Harrison's Internal Medicine Chapter 72. Malnutrition and Nutritional Assessment
Malnutrition and Nutritional Assessment: Introduction
Malnutrition can arise from primary or secondary causes, with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements, metabolism, or absorption. Primary malnutrition occurs mainly in developing countries and under conditions of war or famine.
A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients.
Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies.
Physiologic Characteristics of Hypometabolic and Hypermetabolic States The metabolic characteristics and nutritional needs of hypermetabolic patients who are stressed from injury, infection, or chronic inflammatory illness differ from those of hypometabolic patients who are unstressed but chronically starved. In both cases, nutritional support is important, but misjudgments in selecting the appropriate approach may have disastrous consequences.
Anthropometric measurements provide information on body muscle mass and fat reserves. The most practical and commonly used measurements are body weight, height, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Body weight is one of the most useful nutritional parameters to follow in patients who are acutely or chronically ill. Unintentional weight loss during illness often reflects loss of lean body mass (muscle and organ tissue), especially if it is rapid and not caused by diuresis.
Assessment of Circulating (Visceral) Proteins
The serum proteins most used to assess nutritional status include albumin, total iron-binding capacity (or transferrin), thyroxine-binding prealbumin (or transthyretin), and retinol-binding protein. Because they have differing synthesis rates and half-lives—the half-life of serum albumin is about 21 days whereas those of prealbumin and retinol-binding protein are about 2 days and 12 h, respectively—some of these proteins reflect changes in nutritional status more quickly than others.
This book is about what we consider the essentials of human nutrition.
The science of human nutrition deals with all the effects on people of any component
found in food. This starts with the physiological and biochemical processes involved
in nourishment—how substances in food provide energy or are converted into body
tissues, and the diseases that result from insufficiency or excess of essential nutrients
(malnutrition). The role of food components in the development of chronic degenerative
disease like coronary heart disease, cancers, dental caries, etc.
The end stage of cachexia, marasmus is a state in which virtually all available body fat stores have been exhausted due to starvation. Conditions that produce marasmus in developed countries tend to be chronic and indolent, such as cancer, chronic pulmonary disease, and anorexia nervosa.
Marasmus is easy to detect because of the patient's starved appearance. The diagnosis is based on severe fat and muscle wastage resulting from prolonged calorie deficiency.
Nutritional Status Assessment Full nutritional status assessment is reserved for seriously ill patients and those at very high nutritional risk when the cause of malnutrition is still uncertain after initial clinical evaluation and dietary assessment. It involves multiple dimensions, including documentation of dietary intake, anthropometric
measurements, biochemical measurements
of blood and urine, clinical
examination, health history, and functional status. For further discussion of nutritional assessment, see Chap. 72.
The rate of endogenous protein breakdown (catabolism) to supply energy needs normally falls during uncomplicated energy deprivation. After about 10 days of total starvation, the unstressed individual loses about 12–18 g/d protein (equivalent to approximately 2 oz of muscle tissue or 2–3 g of nitrogen).
USDA’s Economic Research Service (ERS) projects that
average per capita food consumption for 67 low-income
countries will increase in the next decade. ERS also projects
that the number of people failing to meet their nutritional
requirements will decline from 774 million in 2000 to 694
million in 2010, providing an improved outlook for global
food security. But the gains are not uniform across countries
and in many food insecurity will probably intensify.
Harrison's Internal Medicine Chapter 70. Nutritional Requirements and Dietary Assessment
Nutritional Requirements and Dietary Assessment: Introduction Nutrients are substances that must be supplied by the diet because they are not synthesized in the body in sufficient amounts. Nutrient requirements for groups of healthy persons have been determined experimentally. For good health we require energy-providing nutrients (protein, fat, and carbohydrate), vitamins, minerals, and water.
(BQ) Phần 1 cuốn sách "Harrison’s principles internal medicine self - assessment and board review" trình bày các nội dung: Introduction to Clinical Madicine, nutrition, oncology and Hamatology, infecders of the Respiratory System, Disorders of the Respiratory System, Disorders of the Kidney and Urinary Tract,... Mời các bạn cùng tham khảo nội dung chi tiết.
The Directive's main aim is to ensure that the authority giving the primary consent (the
'competent authority') for a particular project makes its decision in the knowledge of any likely
significant effects on the environment. The Directive, therefore, sets out a procedure that must
be followed for certain types of project before they can be given 'development consent'. This
procedure, known as Environmental Impact Assessment (EIA), is a means of drawing together,
in a systematic way, an assessment of a project's likely significant environmental effects.
Acute Care Settings Acute care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the goal is to identify and avoid inadequate intake and ensure appropriate alimentation. Dietary assessment focuses on what patients are currently eating, whether they are able and willing to eat, and whether they experience any problems with eating. Dietary intake assessment is based on information from observed intakes; medical record; history; clinical examination; and anthropometric, biochemical, and functional status.
Priority-setting approaches in the area of health have slighted SRH concerns.
A disease-oriented approach to health priority setting has not recognized the
importance of preventing unintended pregnancies. The consequences of these
extend beyond the direct individual disability concerns to social participation,
familial health and complex empowerment issues. Returns to investments in
SRH are, therefore, difficult to assess and often omitted from policy dialogues.
(BQ) Part 1 book "Nutrition support for the critically ill" presents the following contents: An introduction to malnutrition in the intensive care unit, the immunological role of nutrition in the gut, assessment of the patient, timing and indications for enteral nutrition in the critically ill,...
The most established nationwide medical registry in Germany is the Perinatal Registry, which collects
maternal health records concerning pregnancy, delivery and perinatal outcome from now more than
1100 hospitals. Over the past 16 years, data collection was transformed from printed questionnaires to
digital records. A special web-based information source of the German Perinatal Registry does not
No evidence of a difference in content of nutrients and other substances between
organically and conventionally produced crops and livestock products was detected for the
majority of nutrients assessed in this review suggesting that organically and conventionally
produced crops and livestock products are broadly comparable in their nutrient content.
TIGTA’s audit work is concentrated on high-risk areas and the IRS’s progress in achieving its
strategic goals. To identify FY 2012 high-risk areas for audit coverage, TIGTA uses a risk-
assessment strategy within its core business areas. The Assistant Inspectors General for Audit
advise the Deputy Inspector General for Audit on the major risks facing the IRS in their
respective program areas and annually propose a national audit plan based on perceived risks,
stakeholder concerns, and follow-up reviews of previously audited areas with significant control
Genetically modified foods and food products derived from genetically engineered
organisms are among a number of biotechnological developments intended
to improve shelf life, nutritional content, flavor, color, and texture, as well as
agronomic and processing characteristics. Although in popular parlance the term
genetically modified often is used interchangeably with genetically engineered,
in this report genetic modification refers to a range of methods used to alter the
genetic composition of a plant or animal, including traditional hybridization and