Nutritional assessment Flashcards
(52 cards)
Albumin
35-50 g/L
Hb
< 120 g/L
<140 g/L
hematocrit (%)
< 37 % women, 40% men
glucose
3.9-6.1 mmol/L ( ~4-7mmol/L)
Nitrogen balance equation
( protein intake g / 6.25 ) - ( UUN +4 )
UUN in mmol= (UUN) x volume (L)
UNNmmol x ( 0.028g )
BMI
kg/ m^2
normal BMI
18.5 - 25
% weight change
( UBW- current)/ UBW x 100
- at risk if >5% in 1 mo, >10 % in 6 mo
to assess somatic protein levels?
N balance, creatine levels
4 major visceral proteins
albumin ( 17-21 days), transferritin ( 8-10 days), pre-albumin (2-4 days), RBP ( 10-12 hours)
albumin may be increased due to
dehydration ( diarrhea, vommiting )
albumin may be lowered not just due to inadequate protein but also
neg-acute protein, trauma, liver damage, over hydration, Mal- absorption, aging, edema
when would RBP and TTR be elevated? why?
renal disease, bc they are filtered and metabolized in the kidney
TTR also high in
hodgkins disease
RBP lowered also during?
liver disease, vit A def, zinc def, hyperthyroidism ( same as TTR)
transferrin high during
pregnancy, iron def
order of depletion for iron status
iron stores, transport iron, essential iron
lab tests for anemia
Hb
- if low further tests
serum ferritin ( would be low with low stores)
serum iron ( would also be low with deficiency )
total iron-binding capacity ( TIBC) –> need this to calculate transferrin saturation. if this is high it is indicative of iron def
transferrin saturation: would be lowered ( < 30% def)
erythrocyte protoporphyrin: severe iron def, protoporphyrin will replace Hb, so this would increase in late stages of iron def
- main markers are the first 3 ( hb, ferritin, TIBC)
waist circumference
if >120 W, >140 M, increased risk of CVD and diabetes independent of BMI
lab tests fro folate deficiency anemia
serum folate - to detect first
RBC folate - would indicate more severe folate def
why is Hb not a good indicator of iron deficiency?
as shown in the graphs, it’s decline is not seen until after Fe depletion. In comparison, ferritin stores decline earlier on and before depletion occurs. in this sense, if one measured serum ferritin - iron def could be caught much earlier
risk factors for poor iron status
vegetarian low vitamin C low fortified foods fequent teas and coffee with meals iron inhibitors with meals ( phytates, tannins, oxalates- plant anti-nutrients - beans, grains, nuts, seeds) ASA use menorrhagia 3 + annual blood donations pregnancy
iron supplementation should be what?
ferrous sulfate
- ferrous = 3x better absorption
rise 1 g/L of Hb per week
- take on empty stomach with liquid
Clinical assessment
patients medical, social, psychological history
- physical examination for clinical signs of symptoms
