Laboratory Assessment of Nutritional Status

#1 - Introduction to Laboratory Assessment

I. Measure of Nutritional Status

A. Anthropometric
B. Physical
C. Dietary Intake
D. Biochemical data

II. Factors influencing Lab Values

A. Age
B. Hydration
C. Medication
D. Exercise

III. Review of various lab panels by disease state

A. CBC
B. CMP

IV. Sympathetic nervous system, stress, and disease connection

A. Sympathetic nervous system
B. Acute stress
C. Endocrine system
D. Disease conditions induced by stress

V. Aging and nutrition Status

A. Some demographic stats
B. Boy composition changes
C. Changes in organ system function (Cardiac, GI, Respiratory, Hepatic, Renal)

VI. Hospitalization and SGA

A. Patient nutrition status
B. Measurements to take
C. Monitor and evaluate sequential data
D. Case studies

Behavioral/Learning Objectives:

1. Describe the measures of nutritional status including Anthropometric, Physical, Dietary intake, Biochemical data.
2. Identify the factors that influence lab values.
3. Explain various lab panels necessary by disease state.
4. Identify typical reaction by the sympathetic nervous system, stress and disease state.
5. Describe the impact of aging, on lab values.
6. Explain the rationale for the tests used in pre-surgical screening.

#2 - Laboratory Assessment of Diabetes

I. Laboratory values in Diabetes

A. Fasting Plasma Glucose

1. Fasting Plasma Glucose
2. Factors that increase Glucose
3. Factors the decrease Glucose
4. Interfering factors
5. Abonormal findings
6. Symptoms of diabetes

B. Oral Glucose Tolerance Test

1. Impaired Gluose Tolerance
2. Criteria for diagnosis of Diabetes Mellitus (DM)
3. Normal and gestational DM values
4. Hypoglycemia

C. Hemogloblin A1C (HgbA1c) Reflects bood glucose levels for previous 2-3 months

1. Reference ranges and what they mean

D. Insulin, fasting

1. Reference ranges and what they mean
2. Omega 3 fatty acids role in insulin sensitivity
3. Reduced carb/sugar intake effect on lowering insulin output

II. Electrolytes

A. Definition
B. Sodium

1. Normal values and regulation
2. Relationship to blood glucose
3. Relationship to dehydration
4. Hyponatremia and hypernatremia
5. Medical conditions that increase and decrease levels

C. Potassium

1. Normal values and regulation
2. Relationship to blood glucose
3. Relationship to dehydration
4. Hypokalemia and Hyperkalemia
5. Medical conditions that increase and decrease levels

D. Chloride

1. Normal values and regulation
2. Hypochloremia

E. Phosphorus

1. Normal values and regulation
2. Role in bone development and acid/base balance
3. Inverse relationship with calcium

F. Calcium

1. Normal values and regulation
2. Drugs that increase and decrease calcium levels
3. Hypocalcemia and Hypoparathyroidism

G. Magnesium

1. Normal values regulation
2. Diabetic patients often deficient
3. Role in neuromuscular tissue
4. Symptoms of deficiency and excessive levels
5. Relationship between hypocalcemia, hypokalemia and hypomagnesemia.

H. CO2

1. Normal values and regulation
2. What changing levels of CO2 can cause and what it suggests

III. Urinalysis and Ketones

A. Basics step to urinalysis

1. Reasons to perform a urinalysis
2. Physical color and appearance
3. Microscopic appearance
4. Chemical appearance

B. Ketones

1. If found, how positive results are typically reported
2. What positive test results can indicate

IV. Hydration Issues

A. Dehydration vs. Volume Depletion (hypovolemia)

1. Hypotonic dehydration
2. Hypertonic dehydration
3. Isotonic dehydration
4. Hypovolemia

B. Causes of dehydration

1. External or stress-related causes
2. Infectious disease
3. Malnutrition
4. Other causes

C. Osmolality

1. Plasma osmolality
2. Urine osmolality

D. Assessing dehydration

1. Osmolality
2. Bun/Creatinine ratio
3. Serum sodium
4. Bioelectrical Impedance Analysis

E. Signs of dehydration in infants, young children, and adults

1. Skin turgor
2. Respiratory pattern
3. Anion gap

Behavioral/Learning Objectives:

1. Explain the diagnosis of hypoglycemia and diabetes and impaired glucose tolerance.
2. Describe the HgA1C test and its value in monitoring glucose levels.
3. Identify the factors effecting fluid and electrolyte levels.
4. Explain the causes of Ketones and dehydration.
   

#3 - Laboratory Assessment of Kidney Function

1. Basic review of physiology of the kidney

2. The causes of chronic kidney disease (CKD) and laboratory findings associated with each.

a. glomerulonephritis
b. diabetic nephropathy
c. IgA nephropathy
d. Nephritic syndrome
e. Nephrosclerosis
f. Congenital or hereditary disease
g. Pyelonephritis

3. Glomerular filtration rate (GFR) and stage kidney disease based on Kidney Disease Outcome Quality Initiative (KDOQI) Guidelines from the National Kidney Foundation.

4. Nutritionally significant laboratory parameters for the dialysis patient, comparing normal values to values expected in a patient with kidney failure.

a. pre-BUN
b. albumin
c. creatinine
d. cholesterol
e. nPNA

5. Bone metabolism laboratory parameters for the dialysis patient,
comparing normal values to values expected in a patient with kidney failure

a. calcium
b. phosphorus
c. calcium x phosphorus
d. parathyroid hormone
e. alkaline phosphatase
f. vitamin D

6. Anemia associated with chronic kidney disease. Stress expected levels
for the following laboratory parameters:

a. ferritin
b. transferrin saturation
c. iron
d. hemoglobin

7. CKD associated cardiovascular disease including recommended goals for:

a. LDL
b. HDL
c. Cholesterol
d. triglycerides

Behavioral/Learning Objectives:

1. Recognize the normal ranges for various lab parameters as they relate to renal function.
2. Explain how BUN and creatinine can be affected by kidney impairment.
3. Identify what stage of chronic kidney disease a patient is in by reviewing glomerular filtration rate results.
4. Describe how albumin, electrolytes, bone metabolism parameters as well as anemia can be affected by kidney impairment.
   

#4 - Laboratory Assessment of Liver Enzymes, Heart Disease and Obesity

I. Enzyme levels and biochemical markers of stress and damage

A. Aspartate Amintransferase (AST)

1. Normal values
2. What causes levels to elevate

B. Alanine Aminotranferase (ALT)

1. Normal values
2. What very high, mildly and moderately high ATL levels indicate
3. What can affect test results

C. Alkaline Phosphatase (ALP)

1. Normal values
2. What abnormally high levels of ALP indicate
3. What abnormally low levels of ALP indicate

D. Gamma-Glutamyl Tranferase (GGT)

1. Normal values
2. What elevated levels indicate
3. Drugs and medication that can increase GGT levels

E. LDH

1. Normal ranges
2. Where it is found
3. What increases LDH levels and what it can indicate
4. Isoenzymes found in different tissues.

II. Heart Disease

A. Creatine Phosphokinase (CPK or CK)

1. Normal reference ranges for men and women
2. Clinical indication of test results
3. Isoenzymes and where they are found.

B. Troponins

1. Normal values
2. What elevated levels indicate

C. Inflammation and C-Reactive Protein (CRP)

1. Normal ranges
2. Acute phase protein produced by liver in response to inflammation
3. What positive CRP indicates
4. When the CRP test may be indicated
5. Factors that affect the test

D. Homocysteine

1. Normal values
2. What elevated levels can indicate
3. Drugs and lifestyle choices that can increase levels

III. Obesity Biochemical Assessment

A. Leptin
B. Polycystic Ovarian Syndrome (PCOS)
C. Syndrome X

1. Features of the syndrome
2. DM screening
3. Risk factors

D. Hyperthyroidsim
E. Growth hormone deficiency
F. Lipid Panel

1. Total cholesterol
2. High Density Lipoprotein
3. Low Density Lipoprotein
4. Small Denitiy Particle Tests Lipoprotein (a)

G. Tests of Thyroid Function

Behavioral/Learning Objectives:

1. Identify the liver enzymes AST, ALT,ALP and LDH and their relation to stress and liver damage.
2. Describe the lab tests used for heart attack and chest pain.
3. Explain how C-Reactive Protein is used to measure inflammation and how the test is used to determine various disease states.
4. Identify the tests needed for the biochemical assessment of obesity.
   

#5 - Laboratory Assessment of Malnutrition, Markers for Protein Status and Anemia

I. Nitrogen Balance for malnutrition evaluation

A. Nitrogen output and input
B. Estimated using BUN and UREA contrentaion in urine
C. When and why Positive Nitrogen Balance occurs
D. When and why Negative Nitrogen Balance occurs

II. Protein Status

A. Serum Protein
B. Albumin
C. Pre-Albumin
D. Ferritin
E. Retinol-Binding Protein

III. C-Reactive Protein

IV. Creatinine

V. Anemia

A. RBC indices for Anemia

1. Normocytic, Normochromic Anemia
2. Microcytic Hypochromic Anemia
3. Microcytic, Normochromic Anemia
4. Macrocytic

VI. Iron, TIBC, Transferrin & Transferrin Saturation

A. Normal values
B. Causes and effects of increased levels
C. Causes and effects of decreased levels

Behavioral/Learning Objectives:

1. Select the best test for assessment of protein status.
2. Describe the relationship between acute phase proteins and serum proteins.
3. Explain the tests used to assess anemia and be able to identify the different types of anemia.

#6 - Laboratory Assessment of Thyroid Function/Nutrients and Nutraceuticals

I. Types of Thyroid Disease and associated symptomology

A. Hypothyroidism
B. Hyperthyroidism

II. Protein Bound Iodine

A. T3
B. T4
C. TSH
D. LATS

III. Nutrients & Nutraceuticals - therapeutic levels and functions of

A. Vitamin K2
B. Vitamin D3
C. Omega-3 fatty acids
D. CoQ10
E. Carnitine
F. Zinc
G. Chromium

Behavioral/Learning Objectives:

1. Describe the tests used to assess thyroid function.
2. Explain the rationale for supplementing patients on certain medications with CoQ10.
3. Explain the role and use of vitamin K in osteoporosis.
4. Describe the current trend regarding supplementation with vitamin D.
   

Accreditation Information

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