Assessment 2 and Malabsorption PDF

2. Skinfold thickness (mm): – With special calipers, a pinch of subcutaneous fat is gently taken up, and the width is measured. Caught between the jaws of the calipers is a double layer of fat and skin. – Skinfold thickness provides a measurement of considerable value in assessing subcutane...

2. Skinfold thickness (mm): – With special calipers, a pinch of subcutaneous fat is gently taken up, and the width is measured. Caught between the jaws of the calipers is a double layer of fat and skin. – Skinfold thickness provides a measurement of considerable value in assessing subcutaneous fat and, therefore, the reserve of calories in the body – Skin folds could be measured at many sites, but the best established are Triceps, Biceps, Subscapular, and Suprailiac skin folds. 3. Waist circumference (cm): predicts mortality better than any other anthropometric measurement. – Waist circumference is a simple measurement used to assess abdominal (visceral) fat. – The larger the waist, the greater the risk of obesity-related complications, especially diabetes mellitus, cardiovascular disease, and all-cause mortality. – Waist circumference is determined by measuring the distance around the smallest area below the rib cage and the top of the iliac crest – Men are at increased risk if the waist circumference is greater than 40 inches (102 cm) – Women are at increased risk if the waist circumference is greater than 35 inches (89 cm)  Applied nutrition 4. Hip circumference (cm): – It is measured at the point of greatest circumference around hips and buttocks to the nearest 0.5 cm using a non-stretch flexible fibreglass tape in close contact with the skin, but without indenting the soft tissue. 5. Waist-to-Hip Ratio (WHR): – WHR more precisely measures abdominal adipose tissue and fat distribution. – a WHR of greater than 0.9 in men and 0.80 in women is considered a risk factor for obesity-related conditions 6. Index of Central Obesity (ICO): – It is defined as a ratio of WC (cm), and height (cm) that correlates better with central obesity than WC alone. – It is important to include height as a denominator, as other areas in the body have effects opposite to that of fat in the central region. – The utility of ICO over WC is analogous to that of BMI over crude weight measurement as a parameter of obesity. – The ICO cutoffs obtained ranged from 0.51 to 0.58 among males and 0.47 to 0.54 among females. 7. Head and chest circumferences: – They are additional measurements for assessing the growth of children 9  Dr. AHMED Solimam B) Biochemical and laboratory methods – The most common tests include 1. Serum albumin: widely used but insensitive indicator because it is affected by many factors other than nutrition (hepatic and renal diseases hydration status) 2. Blood glucose concentration 3. Plasma lipids: Fasting plasma TAG, essential fatty acids determination, fecal fat in the assessment of malabsorption 4. Hemoglobin estimation is the most important test and useful index of the overall state of nutrition. 5. Stool examination for the presence of ova and/or intestinal parasites 6. Urine examination and microscopy for albumin sugar and blood. 7. Vitamins, minerals (> 5 gm in the body) and trace elements (< 5 gm) assay 10  Applied nutrition C) Clinical examination methods: – There are a number of physical signs, either specific or non-specific, known to be associated with the status of malnutrition. – The subject is examined from head to foot in good illumination for the presence or absence of these signs D) Dietary Assessment: – The nutritional intake of humans is assessed by three different methods. These are: 1. 24 hours dietary recall 2. Dietary record using a questionnaire 3. Dietary history since early life 11  Dr. AHMED Solimam Nutritional Support – Nutritional support may range from simple dietary advice to long-term total parenteral nutrition (TPN). – In between is a whole spectrum of clinical conditions that need special nutritional support – As we move to the right, climbing the scale of the severity of the disease, we increase the level of support. – Daily Energy Requirements: The daily diet should contain enough energy to provide for the basal metabolic rate and to sustain a level of activity – The BMR is affected by factors 1. Growing children have increased BMR 2. Exposure to cold increases BMR 3. Exercise increases BMR (table) 4. Starvation decreases BMR 5. Fever increases BMR (12% for each degree Celsius rise in temperature) 6. Hormonal abnormalities (hyperthyroidism increases while hypothyroidism decreases BMR) 12  Applied nutrition Weight Changes 1. Weight Loss – Weight loss occurs when energy consumed is greater than the energy intake – First loss occurs from stored carbohydrates and an initial loss of tissues proteins – However, adaptation quickly takes place to conserve protein, and the adipose tissue fat becomes the predominant source of missing energy. – Adipose tissue contains roughly 85% TAG and 15% water, so 1 Kg of adipose tissue can be metabolized to produce: 1 Kg = 850 gm TAG → 850 X 9 Cal/gm = 7650 Cal  7500 Cal/Kg fat – A person who expends about 7500 Cal more than the dietary intake over a period of time loses one Kg body weight 13  Dr. AHMED Solimam 2. Weight Gain – It is more complicated to calculate the energy required for weight gain in a healthy adult because the added weight may be adipose tissues or muscles, depending on the individual’s nutrition, health, and activity – A gain of 1 kg in adipose tissues requires 7500 Cal. However, energy also is needed to synthesize the TAG, transport it to the proper location in the body, and store it in the adipocytes. The amount of energy required for these processes is equal to 7500 Cal for each 1 kg. – Therefore to gain 1 kg of body weight, a person needs to consume about 15000 Cal more than the energy expended by the body over a period of time. – Muscles are composed of roughly 20% proteins and 80% water. To gain 1 kg muscles, 200 gm of protein must be added, which has an energetic value of 200 X 4 = 800 Cal. However, additional energy is needed to synthesize and store the protein and build muscle mass. This makes the estimate is inaccurate – Furthermore, weight gain often results in a combination of adipose tissue and muscles 14  Applied nutrition Nutritional support for patients ▪ Patients requirements: 1. Energy: the principal energy sources in the diet are carbohydrates and fats. The entire calorie load may be administered using carbohydrates, but using a mixture of carbohydrates and lipids is more physiological and serves to reduce the volume of the diet. 2. Nitrogen: it is recommended that protein intake should constitute 10-15% of the total calorie requirements 3. Vitamins and trace elements are micronutrients because they are required in relatively small amounts. They are used in the make-up of artificial diets. ▪ Route of administration: 1. Oral feeding: should be used whenever possible 2. Tube feeding (Enteral): use small nasogastric tubes 3. Parenteral nutrition: Parenteral nutrition (TPN) – Parenteral nutrition is indicated for patients who are unable to eat or absorb food adequately from the GIT ▪ Route of administration: 1. Via peripheral vein: for a short period of 1-2 weeks 2. Via a central vein: long-term TPN may reach years – A peripheral IV line is a short catheter that’s typically placed in the forearm. It starts and ends in the arm itself. – A central line is a longer catheter that’s also placed in the upper arm. Its tip ends in the largest vein of the body, which is why it’s considered a central line. Or placed in the chest or neck 15  Dr. AHMED Solimam ▪ Complications: 1. Catheter site sepsis: the IV nutrient fluid is excellent growth media for MO 2. Misplacement of the catheter and infusion of nutrient extravascular 3. Hyperglycemia and hyperlipidemia 4. Decreased blood potassium, magnesium, and phosphate 5. Hypercalcemia 6. Acid-base imbalance ▪ Monitoring of Parenteral nutrition 16  Applied nutrition Malabsorption – Digestion: is enzymatically breaking down of large nutrient molecules into low molecular weight compounds that can be absorbed – Absorption: is the transport of the digestion products into the portal blood – Malabsorption: is the failure of digestion or absorption 17  Dr. AHMED Solimam ▪ Diagnosis of Malabsorption Physical diagnosis Biochemical investigations 1. History of eating patterns 1. Tests of malabsorption 2. Endoscopy and biopsy 2. Tests of pancreatic function 3. Radiological tests 4. Assess the state of teeth, gums, salivary secretion 5. Presence of diarrhea 18  Applied nutrition Biochemical investigations ▪ Tests of malabsorption 1. Fecal fat: the presence of fatty stools for 5 days indicate malabsorption 2. Fecal microscopy: for fat globules 3. Butterfat test: detection of chylomicrons after standard fat load 14 4. C triglyceride breath test: an oral dose of radiolabelled TG is given, and 14 CO2 in expired air is a measure of the effectiveness of digestion and absorption 5. Xylose absorption test: serum level of xylose is determined after an oral dose ▪ Tests of pancreatic function 1. Lundh test: measure the activity of trypsin and amylase in duodenal contents 2. Secretin test: IV secretin injection stimulates pancreatic secretion 3. Pancreolauryl test: is a non-invasive test of pancreatic function based on the specific splitting by pancreatic esterase of orally administered fluorescein dilaurate. Fluorescein dilaurate is hydrolyzed by cholesterol esterase. The water-soluble fluorescein is absorbed and excreted in urine 19  Dr. AHMED Solimam ▪ GI diseases leading to malabsorption 1. Chronic pancreatitis: the presence of fatty stools for 5 days indicate malabsorption 2. Coeliac disease is a condition where your immune system attacks your tissues when you eat gluten. This damages your gut (small intestine), so you are unable to take in nutrients. Coeliac disease can cause a range of symptoms, including diarrhea, abdominal pain, and bloating 3. Crohn’s disease: is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition 4. Infection: any infection causes intestinal hurry (when food, especially sugar, moves too quickly from the stomach to the duodenum) (salmonella infection). 5. Abnormal bowel anatomy or insufficient bowel (small bowel absorptive surface area) 6. Liver diseases: leads to inadequate bile salt secretion 20