Lecture 25: Malnutrition

Question 1

___ is the science that studies the interaction between nutrients, and other substances in food in relation to maintenance, growth, reproduction, health, and disease of an organism

Answer 1

Nutrition

Question 2

___ is defined as a disease state in which an organism is not receiving required nutrients for it to be able to grow and reproduce

Answer 2

Malnutrition

Question 3

___is a disease state in which an organism is not consuming the minimum amount of various nutrients and/or enough calories for growth and reproduction. Also known as protein-energy malnutrition (PEM)

Answer 3

Undernutrition

Question 4

_____is a disease state in which an individual’s diet results in serious protein deprivation, but still significant caloric intake (carbohydrate-based diets)

Answer 4

Kwashiokor

Question 5

What are the clinical symptoms of Kwashiokor?

Answer 5

-Immune system compromised
-NO significant muscle wasting/loss of fat
-Edema (stomach)
-Poor wound healing
-Stunted growth
-Loss of hair/pigment
-Fatty liver
-Decreased serum albumin

Question 6

Marasmus is a disease state in which an individual’s _____ is greater than the individual’s protein deprivation

Answer 6

caloric deprivation (restriction; starvation conditions)

Question 7

What are the symptoms of Marasmus (chronic state)?

Answer 7

-Anemia
-No edema
-Low mortality
-Extreme muscle wasting (cachexia) and extreme loss of body fat
-Immune system preserved

Question 8

What is an example of non-adaptive malnutrition?

Answer 8

Kwashiokor
(high mortality pathological state)

Question 9

True or False: individuals with Marasmus display anemia and edema

Answer 9

False - individuals with Marasmus display anemia but NOT edema

Question 10

____ is a disease state in which an individual’s caloric deprivation is greater than the individual’s protein deprivation

Answer 10

Marasmus

Question 11

True or False: Extreme muscle wasting and extreme loss of body fat (cachexia) are seen in Kwashiorkor

Answer 11

False - extreme muscle wasting and extreme loss of body fat (cachexia) are seen in Marasmus

Question 12

How are the albumin levels of patients with Marasmus compare to those with kwashiorkor?

Answer 12

Albumin levels are normal in people with Marasmus
Albumin levels are elevated in people with Kwashiorkor

Question 13

True or False: The immune system is compromised in patients with marasmus

Answer 13

False - The immune system is compromised in patients with Kwashiorkor

Question 14

Cachexia is an adaptive response to ____

Answer 14

undernourishment

Question 15

True or False: Marasmus is a low mortality pathological state

Answer 15

True

Question 16

Under starvation conditions, individuals will lose ___ mass to adjust to reduced energy intake. The body uses ___ acids as a source of energy.

Answer 16

muscle; amino

Question 17

One physiological response to starvation is decreased energy expenditure (also known as: BMR_ due to decreased energy ___, decreased body __. This can lead to lethargy.

Answer 17

intake; mass

Question 18

Physiological fasting triggers oxidation of _____ and ___ to provide energy

Answer 18

oxidation of fatty acids and ketosis

Question 19

What mediates the physiological response to starvation?

Answer 19

Endocrine systems (insulin, glucagon, thyroid, adrenal)
Hematological changes (hemoglobin)

Question 20

True or False: During starvation conditions, insulin will be high and glucagon will be low

Answer 20

False
There will be low insulin levels and high glucagon levels (mediates breakdown of fats, proteins, breakdown of glycogen)

Question 21

True or False:
During starvation conditions, (adrenal glands) epinephrine will become elevated while thyroid hormone will decline

Answer 21

True

Question 22

True or False: During starvation conditions, individuals may develop anemia

Answer 22

True

Question 23

Glycogen can be broken down into ____ while protein can be broken down into amino acids, which can be used for the process of ____ in the liver.

Answer 23

glucose; gluconeogenesis

Question 24

During starvation conditions, adipose tissue can be broken into free fatty acids. These can either provide energy (muscle) or make ___ in the liver and provide energy to brain and muscle

Answer 24

ketones

Question 25

How does the physiological response to starvation change when starvation is acute (1-3 days) vs. chronic (10-15 days)?

Answer 25

Under chronic conditions: -more ketogenesis in liver to supply brain and muscle w ketones -more break down of fat Under acute condtions: -gluconeogenesis predominates in liver -brain is supplied w glucose -muscle broken down to get amino acids for gluconeogenesis

Question 26

How can you calculate BMI?

Answer 26

BMI = 703 x (weight)/(height)^2

Question 27

BMI less than 25 is considered ___ weight while over 25 is considered ___

Answer 27

normal; overweight

Question 28

BMI greater than 30 indicates ___ while BMI greater than 40 indicates ___

Answer 28

obesity; morbid obesity

Question 29

If patient is older than 70 years of age, has BMI greater than 20.5, is critically ill, or had a reduced food intake in past week, you should screen them for _____

Answer 29

malnutrition

Question 30

True or False: Albumin, Pre-Albumin, Tranferrin, and CRP are made in the liver

Answer 30

True

Question 31

Can you use albumin as nutritional marker in patient with infection/inflammation or liver/renal failure?

Answer 31

No

Question 32

Why could someone who is malnourished have normal looking albumin levels?

Answer 32

Dehydration

Question 33

What is a good clinical marker for malnutrition?

Answer 33

Albumin (unless inflammation/infection/kidney or liver failure)

Question 34

How do you treat PEM?

Answer 34

1) slow increase in food intake (enteral or parenteral) 2) slow increase in protein intake 3) monitor/reintroduce electrolytes 4) avoid re-feeding syndrome (hypophosphatemia)

Question 35

____syndrome is re-introduction of nutrients in a malnourished individuals trigger the synthesis of proteins, fats, and glycogen, which depletes the serum of potassium, magnesium, and phosphorus (hypophosphatemia)

Answer 35

Re-feeding Syndrome

Question 36

What can be the consequences of malnutrition?

Answer 36

cardiac, pulmonary, and neurological consequences (can be fatal!)