Undernutrition and Dietetics

Question 1

What is MUST?

Answer 1

Malnutrition Universal Screening Tool used to measure risk of malnutrition (considers BMI, weight loss, effect of acute disease)

Question 2

What are the main questions used in MUST?

Answer 2

Have you unintentionally lost weight recently? Have you been eating less than usual? What is your normal weight? What is your height?

Question 3

Undernutrition can be generalised or specific. What is the difference between these?

Answer 3

. Generalised- overall calorie deficit (negative energy balance)
. Specific- deficiency of specific essential nutrient

Question 4

What is the difference between primary and secondary undernutrition?

Answer 4

Primary is related to diet, secondary is related to illness or disease

Question 5

What does PEM stand for?

Answer 5

Protein energy malnutrition (example of primary malnutrition)

Question 6

What does the form of PEM depend on?

Answer 6

Protein-carbohydrate balance

Question 7

What are the two types of PEM?

Answer 7

Dry PEM/Marasmus (no oedema, general) and wet PEM/Kwashiorkor (oedema, specific)

Question 8

What is dry PEM caused by?

Answer 8

Severe calorie and protein deficiency

Question 9

What is wet PEM caused by?

Answer 9

Severe protein deficiency

Linked to hypoalbuminaemia (low plasma albumin)

Question 10

Describe the metabolic consequences of undernourishment

Answer 10

. Decreased calorie intake= decreased circulating insulin
. Protein and fat catabolism
. Decreased intracellular electrolytes
. Tissue wasting and sometimes death

Question 11

Describe what happens in Refeeding Syndrome

Answer 11

. Increase in carbohydrate intake= increased insulin production
. Insulin causes uptake of electrolytes (glucose, potassium, phosphate, magnesium) into cells
. Low electrolytes in blood (esp. phosphate) = rhabdomyolysis, cardiac arrhythmias, respiratory failure, seizures, leukocyte dysfunction, hypotension
. Can lead to coma and death

Question 12

What is rhabdomyolysis?

Answer 12

Breakdown of damaged skeletal muscle (can lead to renal problems because kidneys struggle to remove the high volume of waste)

Question 13

What is dysphagia?

Answer 13

Difficulty/inability to swallow

Question 14

What is the difference between enteral and parenteral feeding?

Answer 14

Enteral= via GI tract (e.g. tube into small intestine)
Parenteral= via blood stream (i.v.)

Question 15

What is Coeliac’s disease? What is it caused by and what are the consequences?

Answer 15

. Gluten enteropathy- Immune response causes mucosa in small intestine to flatten when wheat ingested
. Results in malabsorption of nutrients (wasting in adults, failure to thrive in children), steatorrhea, abdominal discomfort

Question 16

What is Crohn’s disease? What is it caused by and what are the consequences? Give some management options.

Answer 16

. Chronic inflammation of GI tract (commonly in ileum/colon)
. Fistulae, GI haemorrhage can lead to anaemia, malabsorption, diarrhoea, weight loss, pain
. Corticosteroids for inflammation, elemental diet