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  <head>
    <title>050-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Malnutrition, micronutrients, feeding support, and obesity">
      <outline text="Orientation">
        <outline text="Nutrition supplies energy, nutrients, water, electrolytes"/>
        <outline text="Food also carries cultural, social, psychological meaning"/>
        <outline text="Malnutrition has several mechanisms">
          <outline text="Deficient intake, catabolism, absorption, utilisation"/>
          <outline text="Excess adiposity with poor nutrient quality"/>
        </outline>
        <outline text="Body size misleads: obesity can hide muscle loss"/>
        <outline text="Assess mechanism, severity, function, refeeding, route"/>
      </outline>
      <outline text="Energy, protein, and adaptation">
        <outline text="Basal metabolism maintains gradients, turnover, repair"/>
        <outline text="Total expenditure adds activity, growth, illness"/>
        <outline text="No inert protein reserve">
          <outline text="Negative balance consumes muscle and organ protein"/>
        </outline>
        <outline text="Fasting: insulin falls, glucagon and stress hormones rise">
          <outline text="Glycogenolysis, lipolysis, gluconeogenesis, ketones"/>
          <outline text="Brain ketone use limits but does not stop protein loss"/>
        </outline>
        <outline text="Inflammatory catabolism despite feeding">
          <outline text="Not reversed until the disease is controlled"/>
          <outline text="Protein and mobilisation preserve function"/>
        </outline>
      </outline>
      <outline text="Recognising malnutrition">
        <outline text="Risks: poor intake, disease, poverty, high losses"/>
        <outline text="History: intake, duration, weight trajectory, access">
          <outline text="Weight change: tissue, fluid, or both"/>
        </outline>
        <outline text="Examine muscle, fat, oedema, mouth, skin, strength">
          <outline text="Ascites and oedema conceal weight loss"/>
        </outline>
        <outline text="Body mass index neither excludes nor measures"/>
        <outline text="Screening finds risk; diagnosis integrates">
          <outline text="Phenotype plus intake, malabsorption, inflammation"/>
        </outline>
        <outline text="No single blood test diagnoses malnutrition">
          <outline text="Albumin falls with inflammation, leak, dilution"/>
        </outline>
      </outline>
      <outline text="Protein-energy malnutrition">
        <outline text="Weakness, infection, poor healing, falls, hypothermia"/>
        <outline text="Acute illness: rapid muscle loss, stable weight"/>
        <outline text="Sarcopenia: low muscle strength and quantity"/>
        <outline text="Frailty: broader multisystem vulnerability"/>
        <outline text="Resistance exercise, protein, less fasting"/>
        <outline text="Improve meals before escalating route">
          <outline text="Supplements add to, not displace, preferred meals"/>
        </outline>
        <outline text="Dietitian calculates needs and checks delivery"/>
        <outline text="Avoid rigid calorie targets"/>
      </outline>
      <outline text="Micronutrient deficiencies">
        <outline text="Iron deficiency">
          <outline text="Search for bleeding, loss, intake, demand"/>
          <outline text="Ferritin rises with inflammation"/>
          <outline text="Intravenous iron for speed, intolerance, losses"/>
        </outline>
        <outline text="Folate and vitamin B twelve impair DNA synthesis">
          <outline text="B twelve: neuropathy, cord, cognitive, optic injury"/>
          <outline text="Folate alone lets neurological injury progress"/>
        </outline>
        <outline text="Thiamine for oxidative carbohydrate metabolism">
          <outline text="Wernicke: confusion, eye movements, ataxia"/>
          <outline text="Give before carbohydrate, never delay emergency glucose"/>
        </outline>
        <outline text="Vitamin C collagen, D bone, K coagulation"/>
        <outline text="A, E, zinc, copper, selenium: risk-directed tests"/>
      </outline>
      <outline text="Refeeding syndrome">
        <outline text="Insulin drives phosphate, potassium, magnesium into cells">
          <outline text="Thiamine demand rises, sodium and water retained"/>
          <outline text="Arrhythmia, heart failure, respiratory weakness, death"/>
        </outline>
        <outline text="Risk: low weight, minimal intake, alcohol, depletion"/>
        <outline text="Prevention before feeding">
          <outline text="Thiamine, multivitamin, electrolyte correction"/>
          <outline text="Start cautiously and increase progressively"/>
        </outline>
        <outline text="Monitor fluid, cardiac signs, electrolytes, kidneys"/>
        <outline text="Any route, including intravenous glucose"/>
      </outline>
      <outline text="Enteral nutrition">
        <outline text="Preferred when the gut works">
          <outline text="Supports mucosa, fewer line and metabolic harms"/>
        </outline>
        <outline text="Nasal tubes short term, ostomies longer term"/>
        <outline text="Confirm tube position by approved methods"/>
        <outline text="Head elevation, mouth care, flushing, medicines"/>
        <outline text="Gastric residual volume is an imperfect marker"/>
        <outline text="Diarrhoea usually from drugs, infection, rate"/>
      </outline>
      <outline text="Parenteral nutrition">
        <outline text="For a gut that cannot absorb enough">
          <outline text="Obstruction, short bowel, high-output fistula"/>
        </outline>
        <outline text="Central access allows concentrated solutions"/>
        <outline text="Dedicated aseptic line, daily review">
          <outline text="Catheter infection and thrombosis can be fatal"/>
        </outline>
        <outline text="Metabolic complications">
          <outline text="Hyperglycaemia, triglycerides, liver, gallbladder"/>
        </outline>
        <outline text="Transition to enteral or oral intake with a plan"/>
      </outline>
      <outline text="Obesity as chronic disease">
        <outline text="Biology, environment, sleep, medicines, genetics"/>
        <outline text="Adipose dysfunction drives many complications"/>
        <outline text="Assess broadly, speak respectfully, ask permission"/>
        <outline text="Aim for health and function, not a number"/>
        <outline text="Base: nutrition, activity, sleep, psychology"/>
        <outline text="Anti-obesity medicines need long-term strategy"/>
        <outline text="Metabolic surgery: durable loss, lifelong follow-up">
          <outline text="Rapid loss: gallstones and exposed sarcopenia"/>
        </outline>
      </outline>
    </outline>
  </body>
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