CMN E1- REVIEW

How much water should 18-55 yo consume per day?

35 mL/kg body weight

What is PTN restricted to in pts w/ renal failure since nitrogen cannot be eliminated properly?

0.6-0.8 g/kg

What type of pts need tube feeds?

not able to eat or use GI tract: intubated, AMS, dysphagia, gastroparesis, pancreatitis, chronic inadequate intake

What are the ASPEN guidelines for who should receive TPN?

EN contraindicated, severely malnourished, unable to meet EN goal after 7 days, paralytic ileus, mesenteric ischemia, SBO, GI fistula

What is a serious and potentially fatal metabolic condition that occurs when dietary intake is resumed after an individual has not consumed PO for an extended period of time?

Re-feeding syndrome

Triglycerides need to monitored for hypertriglyceridemia in pts that are inpt and on what medication?

Propofol (provides 1.1 calorie/mL)

What labs need to be monitored to watch for re-feeding syndrome?

phosphorus, potassium, magnesium, glucose

What patient populations are most at risk for vitamin deficiencies?

elderly, vegans, alcohol-dependent individuals, pts w/ malabsorption disorders

What are the fat soluble vitamins?

A, D, E, K

Retinol

Vitamin A

Calciferol

Vitamin D

Tocopherol

Vitamin E

Thiamine

Vitamin B1

Riboflavin

Vitamin B2

Niacin

Vitamin B3

Pantothenic acid

Vitamin B5

Pyridoxine

Vitamin B6

Biotin

Vitamin B7 or H

Folic acid

Vitamin B9

Cyanocobalamin

Vitamin B12

Follicular hyperkeratosis results from what vitamin deficiency?

Vitamin A

What drugs interfere with vitamin A absorption?

Mineral oil, Cholestyramine, Neomycin

Which vitamin can be teratogenic if consumed in excessive amounts during pregnancy?

Vitamin A

What is the best lab indicator of Vitamin D adequacy?

Serum 25-OH Vitamin D

What is the physiologically active form of Vitamin D?

1,25(OH)2-Vitamin D

What drug interaction should you be aware of w/ Vitamin E?

Warfarin

What are sources of Vitamin K?

green leafy vegetables, butter/margarine, liver, milk, ground beef, coffee, pears, olive/vegetable/soybean oil

What needs to be monitored in pts taking anti-coag meds?

intake of green leafy vegetables (careful increasing amount)

Who is most susceptible to thiamine (B1) deficiency in the US?

alcoholics & chronically ill (cancer)

What vitamin deficiency causes Beri-Beri?

Thiamine

Wernicke's encephalopathy is due to what vitamin deficiency?

Thiamine

What are sx of Wernicke's encephalopathy?

horizontal nystagmus, ophthalmoplegia, cerebellar ataxia, mental impairment

What are sx of Wernicke-Korsakoff syndrome?

confabulation (distorted memories), psychosis, additional memory loss, may persist for several months

What deficiency causes Pellagra?

Vitamin B3 (niacin)

What are sx of Pellagra?

diarrhea, dementia, dermatitis, death (if untreated)

What vitamin helps produce & maintain new cells particularly during infancy & pregnancy → prevention of neural tube defects?

Vitamin B9 (folate)

What are the RF for Vitamin B12 deficiency?

vegan or vegetarian diet (no animal sources), GI disorders (pernicious anemia, celiac, Crohn’s), post-GI surgery (gastric bypass)

What are sx of Vitamin B12 deficiency?

megaloblastic anemia, glossitis, mood disturbance, elevated MMA, peripheral numbness/tingling, confusion

Ascorbic acid

Vitamin C

What is an important action of Vitamin C?

promotes non-heme iron absorption

What inc the amount of Vitamin C requirement?

smoking, hemodialysis, stress (infection, trauma)

What are sx of Scurvy (vitamin C deficiency)?

- impaired connective tissue formation

- petechiae, ecchymosis

- inflamed, bleeding gums

- bleeding into joints

- in peds, impaired bone growth

What is the most abundant mineral in the body?

Calcium

What can bind to and inhibit calcium absorption?

*Vit D improves absorption

Oxalic acid & Phytic acid

Calcium decreases the absorption of what 4 drugs?

Digoxin, Phenytoin, Tetracycline, Quinolones

Calcium should NOT be taken with what meds?

meds that need to be taken on an empty stomach

What is the female athlete triad?

*RF for Ca deficiency

disordered eating, amenorrhea, osteoporosis

Who is at risk of calcium deficiency?

postmenopausal women, amenorrheic women, female athletes, lactose intolerance, vegetarians

What is the #1 nutritional disorder in the world?

Iron deficiency

What patients are at risk for iron deficiency?

women of childbearing age, pregnant women, preterm/low birth weight, teenage girls, women with heavy menses, kidney failure, chronic malabsorption

What are macronutrients?

PTN, fats, carbohydrates

What are micronutrients?

vitamins, minerals

How much energy does 1g of PTN provide?

4 kcal/g

What is the nitrogen balance if nitrogen excretion is greater than the nitrogen content of the diet?

Negative

Which nitrogen balance is associated w/ healthy adults?

Zero nitrogen balance

Which nitrogen balance is associated w/ childhood growth, pregnancy, muscle building, and healing?

*tissue generation

Positive nitrogen balance

Which nitrogen balance is associated w/ protein malnutrition, essential AA malnutrition, and “stress response”?

*tissue destruction

Negative nitrogen balance

How much energy per 1g do fats provide?

9 kcal/g

What is the main source of high cholesterol?

Saturated fats (butter, lard, oils, bacon fat)

Which type of fat is composed with a single bond making them harder to break down?

Saturated fats

Which type of fats may help lower cholesterol?

Polyunsaturated & Monounsaturated

Very high levels of EPA & DHA (omega-3 fatty acids) are found in what water food source?

Cold water fish (wild salmon, sardines, tuna)

What are Trans-fatty acids are found in?

Processed foods (cakes, cookies, pies, white bread, donuts, etc)

What does density of a lipid refer to?

ratio of lipid (less dense) : PTN (dense)

What is the concern with LDLs? Why do we want less?

greater the # of circulating LDL = greater risk they will adhere to blood vessel walls

Which lipoprotein has low cholesterol content & high PTN content?

HDLs

How much energy per 1g does CHO provide?

4 kcal/g

How is glucose stored?

stored as glycogen

Which type of fiber dissolves in water, is easily digested, and found in fruits?

Soluble fiber

Which type of fiber doesn’t dissolve in water, is not easily digested, and found in wheat & vegetable?

Insoluble fiber

Which type of fiber promotes regular bowel movements → alleviates constipation & decreases the risk of diverticulosis?

Insoluble fiber

What are the 4 micronutrients required to be on the food label?

Vitamin D, calcium, iron, potassium

What is the AMDR for CHO?

45-60%

What is the AMDR for fat?

20-35%

What is the AMDR for PTN?

10-35%

What is a physical sensation that drives us to find food and eat?

Hunger

What is a psychological desire to consume specific foods?

Appetite

What type of organ is fat?

endocrine organ

What is the appetite stimulating hormone?

Ghrelin

What hormone suppresses food intake (→ weight loss)?

*alerts brain you are full

Leptin

Where does the majority of digestion & absorption occur?

Small intestine

What 2 strains of bacteria are specifically used to convert pasteurized milk to yogurt during fermentation?

*”live and active cultures”

Lactobacillus bulgaricus & Streptococcus thermophilus

What is the recommended daily allowance (RDA)?

avg. daily nutrient level that meets the nutrient requirements of 97-98% of healthy individuals at a particular stage of life & gender group

What is basic metabolic rate (BMR)?

energy the body expends to maintain its fundamental physiologic functions (energy output at rest)

What is BMR primarily influenced by?

lean body mass

What is the estimated RME per day?

2200 per day

CHO= 2200×50%

FAT= 2200×30%

PTN= 2200×20%

Which formula can be used to estimate BMR?

Harris Benedict

What artificial sweetener should be avoided in those with PKU?

Aspartame

BMI < 15 =

starvation

BMI < 17.5 =

Anorectic

BMI < 18.5 =

Underweight

BMI 18.5-24.9 =

Ideal weight

BMI 25-29.9 =

Overweight

BMI 30-39.9 =

obese

BMI > 40 =

Morbidly obese

What is the hallmark biochemical feature of refeeding syndrome?

Hypophosphatemia

What potentially fatal complication can occur if feedings (tube or PO) are reintroduced too quickly resulting in a shift of fluids and electrolytes?

*abn Na, hypokalemia, hypomagnesemia, hypophosphatemia

Refeeding syndrome

What pts are at risk for Refeeding Syndrome?

pts w/ poor nutrition > 7-10 days

What type primary malnutrition is d/t poor nutritional intake resulting in failure to thrive and frequently occurs after a child is weaned?

*diet deficient in PTN & micronutrients → energy deficiency

Kwashiorkor

How does Kwashiorkor present?

edema, hypoalbuminemia, skin lesions, fatty liver results, proturberant abd, muscle & fat wasting