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Unit 10 > Week 2: Essentials of Nutrition > Flashcards

Week 2: Essentials of Nutrition Flashcards

1
Q

What is nutrition?

A

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

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2
Q

What is nutrients?

A

Substances required by the body which must be obtained from the diet

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3
Q

What are the six different classes of nutrients?

A

Carbohydrates
Protein
Fat
Water
Vitamins
Minerals

My Pony Can Visit Water Falls

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4
Q

What is the energy value of carbohydrates?

A

4kcal/g

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5
Q

What is the main function of carbohydrates?

A

Energy production
Energy storage
Building macromolecules
Sparing proteins
Lipid metabolism

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6
Q

What are the additional function of carbohydrates?

A

Fibre promotes digestive health
Role in cellular recognition
Sparing fat (avoid ketosis)

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7
Q

What is the relationship between fibre and carbohydrate?

A

Fibre is a type of carbohydrate that the body can not digest

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8
Q

What is the enrgy value of protein?

A

4kcal/g

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9
Q

What is the function of protein?

A

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

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10
Q

What is the nergy value of fats?

A

9kcal/g

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11
Q

What is the function of fat?

A

Storing energy - gluconeogenesis, enters citric acid cycle as acetyl CoA
Regulating and signalling - leptin
Insulation and protection
Aiding digestion - fat soluble vitamins

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12
Q

What is the energy value of water?

A

0kcal/g

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13
Q

What is the function of water as a nutrients?

A

Transport - blood and lymph components
Medium for chemical reactions - cytosol
Lubricant and shock absorbed - gastric secretions, synovial fluid, amniotic fluid
Temperature regulator

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14
Q

What are vitamins?

A

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

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15
Q

What is the main role of vitamins?

A

Co-enzymes - transfers chemical groups to aid enzyme function
Co-factors - binds to enzyme loosely to initiate catalytic effect

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16
Q

What are the two main categories of vitamins?
How are they different?

A

Fat soluble - absorbed like dieetary lipids
Water soluble - absorbed mostly via Na+ dependent cotransport

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17
Q

Give some examples of Fat soluble vitamins?

A

A, D, E, K

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18
Q

How are fat soluble vitamins absorbed?

A

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

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19
Q

What are some examples of water soluble vitamins?

A

B1, B2, B12, C
Biotin, folic acid, nicotininc acid, pantothenic acid

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20
Q

How can a gastrectomy result in a vitamin deficiency?

A

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

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21
Q

What are minerals?

A

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

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22
Q

What is the difference between microminerals and macrominerals?

A

Macrominerals are needed in large amounts
Microminerals are needed in smaller amounts
All are essential to function

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23
Q

What are the microminerals that the body requires?

A

Iron
Zinc
Iodine
Selenium
Copper
Manganese
Flouride
Chromium
Molybdenum

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24
Q

What is the role of iron?

A

Carries oxygen and assists energy production

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25
Q

What is the role of zinc?

A

Protein/DNA production, wound healing, growth and immune system function

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26
Q

What is the role of iodine?

A

Thyroid hormone production, growth and metabolism

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27
Q

What is the role of selenium?

A

Antioxidant

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28
Q

What is the role of copper?

A

Co-enxyme and iron metabolism

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29
Q

What is the role od manganese?

A

Co-enzyme

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30
Q

What is the role of flouride?

A

Bone and teeth maintenance

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31
Q

What is the role of chromium?

A

Assists insulin in glucose metabolism

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32
Q

What is the role of molybdenum?

A

Coenzyme

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33
Q

What are the different macronutrients?

A

Sodium
potassium
magneisum
Chloride
Sulphur
Phosphorus
Calcium

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34
Q

What is the role of sodium in the body?

A

Fluid balance, nerve transmission and muscle contraction

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35
Q

What is the role of potassium in the body?

A

Fluid balance, nerve transmission and muscle contraction

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36
Q

What is the role of magnesium in the body?

A

Protein production, nerve transmission and muscle contraction

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37
Q

What is the role of chloride in the body?

A

Fluid balance, and stomach acid production

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38
Q

What is the role of sulphur in the body?

A

Protein production

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39
Q

What is the role of phosphorus in the body?

A

Important for healthy bones and teeth, part of the system that maintains the acid base balance

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40
Q

What is the role of calcium in the body?

A

healthy bones and teeth
Muscle relaxation and contraction
Nerve functioning
Bloof clotting
Bloos pressure regulation
immune system health

41
Q

What is a calorie?

A

The amount of energy in the form of heat that is required to heat one kilogram of water one degree celsius.

42
Q

What is total energy expenditure?

A

The sum of resting energy expenditure or basal metabolic rate
and diet induced thermogenesis and energy expended in activity

43
Q

What is the resting energy expenditure?

A

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

44
Q

What is basal metabolic rate?

A

The rate at which a person uses energy to maintain a basic functions at complete rest

45
Q

What is diet induced thermogenesis?

A

DIT
Thermal effect of food, calories burned in utilising and digesting food
Digestion, absorption and assimilation of nutrients requires stored energy

46
Q

What are physical activity level factors?

A

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.

47
Q

What are the different physical activity level factors?

A

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

48
Q

What types of patient may have an increased Physical activity level compared to other hospital in patients?

A

Prolonged or regular physiotherapy
increased effort moving injured/painful limbs

49
Q

What are the NICE recommended nutritional requirements?

A

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

50
Q

What makes up the majority of energy demand in a healthy individual?

A

2/3 Basal metabolic rate
20% activity expenditure
10% Diet induced thermogenesis

51
Q

What makes up the majority of an energy demenad of a diseases individual compared to a healthy individual?

A

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

52
Q

What is the PENG recommended guidance for calculating nutritional requirements?

A

BMR + stress + activity
Divided by DIT
kcal/day

53
Q

How do NICE calculate recommended nutritional intake?

A

Recommend 25-33 kcal/kg per day

54
Q

How does ASPEN calcuate recommended nutritional intake?

A

20-35 kcal/kg per day

55
Q

How do we calcualte resting energy expenditure?

A

Total body weight (or fat free mass) x kcal/kg

Value of 25-35kcal/kg is recommended by NICE

56
Q

How do we calculates total energy expenditure?

A

REE x Physical activity level Factor

57
Q

What are the recommended protein intake requirements?

A

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

58
Q

What are the potential implications of protein prescription with a kidney injury?

A

High dietary protein causes interglomerular hypertension - increasing the GFR
THis leads to hyperfiltration causing kidney injury
Can lead to or exaggerated proteinuria

59
Q

What are the recommended fluid intakes?

A

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

60
Q

What are recommended fluid intakes during illness?

A

Should follow healthy requirement plus additional loses
Recomend an additional 2-2.5ml/kg for each degree rise above 37 in pyrexia

61
Q

For a healthy individual give all the recommended dietary intake.

A

20-35kcal/kg/day total energy
0.8-1.5g protein/kg/day
30-35ml/kg/day

62
Q

What factors should be considered when estimating nutritional support?

A

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.

63
Q

Define malnutrition

A

A state of deficiency or excess of energy, protein or other nutrients causes measurable adverse effects of tissue/body function and clinical outcome

64
Q

What are the two aspects involved in malnutrition?
What is the most prevalent clinically?

A

Undernutrition (starved) and overnutrition (obese)
In acute setting majority are undernourished
Around 1/3 of hospital patients are at risk of being undernourished

65
Q

What is MUST Malnutrition Universal Screening Tool?

A

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.

66
Q

What are the four steps to calculate the risk of malnutrition in the MUST tool?

A

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

67
Q

What are the management guidelines based on a MUST score?

A

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

68
Q

What are some common causes of malnutrition?

A

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

69
Q

How might malnutrition present in a Crohns case?

A

Weight loss
Growth impedence
Delayed sexual maturation
Anaemia
Asthenia (muscle weakness)
Osteopenia
Diarrhoea
Oedema
Muscle cramps
Impaire cellular immunity
Poor wound healing

70
Q

What are the three branches that can lead to malnutrition in IBD?

A

Poor nutritional intake
Increased intestinal protein losses
Nutrient malabsoprtion

71
Q

What causes poor nutritional intake in Inflammatory Bowel disease?

A

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

72
Q

What are the causes of increased intestinal protein losses in Inflammatory Bowel Disease?

A

Blood and protein loss thorugh inflammed intestinal mucosa
Intestinal overgrowth impairing tight junctions and poor lymphatic drainage can contribute to protein loss

73
Q

What are the factors contributing to nutrient malabsorption in Inflammatory Bowel disease?

A

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

74
Q

What nutritional support is often offered in IBD?

A

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

75
Q

What is meant be refeeding on a medical term?

A

Re-introducing food after chronic malnurishment or starvation

76
Q

What is the mechanism underpinning refeeding syndrome?

A

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

77
Q

What feeding methods increase the risk of refeeding syndrome?

A

Enterally - directly to stomach or small intestine
Parentally - intravenously

78
Q

What are the common complications of refeeding syndrome?

A

Convulsions, delirum, ataxia, wernicks encelopathy
Hypotension, arryhtmias and heart failure
Renal failure, anaemia and hyperglyceamia (temp)
Peripheral odema, fasciulations and rhabdomylosis

79
Q

What nutritional status indicates high risk for refeedinf syndrome?

A

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

80
Q

What patients are at an extremely high risk for refeeding syndrome?

A

Patients in a starved state BMI<14
Very little or no nutritional for >15 days

81
Q

What are the four main different feeding routes?

A

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

82
Q

What is enteral tube feeding?
What are the different types?

A

Feeding directly into the stomach or small intestine
Naso-gastric tube
Naso-jejunal tube
Jejunostomy
Percutaenours endoscopic gastrostomy
Radiologically inserted gastrostomy

83
Q

What is parenteral nutrition?
What are the different types?

A

Nutrition directly into blood stream
Peripheral vein
Central vein

84
Q

When is enteral feeding commonly used?

A

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

85
Q

What are some potential complications of enteral feeding?

A

Constipation/dehydration as focus on calorie intake
Issues with skin around the site
Unintentional tears in intestine
Infection
Blockages and involuntary displacement of tube

86
Q

What should/might recieve parenteral feeding?

A

When the upper GIT is not viable or oral/enteral intake is insufficient
used if complete bowel rest is recommended

87
Q

What are the risks of parenteral?

A

Dehydration
Electrolyte imbaalcne (fluid balance regulation is difficult)
Thrombosis
Hyperglycemia/hypoglycemia
Infection
Liver failure
Micronutrient deficienes

88
Q

Role and source of Vitamin B1 Thialamin

Reference not memorise

A

Release energy from food
Nervous system and cardiovascular functioning

Found in bread, cereals, nuts, seeds, meat, beans, and peas

89
Q

Role and source of Vitamin B2 riboflavin

REference not memorise

A

Release nergy from food, reduce tiredness and help maintain a normal skin and nervous sytsen

Milk, eggs, oily fish, mushrooms and almonds

90
Q

Role and source of Vitamin B3 Niacin

reference not memorise

A

Release energy from food, reduce tiredness, help maintain normal skin and nervous system

Meat, poultry, fish, wholegrains, bread, nuts, seeds

91
Q

Role and source of Vitamin B6

Reference not memorise

A

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

92
Q

Role and source of Vitamin B12

A

Red blood cells
Nervous system fucntion
Reduce tiredness

Meat, fish, milk, cheese, eggs, fortified breakfast cereals

93
Q

ROle and source of folic acid

Reference not memorise

A

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

94
Q

Role and source of vitamin C

Reference not memorise

A

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.

95
Q

Role and source of vitamin A

Reference not memorise

A

Immune system function
Vision and maintenance of normal skin

Liver, cheese, eggs, dark green leafy vegetables, orange coloured frouts and vegatibles

96
Q

Role and source of vitamin D

Reference not memorise

A

Oily fish, eggs, fat spreads, sunlight exposure

Absorbed calcium tp build and maintain healthy muscle and bones
Aids immune system

97
Q

Role and source of vitamin E

Reference not memorise

A

Protect cells in the body against damage

Vegetable and seed oils, nuts, seeds, avocadoes and olives

98
Q

ROle and source of Vitamin K

reference not memorise

A

Normal blood clotting
Bone structure

Green vegetables and some oils

Unit 10 (37 decks)

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