ASPEN Adult Nutrition Support Core Curriculum - Chapter Questions and correct answers

ASPEN Adult Nutrition Support Core Curriculum - Chapter Questions and correct answerswhich of the following nutrition interventions have been shown to improve clinical outcomes and quality of life in institutionalized older adults? A. diet modification and liberalization B. modification of dining environment C. provision of aides to improve functional status and increased independence at meals D. honoring food preference and providing snacks and fortified foods E. All of the above E. all of the above which of the following nutrition support interventions has demonstrated the best outcomes in frail, community-dwelling older adults in post-operative orthopedic surgery populations? A. oral nutrition supplement B. IV hydration C. EN D. PN A. oral nutrition supplement - oral nutrition supplements display the best outcomes in this population - EN, PN, and IV hydration have demonstrated limited success in achieving positive outcomes in older adults 00:28 01:33 what is the most reasonable justification to initiate EN in an individual with advanced dementia? A. decreased morbidity B. specific and limited goal C. improved mortality D. improved quality of life B. specific and limited goal - EN has not been shown to be an effective intervention to decrease mortality, improve morbidity outcomes, or improve QOL in patients with advanced dementia - however, according to the AND, specific and realistically achievable goal may be a reason to initiate tube feeding in and older adult with advanced dementia of the following, which is the best currently known nutrition intervention to minimize negative outcomes associated with sarcopenia? A. protein supplementation B. amino acid supplementation C. protein adequacy D. omega-3 fatty acid adequacy C. protein adequacy - adequacy of protein intake seems to be the most importance nutrition-related factor in preserving lean body mass in older adults - the type of protein, essential AA supplementation, and omega-3 fatty acid supplementation may all play roles in preventing sarcopenia what is the most accurate way to determine energy requirements for obese patients in ICU requiring EN support? A. harris-benedict B. IC C. mifflin-st jeor D. penn state equation B. Indirect calorimetry - most predictive equations were validated in patients without extremes of weight or age - overestimation of energy requirements when using actual body weight and underestimation when using IBW led to inadvertent overfeeding and underfeeding, respectively - efforts to account for altered body composition by using corrections for actual body weight have led to even more confusion - for this reason, IC should be used when available according to most recent ASPEN and SSCM guidelines, what is the EN feeding strategy based on energy requirements for obese people? A. hypo caloric with normal protein B. hypo caloric with low protein C. hypo caloric with high protein D. hypercaloric with high protein C. hypo caloric with high protein - BMI 30: goal of EN should not exceed 60-70% of target energy requirements - estimated protein requirements may be 2.0 gm/kg/day of IBW for pts with class 1-2 obesity and 2.5 gm/kg/day for pats with class 3 obesity which of the following is criterion for selection patients to undergo gastric bypass surgery? A. BMI /=35 and no history of substance abuse or psychiatric disorders B. BMI equal to or greater than 35 and obesity-associated co-morbidities C. BMI equal to or greater than 30 and obesity associated comobidities D. BMI equal to or greater than 30 and inability to achieve weight control with low calorie diets B. BMI equal to or greater than 35 and obesity-associated co-morbidities - candidate if BMI /=40 or /=35 with co-morbidities and more conservative efforts at weight loss have not resulted in adequate weight control - pts with active bulimia, active substance abuse, or major disturbances of though or mood should be evaluated carefully and these issues should be treated prior to surgery which of the following statements regarding the current WHO and NIH classification of overweight and obesity is true? A. overweight is defined as BMI 25 to 29.9 and obesity is defined as BMI =/ than 30 B. obesity is defined as equal or greater to 120% of IBW C. obesity is defined as body fat equal or greater than 20% of body weight for men and equal to or greater than 30% for women D. obesity is defined as BMI greater than 25, and morbid obesity is defined as BMI greater than 30 A. overweight is defined as BMI 25 to 29.9 and obesity is defined as BMI =/ than 30 - use of BMI is encouraged over iBW bc it provides a standardized method for expressing weight relativly independent of heigh and correlates reasonably well with body fat as well as mortality - although BMI does not always accurately reflect excess body fat (eg when ascites or edema is present), it represents a simple and reproducible method for categorizing weight what percentage of instilled dextrose is typically absorbed from peritoneal dialysate with a 6 hour dwell time? A. 25% B. 50% C. 75% D. 100% ... which is most likely to succeed in improving oral intake in pts with prolonged history of weight loss due to poor intake, nausea, decreased appetite? A. high cal oral liquid supplement x3 daily B. six small, low fat meals per day C. fiber supplemented snacks x3 daily D. plan primarily solid meals; limit fluids B. six small, low fat meals per day may be difficult to meet nutrient targets with 3 regular sized meals. fat, caloric density, and fiber content slow gastric emptying. providing fluids (not limiting them) facilitates gastric emptying fermentable fiber is beneficial in enteral formulas because: A. colonic bacteria acts of to fiber to make SCFA that provide energy source to intestinal mucosa B. colonic bacteria acts of to fiber to make SCFAs, which in turn exert trophic effects of the intestinal mucosa C. fermentable fiber may help control diarrhea by slowing gastric emptying D. all the above D. all the above fermentable fibers (pectins, gum, fructooligosaccharides) are metabolized by colonic bacteria to make SCFA. fiber is not recommended for tx of C Diff PMC (pseudomembrane colitis) or during low flow states. which of the following nutrients is added to rehydration liquids to promote sodium (Na+) absorption in pts with diarrhea? A. glucose B. amino acids C. long-chain fatty acids D. alcohol A. glucose the presence of glucose in the lumen of the small intestine facilitates the absorption of sodium. when more sodium is absorbed, more water from the the lumen of the intestines is absorbed. use NaCl in rehydration solutions 00:02 01:33 which of the following has the greatest influence on total energy expenditure (TEE)? A. resting metabolic rate (RMR) B. thermogenic effect of digestion C. physical activity D. metabolic stress A. resting metabolic rate (RMR) thermogenic effect of digestion contributes no more than 10% to TEE. activity contributes 5-30% of TEE. with exceptions for burn/sepsis, metabolic stress contributes to less than 50% of TEE. RMR contributes 60-75% of TEE the most commonly used method for assessing energy expenditure is A. indirect calorimetry B. predictive equations C. The Reverse Fick equation D. doubly labeled water B. predictive equations indirect calorimetry is most accuracy but underused because of its expense and the clinical expertise required for use/interpretation reverse fick equation - oxygen content differences in arterial and mixed venous blood multiplied by cardiac output measurements from pulmonary arterial catheters which parameter is measured when using indirect calorimetry? A. heat loss B. catabolic rate C. gas exchange D. free energy balance C. gas exchange if proper testing conditions are observed, the gas exchange measurement ratio can to converted to RMR using the Weir equation in the net chemical reaction of glucose catabolism A. pyruvate is the final product B. oxygen is required for adenosine triphosphate (ATP) synthesis C. both water and carbon dioxide (CO2) are produced D. CO2 is produced but water is not E. water is produced but CO2 is not C. both water and carbon dioxide (CO2) are produced - pyruvate is final product of glycolysis. it is transported from the cytoplasm into the mitochondrial matrix. here, pyruvate loses CO2, and the remaining acetyl group is transferred to conenzyme A to form acetyl coenzyme A. - under aerobic conditions (in presence of oxygen), pyruvate can be further oxidized during cell respiration. - under anaerobic conditions (without oxygen), pyruvate can be broken down into lactate - ATP can be produced with or without oxygen - after all energy has been released from glucose moiety, CO2 and water are the final products which of the following incorrectly pairs a metabolic process with its site occurrence? A. glycolysis -- cytosol B. tricarboxylic acid (TCA) cycle -- mitochondrial membrane C. ATP phosphorylation -- cytosol and mitochondria D. oxidative decarboxylation of pyruvate -- mitochondria E. electron transport chain -- mitochondrial DNA B. tricarboxylic acid (TCA) cycle -- mitochondrial membrane - glycolysis is a series of reactions that lead to the oxidative breakdown of glucose into pyruvate, the production of ATP, and the reduction of NAD+ into the reduced for of NADH. all these reactions occur in the cytoplasm - the TCA cycle is the metabolic reaction of cell respiration, which occurs inside the eukaryotic mitochondrion (not on the mitochondrial membrane). - ATP phosphorylation occurs both during glycolysis (in the cytoplasm), and the TCA cycle (in the mitochondrion). - the pyruvate formed during glycolysis is transported from the cytoplasm to the mitochondrial matrix where it is decarboxylated - the electron transport chain is a carrier mechanism located on the inside of the inner mitochondrion THEREFORE: 1. GLYCOLYSIS--cytoplasm. 2. TCA CYCLE--inside the mitochondrion (not on membrane). 3. ATP PHOSPHORYLATION--cytoplasm+mitochondrion. 4. OXIDATIVE DECARBOXYLATION OF PYRUVATE--mitochondrial matrix. 5. ELECTRON TRANSPORT CHAIN -- inner mitochondrion which of the following is least likely to occur during oxygen debt? A. build up of lactic acid B. build up of pyruvate C. decrease in pH D. increased fatigue E. shortage of ATP B. build up of pyruvate under anaerobic conditions, pyruvate accepts H atom from NADH, forming NAD+ and lactic acid. At physiological pH, lactic acid is dissociated into lactate and protons. Thus, the pH decreases (becomes more acidic). using this pathway, only two ATPs can be generated. a shortage of ATP is possible, leading to muscle fatigue select the best answer that describes the human gut microbiota A. is established by the age of 2 and little influences it B. currently is compromised of trillions of bacteria C. is highly dependent on the host for survival but provides little to the host D. is not influenced by the mode of infant delivery B. currently is compromised of trillions of bacteria - humans are sterile in utero and are first sterilized depending on mode of delivery. - the gut microbiota is dependent upon the human die for survival, primarily undigested polysaccharides that they ferment to produce SCFAs, which serve many biological functions in the hosts body. - the gut microbiota hs many other positive benefits to the host select the best answer that describes a probiotic A. is a live organism used to make yogurt B. is a "live nonpathogenic organism (bacteria or yeast) which when administered in adequate amounts confers a health benefit on the host" C. are generally recognized as safe (GRAS) list, and therefore can be safely provided to humans receiving nutrition support therapy D. the mechanisms of probiotics are well known, making probiotic therapy a great addition to nutrition support therapy B. is a "live nonpathogenic organism (bacteria or yeast) which when administered in adequate amounts confers a health benefit on the host" - while cultures to make yogurt (lactobacillus bulgaricus and streptococcus thermophilius) are on the GRAS list, they are not probiotics - there is specific criteria bacteria must meet to be considered a probiotic - because each bacteria strain acts differently in different environments, more research is needed and the use of probiotic therapies in pts receiving nutrition support is generally not recommended select the best answer that describes a prebiotic A. all fibers are considered prebiotics B. prebiotics are synthetic compounds C. prebiotics are dietary polysaccharides that escape digestion by the host enzymes and are fermented by the gut microbiota and influence the gut microbiota pattern in a beneficial manner D. all prebiotics are fermented to yield the same SCFA C. prebiotics are dietary polysaccharides that escape digestion by the host enzymes and are fermented by the gut microbiota and influence the gut microbiota pattern in a beneficial manner - prebiotics escape digestion by the host enzymes - they reach the distal intestine where they are fermented by the host gut microbiota to yield SCFAs and beneficially influence the gut microbiota pattern. - not all fibers are fermentable, and not all fermentable polysaccharides yield the same molar ratios of SCFAs what are the omega-6 and omega-3 fat acid-derived bioactive mediators that are particularly important to the return to homeostasis during and inflammatory process? term-12 A. arachidonic acid (AA) and eicosapentaenoic acid (EPA) B. lipoxins, the E- and D-series resolvins, and protectins C. leukotriene B4 (LTB4), prostaglandin E2 (PGE2), leukotriene B5, and prostaglandin E3 D. linoleic acid and alpha-linolenic acid B. lipoxins, the E- and D-series resolvins, and protectins - lipoxins are produced during the inflammatory response by metabolism of arachidonic acid (AA) - lipoxins inhibit chemotaxis of neutrophils and reduce inflammatory activity as a result - the E- and D-series resolvins are generated from EPA and DHA (docosahexaenoic acid), respectively and serve to slow and eventually resolve inflammation - protectins: substances derived from DHA that also play an active role in resolution of an inflammatory response. these substances, like lipoxin A4, inhibit the neutrophil migration - protectins can also reduce tissue damage due to stroke and help protect the liver from inflammatory damage what condition may occur and why, if a parenteral intravenous fat emulsion (IVFE) is provided only as 10% (weight per volume, w/v), IVFE, such as propofol, or as high amounts of 20% (w/v) IVFE? A. hypercholesterolemia and triglyceridemia may occur due to inference with chylomicron and pseudochylomicron metabolism B. essential fatty acid deficiency (EFAD) can occur because of the interference with normal lipid uptake C. hyperoxidation of the microvilli of the small intestine may be induced due to the high amount of polyunsaturated fatty acids (PUFAs) in 10% IVFE D. insulin resistance will occur due to the interaction of tocopherol with vitamin A within the emulsions A. hypercholesterolemia and triglyceridemia may occur due to inference with chylomicron and pseudochylomicron metabolism - may result from the presence of liposomes within the IVPE - liposomes are formed during the emulsification process when PN IVFE is produced - liposomes are usually metabolized similarly to pseudochylomicrons, but their presence may lead to the formation of a spherical bilayer of phospholipid and cholesterol known as lipoprotein-X. - lipoprotein-X inhibits both lipoprotein lipase and hepatic lipase enzyme activity, and thus can interfere with the proper metabolism of the TGs (triglycerides) that are present as a part of the structure of chylomicrons and pseudochylomicrons - this interference and accumulation of exogenous cholesterol can lead to increase in circulating TGs and cholesterol - because 10% (w/v) IVFE contains a greater number of liposomes relative to 20% as a result of the relative ratio of phospholipid emulsifier to oil, the formula formulation places the patient more at risk for triglyceridemia which ionized form of a SCFA (up to 6 carbons in length), is thought to be the most important to colonic health and why? A. myristate B. caproate C. butyrate D. validate C. butyrate - SCFAs such as actetate, propionate, and butyrate are primarily produced in the colon by bacteria and serves as energy for colonic tissue - butyrate modified inflammatory activity to promote colon health - e.g. when applied directly to the colon, butyrate can attenuate the inflammatory activity seen in UC - fermentation of fiber and production of SCFAs in the colon, esp butyrate production, appears to act as an antitumorgenic stimuli. - addition of sodium butyrate in vitro to endometrial cancer cells lines activates DNA repair systems and suppresses self-renewal of the cells which of the following statements is true relating to hydrochloric acid (HCl) and protein digestion? A. HCl aids in the conversion of pepsin to pepsinogen B. HCl denatures protein structures to make them more susceptible to enzymatic action C. HCl is secreted by the parietal cells within the duodenum in response to dietary proteins D. HCls release is stimulated by the hormone insulin B. HCl denatures protein structures to make them more susceptible to enzymatic action - HCl also converts pepsin to pepsinogen, but primary role is to denature protein structures - HCl is secreted by parietal cells within stomach (not duodenum) - HCl secretion is stimulated by gastrin (not insulin) During protein metabolism, branched chain amino acids: A. are extracted primarily by the liver after a protein-containing meal B. are released by the skeletal muscle at a higher rate than other amino acids C. serve as the primary fuel sources for the enterocytes D. produce oxidative wastes during metabolism within the skeletal muscle, which are removed by alanine and glutamine D. produce oxidative wastes during metabolism within the skeletal muscle, which are removed by alanine and glutamine - nitrogen end products produced during BCAA oxidation within the skeletal muscle are removed by the nitrogen carriers alanine and glutamine - BCAAs are extracted primarily by skeletal muscle (not the liver) - BCAAs are primarily oxidized in the skeletal muscle (not enterocytes) and are released from the muscle at a lower rate than other amino acids proteins perform all the following physiological functions except: A. provide a major source of energy B. maintain acid-base balance C. contribute to immune defense D. serve as a mode of transport for substances A. provide a major source of energy - major energy sources are CHO and fats - protein is not preferential for energy - proteins are primary bugger to maintain acid-base balance - all cells in the immune system remade up of proteins (WBCs, macrophages) - proteins are primary carriers for minerals, vitamins, hormones the rate of protein turnover in catabolic, critically ill patients A. does not change B. decreases C. increases D. is not affected by nutrition support C. increases - nutrition support will improve protein synthesis somewhat, but has little effect on protein degradation evaluating protein adequacy after a traumatic incident calculating nitrogen balance page 104 the administration of a 1 liter of 0.9% sodium chloride (NaCl) to a normonatremic pt will increase the intravascular and interstitial fluid compartments by: A. 1000 mL and 0 mL, respectively B. 0 mL and 1000 mL, respectively C. 750 mL and 250 mL, respectively D. 250 mL and 750 mL, respectively D. 250 mL and 750 mL, respectively - 0.9% NaCl (154 mEq/L) is isotonic and therefore does not contribute to an osmotic gradient. isotonic saline enters and remains in the ECF. thus, administering 1 liter of 0.9% NaCL expands the ECF by 1 liter. - the intravascular volume accounts for 25% of the ECF and will expand by 250 ml. the remaining 750 ml will be distributed to the interstitial fluid compartment. assuming the same weight and serum sodium concentration, which of the following patients has the greatest free water deficit? A. 35 year old man B. 75 year old man C. 35 year old woman D. 75 year old woman A. 35 year old man Free water = TBW x [ 1 - (140/serum sodium) ] - Free water deficit and total body water (TBW) = liters - Serum sodium = mEq/L - % TBW increases as the proportion of lean body mass to adipose tissue increases. In general: %TBW decreases with age and is lower in females than males. - younger men would have the highest proportion of LBW and the highest % of TBW and therefore would have the largest free water deficit a patient with severe intractable nausea and vomiting is at risk for which of the following acid-base disorders? A. hyperchloremic metabolic alkalosis B. hyperchloremic metabolic acidosis C. hypochloremic metabolic alkalosis D. hypochloremic metabolic acidosis C. hypochloremic metabolic alkalosis - gastric fluids contain ~130 mEq/L chloride (Cl-) per liter and are very acidic (pH 1 to 2). - losing large amounts of gastric fluids via vomiting, especially for a long period of time, can result in a hypochloremic metabolic alkalosis, as the loss of acid from the stomach leaves the body with a relative excess of alkali what amount of retinol is equivalent to 24 mcg of beta carotene from food? A. 2 mcg (typo in book?) B. 4 mcg C. 2 mcg D. 1 mg A. 2 mcg. one mcg retinol has the vitamin A activity of 12 mcg beta-carotene. therefore, 24 mcg beta carotene is equivalent to 2 mcg retinol which of the following nutrients does not engage in conversion of homocysteine to methionine? A. choline B. vitamin D C. vitamin B12 D. folate B. vitamin D - vit B12 and folate are needed to convert the cardiac risk factor homocysteine back into methionine. alternatively, choline can also be used for this conversion the first vitamin B deficiency to manifest in people with alcoholism is usually: A. niacin B. pantothenic acid C. vitamin B6 D. thiamin D. thiamin - very small amounts of thiamin are stored in the liver - therefore, this vitamin tends to be the first to become deficient in malabsorption or inadequate intake situations which of the following trace elements is regulated at the level of absorption by not excretion? A. zinc B. copper C. manganese D. iron D. iron - control mechanisms that keep iron levels stable occur at absorption phase - it is very difficult to eliminate iron except in conditions of blood loss (e.g. blood donation or menstruation