Malnutrition and Body Weight Concerns (Test 2)

malnutrition

-state of nutrient imbalance

-can be undernutrition to overnutrition

-inadequate vitamins or minerals (can occur in overweight, normal weight, and underweight people)

1.9 billion

How many people are overweight or obese per WHO?

462 million

How many people are underweight per WHO?

-starvation

-chronic disease

-acute disease

What can malnutrition be related to?

no

Is there inflammation present in starvation-related malnutrition?

acute and chronic disease-related malnutrition

Inflammation is present in what type of issue related to malnutrition?

marasmus

malnutrition syndrome characterized by the wasting or withering of body tissues, particularly muscles and subcutaneous fat, as a result of severe restrictions in energy intake

long-term

For marasmus you have to have ______________ (months to years) deprivation of energy and nutrients. (all body fat stores have been exhausted)

children <5 yrs old because of their increased caloric requirements and increased susceptibility to infections

Is Marasmus most likely to occur in adults or children?

marasmus signs/symptoms

•Emaciated, loose skin from loss of subcutaneous adipose

•Weak

•Lethargic

•Weak with muscle wasting

•Bradycardia, hypotension, and hypothermia

•Can also occur in patients with anorexia nervosa, depression/anxiety, and malabsorption syndromes

grade 1 muscle wasting

wasting of the axilla and groin

grade 2 muscle wasting

wasting of the thighs and buttocks

grade 3 muscle wasting

wasting of the chest and abdoment

grade 4 muscle wasting

wasting of facial muscles

kwashiorkor

malnutrition syndrome characterized by near normal weight but bilateral edema, as a result of inadequate protein intake

areas of famine or with limited food supply (corn, rice, beans)

Where does kwashiorkor typically occur?

kwashiorkor signs/symptoms

-Skin lesions

-Dry, brittle, hypopigmented hair

-Distended abdomen

Hepatomegaly

-Edema precipitated by a combination of low serum albumin, increased cortisol, and inefficient antidiuretic hormone

grade 1

pedal edema in kwashiorkor

grade 2

facial edema in kwashiorkor

grade 3

chest and paraspinal edema in kwashiorkor

grade 4

ascites in kwashiorkor

malnutrition etiology

-marked by the signs of inflammation and injury

-acute and chronic

acute malnutrition

- < 3 months

-Critical illness, major infection/sepsis, ARDS, SIRS, severe burns, major abdominal surgery, multitrauma, and closed head injury

chronic malnutrition

•IBD, CVD, CHF, CF, RA, chronic pancreatitis, cancers, DM, Mets, CVA, dementia, COPD, organ failure/transplant, etc

overall energy balance

What is body weight driven by?

Total Energy Expenditure (TEE)

is equal to basal energy expenditure (BEE)* activity factor

TEE>BEE*AF

underweight, wasting, and stunting occur

TEE

overweight and obesity occur

BMI equation

What are these?

underweight

BMI<18.5

normal

BMI 18.5-24.9

overweight

BMI 25-29.9

obese

BMI greater than or = to 30

class 1 obesity

BMI 30-34.9

Class 2 obestiy

MBI 35-39.9

Class 3 obesity

BMI greater than or equal to 40

2.2

1 kg = ____ lbs

0.035

1 g= __________ oz

0.394

1 cm = _________ in

484

1 lb = _________ g

28.4

1 oz = _______ g

0.394 in

1 cm = ________ in

IBW for Males

50 kg + (2.3 * inches over 5 ft)

IBW for Females

45.5 kg + (2.3 * inches over 5 ft)

AdjBW

IBW + 0.4(TBW-IBW)

-conserves energy by reducing energy expenditure

-restricts growth

-converts and burns stored fat

-utilizes muscles for amino acids, pyruvate, and lactate (which depletes muscle mass)

When energy intake is reduced our body does what?

consequences of wasting

•Reduction in energy availability lowers the efficacy of the sodium pumps that regulate cell membrane permeability, leading to systemic imbalances in sodium and potassium

•Immune system

•Cardiovascular system

•Nervous system

•Digestive system: (effects also contribute)

Hypokalemia, hypophosphatemia, hypernatremia

When you have cachexia you can have a reduction in energy availability that lowers the efficacy of the sodium pump leading to what?

-Cardiac myofibrils are thinned with impaired contractility

-Cardiac output is reduced, noted bradycardia and hypotension

-Risk of arrhythmia due to cardiac changes as well as electrolyte imbalances predisposes

What happens to the cardiovascular system with cachexia?

reduction in neurons/synapses which leads to delays in motor function, memory, and other mental responses

What happens with the nervous system in patients with cachexia?

•Atrophy of the intestinall villi

•Pancreatic atrophy

•Dysbiosis of microbiome

What happens to the digestive system with patients with cachexia?

T2DM, CVD, HTN, stroke

What are the serious health tissues that overweight and obese people can get?

chromium deficiency

Impaired glucose/protein utilization, peripheral neuropathy, weight loss, increased LDL (cholesterol), increased free fatty acid concentrations

copper deficiency

Neutropenia, hypochromic anemia, pallor, dermatitis, neurological dysfunction, osteoporosis, myopathy, thrombocytopenia, decreased bone mineralization

iodine deficiency

Hypothyroid goiter, neuromuscular impairment, deaf-mutism, increased embryonic and postnatal mortality, cognitive impairment, impaired fertility, congenital hypothyroidism

iron deficiency

Microcytic, hypochromic anemia, glossitis, headache, dysphasia, nail changes, gastric atrophy, paresthesia, decreased cognitive function

manganese deficiencies

Nausea; vomiting; dermatitis; hair color changes; hypocholesterolemia; growth retardation; defective carbohydrate, lipid, and protein metabolism

molybdenum deficiency

Tachycardia, tachypnea, altered mental status, visual changes, headache, nausea, vomiting

selenium deficiency

Muscle weakness or pain, cardiomyopathy, skin and hair pigmentation changes, macrocytosis, alopecia and growth retardation

zinc deficiency

Dermatitis, stomatitis, glossitis, mouth and tongue ulcers, altered taste and smell, alopecia, diarrhea, apathy, depression, growth retardation, impaired wound healing, anorexia, confusion, immunosuppression, delayed sexual maturation, hypogonadism

Thiamine Deficiency (B1)

Anorexia, fatigue, depression, impaired memory or concentration, N/V/D, nystagmus

Beriberi: heart failure, edema, neurological deficits (Wernicke’s, Korsakoff’s psychosis, neuropathy)

Riboflavin (B2) deficiency

Mucositis, dermatitis, glossitis, photophobia, corneal vascularization, lacrimation, decreased vision, impaired wound healing and growth, normocytic anemia

Niacin deficiency

Pellagra: dermatitis, dementia, glossitis, diarrhea, memory loss, headaches

Folic acid deficiency

Macrocytic anemia, diarrhea, glossitis, cheilosis, angular stomatitis, fatigue, difficulty concentrating, irritability, headache, palpitations, shortness of breath, heart failure, tachycardia, postural hypotension, lactic acidosis, neural tube defects, impaired cellular immunity, paranoid behavior

cyanocobalamin (B12) deficiency

Pernicious (megaloblastic) anemia, glossitis, spinal cord degeneration, peripheral neuropathy, paresthesias, pancytopenia, personality changes, dementia, depression, psychosis

biotin deficiency

Dermatitis, depression, lassitude, somnolence

Ascorbic acid (C) deficiency

Enlargement or keratosis of hair follicles, impaired wound healing, anemia, lethargy, depression, bleeding, ecchymosis, scurvy

Vitamin A deficiency

Dermatitis, night blindness, xerophthalmia, pruritus, follicular hyperkeratosis, excessive deposition of periosteal bone, hair changes, poor growth and wound healing, impaired resistance to infection

Vitamin D deficiency

Rickets, osteomalacia, osteoporosis, muscle weakness, poor growth, hypocalcemia, immune dysfunction, cardiomyopathy

alpha-Tocopherol (E) deficiency

hemolysis

Vitamin K deficiency

bleeding (ecchymosis, petechiae, hematoma)