WHY?

Answer 9

ALL NEWBORNS
VIT K DOESN’T CROSS THE PLACENTA PROPERLY SO THE FETUS DOESN’T GET IT FROM THE MOTHER
VIT K SHOULD HOWEVER ALSO BE PRODUCED BY COLON BACTERIA, BUT NEWBORNS CAN HAVE POOR MICROBIOME FOR THE 1ST FEW DAYS OF LIFE

Question 10

VIT K DEFICIENCY CAN LEAD TO WHICH CONDITION, AND HOW IS THE RISK SIGNIFICANTLY REDUCED?

Answer 10

VIT K IS ESSENTIAL FOR COAGULATION FACTOR SO DEFICIENCY CAN LEAD TO THE HEMORRHAGIC DISEASE OF THE NEWBORN
ALL INFANTS SHOULD RECEIVE A VIT K INJECTION AT BIRTH!!!!!

Question 11

BREAST FED CHILDREN CAN BE AT RISK OF DEFICIENCIES OF WHICH VITAMINS AND WHY?

Answer 11

VIT D - BREAST MILK POOR IN VIT D, UNLESS THE MOTHER IS TAKING A SUPPLEMENT
VIT B12 - IF THE MOTHER IS VEGAN

Question 12

WHAT IS PEU; PROTEIN-ENERGY UNDERNUTRITION?

Answer 12

• ENERGY DEFICIT DUE TO THE LACK OF ALL MACRONUTRIENTS AND MANY MICRONUTRIENTS
• CAN BE SUDDEN (STARVATION) OR GRADUAL (DISEASE)
• MULTIPLE ORGAN FUNCTIONS IMPAIRED
• OFTEN ASSOCIATED WITH WASTING SYNDROME: UTILIZATION OF PROTEINS AS SOURCE OF ENERGY THAT LEADS TO THE DESTRUCTION OF MUSCLE MASS
• CONSEQUENCES MORE SEVERE IN CHILDREN THAN ADULTS
• CAN BE PRIMARY OR SECONDARY

Question 13

COMMON PREGNANCY DEFICIENCIES?

Answer 13

FOLATE, IRON, VIT D

Question 14

WHAT IS PICA DISORDER?

Answer 14

DISORDER THAT AFFECTS SOME PREGNANT WOMEN; EATING SUBSTANCES WITHOUT ANY NUTRITIONAL VALUE (EATING NON FOOD ITEMS LIKE CHALK ETC)

Question 15

CHANGES IN OLDER AGE THAT ALTER NUTRITION AND FOOD INTAKE?

Answer 15

• INCREASED LEPTIN AND CCK LEVELS
• SARCOPENIA
• ALTERATION OF SMELL AND TASTE AFFECTS REWARD CENTERS
• DEPRESSION, CHRONIC DISORDERS, DEMENTIA ALL ASSOCIATED WITH POORER NUTRITION

Question 16

WHAT IS THE ‘WASTING SYNDROME’?

Answer 16

UTILIZATION OF PROTEINS AS SOURCE OF ENERGY THAT LEADS TO THE DESTRUCTION OF MUSCLE MASS

Question 17

WHAT ARE THE CHARACTERISTICS OF PRIMARY PEM/PEU?

Answer 17

• MOSTLY AFFECTS CHILDREN AND THE ELDERLY
• CAN RESULT FROM SUDDEN LACK OF NUTRITION BUT ALSO ANOREXIA OR PROLONGED FASTING
• CAN LEAD TO STARVATION REGARDLESS OF IF THERE’S ACCESS TO FOOD
• MOSTLY SEEN IN CHILDREN
• HAS 2 MAJOR FORMS: MARASMUS AND KWASHIORKOR

Question 18

WHAT ARE THE CHARACTERISTICS OF SECONDARY PEM/PEU?

Answer 18

• RESULTS FROM MALABSORPTION OF NUTRIENTS DUE TO DISORDERS OR DRUGS (CANCER, AIDS, GI TRACT DISORDERS, INFECTIONS, ANOREXIA)

Question 19

MARASMUS:

Answer 19

• FORM OF PRIMARY PROTEIN ENERGY UNDERNUTRITION
• WEIGHT LOSS AND DEPLETION OF FAT AND MUSCLE
• LINKED TO FOOD INSECURITY (BUT CAN ALSO ARISE FROM INFECTION, EMOTINAL STRESS, DIARRHEA, VOMITING..)
• GIVES CHILD AN APPEARANCE OF OLD PERSON WITH LOOSE SKIN
• ASSOCIATED WITH SEVER WASTING OF FAT AND PROTEIN
• MOST COMMON FORM OF MALNUTRITION IN CHILDREN
• SYMPTOMS: HYPOGLYCEMIA, HYPOTHERMIA, INFECTION, HF

Question 20

WHAT IS THE MOST COMMON FORM OF MALNUTRITION IN CHILDREN?

Answer 20

MARASMUS

Question 21

KWASHIORKOR:

Answer 21

• FORM OF PRIMARY PROTEIN ENERGY UNDERNUTRITION
• RESULTS FROM DISPLACING A CHILD FROM BREAST TOO EARLY AND THEN NOT FEEDING IT EFFICIENTLY (GIVING LOW PROTEIN BUT HIGH CARB FOOD LIKE RICE)
• CHILDREN HAVE A LARGE ABDOMEN ON A TINY BODY
• 6 MONTHS TO 3 Y.O. CHILDREN MAINLY AFFECTED
• ADIPOSE TISSUE PARTIALLY PRESERVED
• OEDEMA, FATTY LIVER
• FLAKY, PAINT-LIKE SKIN!!!

Question 22

WHY IS THE LIVER IN KWASHIORKOR DAMAGED?

Answer 22

FROM LIPID ACCUMMULATION DUE TO EXCESSIVE LIPOGENESIS

Question 23

HOW TO REINTRODUCE PROTEIN IN CHILDREN WITH KWASHIORKOR?

Answer 23

GRADUALLY SO THE LIVER, WHICH IS ALREADY DAMAGED, ISN’T OVERWHELMED WHICH MEANS IT CAN BE DIFFICULT TO PERFORM THE UREA CYCLE

Question 24

HOW ARE NUTRIENTS STORED IN THE FED STATE?

Answer 24

GLYCOGEN IN THE LIVER AND LIPIDS IN ADIPOSE TISSUE

Question 25

WHAT IS CONSIDERED SHORT TERM FASTING/STARVATION?

Answer 25

LESS THAN 72HRS

Question 26

METABOLIC STEPS IN FASTING?

Answer 26

1) USE GLUCOSE RESERVES
2) USE GLYCOGEN FROM THE LIVER (GLYCOGEN-GLUCOSE-GLYCOLYSIS-PYRUVATE-ACETYL COA- NADH AND FADH2-ELECTRON TRANSPORTER CHAIN-ATP)
3) USE LIPID STORAGE FROM ADIPOSE TISSUE (LIPIDS BROKEN DOWN INTO GLYCEROL AND FATTY ACIDS)
4) MAKE GLUCOSE FOR BRAIN AND ERYTHROCYTES
5) GLUCEONEOGENESIS IN THE LIVER FROM PYRUVATE, LACTATE, OXALOACETATE, GLYCEROL
6) LIPID STORAGE USE RESULTS IN RELEASE OF FATTY ACIDS WHICH UNDERGO BETA OXIDATION AND PRODUCE ACETYL COA
7) TOO MUCH ACETYL COA MADE, SO IT IS PARTIALLY UNPROCESSED AND CONVERTED TO KETONE BODIES IN THE LIVER
8) BRAIN CAN USE KETONE BODIES TO AN EXTENT
9) WHEN LIPID STORAGE IS EMPTY, BODY BREAKS DOWN PROTEINS AND USES AMINO ACIDS TO MAKE GLUCOSE
10) PRODUCTION OF A LOT OF NH3, BURDEN FOR THE KIDNEYS

Question 27

WHERE DOES GLUCOENEOGENESIS OCCUR?

Answer 27

IN THE LIVER

Question 28

WHERE DOES ACETYL CoA GET CONVERTED TO KETONE BODIES?

Answer 28

THE LIVER

Question 29

WHICH AMINO ACID IS MAINLY USED FOR GLUCOSE PRODUCTION DURING STARVATION?

Answer 29

ALANINE

Question 30

FIRST SIGN OF STARVATION?

Answer 30

TOO HIGH KETONE BODY LEVELS

Question 31

NORMAL LEVELS OF KETONE BODIES?

Answer 31

lower than 0.6mmol/L

Question 32

WHAT IS STARVATION?

Answer 32

STATE OF METABOLIC STRESS; BY INCREASED LIPID OXIDATION THERE IS HUGE PRODUCTION OF FREE RADICALS + INCREASED CORTISOL, GLUCOCORTICOIDS, IMPAIRED MACROPHAGE FUNCTION REDUCTION OF LEPTIN…

Question 33

WHAT HAPPENS TO INSULIN AND GLUCAGON DURING STARVATION?

Answer 33

INSULIN LEVELS GO DOWN AND GLUCAGON LEVELS GO UP

Question 34

WHICH STARVATION ASSOCIATED PROCESSES ARE STIMULATED BY GLUCAGON TO CREATE ALTERNATIVE FUEL FOR THE BRAIN?

Answer 34

KETONE BODY PRODUCTION AND LIPID BREAKDOWN