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Nutrition > Protein Energy Malnutrition > Flashcards

Protein Energy Malnutrition Flashcards

1
Q

Most nutritional problems around the world are caused by?

A

Eating wrong combinations of food stuffs such as excess refined carbohydrates or a diet low in fresh veg

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2
Q

Undernourishment associated with disease is common in which institutions?

A

Hospitals and care homes

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3
Q

The majority of weight loss leading to malnutrition is caused by?

A

Poor intake secondary to the anorexia associated with the underlying condition

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4
Q

Disease may contribute to malnutrition by causing malabsorption and increased catabolism which is mediated by?

A

Complex changes in cytokines, hormones, drug side-effects and immobility

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5
Q

Which group are at high risk of malnutrition because they often suffer with social isolation and bereavement?

A

Elderly

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6
Q

In the first 24 hours of a low dietary intake, how does the body rely on energy’?

A

The breakdown of hepatic glycogen to glucose

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7
Q

Hepatic glycogen stores are small therefore what is the name of the process that takes place to maintain glucose levels?

A

Gluconeogenesis

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8
Q

What are the main components of gluconeogenesis?

A

Pyruvate, lactate, glycerol and amino acids (especially alanine and glutamine)

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9
Q

The majority of protein breakdown takes place where?

A

In the muscle resulting in atrophy

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10
Q

What is lipolysis?

A

The breakdown of the body’s fat stores

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11
Q

Which hormone inhibits lipolysis?

A

Insulin

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12
Q

Which hormone falls off as starvation continues?

A

Insulin

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13
Q

In starvation stored triglycerides are hydrolysed by which enzyme?

A

Lipase

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14
Q

Lipase enzyme hydrolyses stored triglycerides into what two things?

A

Glycerol used for gluconeogenesis and non esterified fatty acids which can be used directly for fuel or oxidised in the liver to ketone bodies

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15
Q

What adaptive processes take place during starvation to prevent the body’s available protein stored being fully depleted?

A

Decreased metabolic rate and total body energy expenditure, Central nervous metabolism changes from glucose as a substrate to ketone bodies, gluconeogenesis in the liver decreases, protein breakdown in the muscle decreases (both gluconeogenesis and protein breakdown are inhibited by ketone bodies), Most of the energy becomes derived from adipose tissue with some gluconeogenesis from amino acids (particularly alanine in the liver and glutamine in the kidney)

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16
Q

The metabolic response to starvation differs between which groups of people?

A

Lean and obese

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17
Q

One of the main differences in the metabolic response to starvation between obese and lean individuals is?

A

The proportion of energy derived from protein oxidation, which determines the proportion of weight loss from lean tissues

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18
Q

Which group out of lean and obese suffer from a higher proportion of lean tissues following starvation?

A

Lean individuals 3 x more

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19
Q

Which group out of lean and obese individuals have a more rapid deterioration in function and shorter survival time (2months) following starvation?

A

Lean

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20
Q

What happens to the BMR following trauma or shock?

A

Increases

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21
Q

What are 3 key factors that play a role in tissue metabolism?

A

Circulating substrate concentration, blood flow and signals including hormones and cytokines

22
Q

What fuel source serves the brain following prolonged starvation?

A

Ketone bodies

23
Q

Which organ is responsible for the production of ketone bodies?

A

Liver

24
Q

The production of ketone bodies by the liver is dependant on the concentration of?

A

Available free fatty acids derived from adipose tissue

25
Q

What does glucose compete with for metabolism in the muscles and heart?

A

Non-esterified fatty acids

26
Q

The delivery of substrates and other signals to tissues depends on their circulating concentration and?

A

Blood flow

27
Q

Are the ratios of insulin/glucose high or low in the fed state?

A

High - insulin promotes synthesis of glycogen, protein and fat and inhibits lipolysis and gluconeogenesis

28
Q

Are the ratios of insulin/glucose high or low in the fasted state?

A

Low - Glucagon act mainly on the liver and has no action on muscle. Glucagon increases glycogenolysis and gluconeogenesis and increases ketone body production from fatty acids and lipolysis from adipose tissue.

29
Q

What is the name of the monoamine neurotransmitter that has a similar action to glucagon but also affects muscle metabolism?

A

Catecholamine

30
Q

Catecholamines act via cyclic adenosine monophosphate (cAMP) to stimulate which process?

A

Lipolysis producing free fatty acids

31
Q

During weight loss in the absence of disease, the proportion of weight loss from protein metabolism is higher in lean or overweight/obese?

A

Lean

32
Q

During acute disease loss of lean tissue is rapid, which hormones are involved?

A

Corticosteroids, pro-inflammatory cytokines and insulin resistance

33
Q

The metabolic response to trauma, injury and inflammation depends on the balance between?

A

Pro-inflammatory (e.g. tumour necrosis factor (TNF), interleukin-2 (IL-2) and anti-inflammatory cytokines (e.g. IL-10)

34
Q

The production of pro-inflammatory and anti-inflammatory cytokines is influenced by?

A

Polymorphisms (condition occurring in different forms).

35
Q

Cytokines that play a significant role in regulating metabolism are which three?

A

IL-1, IL-6 and TNF

36
Q

In acute disease, IL-1, IL-6 and TNF play a role in?

A

Catabolic processes, glycogenolysis and acute phase protein synthesis

37
Q

TNF inhibits which enzyme?

A

Lipoprotein lipase

38
Q

Which cytokine is one of a number of cachexia (wasting) factors in patients with cancer?

A

TNF

39
Q

If neuropeptide Y hormone secretion is low from the hypothalamus what effect does this have on appetite?

A

Decreased

40
Q

What are the 3 key features that help in the detection of PEM in adults?

A

BMI <18.5kg/m2 , weight loss >10% in last 3-6 months, disease that has resulted in little/no dietary intake in >5days

41
Q

What does MUST stand for?

A

Malnutrition Universal Screening Tool

42
Q

PEM leads to decreased resistance to?

A

Infection

43
Q

In children, what is the key element in the diagnosis of PEM?

A

Growth failure

44
Q

What are the 5 steps of the MUST tool?

A 
Step 1 = BMI score
Step 2 = Weight loss score
Step 3 = Acute disease effect score (intake >5day)
Step 4 = Overall risk of malnutrition
Step 5 = Management guidelines
45
Q

If the patient can eat properly how would you initially address malnutrition?

A

Enteral feeding (mouth) encouraging regular meals that are calorie supplemented

46
Q

If the patient is not able to consume food orally how would you address their malnutrition?

A

A liquified diet given intragastrically by a fine-bore tube or by a percutaneous endoscopic gastrostomy (PEG)

47
Q

The the liquified diet fails what would be the next step in addressing malnutrition?

A

Parenteral nutrition

48
Q

In re-feeding syndrome large increases in energy can lead to?

A

Heart failure, circulatory collapse and death

49
Q

Initial feeding following an acute situation begins with feeds low in?

A

Osmolarity and lactose

50
Q

Iron should only be given to a child following acute starvation after when?

A

The child gains an appetite and weight as iron is a pro-oxidant

51
Q

In the prevention of protein energy malnutrition what does GOBIF stand for?

A

Growth monitoring, Oral rehydration, Breast-feeding, Immunisation, Family planning

Nutrition (12 decks)

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