S1B5 - Nutrition: overview of nutrition in clinical care

Question 1

How many calories are in 1 gram of protein?

Answer 1

1 gram of protein or carbohydrate yields 4 calories.

Question 2

How many calories are in 1 gram of ethanol?

Answer 2

1 gram of ethanol yields 7 calories.

Question 3

How many calories are in 1 gram of fat?

Answer 3

1 gram of fat yields 9 calories. Fat is the most energy-dense macronutrient.

Question 4

What are the 6 essential nutrients?

Answer 4

• Carbohydrates
• Proteins
• Fats
• Water
• Vitamins
• Minerals

Question 5

What are the four main nutritional statuses you can assign a patient?

Answer 5

Nutritional assessment: Evaluation of a patient’s nutritional status and nutrient requirements based on the interpretation of clinical information.

• Well nourished
• Malnourished
• Over-nourished: high body weight / high body fat
• Under-nourished: low body weight / low body mass and / or body fat

Question 6

What are the important parts of a patient’s history for gathering information for a nutritional assessment?

Answer 6

• Past Medical History
• Family History
• Social History
• Diet History
• Dietary Intake Studies

Question 7

What are the three main dietary intake studies and when are they used?

Answer 7

• 24-hour recall
  
  • diabetic patients
• Usual intake / Diet history
  
  • older adults and pediatrics: reflects long term diet habits
• Food frequency questionnaire
  
  • can be geared toward existing medical conditions

Question 8

How do you calculate BMI?

Answer 8

Body Mass Index (BMI)

• BMI = Weight (kg) / Height (m2)

Question 9

What are the NHLBI BMI standards for overweight and obese?

Answer 9

NHLBI sets 25 -29.9 kg/m2as overweight and greater than 30 kg/m2 as obese.

Question 10

Waist circumference greater than 102 cm (40 in) in men 88 cm (35in) in women can indicate what?

Answer 10

Waist circumference greater than 102 cm (40 in) in men; 88 cm (35in) in women indicators of increased risk for type 2 diabetes, dyslipidemia, hypertension, and CVD

Question 11

In what patients is weight loss common?

Answer 11

Weight loss is common in:

• hospitalized patients
• nursing home patients
• older adults 
• those with chronic illnesses or secondary to surgery, chemotherapy or radiation.

Question 12

Albumin, transferrin, and prealbumin levels can give you information about what?

Answer 12

Protein status: albumin, transferrin, prealbumin

Question 13

AST, ALT, thiamine, folate, and B12 can give you information about what?

Answer 13

Alcoholism: AST, ALT, thiamine, folate, B12

Question 14

CBC, MCV, reticulocyte count, folate, and serum B12 can give you information about what?

Answer 14

Anemia: CBC, MCV, reticulocyte count, folate, serum B12

Question 15

glucose, HbA1c, and C-reactive protein can give you information about what?

Answer 15

Diabetes: glucose, HbA1c, C-reactive protein

Question 16

Potassium, albumin, serum amylase, thyroid studies, AST, and ALT can give you information about what?

Answer 16

Eating disorders: potassium, albumin, serum amylase, thyroid studies, AST, ALT

Question 17

Sodium, potassium, chloride, calcium, phosphorous, magnesium, BUN, and creatinine can give you information about what?

Answer 17

Fluid, electrolyte and renal function: Sodium, potassium, chloride, calcium, phosphorous, magnesium, BUN, creatinine

Question 18

25(OH) vitamin D, calcium, phosphate, and PTH can give you information about what?

Answer 18

Musculoskeletal pain / weakness: 25(OH) vitamin D, calcium, phosphate, PTH

Question 19

What does energy expenditure depend on?

Answer 19

Energy Expenditure depends on:

• Basal metabolic rate
  
  • energy necessary to maintain basic functions at neutral environmental temperature and fasting
    
    • proportionate to lean body mass and surface area
  • higher in males than in females, young children and in certain disease states
    
    • higher with fever / hyperthyroidism lower with starvation / hypothyroidism
• Thermogenic effect (specific dynamic effect)
  
  • equivalent to about 10 -15% of total energy expenditure
  • digestion / other stimulation of metabolism due to influx of new substance
• Physical activity
• Environmental temperature

Question 20

Resting Egergy Expenditure (REE)

• What is it?
• How much total energy does it account for
• How does exercise affect it?
• What does it estimate?

Answer 20

Resting Energy Expenditure (REE)

• energy needed to maintain vital organ function in the resting state
• accounts for about 65% of total energy expenditure 
• **exercise can increase REE 

REE is an estimation for BMR 

Adjustments must be made for obese patients because fat is not as metabolically active as lean muscle mass

Question 21

How do you estimate total energy expenditure (TEE)?

Answer 21

Total Energy Expenditure (TEE):

• Estimated by multiplying the REE by a factor which takes into account physical activity or clinical status

Question 22

What are the useful averages for quick estimates for the calories needed for men and women?

Answer 22

Useful average for quick estimates:

• Men: 1.0 kcal / hr / kg
• Women: 0.95 kcal / hr / kg

Question 23

What are EAR and RDA?

Answer 23

EAR - Estimated Average Requirement 

• the amount of a nutrient estimated to meet the nutrient requirement of half of the healthy individuals in a life-style and gender group.

RDA - Recommended Daily Allowance 

• two standard deviations above the EAR – assuming that this dietary intake amount is sufficient for nearly all (98%) healthy individuals.

Question 24

In a patient’s chart, use of vitamins, minerals, dietary supplements should be found in:

A) Past medical history

B) Family history

C) Social history

D) Review of systems

Answer 24

Past medical history