Flashcards in Nutrition Module 12: Nutrition Support Deck (63)
What 4 events are bypassed during IV feeding?
1. Stimulation of mucosal cells
2. Stimulation of GI hormonal response
3. Direct transport to the liver (first pass)
4. Packaging of lipids in chylomicrons
What are some of the long term complications of IV feeding associated with?
Lack of stimulation of GI tract and CKK
What happens to the lumen of the GI tract when it does not receive nutrients for a while?
1. Decreased overall weight of tissue
2. Shortened microvilli
3. Decreased absorptive area
4. Openings on surface
5. Impaired barrier function
What ion causes CKK secretion?
What GI tract hormone stimulates pancreatic secretions?
What AA is an important oxidative fuel for the intestinal mucosa?
What is glutamine a precursor for?
Why is glutamine conditionally essential?
Because needed in diet in severe illness
What causes large amounts of glutamine to be released for gluconeogenesis? From where?
From lungs and skeletal muscle
What would a lack of glutamine in the intestine cause?
Deterioration of mucosal barrier
What foods contain glutamine?
All natural proteins
Is glutamine used in enteral formulas?
Is glutamine used in parenteral formulas? Why?
NOPE because short-lived in solution (but can be added individually)
What are the 3 functions of short-chain FAs?
1. Energy source for intestinal enterocytes and liver
2. Maintain integrity of large intestine by stimulating proliferation and increasing blood flow
3. Stimulate intestinal water and sodium absorption
What are short FAs produced by in the intestine?
Bacteria from dietary fiber
What 10 conditions require specialized nutrition support?
3. Unable to swallow
4. Vomiting (eg: pregnant)
6. GI obstruction
8. Very high energy demands: trauma, major surgery, burns, sepsis
9. Failure to thrive
10. Eating disorder
What organ gets first access to most nutrients?
Why can parenteral feedback affect lipid clearance and metabolism?
Because lipids enter the circulation directly as droplets instead of having the liver control distribution and having normal packaging and apoproteins to regulate absorption
Where is food received in enteral feeding?
Stomach or small intestine
When should supplemental nutrition be initiated?
When inadequate oral intake is expected over a 7 to 14 day period
What are the 3 compartments the body can be divided in? How do these differ between men and women? Include % and acronyms for each.
1. Bone mass (3% lower in women): 12-15%
2. FM = Fat mass (10% higher in women): 15-25%
3. LBM = Metabolic tissues and water (7% lower in women): 63-70%
What does FFM stand for?
Fat Free Mass = body mass - FM
What is a good predictor of basal metabolic rate?
What is one way of estimating LBM? Why?
Creatinine index because it's produced by muscle at a rate proportional to muscle mass and is only excreted in urine
How to calculate the creatinine height index?
CHI (%) = measured 24h urine creatinine / ideal 24h creatinine for height/gender based on healthy young adults *100
For what patients does the creatinine height index grossly overestimates LBM?
Stressed patients where muscle metabolism is high
For what patients does the creatinine height index grossly underestimates LBM?
Vegetarians because of low creatinine intake
What does the amount of increased energy needs depend on in stressed patients?
Degree of illness
What is one way of measuring total energy expenditure?