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144 Cards in this Set
- Front
- Back
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Primary malnutrition |
Due to inadequate dietary intake |
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Secondary malnutrition |
Due to chronic disease |
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causes of malnutrition |
social- child abuse economic- poverty biological- infection vomiting environment- overcrowding |
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wellcome classification |
measures the present or absent of edema edema present is kwashiorkor weight to age |
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marasmic |
stunting and wasting |
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causes of kwashiorkor |
Protein deficiency aflatoxin inflammation and oxidative stress infection late weaning |
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glutathione |
Decrease in edema |
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causes of marasmus |
Chronic energy deprivation early weaning |
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features of marasmus |
apathetic muscle wasting absence of subcutaneous fat bone and skin appearance sunken cheeks |
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features of kwashiorkor |
pitting painless edema hepatomegaly abdominal distention apathetic and irritability dermatitis |
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meal planning for healthy eating |
Staples legumes vegetables fruits animal products less fat |
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food security |
When all people at all times have physical and economical Asses to sufficient safe and nutritious food to meet their dietary need and food preferences for a active and healthy life |
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Low birth weight in children |
develop obesity later in life |
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group at risk for food insecurity |
marginal farmers rural poor urban poor unemployed landless femal headed household elderly homeless large household |
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policies and programs for food insecurity |
1- growth monitoring and promation 2- nutrition clinic 3- program to reduce prevalence of anemia 4-target feeding program- school feeding 5- promoting breastfeeding 6- food stamps and food price subsidy 7- conditional cash transfer- PATH 8- nutrition education |
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growth monitoring and promation |
identify individuals nutritionally at risk early diagnosis of health problems better targeting and intervention |
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nutrition clinic |
refer malnourished children to hospital counseling of malnourished and obese children |
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food law |
1-protect the health of consumers 2-prevent consumer from being cheated 3-fair competition among traders 4-facilitate consumers to make healthy food choices |
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food and nutrition surveillance |
Continous monitoring analysis and interpretation of food and nutrition situation with a country |
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uses of food and nutrition surveillance |
depend on reliable data program management planning decision direct funds to a particular nutritional problem determine prevalence of malnutrition |
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data for food and nutrition surveillance |
nutrition survey secondary data (expensive) |
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brain development |
First 5 years of life |
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Intra uterine growth retardation |
Poor maternal nutrition and infection |
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supplementation for kids |
Mike powder cornmeal |
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stimulation for kids |
weekly 1hr home visit |
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iodine defiency |
Conginital hypothyroidism mental retardation |
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zinc |
cognitive and motor development |
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wernickes korsakoff syndrom cause |
thamin defiency B1 increase alcohol |
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signs of wernickes korsakoff syndrom |
ophthalmoplegia nystagmus ataxia of gait and stance peripheral neuropathy korsakoff psychosis |
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nutrition neuropathy cause |
vitamin B12 deficiency |
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signs of nutrition neuropathy |
impaired motor and sensory function reduce or absent reflex activity distal segment of extremity is more affected |
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nutrition amblyopia |
Rare visual impairment peripheral vision intake defiency of B vitamins |
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Cause of cerebellar degeneration |
alcohol consumption |
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signs of cerebellar degeneration |
Ataxia of stance and gait improve nutrients and administration of B vitamins |
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pellagra cause |
niacin B3 defiency alcohol consumption |
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signs of pellagra |
dementia dermatitis diarrhea death |
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Florid psychosis |
hallucination disorientation confusion |
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vitamin E defiency |
abnormal lipid metabolism and malabsorption of vitamins |
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signs of vitamin E defiency |
ophthalmoplegia Ataxia retinal dysfunction myopathy |
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Wilson disease |
autosomal recessive inheritance cirrhosis deficiency in ceruloplasmin increase copper |
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vitamin B6 defiency pyridoxine |
seizures |
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vitamin A excess |
Use for acne cause psuedotumor (Bening intracranial pressure) |
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cholin |
Acetylcholine egg liver soybean |
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phenylalanine |
Dopamine egg meat soybean beets almonds grains |
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tryptophan |
serotonin eggs milk cheese meat banana yogurts |
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Treatment for pellagra |
niacin B3 |
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Diabetes and nutrition. |
to maintain insulin sensitivity |
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Diabetes cause |
blindness amputation ESRD myocardial infarction stroke |
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exercise and insulin |
improve insulin sensitivity |
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nutrition guidelines for carbohydrates in diabetics |
whole grain vegetables fruits low fat milk |
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older people and diabetes |
encourage physical activity multivitamin |
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insulin and weight |
Increase weight no CVS risk |
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cancer hallmark |
1- unlimited cell replication 2- insensitive to growth inhibitor signal 3- evasion of Apoptosis 4- sustained angiogenises 5- invasion and metastasis 6- growth signal autonomy |
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causes of cancer |
endogenous exogenous chance |
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Malnutrition |
mismatch between intake and demand imbalance between supply and demand |
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consequences of malnutrition |
Increase mortality and morbidity decrease immune competence and poor wound healing psychological and cognitive effects increase health care cost |
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Clinical nutrition management pathway |
screening assessment treatment monitoring and evaluation |
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albumin |
No change in anorexia acute phase protein |
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administration for malnutrition |
enteral- mouth best parenteral- IV central vein |
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carbohydrates source for malnutrition |
dextrose |
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Protein source for malnutrition |
crystalline AA dipeptide |
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Fat source in malnutrition |
Long chain fatty acid soybean sunflower seed |
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types of parenteral nutrition |
Central parenteral nutrition- central vein high osmolarity peripheral parenteral nutrition- peripheral vein |
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macronutrient |
carbohydrates fats protein |
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Micronutrients |
vitamins and minerals |
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Energy derived from fat |
(g ×9)/energy intake |
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resting metabolic rate |
Fall with age higher in males compared to females increase in active individuals affected by thyroid hormone |
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Most variable component of energy expenditures |
activity 20-30% |
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largest components of energy expenditure |
BMR 70% |
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CO2 and O2 consumption |
4.95kcal |
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weirs equation |
Use to measure energy expenditures |
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Direct calorimetry |
Measure heat |
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limitation of direct calorimetry |
cost technically demanding infrequently use confined nature |
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indirect calorimetry |
Measure heat and energy frequently use estimate energy by respiratory gas |
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limitation of indirect calorimetry |
Hyperventilation |
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doubly labeled water isotopes technique |
1-Measure CO2 production 2-use H and O isotopes 3-urine saliva and plasma are sampled using mass spectrometeric analysis 4-difference between isotopes represent CO2 production 5-CO2 production is a result of Fat protein and carb |
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Physical activity level |
Use to measure classification of lifestyle TEE/REE |
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breast milk and cows milk |
higher in carbohydrates and whey lower in protein iron everything |
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indication of parenteral nutrition |
GI failure fistula chrohns disease sever pancreatitis
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TPN administration |
100 g glucose 5-7 min |
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complication of TPN |
Infection catheter related metabolic |
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intermittent gastric feeding |
aspiration increase feed by 10ml for 12/24 hrs if patient is ill flush tube with 30ml of water or Pepsi inclin permitted stomach functional |
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jejunostomy feeding |
Continous incline permitted flush tube with 30ml of water or Pepsi |
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Reduce aspiration |
feeding below the ligament of treitz Continous oral hygiene posture |
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medication administration in TPN |
crush meds and add water |
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immunonutrietion |
arginine- increase macrophages increase protein synthesis increase NO |
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stress response to |
surgery trauma sepsis critical illness |
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systematic response to stress |
Increase epinephrine cortisol ctytokins glucagon |
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local response to stress |
matrix protein synthesis wound repair |
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phases of stress response |
ebb flow/acute phase |
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ebb phase of stress response |
immediately after injury hypovolaemic decrease cardiac output decrease oxygen consumption hypometabolism increase sympathetic activity |
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flow/acute phase of stress response |
hypermetabolic Increase REE temp increase cardiac output increase oxygen consumption ctytokins mediated |
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mediators of stress |
glucagon cortisol epinephrine |
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net result of mediators of stress |
Increase protein mobilization hyperglycemia insulin resistance increase lipolysis |
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ctytokins |
TNF IL-1 IL- 6 IL-8 produced by the endothelial cells and immune cells |
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IL- 1 |
Fever anorexia hypotension inflammation |
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TNF |
catabolism anorexia increase hypothalamic - pituitary - adrenal axis |
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IL-6 |
act on othe ctytokins activate hepatic acute phase reactants |
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Protein metabolism in stress |
negative N balance increase urea excretion decrease LBM decrease albumin |
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administration of protein. |
2g/day |
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nucleotide |
enhance humoral immunity enhance macrophages |
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antioxidants |
Decrease free radicals vitamin A C E |
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sarcopenia |
Decrease in lean body mass seen with aging increase in fat mass |
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Hormones affecting calcium balance |
calcitonin growth hormone prostaglandin sex steroid thyroid hormone adrenal cortex hormone |
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nutrition factors associated with bone loss |
sodium- hypercalciuria because your excretion sodium protein caffeine alcohol- increase cortisol increase metabolism |
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vitamin D defiency |
children- rickets adults- osteomalacia vitamin D calcium and phosphorous defiency decrease sunlight exposure growth plate not calcified bend due to weight |
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Clinical presentation of vitamin D defiency |
Bone pain and tenderness bone fracture bone deformities |
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osteoporosis |
Decrease bone mass increase bone loss Increase risk of death due to fracture |
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Low t score -2.5 |
osteoporosis |
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Estrogen defiency |
Increase bone reabsorption and loss Decrease Ca absorption by intestinal |
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recommend daily calcium intake |
9-18 1300 mg 19- 50 1000 mg 50 up 1200 mg |
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Function of intestinal epithelium |
barrier and immune function protein synthesis fluid and electrolyte secreation and absorption mediator production nutrients digestion and absorption |
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sodium absorption |
colon- Na channel small bowel- Na-H exchange Na dependent channels luminal membrane- Na-glucose |
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potassium absorption |
colon secrets potassium recto - sigmoid absorption |
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chloride absorption |
jejinum ilium depend on HCO3 Ilium colon rectum |
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SGLT-1 |
Transport glucose in renal tubule |
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GLUT2 |
facilitated diffusion |
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peptidase |
hydrolyzed peptide to di and tri peptide for absorption |
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symptom of dumping syndrom |
hypotension hypovolaemic hypoglycemia |
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mild pancreatitis |
enteral feeding |
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sever pancreatitis |
DM TPN |
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Short bowel syndrom |
weight loss diarrhea malnutrition steatorrhea(fat in stool) |
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Greater than 50% resection of colon |
TPN then enteral |
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Greater than 75% resection of colon |
TPN only |
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cancer cachexia |
cachexia is seen in 60-70% of cancer patients increase rate of malnutrition among hospital patient cachexia and anorexia work together |
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causes of cancer cachexia |
altered intake- depression treatment decrease absorption- GI tumor altered metabolism |
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Energy expenditures and cancer |
Increase REE increase in lung and GIT cancer sarcoma |
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Protein metabolism in cancer |
Decrease skeletal muscle mass decrease LBM decrease Protein synthesis |
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interferon gamma |
Inhibit lipoprotein lipase act with TNF to produce ctytokins |
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cancer cachexia management |
Treat tumor nutrition support supplement avoid fatty food vitamins and minerals no parenteral nutrition |
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EPA eicosapentanoic |
fish oil reduce inflammation increase lean body mass |
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glutathione malnutrition |
Decrease esophagitis |
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melatonin |
Decrease enteritis |
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Cause of anorexia |
genetic/families temperment/personality developmental factors sciococultral influence |
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Clinical features of anorexia |
weight loss starvation hide food mood disturbance hair loss dry skin low calorie diet amenorrhea fatigue depression no breast |
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anorexia medical complication |
Decrease in everything muscle wasting iron defiency anemia hypothermia impaired immune function impaired renal function impaired taste osteoporosis hypokalemia decrease GI motility |
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management of anorexia |
supplementation difficult patient must want to change develop relationship with patient start slow and go slow 1kg weekly weight gain to prevent fluid retention |
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refeeding syndrom |
compartment shift in element decrease elements increase Mg excretion affect every organ system hypophosphonemia hypernatremia |
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bulimia nervosa |
Recurrent episode of Bing eating trauma teased late teens |
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purging |
Vomiting misuse of diuretics laxatives and emites electrolyte imbalance |
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Non purging |
excessive exercise fasting |
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Abdominal fat ratio |
waist to height ratio |
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anorexia nervosa |
nervous loss of appetite perfectionist obsesses high achiever |
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Case series |
report generated about a individual or group or individual with the same diagnosis |
