Nutrition

Question 1

what affects food choice?

Answer 1

> likes and dislikes
religious and ethical considerations
social and psychological components

Question 2

what makes up the fixed component of demand of food?

Answer 2

> basal requirements (membrane function; pumps, transport, signalling)
mechanical work (cellular and tissue level)
substrate turnover

Question 3

what part of the demand for food is variable?

Answer 3

> cost of processing dietary intake
physical activity
maintaining body temperature
growth

Question 4

how can the basal metabolic rate be calculated?

Answer 4

by direct calorimetry

depends in lean body mass and there are various adjustment factors for activity and illness.

Question 5

what does the metabolic supply fall onto?

Answer 5

the gut and its associated organs

Question 6

define nutritional failure

Answer 6

> failure to meet nutritional requirements of the individual resulting in the development of deficiencies or excess

Question 7

what is marasmus?

Answer 7

deficiency in both proteins and calories resulting in severe wasting in infants

Question 8

what is kwashiorkor?

Answer 8

Protein calorie malnutrition with an acute or chronic inflammatory component (leaky capillaries, fluid retention, ascites)

Question 9

define malnutrition

Answer 9

a state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body form, function and clinical outcome

Question 10

what bmi is overweight?

Answer 10

> 25

Question 11

what bmi is classed as obese?

Answer 11

> 30

Question 12

what can lead to obesity?

Answer 12

> environment
exercise
genes

Question 13

what metabolic syndromes can arise from obesity?

Answer 13

> hypertension
> cv disease
> type 2 diabetes
> fatty liver
> NASH
> cirrhosis

Question 14

what cancers can obesity lead to?

Answer 14

> breast

> bowel

Question 15

what bmi is underweight?

Answer 15

< 20

Question 16

at what bmi is the patient considered physically impaired?

Answer 16

<18

Question 17

at what bmi is there increasingly severe consequences in under nutrition?

Answer 17

<16

Question 18

what percentage of body mass loss is associated with increasing morbidity?

Answer 18

10%

Question 19

what is used to screen for under nutrition?

Answer 19

the MUST, malnutrition universal screening tool. this can be carried out by people without special training.

Question 20

what is step one on the MUST?

Answer 20

calculate their BMI
< 20 score 1
< 18 score 2

Question 21

what is step 2 in MUST?

Answer 21

have you unintentionally lost weight in the last 3-6months?
> yes 10% score 2
> yes 5% score 1

Question 22

what is step 3 in MUST?

Answer 22

has the patient eaten in the last 5 days?

> no: score 2

Question 23

what would a score of 2 suggest?

Answer 23

a risk of under nutrition

Question 24

what would score 1 suggest?

Answer 24

supplements and watch

Question 25

what does malnutrition associate with?

Answer 25

> illness
social isolation
age
socially vulnerable groups

Question 26

what are the clinical consequences of malnutrition?

Answer 26

> impaired immune response
> reduced muscle strength
> impaired wound healing
> impaired psycho-social function
> impaired recovery from illness
> poorer outcomes

Question 27

what are the broad causes of under nutrition?

Answer 27

> appetite failure
access failure
intestinal failure

Question 28

what can lead to access failure of food?

Answer 28

> teeth
stroke
cancer of the head and neck
head injury

Question 29

define intestinal failure

Answer 29

reduction iin functioning gut mass below the minimal amount necessary for adequate digestion and absorption of nutrients

Question 30

describe percutaneous endoscopic gastrostomy

Answer 30

> patient sedated
needle and guidewire into the stomach via endoscopy
tube pulled back down and out of skin
can last 18 months without replacement