Malnutrition and Nutritional Assessment

What is malnutrition?

a state of nutrient imbalance

True or False: malnutrition can be overnutrition OR undernutrition

true

What are some causes of undernutrition?

inadequate intake, poor absorption, increased utilization of energy

What is starvation-related malnutrition?

a prolonged duration of inadequate intake or feeding intolerate

How would you categorize starvation related malnutrition?

chronic process with unintentional weight loss

What is disease-related malnutrition?

disease associated with an inflammatory state which results in increased energy or protein needs

How would you classify inflammatory bowel disease?

chronic disease-related malnutrition

How would you classify cancer?

chronic disease-related malnutrition

How would you classify organ failure?

chronic disease-related malnutrition

How would you classify cystic fibrosis?

chronic disease-related malnutrition

How would you classify malabsorption?

chronic disease-related malnutrition

How would you classify burns?

acute disease-related malnutrition

How would you classify trauma?

acute disease-related malnutrition

How would you classify traumatic brain injury?

acute disease-related malnutrition

How would you classify major surgery?

acute disease-related malnutrition

How would you classify a serious infection?

acute disease-related malnutrition

What is involved in screening and assessing a patient for malnutrition?

medical history, medication use, objective data, and nutrition calssification

What information is needed in the patient history?

medical history, surgical history, diet history, alcohol or substance use, gastrointestinal disorders

What information is needed when discussing medication use?

nutritional supplements and medications that can cause weight loss/gain

What objective data is needed for malnutrition screening and assessment?

weight, BMI, intake (diet/fluid), laboratory data

What nutrition classifications need to be considered during malnutrition screening and assessment?

malnutrition: under vs. obesity

severity + risk for refeeding syndrome

What is the weight loss % for the screening question?

5-10%

How long must a patient’s inadequate intake be for you to answer yes to the screening question?

1-2 weeks

1 kg = __ lbs

2.2

IBW for males

50 + (2.3 x inches over 60)

IBW for females

45.5 + (2.3 x inches over 60)

BMI

weight (kg) / (heigh (m))²

What category is an adult if their BMI < 18.5?

underweight

What category is an adult if their ABW < 90% IBW?

underweight

What category is an adult if their BMI 18.5 to 24.9?

normal/healthy

What category is an adult if their ABW is 90-120% IBW?

normal/healthy

What category is an adult if their BMI is 25 to 29.9?

overweight

What category is an adult if their ABW is > 120 to < 150% IBW?

overweight

If an adult is underweight and their BMI is 17-18.5, what is their malnutrition severity?

mild

If an adult patient is underweight and their ABW is 80-89% IBW, what is their malnutrition severity?

mild

If an adult is underweight and their BMI is 16- 16.9, what is their malnutrition severity?

moderate

If an adult patient is underweight and their ABW is 70-79% IBW, what is their malnutrition severity?

moderate

If an adult patient is underweight and their ABW is < 69% IBW, what is their malnutrition severity?

severe

If an adult is underweight and their BMI is < 16, what is their malnutrition severity?

severe

What are the criteria for diagnosis of malnutrition?

1. insufficient intake of calories for at least 1-2 weeks

2. unintentional weight loss 5% in 1 month; 10% in 6 months

3. decreased muscle mass

4. decreased fat

5. fluid accumulation

6. decreased functional status

What is refeeding syndrome?

occurrence of electrolyte abnormalities in severely malnourished patients during initiation of nutritional support in an individual who has been exposed to undernourishment for a substantial amount of time

What electrolytes shift intracellularly as a result of refeeding syndrome?

potassium, phosphate, magnesium

What is basal energy expenditure (BEE)?

energy utilization during resting state

What is total energy expenditure (TEE)?

basal energy expenditure plus additional metabolic needs

how do you calculate TEE

BEE x activity factor x stress factor

What instances are parenteral nutrition reserved for?

intestinal tract is not functional/unable to access; energy needs/goals are greater than patient tolerance

What is the preferred method of nutritional supplementation?

oral

When should you initiate EN for a intensive care, high risk, or malnourished patient?

within 24-48 hours

When can you consider a delay of EN?

hospitalized patients who are low risk, well nourished, and expected to resume volitional oral intake

How should you advance EN in patients at high risk for refeeding syndrome?

cautiously, slowly

When do you initiate PN to a well nourished stable adult unable to receive significant EN?

after 7 days

When do you initatite PN to a nutritionally at risk paitent unlikely to reach goal EN?

within 3-5 days

When should you initiate PN to a moderate to severe malnutrition adult where EN is not feasible?

ASAP

When should you initiate PN in an infant if unlikely to tolerate EN for extended time?

within 1-3 days

When should you initiate PN in a child/adolescent if unlikely to tolerate EN for extended time?

within 4-5 days

When should you initiate PN in a very-low birth weight neonate?

promptly after birth

When should you initiate EN in a preterm or ill term neonate?

when unable to meet energy requirements for growth

How many days can a neonate go without fat before developing essential fatty acid deficiency?

3 days

What are examples of indications for use of PN for any age?

impaired absorption, mechanical/motility, bowel rest, inability to utilize gut

Why do pediatric patients have shorter times to initiation?

decreased metabolic stores, higher energy requirements