38 Questions
What are the two types of proteins affected in Protein-Energy Malnutrition (PEM)?
Somatic protein and Visceral protein
What is the role of biochemical tests in assessing PEM?
To provide the most objective and quantitative assessment
What is the significance of C-reactive protein in PEM assessment?
It is a positive acute-phase reactant and an indicator of immunocompetence
What are the two types of acute-phase reactants in PEM?
Positive acute-phase reactants and Negative acute-phase reactants
What are the examples of Hepatic transport proteins used to assess PEM?
Albumin, Transferrin, Prealbumin, Retinol-binding protein, and Creatinine
What is nitrogen balance used to assess in PEM?
The body's nitrogen intake and excretion
What are the technical difficulties associated with storage tissues?
Isolation, centrifugal force, and large blood sample are required.
What are the four types of storage tissues mentioned in the text?
Liver, bone marrow, adipose tissue, and bones.
What are the two most commonly ordered groups of tests in clinical chemistry?
Basic metabolic panel (BMP) and comprehensive metabolic panel (CMP).
What is the requirement for patients before taking the BMP and CMP tests?
Fasting for 10 to 12 hours before testing.
What are the seven components of the basic metabolic panel (BMP)?
Sodium, potassium, chloride, CO2, glucose, blood urea nitrogen (BUN), and creatinine.
What additional components are included in the comprehensive metabolic panel (CMP) compared to the BMP?
Calcium, albumin, total protein, and liver function tests.
What are the components of a complete blood count (CBC)?
Red blood cells (RBC), hemoglobin (Hgb), hematocrit (Hct), mean corpuscular volume (MCV), white blood cell count (WBC), and differential.
What is the purpose of the differential component in a complete blood count (CBC)?
To indicate percentages of different kinds of white blood cells (WBC).
What is the advantage of biochemical assessment in validating data obtained from dietary methods?
Useful to validate data obtained from dietary methods, e.g., comparing salt intake with 24-hour urinary excretion.
What are the limitations of biochemical assessment?
Affected by technical and biological factors other than depleted body stores of the nutrient.
What factors can alter biochemical assessment results?
Organ function, disease states, hydration status, medications, and fasting or non-fasting.
What type of blood specimen reflects recent dietary intake?
Whole blood, serum, or plasma.
What is the difference between serum and plasma?
Serum is the fluid from blood after blood cells and clot are removed, while plasma is the fluid from blood centrifuged with anticoagulants.
What type of specimen is sensitive to recent dietary intake?
Blood.
What type of specimen reflects chronic nutrient status?
Erythrocytes (red blood cells).
What type of blood cells are more sensitive than erythrocytes?
Leukocytes (white blood cells).
What is the primary purpose of biochemical assessment in nutritional assessment?
To detect subclinical deficiency states and to supplement other assessment methods.
What are the two methods used to identify subclinical deficiency states?
Biochemical tests and functional tests.
What is the advantage of biochemical assessment over other assessment methods?
It is the most objective and precise method.
What is the role of biochemical tests in detecting nutrient deficiencies?
Measuring nutrients and their metabolites.
What is the significance of functional tests in nutritional assessment?
Measuring production of abnormal metabolites or changes in enzyme activity dependent on a specific nutrient.
How do biochemical tests help in detecting marginal subclinical deficiency?
They can detect marginal subclinical deficiency before they result in overt signs.
What is the advantage of biochemical assessment in measuring the extent of functional consequences of a specific nutrient deficiency?
It can measure the extent of functional consequences.
Why is biochemical assessment considered a valuable tool in nutritional assessment?
It is the only method that can detect nutrient deficiency and supplement other methods of evaluation.
What is the main characteristic of Kwashiorkor in Protein-Energy Malnutrition (PEM)?
Visceral protein depletion due to inadequate intake of protein and/or hypermetabolic state.
What is the difference between Kwashiorkor and Marasmus in terms of response to starvation?
Kwashiorkor represents a maladaptive response to starvation, whereas Marasmus represents an adaptive response to starvation.
What are the common signs and symptoms of Kwashiorkor?
Edema, muscle wasting, psychomotor changes, anemia, and growth retardation.
What is the characteristic of Marasmus in terms of fat stores?
The body utilizes all fat stores before using muscles.
What is the main difference between Kwashiorkor and Marasmus in terms of edema?
Kwashiorkor is characterized by edema, whereas Marasmus is not.
What is the significance of half-life (t1/2) in evaluating acute-phase proteins?
It is the amount of time in which half of the protein is eliminated or broken down from the body.
What is the characteristic of negative acute-phase respondents in PEM?
They decrease in response to an acute phase response.
What is an example of a negative acute-phase respondent in PEM?
Albumin.
Study Notes
Protein-Energy Malnutrition (PEM)
- Somatic protein: skeletal muscle, visceral protein: hepatic protein, organs, structural protein, and protein found in blood
- Biochemical tests provide the most objective and quantitative assessment for PEM
- Assessment of PEM:
- Hormonal and cell-mediated response to stress
- Nitrogen balance
- Hepatic transport proteins (albumin, transferrin, prealbumin, retinol-binding protein, and creatinine)
- Immunocompetence (e.g., C-reactive protein)
Acute-Phase Proteins
- Change by 25% during an acute phase response
- Positive or negative acute-phase respondents
- Need to consider half-life (t1/2) of protein: amount of time which half of the protein is eliminated or broken down from the body
- Negative acute-phase respondents: albumin, transthyretin or prealbumin, transferrin, retinol-binding protein (decrease)
Clinical Chemistry Panels
- Basic Metabolic Panel (BMP) or Chem 7:
- Sodium (Na+)
- Potassium (K+)
- Chloride (Cl-)
- CO2 (Carbon dioxide)
- Glucose
- Blood Urea Nitrogen (BUN)
- Creatinine (Cr)
- Comprehensive Metabolic Panel (CMP) or Chem 20:
- Above plus calcium, albumin, total protein, liver function tests
- Complete Blood Count (CBC) Includes:
- Red blood cells (RBC)
- Hemoglobin (Hgb)
- Hematocrit (Hct)
- Mean corpuscular volume (MCV)
- White blood cell count (WBC)
- Differential: indicates percentages of different kinds of WBC
Biochemical Assessment
- Advantages:
- Most objective and precise method among all other assessment methods
- Detects marginal subclinical deficiency before they result in overt signs
- Only method that can by itself detect the nutrient deficiency and supplement other methods of evaluation
- Measures the extent of the functional consequences of a specific nutrient deficiency (functional vs. biochemical)
- Useful to validate data obtained from dietary methods
- Precise, accurate, and reproducible
- Disadvantages:
- Affected by technical and biological factors other than depleted body stores of the nutrient
- May be altered due to organ function, disease states, hydration status, medications, and fasting or non-fasting
Specimen Types
- Blood (whole or serum or plasma) tend to reflect recent dietary intake (acute term index)
- Erythrocytes (RBC): reflects only chronic status, unlikely to be a valid index for some nutrients
- Leukocytes (WBC): more sensitive than erythrocytes
Learn about the changes in protein levels during acute-phase response and the effects of Protein-Energy Malnutrition on the body. Topics include C-reactive protein, fibrinogen, and somatic protein.
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