Nutrition in Health and Disease

Question 1

diet

Answer 1

sum of total of all foods ingested

Question 2

food

Answer 2

individual item ingested

Question 3

nutrients

Answer 3

chemically defined compounds required by the body

Question 4

variable components of energy demand in the body

Answer 4

• processing of dietary intake
• physical activity
• maintaining body temperature
• growth

Question 5

what is used to estimate nutritional requirements of a person

Answer 5

basal metabolic rate (via Schofield equation)

Question 6

Key concepts of nutritional failure

Answer 6

• failure to meet the nutritional requirements of the individual
• development of deficiencies
• weight loss
• obesity

Question 7

different ways malnutrition can present

Answer 7

• marasmus
• kwashiorkor
• obesity

Question 8

malnutrition definition

Answer 8

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

Question 9

how do we define over-nutrition

Answer 9

BMI>25 overweight

BMI>30 obese

Question 10

how is malnutrition defined

Answer 10

BMI < 20 underweight
BMI < 18 physical impairment
BMI < 16 increasingly severe consequences

Question 11

malnutrition universal screening tool

Answer 11

• picks up patients at risk of malnutrition
• validated in the community and hospital
• can be carried out by people without special training

Question 12

what score on the malnutrition universal screening tool suggests malnutrition

Answer 12

2+

Question 13

what factors increase risk of malnutrition

Answer 13

increasing age
female
social isolation
illness
socially vulnerable groups

Question 14

clinical consequences of malnutrition

Answer 14

• impaired immune function
• reduced muscle strength
• impaired wound healing
• impaired psycho-social function
• poorer clinical outcomes
• impaired recovery from illness and surgery

Question 15

how much does undernutrition cost the UK per annum

Answer 15

£13billion

Question 16

what is the procedure for determining treatment in a patient with suspected malnutrition

Answer 16

• take a history
• examine the patient
• analyse the problem
• work out what their nutritional requirement is

Question 17

2 ways of working out nutritional requirement, and which is easier and harder

Answer 17

1. work it out yourself using the Schofield method

2. refer patient to a dietician and get them to work out the nutritional requirement

Question 18

3 primary causes of undernutrition

Answer 18

1. appetite failure
2. access failure
3. intestinal failure

Question 19

examples of appetite failure

Answer 19

• anorexia nervosa

- disease related

Question 20

examples of access failure that can lead to malnutrition

Answer 20

• teeth
• stroke
• cancer of head and neck
• head injury

Question 21

describe intestinal failure

Answer 21

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

Question 22

solutions to access problems

Answer 22

fine bore nasogastric tube

PEG

Question 23

describe a percutaneous endoscopic gastronomy

Answer 23

patient sedated

endoscopy carried out

needle and guide-wire into stomach

tube pulled back down and out of the skin

can be placed radiologically

safe but carries definite risks

can last 18 months without replacement

can be used at home

Question 24

management of nutritional failure

Answer 24

• establish IV feeding
• deal with sepsis urgently
• small amounts of enteral feeding