Obesity

Question 1

kwashiokor vs marasmus

basic definitions

Answer 1

2 types of food deficiencies:
kwashiorkor ( protein deficiency)
marasmus (protein and general energy deficiency)

Question 2

who gets kwashiokor?

Answer 2

developing part of the world
typically seen in weaning infants (coming off protein rish breastmilk) and in an area where protein-rich food isnt available.
-lean or overweight people

Question 3

who gets marasmus?

Answer 3

developing part of the world
protein and energy deficiency: where adequate quantities of food are not available
-muscle and fat wasting

Question 4

onset and albumin levels for kwashiokor vs marasmus?

Answer 4

kwash: abrupt onset, low albumin
marasmus: slow onset, normal albumin (at times)

Question 5

lower albumin =

Answer 5

proteins needs are outweighing the supply

Question 6

in industrialized societies, protein-energy malnutrition is most often secondary to other diseases… what are these for kwashkiokor vs marasmus?

Answer 6

kwashkiokor-like secondary protein malnutrition: hyper metabolic acute illness like trauma, burns, sepsis

marasmus-like energy malnutrition: chronic diseases like COPD, CHF, cancer, AIDS

Question 7

protein-energy deficiency malnutrition secondary to other diseases are present in at least ___ % of hospitalized pts.

Answer 7

20 %

Question 8

main concern with re-feeding for kwash/marasmus malnutrition ?

Answer 8

mineral and electrolyte problems during refeeding

restoration of protein and energy must be slow and careful

Question 9

anorexia vs bulemia?

Answer 9

anorexia involves actual weight loss, bulemia doesnt always

Question 10

thiamine and/or niacin deficiency indicates what kind of issue?

Answer 10

alcoholism

Question 11

what kind of vitamin deficeincy is scurvy? what is a key sign of it?

Answer 11

vit C deficiency- bleeding gums is a key

Question 12

B vitamin deficiencies can cause what?

Answer 12

mouth-soreness

Question 13

why do gastric bypass pts have different vitamin needs than healthy people?

Answer 13

b/c part of the stomach has been taken away.. lost part of the gut that takes up certain vitamins

Question 14

Macrocytic anemia, what is it and how can you tell if its from vitamin B12 or folate deficiency?

Answer 14

RBCs cant undergo cell division (something B12 is key in) and therefore are large.

• folate: macrocytic anemia w/out neurological defects
• B12: macrocyctic anemia WITH neuropathy

… therefore: you can only fix neuro problems with folate if folate def. is the primary problem, its its B12 def. then neuro wont get better adding folate. so think B12 first then folate as its more important for neuro .

Question 15

which does the body develop stores of, B12 or folate?

Answer 15

only B12

Question 16

where is bound intrinsic factor–B12 taken up in the gut?

Answer 16

distal ileum

Question 17

3 fat soluble vitamins

Answer 17

A, D, E

Question 18

why does post-bariatric surgery require lifelong supplementation of vitamins? what vitamins are they?

Answer 18

reduced gut absorption in addition to gastric restriction

vitamins D, B12, calcium and iron.

Question 19

what is the BMI for underweight, overweight, obese, and morbidly obese

Answer 19

<18.5
25-29
30-39
>40

Question 20

simple explanation for obesity

Answer 20

energy imbalance: more calories in than out

-energy is being stored in adipocytes

Question 21

leptin levels and their effect on weight

.. what theory does this coincide with ?

Answer 21

increased levels = eat less = weigh loss
decreased levels = eat more = obese
… theory: feedback regulation maintains appropriate body weight unless their is something “broken”

Question 22

obesity is not a leptin deficiency, its…

Answer 22

a leptin resistance, too much leptin causes hypothalamus to become insensitive to it.

Question 23

obesity can cause increased risk for…

Answer 23

metabolic syndrome, CVD risk, cancer risk, musculoskeletal problems/arthritis, obstructive sleep apnea, gall bladder disease, GERD, reduced life span

Question 24

metabolic syndrome

Answer 24

cluster of conditions that inc. your risk for heart disease, stroke and DM.

Question 25

CVD risk relates to level of _____ within the fat. what is the explanation for this?

Answer 25

inflammation
(some individuals have more inflammatory fat cells than others, but obese people without this increased inflammation- their risk for CVD is the same as with lean people)
=bottom line: not all obesity is equal

Question 26

what 5 things work for obestity txt?

Answer 26

advice from provider, referrals to dietician, diet/exercise, drugs, surgery

Question 27

how many calories burned to lose 1 lb?

Answer 27

3,500

Question 28

3 types of bariatric surgery

Answer 28

restrictive (gastric banding)

malabsorptive (ex/biliopancreatic diversion- less bowl for uptake of nutrients)

combo (gastric bypass) - works better than either type alone

Question 29

gastric bypass, what improves even before they begin to lose weight?

Answer 29

DM improves… we have no idea why

Question 30

a deficit of ____ calories per day = 1lb loss per week

Answer 30

500