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Part II Nutrition Assessment, Consequences, and Implications

● growth hormone insulin

● ● ●

phenazopyridine progesterone

The following drugs may decrease albumin levels (1): ●

● ●

ammonium ios estrogens

hepatotoxic drugs ● Serum B-12

Normal Values ●

160 to 950 pg/mL; 118 to 701 pmol/L (5) Nutritional Significance

Serum B-12 is a measure used to identify pernicious anemia and megaloblastic anemia in older adults. Low levels may reflect poor intake or lack of intrinsic factor. Some studies suggest that a serum B-12 less than 350 pg/mL should be considered a deficiency state and treated accordingly (13,14). Serum B-12 levels increase with (1): ●

liver disease ● ●

chronic myelocytic leukemia polycythemia urea

Serum B-12 levels decrease with (1): ●

● ● ● ● ●

Zollinger-Ellison syndrome B-12 deficiency hypothyroidism folate deficiency alcoholism

aplastic anemia ● myeloma

● megadoses of vitamin C ● HIV

● transcobalamin I deficiency

The following drugs may decrease serum B-12 levels (1): ●

● ● ● ● ● ● ●

antibiotics aspirin

cimetidine

chlorpromazine ranitidine

cholestyramine antifolate drugs

extended-release K preparations

Total Serum Cholesterol, Low-Density Lipoprotein, and High-Density Lipoprotein

Normal Values, Adults ●

●

Total cholesterol: less than 200 mg/dL; less than 5.20 mmol/L (SI) (1,15)

Low-density lipoprotein (LDL): less than 130 mg/dL; less than 3.37 mmol/L (SI) (1,15)

High-density lipoprotein (HDL): male, greater than 45 mg/dL, greater than 1.175 mmol/L; female, greater than 55 mg/dL, greater than 1.43 mmol/L (1,15)

Nutritional Significance

Elevated serum cholesterol has been associated with increased risks for arteriosclerotic vascular disease in young and middle-aged adults. The most accurate results are from a fasting blood cholesterol test. Current research suggests that arteriosclerotic vascular disease is a multifactorial condition. Dietary choles- terol may not be as important as once believed, espe- cially for older women with no history of heart disease, hypertension, or diabetes. For older adults with no history of heart disease, an elevated cholesterol is probably not justification for a cholesterol-lowering diet (16-18).

Cholesterol is used as an indicator of malnutrition. When cholesterol levels decline along with other indi- cators of protein status, nutrition needs are probably not being met, and the risk for skin breakdown increases. In older adults, the problem may be chronic failure to thrive, very low intake, or overall declining status. Cholesterol of less than 160 mg/dL may indicate malnutrition and may be a predictor of mortality. Historic cholesterol levels must be considered in evalu- ating the risk for malnutrition (1,16-18). Total serum cholesterol levels increase with (1):

● ● ● ●

hypercholesterolemia hyperlipidemia hypothyroidism

uncontrolled diabetes ● nephrotic syndrome stress

● ● ● ●

high-cholesterol diet xanthomatosis hypertension

● MI ●

● ●

atherosclerosis nephrosis

biliary cirrhosis