10. Nutritional Flashcards
(30 cards)
Define nutritional assessment
The evaluation of an individual’s nutritional status + nutrient requirements
Why is nutritional assessment so important?
Acute + chronic malnutrition prevalent
Over and under-nutrition increasing
As indicated by national diet + nutrition survey 2008-2012;
Sugars: 11% limit (4-18 years higher)
Sat fat: 11% limit (19-64 years 12.6%)
Salt: 6g/day (>65 years 7.2g/day)
Fruit + veg: 5 portions/day (19+ years eating less, particulary girls 11-18 years)
Oily fish: average intake well below rec 1 portion/week in all age groups
Vit D: low vit D status in 23% adults + 22% children over whole year
- increases to 40% in both groups in winter
Iron: 46% girls + 23% women low iron intakes
How does the northern Irish diet compare to the rest of the UK?
Consume more unhealthy foods;
- milk/cream, carcass meat, butter, fresh potatoes (+78%)
Less healthy foods;
- margarine (-60%), fresh fish, fruit juice, other fresh produce
People living in London consumed nearly twice as much fresh fruit + veg as people living in N Ireland
How is nutritional status assessed?
History
Examination
Lab tests
What factors are identified in a general medical history that affect or indicate nutritional status?
Obesity Hyperlipidemia/CVD Hypertension Diabetes Alcoholism Failure-to-thrive Eating disorder Weight loss/gain Lactose intolerance GI disorders
What medications + vitamin/mineral supplements affect nutritional status?
Pharmaceutical agents
Over the counter medications
Vitamin + mineral intake
Herbal remedies
What social history + diet information (non medical) can be useful in a general history for assessing nutritional status?
Lifestyle assessment: employment + exercise
Alcohol history
Following special diet
How is a persons functional status assessed?
By Activities of Daily Living (ADLs);
- bathing
- dressing
- toileting
- transferring
- continence
- feeding
How is a persons diet history determined?
- 24 hour recall
- food frequency
- usual intake
- food record
Describe the 24 hour recall method for determining diet history
Documents pts intake of all food + beverage during previous 24 hr period
Ideal for;
- pts with diabetes: ability to assess timing of meals, snacks, insulin injections
Limitations;
- many pts do not rmb what they ate + cannot accurately estimate quantities consumed
Describe the Food Frequency method for determining diet history
Estimate the frequency + quantity of foods eaten during a weekly/monthly period;
- how often do you consume X during a typical week?
- how often do you eat out during a typical week?
Ideal method to evaluate intake of;
- fat
- sodium
- sugar
- dairy
- fruit/veg intake
Ideal for;
- pts with CVD, hypertension, osteoporosis
- pts questioning requirement of vitamin supp
- elderly pts who avoid food groups
Limitations;
- many pts do not remember what they ate + cannot accurately estimate quantities consumed
Describe the Usual Intake Method of determining diet history
Documents a pts usual intake, including breakfast, lunch, dinner + snacks
Ideal for;
- elderly pts (assess no meals eaten/skipped)
- infants/children/adolescents whose diets are not varied
Limitations;
- many pts not consistent with eating habits + state there is no usual pattern
List what a physical exam can reveal about a pts nutritional status
Head/neck: temporal wasting Triceps: skin fold measurements Hands: interosseus muscle wasting Mouth: condition of teeth, gums, tongue Abdomen: ascites, site of jejunostomy tube Skin: xanthomas, rash, edema
What is commonly examined in a laboratory evaluation of nutritional status?
Anaemia: Fe, folate, vitamin B12
Micronutrients
General malnutrition: serum proteins
Discuss the lab evaluation of serum proteins in assessing nutritional status
Albumin: 18-20 day half life
- slow fall in malnut/slow rise with repletion
- 50-60% blood plasma proteins
- ref range: 3.5-6.5 g/dL
Transferrin: 8-9 day half life
- influenced by status of iron stores
- TIBC measures capacity to bind iron with tf
- TIBC ref range: 250-370ug/dL
Prealbumin: 2-3 day half life
- decreases early in malnut/increases quick with repletion
- ref range: 19-38mg/dL
Changes in serum proteins indicate; Normal/increased levels; - increased synthesis - decreased losses - dehydration - well nourished
Decreased levels;
- decreased synthesis
- increased losses
- dilutional effect
- malnutrition
Define malnutrition
An unintentional weight loss of greater than 10% of body weight associated with serum albumin <3.5g/dL
What types of pts are at risk of malnutrition?
50% of hospitalised surgical pts experience malnutrition
What is MUST + how is it used in nutritional assessment?
MUST = Malnutrition Universal Screening Tool
5 step screening tool to identify adults who are;
- malnourished
- at risk of malnutrition (undernutrition)
- obese
Includes management guidelines - can be used to develop care plan
Used in hospitals, community + other care settings
Step 1: height + weight = BMI score
Step 2: note % unplanned weight loss + score
Step 3: Establish acute disease effect + score
Step 4: Add scores from previous steps to obtain overall risk of malnutrition
Step 5: Use management guidelines/local policy to develop care plan
What is malnutrition associated with (regardless of aetiology)?
Sub-optimal surgical outcome Increased rate of infection Longer hospital stay Impaired wound healing Frequent hospital re-admission for elderly More frequent post-op complications Increased risk of death
What are the 2 main types of malnutrition?
Marasmus: protein-energy malnutrition
Kwashiorkor: protein malnutrition
Describe marasmus
Protein-energy malnutrition;
- severe tissue wasting
- excessive loss of lean body mass + fat stores
- dehydration
- weight loss
S+Ss;
- normal hair
- old man appearance
- thin limbs with little muscle or fat
- very underweight body
Describe kwashiorkor
Protein malnutrition;
- retarded growth
- changes in skin + hair pigmentation
- edema
- low serum albumin
S+Ss;
- swelling of legs (edema)
- sparse hair
- moon face with little interest in surroundings
- flaky appearance of skin
- swollen abdomen
- thin muscles but fat present
Describe the main mechanisms of malnutrition
Impaired dietary intake
Malabsorption;
- coeliac disease
- Crohn’s disease
- short bowel syndrome (trauma/surgery, etc)
What are the routes for nutritional support?
Oral supplements Tube feeding; - nasogastric (NG) - naso-jejunal (NJ) - gastrostomy - jejunostomy Parenteral (IV)
