Weight Loss Flashcards
Malnutrition definition
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients
2 broad groups of conditions covered by malnutrition
Undernutrition and micronutrient deficiencies
Overweight, obesity, diet-related noncommunicable diseases
Food security encompasses what 3 things
Availability (sufficient, consistent)
Access (resources to obtain food)
Use (knowledge of basic nutrition, water and sanitation, safe storage)
What is the number one factor contributing to food insecurity and malnutrition?
Poverty
Who is most at risk of malnutrition
Children under 5 (especially under 2 after weaning) Adolescents and elderly Pregnant and lactating women Persons with chronic disease Infectious disease
2 types of undernutrition
Protein energy malnutrition
Micronutrient deficiency
Protein energy malnutrition
Decrease in the amount of macronutrients (protein, carbs, fat)
Growth failure
2 types: wasting (acute) and stunting (chronic)
Micronutrient deficiency
Vitamins, minerals, trace elements
Less obvious, but can have serious impacts on ability to grow, develop, and deal with stress
Kwashiorkor vs Marasmus
Both are types of protein energy malnutrition and involve rapid weight loss
K: slightly older children, swelling of legs, sparse hair, moon face, flaky skin, swollen abdomen, thin muscles
M: children under 1, normal hair, old man or wizened appearance, thin limbs with little muscle or fat, very underweight body
Kwashiorkor
Usually 6 months to 3 years
Rapid
Often due to acute illness, infections, trauma
Protein deficiency
Marasmus
Usually under 1 year
Slow, chronic
Prolonged starvation (famine, conflict)
Protein and calorie deficiency
Stunting
Type of PEM (chronic malnutrition)
Low height for age compared to reference population
Look younger than age
Can have poor cognitive development
Consequences of malnutrition
Risk of death from a common illness is much higher
Poor pregnancy outcomes, anemia, mental and growth retardation, blindness, etc
Increased susceptibility to infection
Anorexia definition
The loss of appetite or reduced caloric intake
Cachexia
Multifactorial syndrome of continuous involuntary loss of skeletal muscle mass, which cannot be fully revered by conventional nutritional support
Includes 3/5 of following: decreased muscle strength, reduced muscle mass, fatigue, anorexia, biochemical alterations (anemia, inflammation, low albumin)
Anorexia-cachexia syndrome
Involuntary loss of weight and appetite with advanced illness
In cancer, HF, COPD, HIV, CKD
Poor prognostic indicator
Pathogenesis of anorexia-cachexia
Cytokine driven
Causes dysregulation in 3 groups
1. Altered intake (gut-brain axis)
2. Inflammation/catabolism (muscle-liver axis)
3. Anabolic dysbalance (brain-muscle axis)
Treatment principle for anorexia-cachexia
Medical optimization of secondary nutrition impact symptoms and acute/chronic conditions
Like nausea, pain, constipation, depression, dyspnea, etc etc
Non-pharmacologic treatment for anorexia-cachexia
Useful for all patients
Quality over quantity
Counselling and education (increasing calories doesn’t reverse process and may harm, not starvation, it is natural and common in advanced illness)
Consultation with nutritionist
Pharmacologic treatment for anorexia-cachexia
Does not reverse cachexia
No mortality benefit
May improve QoL with distressing anorexia
Progesterone analogs, corticosteroids, cannabinoids
Is artificial nutrition and hydration ever used for A-C
Not indicated
No evidence that it prolongs life or improves QoL
Not without risks
4 ways parasites can cause disease in humans
Mechanical effects
Invasion and destruction of host cells
Allergic or inflammatory immune reaction
Competition for specific nutrients
Trophozoites vs cysts
Two life stages of protozoa
Trophs: motile, delicate, usually non-infectious
Cysts: resting stage, tough, infectious via fecal oral route
Giardia lamblia symptoms
Can have asymptomatic carriage
Chronic watery diarrhea, cramping, bloating
NO VOMITING
Chronic malabsorption and weight loss
Giardia lamblia
- Risk factors for infection
- Diagnosis
- Treatment
- Contaminated well or stream water, day care centers, sexual transmission (MSM)
- Wet mount of stool sample, antigen detection (EIA)
- Metronidazole
Entamoeba histolytica symptoms
Can have asymptomatic carriage (E. dispar)
Diarrhea, abdominal pain, dysentery
Liver, lung, brain abscesses
Entamoeba histolytica
- Risk factors for infection
- Diagnosis
- Contaminated food/water, travellers/immigrants, sexual transmission (MSM)
- Wet mount of stool sample, antigen detection (EIA), Antibody detection
Treatment for Entamoeba histolytica
Metronidazole (for the trophs)
Iodoquinol/Paramomycin (for cysts)
3 groups of helminths
Trematodes (schistosomes vs non-schistosomes)
Nematodes (filaria vs soil transmitted helminths)
Cestodes
3 main soil-transmitted helminths
Roundworm
Hookworm
Whipworm
3 ways worms cause malnutrition
Feeding on host tissues and blood (Fe and protein loss)
Competing for nutrients and causing malabsorption
Causing appetite loss, diarrhea or dysentery
Biggest human impact of helminths is on which age group? Why?
Children ages 3-8
Growth stunting, malnutrition and cognitive impairment
Species of 1. Roundworm 2. Hookworm 3. Whipworm that cause disease
- Ascaris lumbricoides
- Acyclostoma duodenale and Necator americanus
- Trichuris trichiura
