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ESS1606 Nutrition and metabolism > Undernutrition > Flashcards

Undernutrition Flashcards

1
Q

nutritional aspects of disease

A

aetiological

consequences

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2
Q

aetiological aspect of disease

A

disease caused by nutrition

Diseases of nutritional deficiency or excess

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3
Q

consequences aspect of disease

A

Impact of disease on nutrition status

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4
Q

what can undernutrition be?

A

generalised

specific

primary

secondary

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5
Q

generalised nutrition

A

deficiency of calories

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6
Q

specific nutrition

A

deficiency of an essential nutrient

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7
Q

primary undernutrition

A

related to the diet

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8
Q

secondary undernutrition

A

related to an illness or condition

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9
Q

consequences of undernutrition (Also relates to generalised undernutrition)

A

(Example of primary undernutrition)

Protein-Energy-Malnutrition affects 400+ million people worldwide.

Affects every organ and system within the body
- e.g. ability to fight infection

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10
Q

forms of PEM

A

dry

wet

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11
Q

dry PEM

A

Marasmus (no oedema, general)

Severe calorie and protein deficiency

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12
Q

wet PEM

A

Kwashiorkor (oedema, specific)

Protein deficiency with adequate calories,
generally from carbohydrate

(Ghanaian 1st – 2nd child)

Low protein reduces synthesis of blood proteins, particularly albumin. Low protein in the blood has an osmotic effect and causes water to diffuse into the interstitial fluid (oedema)

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13
Q

energy balance equation

A

energy intake = energy expenditure +- energy stored

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14
Q

causes of undernutrition

A
  1. reduced delivery of nutrients to the gastrointestinal system
  2. increased demand for nutrients
  3. inability for gastrointestinal system to absorb nutrients
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15
Q
  1. reduced delivery of nutrients to the gastrointestinal system
A

Decreased food availability

Mechanical - E.g. oesophagus doesn’t work, not physically able to open/get to food

Functional (neurological) - anorexia nervosa/stroke - affected ability to swallow

Not enough energy into system - neg energy balance

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16
Q
  1. increased demand for nutrients
A

Physiological

Pathophysiological - Increased metabolic rate in burns, trauma, infection, cancer

E.g. pregnancy, increase energy requirements and demand

17
Q
  1. inability for gastrointestinal system to absorb nutrients
A

Intrinsic problem
- Coeliac disease, diarrhoea

Post-surgery
- Part of bowel removed, reduce absorption capacity

18
Q

example of cause: Cancer cachexia

A

Multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. >5% weight loss in 6 months.

Acute phase proteins (APP) are released from the liver and signal a ‘stress’ response to breakdown muscle tissue for energy

The tumour needs energy, and energy is required to produce cytokines and acute phase proteins, and also gluconeogenesis§

Tumour - releases factors to allow body to release energy - increase met rate - increase demand for nutrients

Signals desire to eat - leads
to anorexia

19
Q

undernutrition in cancer patients

A

at the time of diagnosis approximately 75% of cancer patients are undernourished, with a significantly lower lean mass than healthy controls.

Patients with highest weight loss are those with cancer of oesophagus, stomach, and larynx.
- Gastrointestinal system - impair function

Surgery/chemotherapy

  • Anorexia, taste changes, dysphagia, nausea/vomiting, diarrhoea
  • Trauma = increased met rate
  • General feeling unwell reduces desire to eat

Nutritional support essential to increase the likelihood of completion of cancer treatment, enhance immune function, reduce mental and physical fatigue, and improve quality of life

20
Q

dietician

A

state registered care professional

21
Q

dietetics

A

use of diet in prevention/treatment of disease

22
Q

aim of dietetics

A

modify nutritional intake via therapeutic/nutritional support

23
Q

basic requirements of dietetics

A

1) Know normal nutritional requirements
2) Identify the nature of the disorder

3) Assess patient’s nutritional status and intake
- e.g. body composition, energy requirements, blood markers, food diary

4) Know the composition of foods, supplements and artificial feeds
5) Devise a meal plan / feed regimen
6) Monitor compliance and progression
7) Reassess and adjust as appropriate

24
Q

case study: oesophageal cancer

A

50 year old man, heavy drinker for 30 years, BMI 17.5 kg/m2 - underweight

Diagnosed

Oesophagectomy Jejunostomy - part of oesophagus removed

Radiotherapy

25
Q

enteral nutrition support

A

Provided when patients are expected to (or have) not received adequate nutrition for 7 days

Small bowel feeding administered with pump over 8-20 hours. Usually around 30 to 40 ml/h

Formulas come in a variety of energy densities, but most patients with standard fluid requirements will tolerate 1 to 1.2 kcal/ml

can’t give carb fat/protein - can’t be digested

26
Q

refeeding syndrome

A

Phosphate is involved in the regulation of most metabolic pathways and is required for ATP resynthesis

27
Q

oedema

A

water accumulation

28
Q

the laws of thermodynamics dictate that e neg energy balance will result in reduced energy stores, but they don’t tell us how

A

Fat towards adipose tissue
and stored

After eating go to pos fat
storage into adipose tissue -
release insulin and prevent
FAs being released

Won’t go back to release fat if eat enough

If don’t eat enough fats released for tissue and not stored - back into neg adipose tissue flow

29
Q

hypophosphataemia

A

low phosphate levels

30
Q

what does form of PEM depend on?

A

protein-carbohydrate balance

31
Q

what does energy undernutrition mean?

A

more time in postabsorptive state

32
Q

what does starvation mean?

A

more time in fasting state

ESS1606 Nutrition and metabolism (19 decks)

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