Define:

Optimal Nutritional Status

Achieved when nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy or illness

(People with optimal nutritional status are more active, have fewer illness and live longer)

Define:

Undernutrition

When nutritional reserves are depleted or when nutrient intake is inadequate to meet day-to-day or metabolic demands

(Vulnerable in children, infants, immigrants, hospitalized patients and low SES)

Define:

Overnutrition

Consumption of nutrients (calories, fat and sodium) in excess of body needs

* Major problem in US - leads to obesity, CHF, Diabetes, HPN, Stroke, Gallbladder disease, sleep apnea, cancers, osteoarthritis

Development: Infants and Children:

When is the most rapid period of growth in the life cycle?

Birth to 4 months of age

(Double birth weight by 4 months and triple birth weight by 1 year)

Development: Infants and Children:

What is the recommendation for the primary source of nutrients for infants to age 1? 

Breast milk - Formulated to promote normal infant growth and development and natural immunity

* Exception: Women who are HIV positive

Development: Infants and Children:

By age ___, the brain has reached 50% of its adult size; by age __, the brain has reached 100% of its size;

As a result, what type of diet should children have to promote CNS development?

2

8

Fatty diets (whole milk, essential fatty acids and calories) - Fats are required for CNS growth and development

Development: Adolescene

Females have __________ body fat of _##_, while males _____ body fat to ___ during adolescence

Development: Adolescene

True or False

Teens should eat 3 Full meals a day to meet all of their nutritional demands.

Development: Adolescence

What type of diets should teens follow? Why?

*Caloric and protein required to meet demands of bone growth and increase muscle mass

*Girls: Calcium and iron to meet menstrual cycle demands

Development: Pregnancy and Lactation

Recommended weight gain for optimal nutritional women during pregnancy? Weight gain for undernutrition? Weight gain for overnutrition?

Normal: 25-35lbs

Undernutrition: 28-40lbs

Overnutrition: 15-25lbs

*Pregnant women sould consume increased protein, vitamins, minerasuesls and calories for support of maternal and fetal tissues

Development: Adulthood

Growth and nutrients should be:

A. Increased

B. Decreased

C. Stabilized

C. Stabilized

* Lifestyle factors contribute to a variety of physiological diseases in adulthood (ex: Obestiy, hypertension, atherosclerosis, cancer, osteoporosis, diabetes)

Development: Aging Adult

What are some risk factors that make the aging adult more prone to under- or overnutrition?

Development: Aging Adult

Normal physiological changes in adults that affect nutritional status include.....

1. Poor dentition (teeth)

2. Decreased visual acuity

Decreased saliva production

Slowed GI Motility

Decreased GI Absorption

Diminished Olfactory and Taste

*Results in loss of body mass and metabolic activity

Cross Cultural Care

Why are newly arriving immigrants at nutritional risk?

What are common nutrient related problems new immigrants from developing countries have?

Come from countries with limited food supplies caused by poverty, poor sanitation, war or political strife

New immigrants have the following nutritional problems: Hypertension, undernutrition, diarrhea, lactose intolerance, scurvy, dental caries, osteomalacia (soft bones)

View individuals of common cultural backgrounds fimilarly and according to a preconceived notion of how they "ought" to behave

Ex: Italians who do not like spaghetti

Fasting (Catholics, Muslims, Jewish)

View pages 196-197 for complete list of religious groups and their food restrictions

1. Identify indivdiaus who are or at risk for being malnourished

2. Provide data for designing a nutrition care plan that will prevent or minimize the development of malnutrition

3. Establish baseline data for evaluating the efficacy of nutritional care

Quick-easy way to identify inviduals at nutrition risk (weight loss, inadequate food intake, illness); 1st step in assessing nutritional status;

Nutritional screening measures weight, conditions, diets, lab data

24-Hour Recall

Food frequency questionnaire

Food Diary

During Hospitalization: Document nutritional intake

What is the 24-hour recall nutritional test?

What are some sources of error with this test?

24-horu recall test: Individual or family member completes a aquetionnaire to recall everything eaten in the last 24 hours

Errors:

1. Cannot recall the amount of food eaten

2. Last 24-hour intake may be atypical of usual intake

3. Truth may be altered

4. Snak items and/or gravies, sauces or condiments are often underreported

Food frequency questionnaire:

How many times per day, week or month the individual eats particular foods

Drawbacks: Does not quantify intake amount; Relies on individuals memory of food eaten

What are Food Diaries?

Are they beneficial? Why?

Food Diary: Individual or family member write down everything consumed over 3 days (2 wkdays and 1 wkend)

Problems: Noncompliance, Inaccurate recording, Atypical intake on recording days, conscious alteration of diet during the recording period

Eating patterns, unusual weight, Changes in appetite, taste, smell, chewing or swallowing, Surgery, Trauma, Burns, Infection, Chronic Illnesses, Nausea, vomiting, diarrhea, consitpation, food allergies, medications, nutritional supplements, self-care behaviors, alcohol or drug use, exercie, family history

Children: Gestational Nutrition, Infant Breastfed, Willingness to eat what you prepare

Adolescent: Present weight, anabolic steroids, Snacks, Fast foods, Menstruating

Pregnancy: # of times pregnant, Preferred foods

Aging Adult: How is your diet different from 40s-50s?

Clinical Signs of Malnutrition:

Neurological

Normal: Normal reflexes

Malnutrition:

Peripheral Neuropathy (Thiamine and Vit B6 Deficiency)

Hyporeflexia (Thiamine Deficiency)

Disorientation or Irritability (Bitamin B12 Deficiency)

the condition of below normal or absent reflexes

(Thiamine Deficiency)

softening of the bones due to defective bone mineralization

Vitamin D and Calcium Deficiency

Anthropomorphic Measures:

What is anthropometry?

Anthropomorphic Measures:

Calculate Body weight as a % of ideal body weight

What are abnormal findings?

% of Ideal body weight = (Current weight/Ideal Weight) * 100

Abnormal Findings

80-90%: Mild malnutrition

70-80%: Moderate Malnutrition

70%>: Severe malnutrition

Anthropomorphic Measures:

Calculate the percent  of usual body weight

What are abnormal findings?

% Usual body weight = (Current weight/Usual Weight) * 100

85%-95%: Mild Malnutrtion

75-84%: Moderate malnutrition

75%>: Severe Malnutrition

Anthropomorphic Measures:

Calculate recent weight changes

Significant findings

([Usual Weight-Current Weight] / Usual Weight) * 100

>5% over 1 mo

>7.5% over 3 mos

>10% over 6 mos

Anthropomorphic Measures:

Calculate Body Mass Index

What do the findings indicate?

Body mass Index = Weight (kg)/Heigh (meters) (squared)

OR

(Weight (lbs) / Height (in) squared) X 703

<18.5: Underweight

18.5-24.9: Normal weight

25.0-29.9: Overweight

30.0-39.9: Obestiy

<40: Extreme Obestiy

Anthropomorphic Measures:

Waist-Hip Ratio

Abnormal Findings

Waist/Hip Circumference

Assesses body fat distribution as indicator of health risk

Abnormal Findings

1 >in men or .8> in women - inicates android (upper body obesity) and increased risk for obese related diseases

Anthropomorphic Measures:

Skin Fold Thickness

Provides an estimate of stored body fat or the extent of obestiy or undernutrition

Triceps Skin Fold (TSF): Commonly selected place

Anthropomorphic Measures:

Mid-Upper Arm Circumference (MAC)

Lab Results:

What is their purpose?

Lab Results:

What is the purpose of the hemoglboin test?

Lab Results:

What do increased hemoblogin levels suggest? Decreased Levels?

Increased hemoglobin levels:

Hemoconcentration (Increase amount of cells and solids in blood due to loss of plasma and fluids) due to polycthemia vera (blood disorder in which bone marro wmakes too much RBC's) or dehydration

Lab Results:

What does a hematocrit test measure?

Lab Results:

What does a low iron level indicate?

Insufficient hemoglobin formation

(Note: Hematocrit & hemoglvin values shoudl be interpreted together)

Lab Results:

Why is cholesterol measured?

Lab Results:

Coronary artery disease risk increases as ________ rises

Serum cholesterol rises (Cholesterol levels of 200-239mg/dL - borderline high)

Moderate risk (240 mg/dl

High (240 mg/dl < = CAD, MI, Brain attack, Peripheral Vascular Disease

Lab Results:

What to triglyceride tests measure?

Screen for hyperlipidemia and etermine risk for C.A.D

Borderline: 250-500mg/dl

High: 500mg/dl <

Lab Results:

What is the most commonly used tests of immune functioning?

Lab Results:

What does the TLC (Total lymphocy count) test indicate?

Indicator of visceral protein status and cellular immune function

TLC = WBC * (# of Lymphocytes / 100 Cells)

Mild Lymphocyte Depletion: 1500-1800

Moderate Depletion: 900-1500

Severe Depletion: Less then 900

Lab Results:

What are non-nutritional factors factors that affect the TLC (Total Lymphocyte Count)?

Lab Results:

Immunity can alse be tested through ________ antigens. 6 antigens are injected intradermally in the forearm area and response (redness) is noted in 1-2 days

What is obesity?

What are causes of Obesity?

More then 20% above ideal body weight

Overweight and obese conditiosn are complex or multifaceted (Genetic, social, cutlural, pathologic, psychologic, physiologic)

Imbalance of caloric intake and caloric expenditure

Surpolus caloric intake over a long period of time

What is Marasmus?

Causes of Marasmus?

Protein Calorie Malnutrition

Marasmus: Inadequate intake of protein and calories or prolonged starvation (anorexia, bowel obstruction, cancer cachexia, chronic illness)

Kwashiorkor

Causes?

Protein Malnutrition

Due to diets high in calories but low or no protein

Marasmus vs. Kwashiorkor

What is the primary difference between the 2?

Kwashiorkor: Have decreased visceral protein levels and depressed immune function but have appropriate anthropometric measures

Marasmus: Decreased anthropometric measures, normal visceral protein levels

Due to prolonged inadequate intake of protein and calories (severe starvation and catabolic states)

Muscle, fat and visceral protein wasting

Undergone acute catabolic stress (ex: Major surgery, trauma, burns)

Pigmented keratotic scaling lesions resulting form a deficiency of niacin

Lesions are prominent in areas exposed to sun (hands, arms, neck, legs)

Diet of mostly carbs and little or n protein and are under stress (infection, parasitic, surgery, trauma, burns)

Edema, scaling areas of decreased pigmentation and decreased hear pigmentation

Appears nourished (round abdomen) - Unlike Marasmus which looks completely starved

Dry, bumpy skin associated with Vitamin A and/or Linoleic acid (essential fatty acid) deficiency

Deficiency of Vitamin C

Swollen Gums, ulcerated and bleeding due to Vitamin C-induced defects in oral epithelial basement membrane and periodontal collagen fiber synthesis

Foamy plaques of the cornea that signifies a Vitamin A deficiency

Severe depltion results in conjunctival xerosis (drying) and progress to corneal ulceration and finally keratomalacia (destruction of the eye)

Sign of Vitamin D and Calcium deficiencies

Children: Disorders of cartilage growth, enlargement of epiphyseal growth plates

Adults: Osteomalacia (softening of the bones due to defective bone mineralization)

Beefy red colored tongue

(Dr. Davenport stressed in class - may be on exam!!)

Abnormal condition of Obesity:

Risk factors include:

Fasting plasma glucose level, Raise in blood Pressure, Increase wasit circumference, high density lipoprotein and high Triglyceride level

MetS is associated with in crease risk for CV disease, Diabetes and Mortality

Lab Results:

What does Creatinine-Height Index Measure?

Estimate amount of skeletal muscle mass

Creatine is derived from the breakdown of muscles (energy complex in muscle) - It is excreted unchagned in the urine at a constant rate in proporition to the amount of body muscle

Lab Results:

What does Nitrogen Balance tests measure?

Protein nutritional status

Nitrogen is released with the catabolism of amino acids and is excreted in the urine as urea

Nitrogen balance indicates whether a person is anabolic (positive nitrogen balance) or catabolic (negative nitrogen balance)

Lab Results:

What does C-Reactive Protein (CRP) indicate?

Lab Results:

What do levels of Prealbumin indicate?

Prealbumin transports protein for Thyroxine (T4) and retinol-binding protein

Elevated: Renal disease

Reduced: Surgery, trauma, burns, infection

Lab Results:

What do serum Transferrin protein levels indicate?

Serum transferrin is an iron transport protein

Measures total iron binding capacity - indicator of visceral protein status

Lab Results:

What does serum albumin measure?

Visceral Protein status

Low levels are associated with protein-calorie malnutrition, altered hydration status, decreased liver function

Dr. Davenport Nutrition Lecture:

What is BMR (Basal Metabolic Rate)

Dr. Davenport Nutrition Lecture:

What factors influence BMR (Basic metabolic Rate)?

Exercise: More exercise, more enrgy, more needed

Age: Younger people have faster metabolic rates, therefore they require more caloreis

Hypothyroidism: Decreased metabolic rate

Hospitalization: Caloric intake goes down

Critical Care: Follow nutrition on long-term basis

Dr. Davenport Nutrition Lecture:

More calories then energy needs =

Dr. Davenport Nutrition Lecture:

Less calories then energy needs =

Dr. Davenport Nutrition Lecture:

Equal calories then energy needs =

Dr. Davenport Nutrition Lecture:

Carbs are a major source of _____ & _____

Dr. Davenport Nutrition Lecture:

Carbs are stored in the _____ & ______.

Dr. Davenport Nutrition Lecture:

1 gm of carbs = ___ kcal of energy

Dr. Davenport Nutrition Lecture:

Surplus carbs are stored as ______.

Dr. Davenport Nutrition Lecture:

Daily diet should be ___% carbs

Dr. Davenport Nutrition Lecture:

Protein is essential for:

Growth & Repair of tissues

Energy Source

Dr. Davenport Nutrition Lecture:

Essential animo acids are ________ by the body. How must they be obtained?

Dr. Davenport Nutrition Lecture:

Complete proteins contain all  ____ Amino Acids

A. Essential

B. Non Essential

Dr. Davenport Nutrition Lecture:

How is excess protein stored?

Dr. Davenport Nutrition Lecture:

1g of protein = _____ kcals of energy

Dr. Davenport Nutrition Lecture:

Protein consists of _____% of the daily diet

Dr. Davenport Nutrition Lecture:

Why are fats important to the body?

Normal Growth and Development

Hormone Synthesis

Impulse Transmission

Energy

Insulation

Metabolism

Stored Energy

Dr. Davenport Nutrition Lecture:

Fat converts to glucose through ___________.

Gluconeogenesis (Means New)

Wasn't glucose before - converts fat to glucose

Dr. Davenport Nutrition Lecture:

Excess intake of fats is stored as _______________.

Dr. Davenport Nutrition Lecture:

1g of Fat = ____ kcal of energy

Dr. Davenport Nutrition Lecture:

The normal amount of daily fat caloric intake should be ____%;

however, most Americans receive ____% of fat

30% (ideal)

37-40% of fat (Americans)

Dr. Davenport Nutrition Lecture:

Fat Soluble vs. Water Soluble Vitamins

Fat Soluble: 4 fat-soluble (A, D, E and K); absorbed through the intestinal tract with the help of lipids. Because they are more likely to accumulate in the body, they are more likely to lead to hypervitaminosis

Water Soluble: 9 water-soluble (8 B vitamins and vitamin C); vitamins dissolve easily in water, and are excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. Because they are not readily stored, consistent daily intake is important

Dr. Davenport Nutrition Lecture:

Major Minerals vs. Trace Minerals

Examples of each

Major Minerals: Iron

Trace Minerals: Flouride, Copper

Dr. Davenport Nutrition Lecture:

How much of the body is water?

What is the main function of water in the body?

60-70%

Cellular Function

Dr. Davenport Nutrition Lecture:

When do water needs increase?

Fever

Infections

Wounds (Open wounds loose lot of water)

GI Loss (Diarrhea, Vomiting, NG Sunction)

Respiratory disease (More energy to breathe, helps keep mucous liquified, Artificial Airway: Reduce ability of lungs to be provided with liquid by blocking the mucous membranes)

Dr. Davenport Nutrition Lecture:

Nutritional Assessment - Bus Stop Assessment

Weight (Too much or not enough)

Color Of Skin (Yellow: Jaundice = Liver disease = change in protein synthesis)

Teeth: Difficulty getting nutrition

Hair

Physical Signs: Rickets

SES: Homeless - inadequate nutrution

Appetite: Too great or low

Food Prefernce: Likes vs. Dislikes

Dietary Restrictions (sodium, sugar (diabetics), Potassium (Diuretics (K+), K+ Sparing, restrict K+); Renal Disease (Hyperkalemia)

Daily intake (fluids)

Weight change - esp. in past 6 months

Food intolerance

Allergies

Problems obtaining food, driving, finances

Pharmalogical nutrition defects (Some drugs cannot be taken with food)

Alcoholics - Malnutrition - unable to metabolize Vitamin B - tend to be anemic

Dr. Davenport Nutrition Lecture:

What is the difference between Anorexia and Anorexia Nervosa

Anorexia: Physiological Disorder

Anorexia Nervosa: Psychological Disorder

Dr. Davenport Nutrition Lecture:

How does liver disease effect nutrition?

Dr. Davenport Nutrition Lecture:

Alcoholics cannot absorb _______.

Alcoholics tend to be  ______.

Vitamin B

Anemic

Dr. Davenport Nutrition Lecture:

Rickets

Dr. Davenport Nutrition Lecture:

Kwashiorkor

Dr. Davenport Nutrition Lecture:

Bitot's Spots

Dr. Davenport Nutrition Lecture:

Follicular Hyperkeatosis

Vitamin A Deficiency

Dr. Davenport Nutrition Lecture:

Pellagra

Dr. Davenport Nutrition Lecture:

Kwashiorkor

Decreased Protein

Generalized Edema: Enlarged Abdomen due to to edema because of not enough proteins (proteins are responsibel for osmosis to hold on to fluid)

Change of hair color - Significant protein malnutrition

Dr. Davenport Nutrition Lecture:

Rickets

Calcium and Vitamin D deficiency

Proglm in U.S.

Vitamin D deficiency b/c no one is in the sun or they wear sunscreen

Dr. Davenport Nutrition Lecture:

Beefy Red tongue

Dr. Davenport Nutrition Lecture:

Waist-To-Hip Ratio

Apple vs. Pear Shape

Waist divided by hip

Females < 0.8

Males < 1.0

Pear: Healthier shape

Dr. Davenport Nutrition Lecture:

Calculate BMI 

KG/m(squared)

OR

LBS * 705 / Height in Inches (squared)

Dr. Davenport Nutrition Lecture:

What is Desired Body Weight?

How is it calculated?

What is normal and what is considered malnutrition?

DBW is the actual weight within 10% of desired body weight

It is calculated in

Females: 100 lbs for 1st 5ft + 5lbs for additional in over 5ft (+/- 10%)

Males: 106lbs for 1st 5ft + 6lbs for each inch over 5ft (+/- 10%)

80-90%: Ideal - mild malnutrition

70-80%: Moderate malnutrition

< 70%: Severe malnutrition

**Problem: Does not look at Muscle Mass

Dr. Davenport Nutrition Lecture:

What does the Tricep skinfold test estimate?

How to preform Tricep Skinfold Test?

What is considered malnutrition? Overnutrition?

TSF estimates fat the body stores

Easy to preform, pinch skin, back of non-dominant upper arm, pull away from muscle, use calipers to measure (repeat 3 x - take average)

TSF below 10% standard: Malnutrition

TSF Above 10% standard: Overnutrition

Dr. Davenport Nutrition Lecture:

Hemoglobin and hematocrit Tests

Detects Iron deficiency anemia

Look at what the red blood cells look like

Dr. Davenport Nutrition Lecture:

Lipid Profile Measures .....

Total cholesteral to evaluate fat metaboslism and assess C.A.D. Risk

Norm: 120-200 mg/dL

C.A.D. Risk - > 200 mg/dL

Compare HDL (good) and LDL (bad) and Triglycerides

Dr. Davenport Nutrition Lecture:

Total Lymphocyte Count (TLC)

Dr. Davenport Nutrition Lecture:

Serum Protein

Albumin vs. Pre albumin

Serum Protein: Identifies protein the body stores

Albumin: Visceral protein status (not early indicator)

Prealbumin (short half life of 2 days) more senstive to recent changes in protein status - good indicator of recent protein loss

Dr. Davenport Nutrition Lecture:

Nitrogen Balance

Indications

Index of protein nutritional status

* Nitrogen is released wit the catabolism of amino acids

Indicates: Anabolism (Positive nitrogen balance), Catabolism (- Nitrogen balance)

Nitrogen Intake = Nitrogen Excretion

Dr. Davenport Nutrition Lecture:

Calculate BMI

< 18.5 - Underweight

25-30 - Overweight

> 30 - Obese

> 40 Severly Obese (Morbidity Obese)