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Z Nutrition Assessment Exam #1 > Chapter 8 & 9 > Flashcards

Chapter 8 & 9 Flashcards

1
Q

What is biomarker assessment?

What are characteristics of a nutritional biomarker?

A

*Involves the use of biologically available chemicals inside the body that perform as objective indicators of health/nutrition status

Involves a nutritional biomarker:
* An organic test used as an indicator of nutritional
status if it relates to the intake or metabolism of dietary components
* Can be a biochemical, functional, or clinical index of the status of an essential nutrient / dietary component

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2
Q

Purpose of biomarker assessment?

A

*Help clinicians, researchers, and policy makers
make diet and nutrition recommendations to
address disease and improve both individual and public health

*Is more objective and precise for measuring nutritional status than community and dietary
assessments are

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3
Q

Benefits of biomarker assessment?

A

*Has no bias of self-reported dietary intake errors
*Has no challenge of intra-individual and diet variability
*In the nutrition framework, biomarkers are classified as markers of exposure, status, and function or effect

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4
Q

What is the difference between function and effect biomarkers

A

*Function biomarkers: help describe the role of specific nutrients and potential interactions between different nutrients in biological
systems.
*They also classify the roles of nutrients across the lifespan and under different physiological
states.

*Effect biomarkers: help us understand the direct and indirect results—that is, those affecting cells and those affecting system function—of a nutrient deficiency.

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5
Q

What does creatinine protein measure?
What does high value indicate?

A

Measures kidney function, high with muscle wasting or
malnutrition

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6
Q

What does dietary protein measure?

A

Measures nutrient intake

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7
Q

What does high and low Albumin indicate?

A

Low with acute infection, trauma
High with dehydration

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8
Q

What do abnormal Prealbumin levels indicate?

A

high/low with liver disease; inflammation

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9
Q

What does Transferrin do?
What nutritional status does it correlate with?

A

*Transports iron from absorption centers in the duodenum (intestines) and white-blood-cell
macrophages to all tissues
*Not a reliable indicator of nutritional status alone

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10
Q

What does high Retinol Binding Protein (RBP) indicate?

A

High with chronic illnesses (i.e. Type 2 Diabetes)

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11
Q

What does low and high serum Ferritin (Iron) indicate?

A

Low with iron-deficiency anemia
High in autoimmune conditions

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12
Q

What does high Soluble Transferrin Receptor (sTfR) indicate?

A

High with iron-deficiency anemia

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13
Q

What can an abnormal Hematocrit indicate?

A

High with sickle-cell anemia, thalassemia, and iron deficiency

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14
Q

What does abnormal Mean Corpuscular Hemoglobin (MCH) indicate?

A

Low with iron deficiency and thalassemia
High with macrocytosis

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15
Q

What does abnormal Mean Corpuscular Volume (MCV) indicate?

A

High levels indicate B12 and/or folate deficiency

High/Low indicates iron-deficiency anemia

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16
Q

What does abnormal Hemoglobin (Hgb) indicate? When combined with what other factors?

A

When low in combination with low HCT & high/low MCV, indicates iron-deficiency anemia

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17
Q

What does abnormal zinc levels indicate?

A

Low in urine/blood with acute infection/trauma, GI malabsorption, or nutrient deficiency
Often low in combination with low albumin

High in urine indicates too much dietary intake

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18
Q

What does low calcium indicate?

A

Low levels indicate hypocalcemia

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19
Q

What does abnormal Iodine indicate?

A

Low in cases of hypothyroidism, mental retardation, goiter, cretinism, developmental irregularities

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20
Q

What does abnormal Phosphorous (P, PO4) levels indicate?

A

high/low related to phosphorus/calicum-balance related
conditions

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21
Q

What does abnormal Potassium (K) indicate?

A

High in hypkalemia; low in hypokalemia

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22
Q

What does abnormal sodium (Na) levels indicate)?

A

Low with hyponatremia (due to diarrhea/vomiting,
diuretics, kidney disease

High with hypernatremia (due to dehydration, Cusher’s Syndrome

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23
Q

What does Vitamin A abnormal levels indicate?

A

Low with dietary deficiency
May be artificially low with severe protein-calorie malnutrition

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24
Q

What does abnormalities in Vitamin D indicate?

A

Low with autoimmune conditions, Type II diabetes, rickets, osteopenia, osteoporosis Low with poor dietary intake/low sunlight

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25
Q

What can abnormal vitamin C indicate?

A

Deficiency rare, low with chronic smoking

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26
Q

What can Vitamin B6 abnormalities indicate?

A

Rare to be low, unless accompanied with low B12 and folate

Can be low with illness

27
Q

What does abnormal folate indicate?

A

May be low with poor dietary intake, excessive alcohol consumption, malabsorption disorders. Often associated with low B12/B6

28
Q

What can B12 abnormalities indicate?

A

Low with pernicious anemia, postsurgical malabsorption,
dietary deficiencies

29
Q

What can Alanine Aminotransferase (ALT) abnormalities indicate?

A

High indicates liver injury; extremely high indicate acute hepatitis or overwhelming exposure to toxin/drug

30
Q

What can Bilirubin abnormalities indicate?

A

Elevated with jaundice, liver cirrhosis, pernicious anemia, acute hepatitis

31
Q

What does Blood Urea Nitrogen (BUN) indicate?

A

High or low indicate poor liver or kidney function

32
Q

What can CO2 test indicate?

A

high/low indicates imbalance acid-base

33
Q

What levels of cholesterol indicate what?

A

Below 200, low risk for CVD
Between 200-239 moderate risk for CVD
Above 240 high risk CVD

34
Q

What level of triglycerides indicate what?

A

Less than 150 low risk for CVD
150-199 borderline high risk
200-500 high risk
Greater than 500, very high risk

35
Q

What levels of HDL are crucial?

A

Above 40 low risk
Less than 40 moderate-high risk

36
Q

What level of HDL are good?

A

Above 40 low risk
Less than 40 moderate-high risk

37
Q

What is the greatest thing to consider when evaluating lipid profiles?

A

Note lipid ratio is greatest indicator
of risk!

38
Q

What blood glucose ranges are good?

A

0-99 normal; greater than 99 indicates increased risk for type II diabetes. Sometimes elevated with illness

39
Q

What levels of A1C are important?

A

Indicates long-term blood sugar status:
5.7-6.4% prediabetes
6.5% or great indicates type II diabetes

40
Q

What does a NFPE provide?
What does a NFPE include?
What does a NFPE help identify?
What techniques does NFPE use?
What body parts does a NFPE look at?

A

Nutrition-Focused Physical
Examination (NFPE)
*Provides information that cannot be gleaned from the food- and nutrition-related history, client history, anthropometric measurements,
biochemical data, and medical tests and procedures
*Includes evaluation of physical appearance, muscle and fat wasting, swallowing function, appetite, and affect, which can help determine
nutritional status, signs of malnutrition, and nutrient deficiencies
*Helps identify two general categories for potential nutrient deficiencies: macronutrients (energy, protein, fluids) or micronutrients
(vitamins or minerals)
*Techniques used in the NFPE include
inspection, palpation, percussion and
inspection—the most commonly used
technique.
*Skin, hair and eyes, oral cavity (mouth, lips, and tongue), neck, nails, abdomen, bones, muscles

41
Q

What is sarcopenia?
What losses does it include?
Time frame of sarcopenia?
How define for diagnostic purposes?
What type of state might it induce?
How can it be described?

A
  • A loss of skeletal muscle mass and strength with aging
  • Includes a loss of α-motor neuron input, changes in anabolic hormones, decreased intake of dietary protein, and a decline in physical activity
  • Loss of muscle mass can begin as early as the fourth decade of life, with evidence suggesting that skeletal muscle mass and skeletal muscle strength decline in a linear fashion, with as much as 50% of mass being lost by the eighth decade of life.
  • For diagnostic purposes, defined as appendicular skeletal muscle mass/height2 (square meters) that
    is less than two standard deviations below the mean for young and healthy reference populations
  • May be a “smoldering” inflammatory state propelled by both cytokines and oxidative stress
  • May be described as a condition of both cachexia and failure to thrive
  • Sarcopenic obesity
42
Q

What are characteristics of a subjective global assessment tool?

A
  • Evaluates five components of a patient’s medical history (weight status, dietary-intake changes,
    gastrointestinal symptoms, functional capacity, and metabolic stress from disease)
  • Evaluates three components of physical examination (muscle wasting, fat depletion, and nutrition-related edema
  • Seven-point scale
  • Patient-generated subjective global assessment
    (PG-SGA) for individuals with cancer
43
Q

What is anthropometry?
What measurements does it include?
Why are these chosen?

A

*The study of the measurement of the human body in terms of the dimensions of bone, muscle, and adipose (fat) tissue
*Includes the measurement of weight, height, weight changes, and body composition, including body mass index (BMI)
*Some measurements are easy, noninvasive, and inexpensive.
*Others require specialized equipment and training.

44
Q

Weight:
What does it monitor?
What does it not do?
How do be accurate?

A

*Used to monitor the patient’s or individual’s nutritional status and as a rough estimate of
energy stores
*Does not provide information on actual body composition
*Accuracy is important; adjust for casts, clothing, etc.
*Weight(s) and weight changes are part of the assessment

45
Q

Height:
Why accuracy?
Estimates?

A

*Accuracy needed, because body weight is compared to height
*Estimations: Arm span, knee height, forearm or ulnar length, segmental measurement

46
Q

Who is there recommendations for BMI and by who?

A

BMI recommendations per the Centers for Disease Control and Prevention (CDC) for adults 20 years of age and older, both male and female:

47
Q

What are other tools for anthropometry?

A

Skinfold
Circumference (calf, arm, waist, hip)
BIA
DXA
Air-Displacement Plethysmography

48
Q

How skinfold good?

A

*Skinfold measures: Relatively easy to measure and noninvasive. Unlike body weight, they are also less affected by hydration status.

49
Q

Waist measure standards?

A

Note: At BMIs equal to or more than 35, waist circumference has little additional predictive power
of disease risk beyond that of BMI

High risk of disease: men >102 cm (>40 inches), women > 88 cm (>35 inches)

50
Q

Waist-to-hip ratio standards?

A

Waist-to-hip ratio:
* For men, normal risk is a ratio of 0.90 or less
* For women, 0.80 or less
* For both men and women, a WTH ratio above 1.0 is
considered at risk for cardiovascular and other
chronic diseases

51
Q

What have studies shown in waist and waist-to-hip measures?

A
  • Studies show that waist circumference is more predictive of cardiovascular disease risk, while
    others have reported that WTH ratio is a more sensitive indicator of disease risk.
  • Both measurements have been found to be predictive of cardiovascular events.
52
Q

What is BIA?

A

Bioelectrical Impedance
Analysis (BIA)
*A relatively quick, simple, and noninvasive method to measure body composition (lean
body mass and fat mass)
*Electrical conductivity of lean mass vs. fat mass

53
Q

What is DXA

A

Dual-Energy X-Ray
Absorptiometry (DXA)
* Measures body composition as well as bone-mineral density to assess the risk of osteoporosis

54
Q

What is Air-Displacement Plethysmography?

A

Air-Displacement
Plethysmography
*Gold standard for getting fat mass vs. lean mass
*Underwater weighing (i.e., BODPOD)

55
Q

What general things does a client history provide?

A

*Provides information regarding acute and chronic medical conditions that can have an impact on nutrition status
*Personal history
* Medical, health, and family history
*Treatments and complementary or alternative medicine use
*Social history

56
Q

What is included in personal history?

A
  • Age; gender; race or ethnicity; language spoken and written; literacy factors such as a language barrier or low literacy; educational level;
    physical disability, including impaired vision, hearing, or other; and mobility
  • These data are important to the nutritional assessment, as the delivery of nutrition care and nutrition education and counseling may be
    affected by these factors.
57
Q

What is included in Medical, health, and family history?

A
  • Includes current and past medical diagnoses, conditions, and illnesses that can have an effect on nutritional status
58
Q

What does social history include?

A
  • Nonmedical factors can affect nutrition intake and the retention of nutrition education.
  • Socioeconomic factors, living or housing situations, domestic issues, social and medical support systems, geographic location of the home,
    occupation, religion, history of recent crisis, and daily stress level
59
Q

What does a nutrition and food related history include?

A

*Identifies current eating patterns and types and amounts of foods and beverages consumed

Information about a typical day’s eating pattern:
* Meals
* Beverages
* Snacks
* Occasional alternative foods consumed
* Usual portion sizes

Information about a typical day’s eating pattern:
* Past changes in eating patterns
* Food preferences and dislikes
* Food allergies
* Food intolerances or aversions
* Ethnic, cultural, and religious food practices and preferences

60
Q

What should be assessed in a food and nutrition related history?

When should data be collected?

What types of questions?

Can the histories be modified?

A

*Assess food security, transportation availability, cooking facilities, and health-related dietary restrictions.
*Assess medication regimen, alcohol
consumption, and nutritional and
non-nutritional supplement use.
*The diet history can be taken for a three-day period, with one weekend day, or for one day if time is a limiting factor.
*Questions should be specific and not
judgmental about food-intake behaviors, to promote open and honest answers.
*Food histories can be modified based on the presenting medical condition(s) of the client or patient to obtain additional information to aid in
planning for nutritional care

61
Q

What is 24 hour recall?

A

*Trained interviewer
*Generally takes about 20 minutes to 60 minutes to complete
*In person or by telephone
*Examples: USDA’s Automated Multiple-Pass Method, National Cancer Institute’s Automated
Self-Administered 24-hour (ASA24) dietary assessment tool

62
Q

Daily food checklist what is it?
Benefits?

A

*Provides a list of foods
*Over a one-day period, the respondent makes a check beside the food each time he or she
eats it.

Benefits:
* The individual does not need to recall foods eaten the previous day.
* Little effort is required to complete the list.

63
Q

What is a food frequency questionnaire?

A

*A defined list of foods and beverages, with response categories to indicate usual intake of food over a certain time period
*Approximately 80–120 foods and beverages included
*Usual portion size queried
*Can also include questions regarding
supplement intake
*Typically self-administered and can be completed in 30 to 60 minutes
*Used for large population studies
*Variations based on ethnic groups

Z Nutrition Assessment Exam #1 (3 decks)

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