Week 2: Essentials of Nutrition Flashcards
What is nutrition?
A sum of all the processes involved by which living organisms use nutrients to support body function, including respiration, reproduction etc.
How we obtain, metabolism and utilise nutrients
What is nutrients?
Substances required by the body which must be obtained from the diet
What are the six different classes of nutrients?
Carbohydrates
Protein
Fat
Water
Vitamins
Minerals
My Pony Can Visit Water Falls
What is the energy value of carbohydrates?
4kcal/g
What is the main function of carbohydrates?
Energy production
Energy storage
Building macromolecules
Sparing proteins
Lipid metabolism
What are the additional function of carbohydrates?
Fibre promotes digestive health
Role in cellular recognition
Sparing fat (avoid ketosis)
What is the relationship between fibre and carbohydrate?
Fibre is a type of carbohydrate that the body can not digest
What is the enrgy value of protein?
4kcal/g
What is the function of protein?
Motion (myosin)
Structure (Keratin in nails)
Enzymes
Hormones
Acid base balance - have acidic or basic groups
Transport - protein channels
Protection - antibodies
Wound healing - fibrin clot
Energy production - gluconeogenesis
What is the nergy value of fats?
9kcal/g
What is the function of fat?
Storing energy - gluconeogenesis, enters citric acid cycle as acetyl CoA
Regulating and signalling - leptin
Insulation and protection
Aiding digestion - fat soluble vitamins
What is the energy value of water?
0kcal/g
What is the function of water as a nutrients?
Transport - blood and lymph components
Medium for chemical reactions - cytosol
Lubricant and shock absorbed - gastric secretions, synovial fluid, amniotic fluid
Temperature regulator
What are vitamins?
Complex organic structures essential for growth and nutrition, typically only needed in small amounts and can’t by synthesised in sufficient quantities in the body
Acquired by diet and absorbed in the GIT
What is the main role of vitamins?
Co-enzymes - transfers chemical groups to aid enzyme function
Co-factors - binds to enzyme loosely to initiate catalytic effect
What are the two main categories of vitamins?
How are they different?
Fat soluble - absorbed like dieetary lipids
Water soluble - absorbed mostly via Na+ dependent cotransport
Give some examples of Fat soluble vitamins?
A, D, E, K
How are fat soluble vitamins absorbed?
Incorporated into micelles and transported to the apical membrane of intestinal cells
Diffuse across the apical membrane and into the cells.
incorporated in chylomicrons
Exudated into lymph, which delivers them into general circulation
What are some examples of water soluble vitamins?
B1, B2, B12, C
Biotin, folic acid, nicotininc acid, pantothenic acid
How can a gastrectomy result in a vitamin deficiency?
Remove stomach
Loss of intrinsci factor from parietal cells
Failure to absorb VB12 can lead to pernicous anaemia - must be treated by injection of hydroxycobalamin
What are minerals?
Inorganic substances - solid
Not directly used for making energy
Found on the periodic table - can be classified as essential, suggested for essential and non-essential
What is the difference between microminerals and macrominerals?
Macrominerals are needed in large amounts
Microminerals are needed in smaller amounts
All are essential to function
What are the microminerals that the body requires?
Iron
Zinc
Iodine
Selenium
Copper
Manganese
Flouride
Chromium
Molybdenum
What is the role of iron?
Carries oxygen and assists energy production
What is the role of zinc?
Protein/DNA production, wound healing, growth and immune system function
What is the role of iodine?
Thyroid hormone production, growth and metabolism
What is the role of selenium?
Antioxidant
What is the role of copper?
Co-enxyme and iron metabolism
What is the role od manganese?
Co-enzyme
What is the role of flouride?
Bone and teeth maintenance
What is the role of chromium?
Assists insulin in glucose metabolism
What is the role of molybdenum?
Coenzyme
What are the different macronutrients?
Sodium
potassium
magneisum
Chloride
Sulphur
Phosphorus
Calcium
What is the role of sodium in the body?
Fluid balance, nerve transmission and muscle contraction
What is the role of potassium in the body?
Fluid balance, nerve transmission and muscle contraction
What is the role of magnesium in the body?
Protein production, nerve transmission and muscle contraction
What is the role of chloride in the body?
Fluid balance, and stomach acid production
What is the role of sulphur in the body?
Protein production
What is the role of phosphorus in the body?
Important for healthy bones and teeth, part of the system that maintains the acid base balance
What is the role of calcium in the body?
healthy bones and teeth
Muscle relaxation and contraction
Nerve functioning
Bloof clotting
Bloos pressure regulation
immune system health
What is a calorie?
The amount of energy in the form of heat that is required to heat one kilogram of water one degree celsius.
What is total energy expenditure?
The sum of resting energy expenditure or basal metabolic rate
and diet induced thermogenesis and energy expended in activity
What is the resting energy expenditure?
REE
The energy expanded lying still at physical and mental rest after a 10 hour overnight fact with no stimulants in the previous 24 hours
What is basal metabolic rate?
The rate at which a person uses energy to maintain a basic functions at complete rest
What is diet induced thermogenesis?
DIT
Thermal effect of food, calories burned in utilising and digesting food
Digestion, absorption and assimilation of nutrients requires stored energy
What are physical activity level factors?
A system used to match a description of physical activity to a numerical value that can be used to calculate the extra energy intake needed ontop of REE.
What are the different physical activity level factors?
1.00 to 1.10 - in bed or immobile e.g in acute illness
1.10- to 1.20 - in bed and/or sitting our e.g in a hospital ward or care home
1.20 to 1.25 - limited mobility - hospital ward or at home with full time care
1.25 to 1.40 sedentary - care home at home
What types of patient may have an increased Physical activity level compared to other hospital in patients?
Prolonged or regular physiotherapy
increased effort moving injured/painful limbs
What are the NICE recommended nutritional requirements?
For healthy indivduals not at risk of re-feeding syndrome
- 25 to 35kcal/kg/day including protein - less if BMI over 25
- 0.8 to 1.5 g of protein daily
- 30 to 35 ml fluid/kg
Adequate fluid, minerals, micronutreints and fibre if appropraite
What makes up the majority of energy demand in a healthy individual?
2/3 Basal metabolic rate
20% activity expenditure
10% Diet induced thermogenesis
What makes up the majority of an energy demenad of a diseases individual compared to a healthy individual?
Still large majority is BME - alongside additional demands from stress
DIT -remains constant at 10%
Activity expenditure decreases to around half a normal healthy individual
What is the PENG recommended guidance for calculating nutritional requirements?
BMR + stress + activity
Divided by DIT
kcal/day
How do NICE calculate recommended nutritional intake?
Recommend 25-33 kcal/kg per day
How does ASPEN calcuate recommended nutritional intake?
20-35 kcal/kg per day
How do we calcualte resting energy expenditure?
Total body weight (or fat free mass) x kcal/kg
Value of 25-35kcal/kg is recommended by NICE
How do we calculates total energy expenditure?
REE x Physical activity level Factor
What are the recommended protein intake requirements?
BMI 18.5-30 recommend 0.8-1.5g/kg/day
Up to 1.9 g/kg/day can be uses in a deficit or in anabolism post surgery
What are the potential implications of protein prescription with a kidney injury?
High dietary protein causes interglomerular hypertension - increasing the GFR
THis leads to hyperfiltration causing kidney injury
Can lead to or exaggerated proteinuria
What are the recommended fluid intakes?
18-60yrs: 35ml/kg
>60 yrs: 30ml/kg - reduced kidney function and metabolic rate
In elderly or frail may use 20-25ml/kg
In high BMI recommended that you do not give over 3L
What are recommended fluid intakes during illness?
Should follow healthy requirement plus additional loses
Recomend an additional 2-2.5ml/kg for each degree rise above 37 in pyrexia
For a healthy individual give all the recommended dietary intake.
20-35kcal/kg/day total energy
0.8-1.5g protein/kg/day
30-35ml/kg/day
What factors should be considered when estimating nutritional support?
Age, weight, Height, Gender
Type and severity of illness
Metabolic state
Current nutritional status v desired nutritional status
Other interventions
Absoprtive capacity
Psychological state
Physical state hence activity
Goals and duration of nutritional support.
Define malnutrition
A state of deficiency or excess of energy, protein or other nutrients causes measurable adverse effects of tissue/body function and clinical outcome
What are the two aspects involved in malnutrition?
What is the most prevalent clinically?
Undernutrition (starved) and overnutrition (obese)
In acute setting majority are undernourished
Around 1/3 of hospital patients are at risk of being undernourished
What is MUST Malnutrition Universal Screening Tool?
A five step screening to identify adulsts who are at risk of or are malnourished.
Also includes management guidelines to develop a care plan, can be used by all health care workers in primary, secondary and tertiary care.
What are the four steps to calculate the risk of malnutrition in the MUST tool?
Step 1: BMI score, above 20 is o, above 18.5 is 1 and below 18.5 is 2
Step 2: score weight loss in past 3months; less than 5% is 0, up to 10% is 1, more than 10% is 3
Step 3: if acutely ill and likely to be no nutritional intake for more than 5 days score 2
Add score together
0 = low risk, 1=medium risk, 2 or more means high risk
What are the management guidelines based on a MUST score?
Score 0= low risk = routine care = repeat screening at appropriate interval
Score 1 medium risk = observe = monitor intake for 3 days, is inadequate follow local policy, is adequate repeat screening at appropriate interval
Score 2+ high risk needs treatment = set goals to improve nutrition, monirt and review at regular intervals, refer to dietitan, nutritional support team or follow local policy
What are some common causes of malnutrition?
Health conditions
Medication
Phsycial and social factors
Reduced appetite due to stress/anxiety
Dislike of hospital food
Repeated fasting for surgeries/procedures
Difficulty eating, swallowing or chewing
Underlying cogntivie difficulties such s dementia
Increased metabolic requirements due to injuries
How might malnutrition present in a Crohns case?
Weight loss
Growth impedence
Delayed sexual maturation
Anaemia
Asthenia (muscle weakness)
Osteopenia
Diarrhoea
Oedema
Muscle cramps
Impaire cellular immunity
Poor wound healing
What are the three branches that can lead to malnutrition in IBD?
Poor nutritional intake
Increased intestinal protein losses
Nutrient malabsoprtion
What causes poor nutritional intake in Inflammatory Bowel disease?
vomitting/diarrhoea - phsyical loss
Feat of symptoms/flare up - restrict diet before important event or regularly - linked to anorexia nervosa
Abdominal pain and discomfort - loss of appetite, fear of eating
Drugs - cause intestinal upset
Recommended dietary restrictions of lactose or other trigger foods
What are the causes of increased intestinal protein losses in Inflammatory Bowel Disease?
Blood and protein loss thorugh inflammed intestinal mucosa
Intestinal overgrowth impairing tight junctions and poor lymphatic drainage can contribute to protein loss
What are the factors contributing to nutrient malabsorption in Inflammatory Bowel disease?
Upper GI tract involvement - impaired digestion in stomach, duodenum and ileum - lost in faeces
Bowel resections ‘short bowel syndrome’ loss of functional areas in absorption
Particulary loss of terminal ileum - impair bile-salt and fat absorption
Intestinal bacterial overgrowth - impede carbohydrate and protein absorption and bile-salt metabolism
Protein break down normally overrules protein synthesis resulting in depletion
Contrasting evidence over changes in metabolic rate
What nutritional support is often offered in IBD?
Mild to moderate attacks - typically managed with conventional oral diet
No major dietary restrictions should be given, except for avoidance of coarse fibre than can worsend diarrhoea
Milk should not be avoided unless lactose interlant
May need artificial nutrition
What is meant be refeeding on a medical term?
Re-introducing food after chronic malnurishment or starvation
What is the mechanism underpinning refeeding syndrome?
Chronic malnutrition or prolonged fast
Reduced insulin and increased glucagon and cortisol
Increased levels of glycogenolysis, gluconeogenesis and protein catabolism leading to depletion of electrolyte and mineral stores
Start refeeding - spike in glucose causes a spike in insulin
This results in increased cellular protein synthesis and glycogen storage
Leads to enhanced cellular uptake of glucose and minerals, such as phosphorus and potassium and magnesium
This leads to water and electrolyte disturbances typically hypokalemia, hypophosphasemia
What feeding methods increase the risk of refeeding syndrome?
Enterally - directly to stomach or small intestine
Parentally - intravenously
What are the common complications of refeeding syndrome?
Convulsions, delirum, ataxia, wernicks encelopathy
Hypotension, arryhtmias and heart failure
Renal failure, anaemia and hyperglyceamia (temp)
Peripheral odema, fasciulations and rhabdomylosis
What nutritional status indicates high risk for refeedinf syndrome?
BMI below 16
Unintentional weight loss.15% is last 3-6 months
Little or no nutritional intake for >10 days
Low levels of electrolytes
Or two or more of:
BMI<18.5
Weight loss >10% in3-6months
Little or no nutritional intake for >5 days
history of alcohol or drug misuse
What patients are at an extremely high risk for refeeding syndrome?
Patients in a starved state BMI<14
Very little or no nutritional for >15 days
What are the four main different feeding routes?
Food first - oral intake of food - typically suggest eatwell guide
Oral nutritional supplements - milkshapes, juices, high energy powders etc
Enteral tube feeding ETF
Parenteral nutrition
What is enteral tube feeding?
What are the different types?
Feeding directly into the stomach or small intestine
Naso-gastric tube
Naso-jejunal tube
Jejunostomy
Percutaenours endoscopic gastrostomy
Radiologically inserted gastrostomy
What is parenteral nutrition?
What are the different types?
Nutrition directly into blood stream
Peripheral vein
Central vein
When is enteral feeding commonly used?
In patientes when oral intake is insufficient or unsafe and they have a functional GIT
Commonly:
Unconscious patients
Swallowing difficulties
Anorexia nervosa
Upper GIT obstruction
What are some potential complications of enteral feeding?
Constipation/dehydration as focus on calorie intake
Issues with skin around the site
Unintentional tears in intestine
Infection
Blockages and involuntary displacement of tube
What should/might recieve parenteral feeding?
When the upper GIT is not viable or oral/enteral intake is insufficient
used if complete bowel rest is recommended
What are the risks of parenteral?
Dehydration
Electrolyte imbaalcne (fluid balance regulation is difficult)
Thrombosis
Hyperglycemia/hypoglycemia
Infection
Liver failure
Micronutrient deficienes
Role and source of Vitamin B1 Thialamin
Reference not memorise
Release energy from food
Nervous system and cardiovascular functioning
Found in bread, cereals, nuts, seeds, meat, beans, and peas
Role and source of Vitamin B2 riboflavin
REference not memorise
Release nergy from food, reduce tiredness and help maintain a normal skin and nervous sytsen
Milk, eggs, oily fish, mushrooms and almonds
Role and source of Vitamin B3 Niacin
reference not memorise
Release energy from food, reduce tiredness, help maintain normal skin and nervous system
Meat, poultry, fish, wholegrains, bread, nuts, seeds
Role and source of Vitamin B6
Reference not memorise
Make red blooc cells, aid immune system, regulate hormones and reduce tiredness
Meat, poultry, fish, egg, yeast, soya beans, sesame seeds, some fruit and vegetables
Role and source of Vitamin B12
Red blood cells
Nervous system fucntion
Reduce tiredness
Meat, fish, milk, cheese, eggs, fortified breakfast cereals
ROle and source of folic acid
Reference not memorise
Make Red blooc cells
Reduce tiredness
Imporve immune function
Normal development of NS in unborn babies
Found in green leafy vegetables, breads, please, oranges, berries
Role and source of vitamin C
Reference not memorise
Protect cells from damage
Forms collagen - bones, gums, teeth and skin
Immune and nervous system function
Found in fruit (particularly citrous fruits), green vegetables, peppers and tomatoes.
Role and source of vitamin A
Reference not memorise
Immune system function
Vision and maintenance of normal skin
Liver, cheese, eggs, dark green leafy vegetables, orange coloured frouts and vegatibles
Role and source of vitamin D
Reference not memorise
Oily fish, eggs, fat spreads, sunlight exposure
Absorbed calcium tp build and maintain healthy muscle and bones
Aids immune system
Role and source of vitamin E
Reference not memorise
Protect cells in the body against damage
Vegetable and seed oils, nuts, seeds, avocadoes and olives
ROle and source of Vitamin K
reference not memorise
Normal blood clotting
Bone structure
Green vegetables and some oils
