Malnutrition Maclary Flashcards
(98 cards)
1
Q
Definition of malnutrition
A
Insufficient energy and/or protein available to meet metabolic demands
2
Q
Definition of macronutrient malnutrition
A
Deficiency in protein energy intake
3
Q
Definition of micronutrient malnutrition
A
Deficiency in vitamin and mineral intake
4
Q
Types of malnutrition
A
- Macronutrient
- Micronutrient
5
Q
What is necessary to maintain stable weight?
A
Energy input = energy output
6
Q
Standard unit of energy
A
Calorie or kilocalorie
1 kcal = 1000 cal
7
Q
How many kcal/gram in carbs, fat, and protein?
A
- 4.1 kcal/gram of carbs
- 9.3 kcal/gram of fat
- 4.1 kcal/gram of protein
8
Q
Average energy intake for American male per day
A
2600 kcal/day
9
Q
Average energy intake for American female per day
A
1900 kcal/day
10
Q
How to estimate caloric need?
A
Calculate resting energy
- males 900 kcal + 10x kg mass
- females 700 kcal + 7x kg mass
11
Q
Protein requirement per day
A
0.6 g/kg
10-14% of calories
12
Q
Fat requirement per day
A
No more than 30% calories
13
Q
Carbs requirement per day
A
45-55% of calories
14
Q
Describe carbohydrates
A
- Main source of fuel
- Easily used for energy
- Stored in liver and muscle for later use
- Found in grains, potatoes, fruits, milk, veggies
15
Q
What is the main source of fuel?
A
Carbohydrates
16
Q
Describe protein
A
- Needed for growth
- Tissue repair and immune function
- Energy source when carbs are not available
- Preserves lean muscle mass
- Found in meats, fish, cheese
17
Q
Describe fats
A
- Some needed for survival
- Needed for normal growth/development
- Absorbs certain vitamins
- Provides cushion for organs
- Found in meat, nuts, dairy
18
Q
Describe water as a nutrient
A
- Regulation of core temp
- Transport of nutrients, O2, waste
- Amt decreases w/aging
19
Q
What contributes to a third of all deaths in children under 5?
A
Malnutrition
20
Q
Where are 80% of the world’s undernourished children located?
A
Just 20 countries around the world
21
Q
Malnutrition affects which populations?
A
Both rural and urban
22
Q
Which developing country has the highest rate of undernourished children?
A
India
23
Q
Which developing countries have highest prevalence of undernutrition?
A
South Asia
Sub-Saharan Africa
24
Q
Direct etiologies of malnutrition
A
- Primary (inadequate food intake)
- Secondary (underlying disease)
25
Indirect causes of malnutrition
Poverty, poor health, war, discrimination, governmental
26
What percent of weight loss is usually tolerated without loss of physiologic function?
5-10%
27
What percent of weight loss usually results in death?
35-40%
28
Which organ systems does malnutrition affect?
Every organ system
29
Factors to evaluate while screening for malnutrition:
- Underweight
- Poor intake
- Hypermetabolic states
- Alcohol or drug abuse
30
What screening tool is used for malnutrition?
MUST (5 step screening for adults)
1. BMI
2. Weight loss
3. Acute disease
4. Evaluate risk
5. Record score and start care plan
31
Treatment of malnutrition
- Treat underlying process
- Diet modification
- Replenish micronutrients
- Referrals
32
Types of macronutrient malnutrition
1. Marasmus/cachexia
| 2. Kwashiorkor/protein calorie malnutrition
33
Define marasmus
- All available body fat stores have been exhausted d/t starvation
- Decreased energy intake
- Can be a chronic state
34
How long does it take to develop marasmus?
May take months to years
35
Define cachexia
Involves substantial loss of lean body mass d/t chronic systemic inflammation
36
Marasmus commonly occurs with what health condition?
Anorexia nervosa
37
Cachexia commonly occurs with what health condition?
COPD
| *Any other chronic disease state
38
Clinical features of marasmus
- Starved appearance
- Wt less than 80% standard for height
- Triceps skinfold less than 3 mm
- Midarm muscle circumference less than 15 cm
- Absolute weakness
39
Immunocompetence, wound healing, ability to handle short term stress is well preserved in which condition?
Marasmus
40
What is low creatinine height index possibly seen in and what does it reflect?
- Marasmus
| - Reflects loss of muscle mass
41
A slightly decreased serum albumin is seen in what condition?
Marasmus
42
Treatment of marasmus
- Cautious and slow
- Body needs to readapt
- Oral nutritional support is preferred
43
What nutritional support is preferred in treating marasmus?
Oral
44
Define kwashiorkor
- Protein malnutrition
| - Acute life threatening illness such as sepsis and trauma
45
Clinical features of kwashiorkor
- May be subtle at first
- Easy hair pluck
- Edema
- Skin breakdown
- Poor wound healing
- Pot belly appearance
46
Which type of malnutrition usually has drastic lab abnormalities?
Kwashiorkor
47
Lab findings of kwashiorkor
- Serum albumin less than 2.8
- Total iron binding capacity less than 200
- Lymphocytes less than 1500
48
Treatment of kwashiorkor
- Aggressive nutritional support
- Restore balance quickly
- Parenteral replacement
49
Which type of malnutrition requires quick and aggressive nutritional support?
Kwashiorkor
50
Which type of malnutrition requires slow restoration of nutrition?
Marasmus
51
What is the prognosis of kwashiorkor?
Poor - high mortality rate
52
How does metabolic rate change in starvation and semistarvation?
- Falls between 10 and 30%
- Body's response to energy restriction
- Wt loss is slowed by this process
53
How is metabolic rate affected by physiologic stress?
- Resting rate rises
| - Degree of rise depends on degree of stress (e.g. elective surgery only 10% rise vs. major burns with 110% rise)
54
Types of metabolic states (define and what malnutrition state are they at risk for)
- Hypermetabolic (stressed from injury/infection, risk for kwashiorkor)
- Hypometabolic (unstressed but chronically starved, risk for marasmus)
55
Which type of metabolic state causes an increased risk for marasmus?
Hypometabolic state
56
Which type of metabolic state causes an increased risk for kwashiorkor?
Hypermetabolic state
57
How is rate of catabolism affected by stress or injury?
Rate increases proportional to degree of injury
58
What are the major gluconeogenic tissues?
Liver and kidney
59
Key gluconeogenic enzymes are expressed where?
Small intestine
60
What is glucose especially necessary for?
- Nervous system
| - Erythrocytes
61
Vit B1 (thiamine) deficiency causes
- Lack of thiamine intake (alcoholic, starvation, gastric bypass)
- Increased depletion (diuretics, diarrhea)
- Decreased absorption (chronic intestinal disease, malnutrition)
62
Prolonged thiamine deficiency causes:
Beriberi
63
What causes Wernicke encephalopathy?
Thiamine deficiency
64
What causes Wernick-Korsakoff syndrome?
Thiamine deficiency
65
Describe Wernicke encephalopathy
- Occurs in alcoholic pts w/thiamine deficiency
| - Acute sequence of vomiting, horizontal nystagmus, fever, ataxia, progressive mental impairment
66
Describe Wernicke-Korsakoff syndrome
- Chronic thiamine deficiency
- Memory loss
- Confabulatory psychosis
67
Describe riboflavin and how it is affected
- Vit B2
| - Glass milk containers promote degradation of the vitamin from exposure to light
68
Clinical findings of riboflavin deficiency
- Cheilitis (chapping/fissuring of lips)
- Sore red tongue
- Oily scaly skin
69
Vitamin B3 is also called
Niacin
70
Niacin deficiency
- Diarrhea, dermatitis, dementia, death
| - Pellagra (scaly sores, mucosal changes)
71
Vitamin B5 is also called
Pantothenic acid
72
Clinical findings of Vit B5 deficiency
Nonspecific symptoms
73
Vit B6 is also called
Pyridoxine
74
Vit B6 deficiency
Rare bc it is found in a lot of foods
75
Vit B12 is also called
Cobalamin
76
Vit B12 deficiency occurs in what pts?
- Inadequate intake (alcoholics, vegetarians)
| - Malabsorption (lack of intrinsic factor like in pernicious anemia)
77
Vit B9 is also called
Folic acid
78
Causes of Vit B9 deficiency
- Poor diet
- Malabsorption
- Deficiency in B12
- Anticonvulsants
79
Vit C is also called
Ascorbic acid
80
Causes of Vit C deficiency
- Poor diet
- Smokers
- Increased consumption states (pregnancy, lactation)
81
How does scurvy present?
- Easy bruising
- Gingivitis
- Decreased wound healing rate
- Dry, splitting hair
82
Vit A deficiency
- Uncommon in US
| - Caused by poor diet, malabsorption, vegans, alcoholics
83
Bitot spots occur with what deficiency?
Vit A deficiency
| esp young children
84
What are bitot spots?
- Area of abnormal squamous cell proliferation and keratinization of the conjunctiva
- Can be seen in young children with Vit A deficiency
85
Clinical presentation of Vit A deficiency
- Bitot spots
- Night blindness
- Xerophthalmia
86
Causes of Vit E deficiency
- Pts who cannot absorb dietary fat
- Premature infants w/low birth wt
- Rare disorders of fat metabolism
87
Clinical presentation of Vit E deficiency
- Anemia
- Impairment of immune response
- Male infertility
- Neuromuscular problems
88
Presentation of acute calcium deficiency
- Convulsions
- Arrhythmias
- Tetany
- Numbness in hands, feet, around mouth and lips
89
Presentation of long term calcium deficiency
- Rickets
| - Osteoporosis
90
Causes of calcium deficiency
- HypoPTH
- Eating disorders
- Excessive dietary Mg
- CKD
- Absence of Vit D
91
What is the function of zinc?
- Cell division
- Clotting
- DNA synth
- Protein synth
92
Define acrodermatitis enteropathica
Autosomal recessive metabolic disorder affecting the uptake of zinc
93
Function of copper
Bone and CT production
94
Why is copper deficiency rare?
Body requirements are very low
95
What causes copper deficiency?
- Bariatric surgery
- Menkes disease
- Wilson's disease
96
What is considered clinically significant involuntary weight loss?
10 lbs or 5+% over a 6-12 month timeframe
97
Main categories of involuntary weight loss
1. Malignant neoplasms
2. Chronic inflammatory or infectious diseases
3. Metabolic disorders (DM)
4. Psych
98
Major manifestations of involuntary weight loss
1. Anorexia
2. Sarcopenia
3. Cachexia
4. Dehydration
