CheatSheet: Nutrition

1. Energy and Macronutrients

1.1 Energy Requirements

1.2 Carbohydrates

1.3 Proteins

1.4 Fats

2. Micronutrients - Vitamins

2.1 Fat-Soluble Vitamins

2.2 Water-Soluble Vitamins - B Complex

2.3 Vitamin C

3. Micronutrients - Minerals

3.1 Macrominerals

3.2 Trace Elements - Iron

3.3 Other Trace Elements

4. Protein-Energy Malnutrition

4.1 Classification

4.2 Anthropometric Assessment

4.3 Management Principles

• Initial stabilization: Treat hypoglycemia, hypothermia, dehydration (use ReSoMal - reduced osmolarity), electrolyte imbalance
• Infections: Broad-spectrum antibiotics empirically
• Micronutrients: Multivitamin, folic acid, zinc, copper
• Feeding: Start with 80-100 kcal/kg/day, protein 1-1.5 g/kg/day; gradually increase
• F-75 formula (initial stabilization): 75 kcal/100 mL, 0.9 g protein/100 mL
• F-100 formula (rehabilitation): 100 kcal/100 mL, 2.9 g protein/100 mL
• Ready-to-Use Therapeutic Food (RUTF): Peanut-based paste, 500 kcal/92 g sachet
• Refeeding syndrome: Risk of hypophosphatemia, hypokalemia, hypomagnesemia; thiamine deficiency; monitor closely

5. Obesity

5.1 Classification and Assessment

5.2 Central Obesity

5.3 Complications

• Metabolic: Type 2 diabetes, dyslipidemia, metabolic syndrome, insulin resistance
• Cardiovascular: Hypertension, coronary artery disease, stroke, heart failure
• Respiratory: Obstructive sleep apnea, obesity hypoventilation syndrome, restrictive lung disease
• Gastrointestinal: NAFLD, NASH, gallstones, GERD
• Musculoskeletal: Osteoarthritis, gout
• Reproductive: PCOS, infertility, complications in pregnancy
• Malignancy: Breast, endometrial, colon, kidney, esophageal cancers
• Psychological: Depression, low self-esteem

5.4 Management

6. Specific Nutritional Deficiencies

6.1 Iodine Deficiency Disorders

6.2 Zinc Deficiency

• Growth retardation and dwarfism
• Hypogonadism and delayed sexual maturation
• Acrodermatitis enteropathica: periorificial and acral dermatitis
• Delayed wound healing
• Immune dysfunction, increased infections
• Alopecia, glossitis, nail dystrophy
• Night blindness, photophobia
• Diarrhea

6.3 Vitamin A Deficiency

6.4 Vitamin D Deficiency

7. Special Nutritional Requirements

7.1 Pregnancy

7.2 Lactation

7.3 Elderly

• Decreased energy requirements due to reduced basal metabolic rate and physical activity
• Increased protein requirements: 1.0-1.2 g/kg/day to prevent sarcopenia
• Vitamin D: 800-1000 IU/day (reduced skin synthesis, decreased sun exposure)
• Vitamin B12: Risk of deficiency due to atrophic gastritis, decreased intrinsic factor
• Calcium: 1200 mg/day (prevent osteoporosis)
• Fiber: Prevent constipation
• Hydration: Decreased thirst sensation, risk of dehydration

7.4 Athletes

8. Nutritional Support

8.1 Enteral Nutrition

8.2 Parenteral Nutrition

8.3 Refeeding Syndrome

• Definition: Metabolic complications following reintroduction of nutrition in malnourished patients
• Mechanism: Insulin surge → intracellular shift of phosphate, potassium, magnesium; thiamine depletion
• Risk factors: Prolonged fasting, chronic malnutrition, anorexia nervosa, chronic alcoholism
• Features: Hypophosphatemia (<0.6 mmol/l),="" hypokalemia,="" hypomagnesemia,="" thiamine="">
• Complications: Cardiac arrhythmias, heart failure, respiratory failure, seizures, rhabdomyolysis, hemolysis
• Prevention: Start nutrition slowly (25% of requirements); supplement thiamine, phosphate, potassium, magnesium; monitor electrolytes closely

9. Nutritional Assessment

9.1 Anthropometric Measurements

9.2 Biochemical Markers

9.3 Screening Tools

• MUST (Malnutrition Universal Screening Tool): BMI, weight loss, acute disease effect
• NRS-2002 (Nutritional Risk Screening): Severity of disease, nutritional impairment, age
• SGA (Subjective Global Assessment): History (weight change, intake, GI symptoms, functional capacity) + physical examination
• MNA (Mini Nutritional Assessment): Primarily for elderly

10. Disease-Specific Nutrition

10.1 Diabetes Mellitus

• Carbohydrates: 45-60% of total energy; emphasize complex carbohydrates, low glycemic index foods
• Fiber: ≥25 g/day (F), ≥38 g/day (M)
• Protein: 15-20% of total energy; 1.0-1.5 g/kg/day
• Fats: <30% total="" energy;="" saturated="" fats=""><7%, trans="" fats="">
• Sodium: <2.3 g/day;=""><1.5 g/day="" if="">
• Alcohol: Moderate (≤1 drink/day for F, ≤2 drinks/day for M); avoid if poor glycemic control or hypertriglyceridemia

10.2 Chronic Kidney Disease

10.3 Chronic Liver Disease

• Energy: 35-40 kcal/kg/day
• Protein: 1.2-1.5 g/kg/day; use branched-chain amino acids if hepatic encephalopathy
• Sodium: <2 g/day="" if="">
• Fluid restriction: If hyponatremia present
• Vitamin supplementation: Thiamine, folate, vitamin K
• Zinc supplementation: 220 mg zinc sulfate twice daily
• Late evening snack: Prevent overnight catabolism

10.4 Inflammatory Bowel Disease

• Active Crohn disease: Low residue diet, consider elemental/polymeric feeds
• Stricturing Crohn: Low fiber to prevent obstruction
• Fat malabsorption: Medium-chain triglycerides
• Lactose intolerance: Common; limit dairy
• Iron, B12, folate, vitamin D, zinc supplementation as needed
• Parenteral nutrition: Severe disease, bowel rest, fistulas

10.5 Cardiovascular Disease

• Total fat: <30% of="" energy;="" saturated="" fat=""><7%; trans="" fat="">
• Cholesterol: <200>
• Omega-3 fatty acids: 1 g/day EPA+DHA; fish 2 times/week
• Fiber: 25-30 g/day (soluble fiber reduces LDL)
• Sodium: <2.3 g/day;=""><1.5 g/day="" if="" hypertension/heart="">
• DASH diet: Emphasize fruits, vegetables, low-fat dairy, whole grains
• Mediterranean diet: Olive oil, nuts, fish, fruits, vegetables