10 Nutrition
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Questions and Answers

What is the caloric need approximately for an average healthy adult male?

  • 25-30 calories/kg/day
  • 30-35 calories/kg/day
  • 20-25 calories/kg/day (correct)
  • 15-20 calories/kg/day

    • How many calories are provided by 1g of fat (lipids)?

  • 9 calories/g (correct)
  • 11 calories/g
  • 7 calories/g
  • 5 calories/g

    • What percentage of protein calories is required for an average healthy adult male?

  • 25%
  • 20% (correct)
  • 10%
  • 15%

    • How much does trauma, surgery, or sepsis stress increase the kcal requirement?

    <p>30%–40%</p> Signup and view all the answers

    By how much does pregnancy increase the kcal requirement?

    <p>300 kcal/day</p> Signup and view all the answers

    What does the Harris–Benedict equation calculate based on?

    <p>Weight, height, age, and gender</p> Signup and view all the answers

    Which vitamin deficiency can lead to night blindness?

    <p>Vitamin A</p> Signup and view all the answers

    What is the potential effect of a deficiency in thiamine (B1)?

    <p>Wernicke's encephalopathy</p> Signup and view all the answers

    Which mineral deficiency can lead to cardiomyopathy and weakness?

    <p>Selenium</p> Signup and view all the answers

    What is the potential effect of a deficiency in cobalamin (B12)?

    <p>Megaloblastic anemia</p> Signup and view all the answers

    Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?

    <p>Niacin</p> Signup and view all the answers

    What is the potential effect of a deficiency in pyridoxine (B6)?

    <p>Peripheral neuropathy</p> Signup and view all the answers

    Which mineral deficiency can lead to poor wound healing, alopecia, and rash?

    <p>Zinc</p> Signup and view all the answers

    Which nutrient deficiency is characterized by anorexia, weight loss, and wasting, and believed to be mediated by TNF-α?

    <p>Protein deficiency</p> Signup and view all the answers

    Where does the majority of protein breakdown from skeletal muscle occur?

    <p>Liver</p> Signup and view all the answers

    Which nutrient cycle removes urea from the body with the help of kidneys?

    <p>Urea cycle</p> Signup and view all the answers

    Where does fat digestion primarily occur, involving the formation of micelles for absorption?

    <p>Small intestine</p> Signup and view all the answers

    Which fatty acids are essential for prostaglandin synthesis and immune cells?

    <p>Linolenic and linoleic acids</p> Signup and view all the answers

    In central venous TPN, what percentage of amino acid solution is typically included?

    <p>10%</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>Glutamine</p> Signup and view all the answers

    In the respiratory phase, what does a high Respiratory Quotient (RQ) indicate?

    <p>Lipogenesis</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?

    <p>Refeeding syndrome</p> Signup and view all the answers

    In the postoperative phases, which state has different nutritional requirements compared to diuresis and catabolic states?

    <p>Anabolic state</p> Signup and view all the answers

    What is the maximum administration rate of glucose in Central line Total Parenteral Nutrition (TPN)?

    <p>3 g/kg/h</p> Signup and view all the answers

    What should be considered to prevent refeeding syndrome?

    <p>Starting re-feeding at a very low rate</p> Signup and view all the answers

    What is the potential effect of a deficiency in selenium?

    <p>Cardiomyopathy, weakness</p> Signup and view all the answers

    Which mineral deficiency can lead to alopecia, rash, and poor wound healing?

    <p>Zinc</p> Signup and view all the answers

    What is the potential effect of a deficiency in phosphate?

    <p>Weakness, encephalopathy, decreased phagocytosis</p> Signup and view all the answers

    Which vitamin deficiency can lead to scurvy and poor wound healing?

    <p>Vitamin C</p> Signup and view all the answers

    What is the primary effect of a deficiency in niacin?

    <p>Pellagra (diarrhea, dermatitis, dementia)</p> Signup and view all the answers

    Which effect is associated with a deficiency in vitamin K?

    <p>Coagulopathy</p> Signup and view all the answers

    What is the potential effect of a deficiency in vitamin D?

    <p>Rickets, osteomalacia, osteoporosis</p> Signup and view all the answers

    Which mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?

    <p>Chromium</p> Signup and view all the answers

    What is the potential effect of a deficiency in cobalamin (B12)?

    <p>Megaloblastic anemia, peripheral neuropathy, glossitis</p> Signup and view all the answers

    What does the Cori cycle involve?

    <p>Transport of lactate from muscle to the liver for gluconeogenesis</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>Glutamine</p> Signup and view all the answers

    What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?

    <p>Lipogenesis and the need to decrease carbohydrates and caloric intake</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition characterized by a shift from fat to carbohydrate metabolism?

    <p>Refeeding syndrome</p> Signup and view all the answers

    What should be considered to prevent refeeding syndrome?

    <p>Starting re-feeding at a low rate (10-15 kcal/kg/day)</p> Signup and view all the answers

    Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?

    <p>Enteral nutrition</p> Signup and view all the answers

    What fatty acids are essential for prostaglandin synthesis and immune cells?

    <p>Short-chain fats such as butyric acid</p> Signup and view all the answers

    In the case of conditions like CVA where regular feeding is not possible, what can be considered for tube feeds?

    <p>PEG tube</p> Signup and view all the answers

    What can treat high gastric residuals?

    <p>Reglan and erythromycin</p> Signup and view all the answers

    What does starvation initially deplete before switching to fat metabolism?

    <p>Glycogen stores</p> Signup and view all the answers

    What mineral deficiency can lead to poor wound healing, alopecia, and rash?

    <p>Zinc</p> Signup and view all the answers

    What is the major site of protein production and breakdown?

    <p>Liver</p> Signup and view all the answers

    Which nutrient cycle removes urea from the body with the help of kidneys?

    <p>Urea cycle</p> Signup and view all the answers

    Where does fat digestion primarily occur, involving the formation of micelles for absorption?

    <p>Small intestine</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?

    <p>Refeeding syndrome</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>Glucose</p> Signup and view all the answers

    Which organ is the major stressor in increasing catecholamines, cortisol, and cytokines?

    <p>Liver</p> Signup and view all the answers

    What should be considered to prevent refeeding syndrome?

    <p>Gradual increase in calorie intake</p> Signup and view all the answers

    Which mineral deficiency can lead to poor wound healing, alopecia, and rash?

    <p>Zinc</p> Signup and view all the answers

    In central venous TPN, what percentage of dextrose solution is typically included?

    <p>15</p> Signup and view all the answers

    How many calories are provided by 1 gram of fat (lipids)?

    <p>9 calories</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>Carbohydrates</p> Signup and view all the answers

    What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?

    <p>Preferential use of carbohydrates as a fuel</p> Signup and view all the answers

    Which nutrient cycle removes urea from the body with the help of kidneys?

    <p>Urea cycle</p> Signup and view all the answers

    What is the potential effect of a deficiency in cobalamin (B12)?

    <p>Pernicious anemia</p> Signup and view all the answers

    Which mineral deficiency can lead to poor wound healing, alopecia, and rash?

    <p>Zinc</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?

    <p>Re-feeding syndrome</p> Signup and view all the answers

    What is the potential effect of a deficiency in thiamine (B1)?

    <p>Beriberi</p> Signup and view all the answers

    Which nutrient is the primary fuel for most neoplastic cells?

    <p>Glutamine</p> Signup and view all the answers

    What is the approximate half-life of albumin?

    <p>18 days</p> Signup and view all the answers

    What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?

    <p>Lipogenesis and decreased carbohydrates intake</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?

    <p>Refeeding syndrome</p> Signup and view all the answers

    In the postoperative phase, which state is characterized by diuresis (days 2-5)?

    <p>Anabolic state (days 3-6)</p> Signup and view all the answers

    What is the preferred nutrition method postoperatively to avoid bacterial translocation and TPN complications?

    <p>Enteral nutrition</p> Signup and view all the answers

    What can be considered for tube feeds in conditions where regular feeding is not possible, such as CVA?

    <p>Enteral nutrition via PEG tube</p> Signup and view all the answers

    Which mineral can lead to poor wound healing, alopecia, and rash if deficient?

    <p>Zinc (Zn)</p> Signup and view all the answers

    Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?

    <p>Thiamine (B1)</p> Signup and view all the answers

    Which effect is associated with a deficiency in vitamin K?

    <p>Decreased blood clotting</p> Signup and view all the answers

    What is the maximum recommended daily caloric intake for an average healthy adult male?

    <p>3,000 calories/day</p> Signup and view all the answers

    How much can trauma, surgery, or sepsis stress increase the kcal requirement in percentage?

    <p>30%–40%</p> Signup and view all the answers

    By what percentage does pregnancy increase the kcal requirement?

    <p>300%</p> Signup and view all the answers

    Which equation calculates basal energy expenditure based on weight, height, age, and gender?

    <p>Harris–Benedict equation</p> Signup and view all the answers

    What is the recommended protein requirement for an average healthy adult male in grams per kilogram per day?

    <p>1 g/kg/day</p> Signup and view all the answers

    What is the maximum recommended calorie intake for burns per day?

    <p>$3,000 calories/day + (30 calories/day × % burn)$</p> Signup and view all the answers

    How much does lactation increase the kcal requirement?

    <p>$500 kcal/day$</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>$Carbohydrates$</p> Signup and view all the answers

    What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?

    <p>Fat is being used as the primary energy source.</p> Signup and view all the answers

    What mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?

    <p>Selenium</p> Signup and view all the answers

    What is the primary function of the urea cycle?

    <p>Remove ammonia from the body with the help of kidneys</p> Signup and view all the answers

    Which nutrient is essential for prostaglandin synthesis and immune cells?

    <p>Linolenic and linoleic acids</p> Signup and view all the answers

    Where does the majority of protein breakdown from skeletal muscle occur?

    <p>Liver</p> Signup and view all the answers

    What is the primary site of fat digestion, involving the formation of micelles for absorption?

    <p>Small intestine</p> Signup and view all the answers

    Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?

    <p>Lipids</p> Signup and view all the answers

    What is the primary effect of a deficiency in niacin?

    <p>Poor wound healing</p> Signup and view all the answers

    What is the caloric need approximately for an average healthy adult male?

    <p>$2200-2500$ kcal/day</p> Signup and view all the answers

    Which mineral deficiency can lead to alopecia, poor wound healing, and rash?

    <p>Selenium</p> Signup and view all the answers

    What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?

    <p>$eta$-oxidation</p> Signup and view all the answers

    What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?

    <p>Increased carbohydrate metabolism</p> Signup and view all the answers

    Which mineral deficiency can lead to pancytopenia?

    <p>Copper</p> Signup and view all the answers

    What is the potential effect of a deficiency in pyridoxine (B6)?

    <p>Sideroblastic anemia</p> Signup and view all the answers

    What does a high TAGs level indicate in the context of metabolic syndrome?

    <p>High triglycerides level</p> Signup and view all the answers

    What is the primary effect of a deficiency in niacin?

    <p>Pellagra</p> Signup and view all the answers

    Where does fat digestion primarily occur, involving the formation of micelles for absorption?

    <p>Small intestine</p> Signup and view all the answers

    What is the primary fuel for most neoplastic cells?

    <p>Glucose</p> Signup and view all the answers

    What can be considered for tube feeds in the case of conditions like CVA where regular feeding is not possible?

    <p>Enteral nutrition</p> Signup and view all the answers

    By how much does pregnancy increase the kcal requirement?

    <p>+500 kcal/day</p> Signup and view all the answers

    What percentage of dextrose solution is typically included in central venous TPN?

    <p>&lt; 30%</p> Signup and view all the answers

    What mineral deficiency can lead to osteomalacia and osteoporosis?

    <p>Vitamin D</p> Signup and view all the answers

    Study Notes

    • Central line Total Parenteral Nutrition (TPN) uses glucose as the main component, with a maximum administration rate of 3 g/kg/h.

    • Peripheral line Parenteral Nutrition (PPN) is based on short-chain fats, such as butyric acid, which fuel colonocytes.

    • Glutamine is an essential amino acid, the most common one in the bloodstream and tissues, and plays a crucial role in small bowel enterocytes. It enhances immune function and is the primary fuel for most neoplastic cells.

    • Preoperative nutritional assessment involves evaluating the approximate half-lives of albumin (18 days), transferrin (8 days), and prealbumin (2 days). Normal protein and albumin levels are 6.0-8.5 and 3.5-5.5, respectively. Signs of severe malnutrition include acute weight loss (>20% in 3 months), low prealbumin levels (<15), and an energy deficit.

    • In the respiratory phase, the ratio of CO2 produced to O2 consumed (Respiratory Quotient, RQ) measures energy expenditure. A high RQ (>1) indicates lipogenesis and the need to decrease carbohydrates and caloric intake. A low RQ (<0.7) signifies ketosis and the need to increase carbohydrates and caloric intake.

    • In the postoperative phases, diuresis (days 2-5), catabolic (days 0-3), and anabolic (days 3-6) states have different nutritional requirements. Starvation or major stress (surgery, trauma, systemic illness) cause significant metabolic differences, with a shift from fat to a mixed fuel source, increased ketone body production, and gluconeogenesis.

    • With starvation, the body initially depletes glycogen stores and switches to fat metabolism. However, in trauma, protein-conserving mechanisms do not occur, and the energy source is a mixed fat and protein.

    • Enteral nutrition is preferred postoperatively to avoid bacterial translocation and TPN complications. In severely ill patients, it should be started within 24-48 hours and continued for at least 5-7 days, if not able to start regular feeding.

    • In the case of conditions like CVA where regular feeding is not possible, a PEG tube can be considered for tube feeds. Renal formulations should be used for patients with renal issues, while diarrhea requires a slow rate, fiber addition, and less-concentrated feeds.

    • High gastric residuals can be treated with medications like Reglan and erythromycin. Patients can tolerate about 5-7 days without eating and should start TPN at that point if not able to begin enteral nutrition.

    • Refeeding syndrome occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism, which can lead to symptoms like decreased potassium (K), phosphorus (PO4), and magnesium (Mg), cardiac dysfunction, profound weakness, encephalopathy, congestive heart failure, and failure to wean from the ventilator. To prevent this, it is recommended to start re-feeding at a low rate (10-15 kcal/kg/day).

    • Ethanol abuse can cause malnutrition and, when combined with re-feeding, can lead to refeeding syndrome. Symptoms include a shift from fat to carbohydrate metabolism and a decrease in K, Mg, and PO4.

    • Cachexia: condition characterized by anorexia, weight loss, and wasting, believed to be mediated by TNF-α

    • Results in glycogen breakdown, lipolysis, and protein catabolism

    • Kwashiorkor: protein deficiency, Marasmus: starvation, major stressors increase catecholamines, cortisol, and cytokines (TNF-α, IL-1), leading to significant protein breakdown and negative nitrogen balance

    • Nitrogen balance: N in = protein intake (g), N out = urine N + 4g, protein synthesis for normal 70kg male is 250g/day

    • Liver: major site of protein production and breakdown, majority of protein breakdown from skeletal muscle is glutamine and alanine

    • Urea cycle: NH3 donor is glutamine, occurs in liver, removes urea from the body with the help of kidneys, accounts for 90% of total N loss

    • Homeostatic adjustments after injury, fat digestion: involves TAGs, cholesterol, and lipids, micelles formed for fat absorption, enterocytes absorb chylomicrons, long-chain fatty acids enter lymphatics, and medium-chain fatty acids into the portal vein

    • Essential fatty acids: linolenic and linoleic acids, needed for prostaglandin synthesis and immune cells

    • Carbohydrate digestion: begins in the mouth and continues in the small intestine, glucose, galactose, and fructose are absorbed, and the rest enters the portal vein

    • Protein digestion: stomach pepsin, followed by trypsin, chymotrypsin, and carboxypeptidase, amino acids absorbed by the gut, branched-chain amino acids are important in liver failure, and non-essential amino acids start with A, G, or C

    • Central venous TPN: contains 10% amino acid and 25% dextrose solutions, along with electrolytes, minerals, and vitamins, and lipids are given separately.

    • Cachexia: condition characterized by anorexia, weight loss, and wasting, believed to be mediated by TNF-α

    • Results in glycogen breakdown, lipolysis, and protein catabolism

    • Kwashiorkor: protein deficiency, Marasmus: starvation, major stressors increase catecholamines, cortisol, and cytokines (TNF-α, IL-1), leading to significant protein breakdown and negative nitrogen balance

    • Nitrogen balance: N in = protein intake (g), N out = urine N + 4g, protein synthesis for normal 70kg male is 250g/day

    • Liver: major site of protein production and breakdown, majority of protein breakdown from skeletal muscle is glutamine and alanine

    • Urea cycle: NH3 donor is glutamine, occurs in liver, removes urea from the body with the help of kidneys, accounts for 90% of total N loss

    • Homeostatic adjustments after injury, fat digestion: involves TAGs, cholesterol, and lipids, micelles formed for fat absorption, enterocytes absorb chylomicrons, long-chain fatty acids enter lymphatics, and medium-chain fatty acids into the portal vein

    • Essential fatty acids: linolenic and linoleic acids, needed for prostaglandin synthesis and immune cells

    • Carbohydrate digestion: begins in the mouth and continues in the small intestine, glucose, galactose, and fructose are absorbed, and the rest enters the portal vein

    • Protein digestion: stomach pepsin, followed by trypsin, chymotrypsin, and carboxypeptidase, amino acids absorbed by the gut, branched-chain amino acids are important in liver failure, and non-essential amino acids start with A, G, or C

    • Central venous TPN: contains 10% amino acid and 25% dextrose solutions, along with electrolytes, minerals, and vitamins, and lipids are given separately.

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    Test your knowledge of cachexia, kwashiorkor, and marasmus, as well as the physiological mechanisms and factors contributing to these conditions such as TNF-α, protein catabolism, and nitrogen balance.

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