Term
| What are the two broad types of nutritional tests? |
|
Definition
| static tests and functional tests |
|
|
Term
| If you are measuring the urinary excretion rate of a nutrient, what type of nutritional test are you performing? |
|
Definition
|
|
Term
| What types of tests are classified as functional tests? |
|
Definition
| production of an anormal metabolite, change in activity of certain enzymes or blood components, or behavioral or physiological functions |
|
|
Term
| What abnormal metabolite do you have increased excretion of in vitamin B6 deficiency? |
|
Definition
|
|
Term
| Which enzyme dependent on selenium is measured to determine whether there is a selenium deficiency? |
|
Definition
|
|
Term
| Which enzyme dependent on riboflavin is measured to diagnose a riboflavin deficiency? |
|
Definition
|
|
Term
| What enzyme dependent on thiamin is measured to diagnose a thiamin deficiency? |
|
Definition
|
|
Term
| Describe two in vitro tests that test in vivo functions? |
|
Definition
| leukocyte chemotaxis for protein-energy, zinc, and iron |
|
|
Term
| Luekocyte chemotaxis functional test is testing for... |
|
Definition
| protein-energy, zinc and iron |
|
|
Term
| D-urinidine suppression test is a test for... |
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Definition
|
|
Term
| Delayed cutaneous hypersensitivity tests for.. |
|
Definition
|
|
Term
| A histidine load test is testing for... |
|
Definition
|
|
Term
| A relative dose response can be used to test for... |
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Definition
|
|
Term
| A tryptophan load test, tests for... |
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Definition
|
|
Term
|
Definition
|
|
Term
| A valine load test tests for... |
|
Definition
|
|
Term
| What nutriant can cause delayed sexual maturation if you are deficient in it? |
|
Definition
|
|
Term
| What nutrient deficiency can cause decreased growth velocity? |
|
Definition
|
|
Term
| What nutrient deficiency can cause a decline in cognifive performance? |
|
Definition
|
|
Term
| Dark adaptation tests for... |
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Definition
|
|
Term
| Capillary fragility test tests for... |
|
Definition
| vitamin C deficiency (also Dengue fever) |
|
|
Term
| What are the six protein compartments of the body? |
|
Definition
| muscle, skeleton, viscera and skin, extracellular, fat |
|
|
Term
| In which compartment does the body store dispensable protein? |
|
Definition
| the body does not have dispensable protein stores: loss of body protein results in a loss of essential structural elements as well as impaired function |
|
|
Term
| What percent of body protein is found in skeletal muscle and the smaller visceral protein pool? |
|
Definition
|
|
Term
| What is another name for skeletal muscle protein? |
|
Definition
|
|
Term
| How can you estimate whole body protein? |
|
Definition
| total body potassium or nitrogen, anthropometric measures such as mid-upper-arm muscle area |
|
|
Term
| What happens to the body in marasmus? |
|
Definition
| loss of muscle mass and adipose tissue |
|
|
Term
|
Definition
| inadequate protein intake --> no depletion of skeletal muscle protein, instead the visceral portion is depleted and edema occurs |
|
|
Term
| Kwashiorkor can be precipitated by... |
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Definition
|
|
Term
| How can you assess somatic protein status? |
|
Definition
| urinary creatinine excretion (mg/24 hrs, mg/cm body height, %measured/ideal) OR 3-methyl histidine excretion |
|
|
Term
| What factors affect creatinine excretion? |
|
Definition
| diurnal and day-to-day variation; strenuous exercise, stress, dietary intake, menstruation, age, infection/fever, trauma, chronic renal failure |
|
|
Term
| Why is visceral protein status a good marker for short term changes? |
|
Definition
| rapid rate of synthesis, very short half life, fairly constant catabolic rate, small body pool, major proportion in the vascular space |
|
|
Term
| What can you measure as a marker of visceral protein status? |
|
Definition
| total serum protein, albumin, prealbumin, transferrin, retinol-binding protein, IGF-1 (somatomedin C) |
|
|
Term
| What are the advantages and disadvantages to using total serum protein to determine visceral protein status? |
|
Definition
| easy to measure but insensitive |
|
|
Term
| T/F Exercise can affect serum protein concentrations. |
|
Definition
|
|
Term
| What are the advantages and disadvantages of measuring serum albumin as a marker of visceral protein status? |
|
Definition
| easy to measure and inexpensive; large body pool, 50% outside vascular space, insensitive, long half life |
|
|
Term
| What are the advantages of using transferrin to determine visceral protein status? |
|
Definition
A= shorter half life and smaller body pool
D= affected by many factors: GI, renal, liver disease, CHF inflammation, more expensive and time consuming |
|
|
Term
| What are the advantages and disadvantages to measuring retinol binding protein to determine visceral protein status? |
|
Definition
A= small pool, short half life, falls quickly and responds to treatment quickly
D= low specificity |
|
|
Term
| What are the advantages and disadvantages to using prealbumin to estimate visceral protein status? |
|
Definition
A= 2 day half life, small pool, easy to assay, conc 4-5x higher than RBP, sensitive (responds to treatment quickly)
D= disease presence reduce its specificity, extremely sensitive to stress and inflammation |
|
|
Term
| What are the advantages and disadvantages to using IGF-1 to estimate visceral protein status? |
|
Definition
A= half life of several hours so responds quickly to treatment
D= ELISA or RIA- longer TAT than prealbuin |
|
|
Term
| What is teh serum amino acid ratio? |
|
Definition
| NEAA:EAA (glycine, serine, glutamine and taurine: isoleucine, leucine, valine, methionine) |
|
|
Term
| What are some metabolic changes as a result of protein status? |
|
Definition
| urinary 3-hydroxyproline excretion, hydroxyproline:creatinine ratio, hydroxyproline index, nitrogen balance, urinary nitrogen:creatinine ratio |
|
|
Term
| Urinary urea:creatinine ratio is a surrogate for... |
|
Definition
|
|
Term
| What's a way to assess protein status during physical exam? |
|
Definition
| muscle function tests like handgrip strength |
|
|
Term
| What immunological tests can be used to assess protein status? |
|
Definition
| thymus-dependent lymphotcytes, lymphocyte mitogen assays, delayed cutaneous hypersensitivity, mixed leukocyte culture |
|
|
Term
| What is the most common micronutrient deficiency? |
|
Definition
|
|
Term
| What are the three stages of iron deficiency anemia |
|
Definition
| iron depletion, iron deficient erythropoesis, iron defiency anemia |
|
|
Term
| What are the components of the ferritin model for measuring iron status? |
|
Definition
|
|
Term
| What is the MCV model for measuring iron status? |
|
Definition
|
|
Term
| What kinds of tests can you use to assess vitamin A status? |
|
Definition
| retinol, retinyl esters, carotenoids, relative dose response, rapid dark adaptation test |
|
|
Term
| What labs can you order to assess vitamin D status? |
|
Definition
| 25 hydroxy vitamin D; 1,25 dihydroxy vitamin D, alkaline phosphatase, calcium (total and/or ionized), phosphorus, PTH |
|
|
Term
| What tests can be used to assess vitamin E status? |
|
Definition
| serum tocopherols, erythrocyte tocopherols, platelet tocopherols, adipose tissue tocopherols, erythrocyte hemolysis test, breath pentane, erythrocyte malondialdehyde release |
|
|
Term
| What tests can you perform to assess vitamin C status? |
|
Definition
| serum ascorbic acid, leukocyte ascorbic acid, urinary excretion of ascorbic acid and metabolites, salivary ascorbic acid, body pool size, capillary fragility |
|
|
Term
| What tests can you use to assess thiamin levels? |
|
Definition
| erythrocyte transketolase activity, urinary thiamin excretion |
|
|
Term
| Why is serum thiamin not used to measure thiamin status? |
|
Definition
| it is a very insensitive measure |
|
|
Term
| What tests can you order to determine riboflavin status? |
|
Definition
| erythrocyte glutathione reductase activity, urinary riboflavin excretion |
|
|
Term
| Can you use serum riboflavin levels to determine riboflavin status? |
|
Definition
| serum levels have limited value--conc. is heavily influenced by recent dietary intake and is too variable to be useful |
|
|
Term
| How do you determine niacin status? |
|
Definition
| urinary excretion of N'-methylnicotinamide and N'-methyl-2-pyridone-5-carboxylamide |
|
|
Term
| What does a serum niacin level tell you? |
|
Definition
| indicates intake not stores |
|
|
Term
| What tests can be ordered to assess vitamin B6 status? |
|
Definition
| erythrocyte aminotransferase activities, pyridoxyl 5' phosphate, urinary B6 excretion, urinary 4-pyridoxic acid excretion, tryptophan load test, kynurenine load test, methionine load test |
|
|
Term
| What test can be ordered to assess folate status? |
|
Definition
| red cell indices, serum folate, red blood cell folate, forminoglutamate excretion, polymorphonuclear leukocyte lobe count |
|
|
Term
| What tests are ordered to assess vitamin B12 status? |
|
Definition
| serum B12, red blood cell B12, deoxyuridine supression test, methylmalonic acid excretion, schilling test |
|
|
Term
| How do you test for magnesium status? |
|
Definition
| magnesium, RBC magnesium, WBC magnesium, magnesium load tests |
|
|
Term
| What are the essential trace elements? |
|
Definition
| chromium, cobalt, copper, flourine, iodine, iron, manganese, molybdenum, selenium, and zinc |
|
|
Term
| How many mg of copper does the average adult have? Where is it stored |
|
Definition
| 70-80 mg of copper: skeletal muscle, bone marrow, liver, brain, skin, skeleton |
|
|
Term
| What tests can be used to determine copper status? |
|
Definition
| serum plasma copper, ceruloplasmin, erythrocyte superoxide dismutase activity, other copper dependent enzymes, hair copper |
|
|
Term
| What are the methods to assess nutritional status of hospitalized patient that are based on a single index? |
|
Definition
| anthropomorphic measurements, laboratory determinations, diet and nutrition status |
|
|
Term
| What are the laboratory methods used to asses nutritional status in a hospitalized patient? |
|
Definition
| albumin, total iron binding capacity, transferrin, lymphocyte count, white blood cell count, 24 hour urine urea nitrogen, 24 hour urine creatinine, creatinine height index as a % of standard |
|
|
Term
| What measurements are utilized in the prognostic nutritional index? |
|
Definition
| serum albumin, serum transferrin, tricepts skinfold, delayed cutaneous hypersensitivity |
|
|
Term
| What is the equation of the Prognostic nutritional index? |
|
Definition
| PNI=158-(16.6*ALB)-(0.78*TSF)-(0.2*TFN)-(5.8*DCH) |
|
|
Term
| What is the hospital prognostic index based on? |
|
Definition
| albumin, delayed hypersensitivity response to recall skin antigens, clinical status (septic or not), and presence or absence of cancer |
|
|
Term
| What is the equation for the hospital prognostic index? |
|
Definition
| HPI=(.91*ALB)-(1.00*DCH)-(1.44*SEP)-(.98*DX)-1.09 |
|
|
Term
| What nutritional marker is the best single predictor of mortility, anergy, and sepsis? |
|
Definition
| serum albumin; <2.2 g/dL is associated with a 75% chance of mortality, anergy, or sepsis during hospitalization |
|
|
Term
| What is a cluster analysis? |
|
Definition
| a statistical method used to group patients on the basis of selected clinical, physiological and therapeutic variables |
|
|
Term
|
Definition
| only minor variation from normal occur in values for all indices |
|
|
Term
|
Definition
| adult kwashiorkor-like syndrome. These patient shave delayed cutaneous hypersensitivity responses and reduction in their visceral protein compartment but have normal body weight. These patients have a high mortality rate, highest incidence of palliative procedures, and a high incidence or post operative sepsis |
|
|
Term
|
Definition
| nutritional state similar to a mixed kwashiokor-marasmus type pattern. Mild visceral depletion, decrease in some immunologic parameters. Mortality rates and infection rates are less than 2/4 but greater then cluster 1 |
|
|
Term
|
Definition
| pronounced increase in acute phase proteins (ceruloplasmin, transferrin, retinol-binding protein, prealbumin) |
|
|
Term
| What is the mortality rate in patients with cluster 4? |
|
Definition
|
|
Term
| What are the different types of bariatric surgery? |
|
Definition
| laparoscopic adjustable gastric band (LAGB), roux-en-Y gastric bypass (RYGB), sleeve gastrectomy |
|
|
Term
| How does a sleeve gastrectomy cause weight loss? |
|
Definition
| restriction of meal size, decrease in ghrelin, possible increase in GLP-1 |
|
|
Term
| What is the MOA of the roux-en-Y gastric bypass? |
|
Definition
| increase GLP-1, PYY; decrease Ghrelin |
|
|
Term
| What is different about the MOA of the lab band version of bariatric surgery compared to the others? |
|
Definition
| lab band causes NO change in hormones that control weight |
|
|
Term
| What drug is contraindicated in patients post gastric bypass? |
|
Definition
| NSAIDS or aspirin because they will get an ulcer at the anastomosis |
|
|
Term
| How do treat a patient with osteoporosis secondary to bariatric surgery? |
|
Definition
| replace calcium, replace vitamin D with pharmacologic doses, consider IV bisphosphanates |
|
|
Term
| What type of calcium is given to patients with calcium deficiency? |
|
Definition
|
|
Term
| What percent of patients that get a lab band end up needing surgery to correct a problem with it? |
|
Definition
|
|
Term
| What should you tell diabetic patients to do as they prepare for bariatric surgery? |
|
Definition
| stop taking diabetic medication because during the surgery GLP-1 will go up and improve diabetes |
|
|
Term
| If a patient is hypoglycemic and thiamine deficient, what abnormality should you correct first? |
|
Definition
|
|
Term
|
Definition
| unusual food preferences that can be a symptom of iron deficiency |
|
|
Term
| What is the easiest iron to use IV? |
|
Definition
|
|
Term
| How can you administer B12 to a patient with problems absorbing B12 from the GI tract? |
|
Definition
| can replace by sublingual B12 once or twice a week; that doesn't work 20% of the timeand you have to give IM or sub Q B12 |
|
|
Term
| What is the recommended follow-up schedule for a patient post-bariatric surgery? |
|
Definition
| 1 month, 3 months, 6 months, 12 months, 18 months, 24 months |
|
|
Term
| What labs should you order as part of follow up on a patient post bariatric surgery? |
|
Definition
| chemistry panel, CBC, iron, B12, vitamin D, PTH, bone density, magnesium |
|
|
Term
| What percent of patients get hyperparathyroidism after gastric bypass? |
|
Definition
|
|
Term
| Why does gastric bypass lead to hyperparathyroidism? |
|
Definition
| malabsorption of calcium and vitamin D and possibly decreased intake of Ca and vitamin D |
|
|
Term
| How soon after gastric bypass can patients get hyperparathyroidism? |
|
Definition
| becomes more common in patients who are years out from bariatric surgery but can be seen as early as 6 months after surgery |
|
|
Term
| What do you do for a patient who is post gastric bypass and now has low vitamin D and normal PTH? |
|
Definition
| low dose replacement (OTC doses) |
|
|
Term
| What do you do for a patient who is status post gastric bypass and has low vitamin D and high PTH? |
|
Definition
| replace vitamine D with perscription strength once a week and follow calcium and PTH and titrate up vitamin D |
|
|
Term
| What should a patient be taking in terms of nutritional supplements after they have had gastric bypass? |
|
Definition
| multivitamin with Iron and calcium (1500 to 2000 mg per day), first year may need potassium or magnesium, possible vitamin D or sublingual B12 |
|
|
Term
| Why is it better to use calcium citrate over calcium carbonate? |
|
Definition
|
|
Term
| What is a complication of treating a patient with gastric bypass with zinc suppliments? |
|
Definition
| they may get a copper deficiency because zinc competes with copper for absorption |
|
|
Term
| Can diabetic patients who have been successfully treated with gastric bypass get diabetes again? |
|
Definition
| yes; you need to keep following the A1C every 6-12 months as many patients can return to diabetic status years after surgery |
|
|
Term
| Before starting a patient on a diet, you should understand their current dietary patterns by... |
|
Definition
| eating questionaire, patient interview, or food diary |
|
|
Term
| What are the stages of change for a patient undergoing dietary management of obesity? |
|
Definition
| precontemplation, contemplation, preparation, action, maintenance |
|
|
Term
| For obese patients on dietary managment, what should be their calorie deficit each day? what should be their rate of weight loss on this diet? |
|
Definition
| 500-1000 kcal/day; 1-2 lbs per week should be lost |
|
|
Term
| What percent of your calories should come from fat vs. protein vs. carbs? |
|
Definition
| fat= 20-35%, protein= 10-35%, carbs= 45-65% |
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