Managing Nutrition and FoodRelated Problems

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Managing Nutrition and Food-Related Problems

• Deon Bent R.D
• March 29, 2006

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Outline

• Overview of common nutritional problems and
  dietary strategies for management
• Anorexia
• Constipation, diarrhea, malabsorption
• Nausea, vomiting
• Oral and swallowing problems
• Fatigue

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Causes of Food-Related Problems

• Opportunistic infection
• Food or water borne pathogen
• HIV-enteropathy
• Antiretroviral therapy
• Depression

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Anorexia

• Make every bite count
• Small frequent meals and snacks
• Eat on schedule
• Enhance the eating environment
• Use available community and family supports and
  services
• Use nutritional supplements if available/affordabl
  e
• Consider appetite stimulants if available
• Take a multivitamin-mineral supplement

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Constipation

• Increase fibre such as wheat bran, whole grains,
  fruits and vegetables, legumes, provisions
• Prunes contain a natural laxative as well as
  fibre
• Increase fluids
• Exercise such as walking after meals can
  stimulate bowel movements
• Avoid laxative dependency

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Diarrhea Malabsorption

• Goals of nutrition therapy are to
• slow intestinal transit
• decrease exposure to intestinal irritants
• replace lost nutrients, electrolytes, fluids
• Low lactose, low residue, low fat diet is the
  most effective strategy

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Diarrhea Malabsorption

• Small frequent meals
• Emphasize soluble fibre (oats, rice, provisions)
• Replace fluids and electrolytes
• Reduce intake of the following
• Insoluble fibre
• High fat foods
• Fluids high in sugar, especially juices, soft
  drink
• Lactose

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Diarrhea Malabsorption

• Pro-biotic e.g. Acidophilus or Bifida-bacteria
• Sorbitol can worsen diarrhea
• Medium Chain Triglycerides improve fat absorption
• Liquid nutritional supplements that are lower in
  osmolality and contain a portion of fat as MCT
  can replace fluids and nutrients

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Diarrhea Malabsorption

• Rice porridge 1 cup rice cooked for 1 hour in 6
  cups broth
• Rice water 1/2 cup rice cooked in 4 cups water.
  Drink the cooled water.
• Clove tonic 12 cloves simmered in 1 cup green
  tea.

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Nausea and Vomiting

• Small frequent meals and snacks
• Eat to tolerance
• Eat bland, low fat, low sugar foods, cold foods
  and salty foods
• Avoid foods that make it worse (e.g. spicy foods)
• Avoid cooking odors
• Avoid gastric irritants like coffee, alcohol

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Nausea and Vomiting

• Avoid drinking and eating solids at the same time
• Do not lay down after eating
• Wear loose clothing
• Replace fluids and electrolytes if vomiting
• Ginger is an effective anti-nausea agent
• Use anti-emetic medications if required

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Stomatitis

• Soft moist foods are better tolerated
• Avoid acidic, spicy, coarse or dry foods
• Avoid irritants like tobacco, alcohol
• Blenderized foods may be helpful
• Cold or room temperature foods are better
• Keep lips moist with lip balm
• Limit sugar containing foods and fluids

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Dysguesia

• Malnutrition causes decreased number of taste
  receptors
• Medications can leave a bitter residue in the
  mouth
• Medications and/or HIV can cause abnormal tastes
  such as persistent metallic or sweet taste
• Children are especially susceptible to loss of
  appetite due to decreased taste acuity

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Dysguesia

• Chew food well and move it around mouth to
  stimulate the most taste receptors
• Use flavor enhancers
• Sugar masks salty salt masks sweet sour masks
  metallic tastes
• Sugar-free candy and gum mask bitter taste
• Use of plastic utensils decreases a metallic taste

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Mouth Rinses

• To 1 cup of lukewarm water add one of the
  following
• 1/4 teaspoon salt or
• 1/4 teaspoon baking soda or
• 1/4 teaspoon glycerin or
• 1 tablespoon 3 hydrogen peroxide
• Rinse mouth often do not swallow

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Dysphagia

• Feeding assessment for the following warning
  signs
• Drooling
• Coughing or choking while eating
• Gurgly voice after eating or drinking
• Complaints that food catches in throat
• Repeated swallows for one bite of food
• Texture modifications
• minced, pureed or blenderized solids
• thickened fluids

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Conclusion

• Complications with nutritional implications are
  common
• Nutrition therapy can improve symptoms and
  adherence to antiretroviral medications
• Dietary modifications are the first line of
  nutrition therapy

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Food-Drug Interactions

• Deon Bent R.D
• March 29, 2006

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Outline

• Food drug interactions
• Strategies for managing food drug interactions

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Drug Food Interactions

• Effects of food on medication efficacy
• Effect of medication on nutrient utilization
• Effect of medication side effect on food
  consumption

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The Role of Nutrition Intervention

• Health care workers should know the food
  requirements for medications
• Nutrition counsellors can help with
• Strategies to minimize or treat side effects
• Ideas for meals and foods to take with
  medications
• Ensure that medications are taken appropriately
  with or without food

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Pharmacokinetic Interactions

• Drug Absorption

Drug Metabolism
Drug Distribution
Drug Excretion
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Pharmacokinetic InteractionsDrug Absorption

• Increased or decreased by
• Food
• Food components phytates, acid, dairy
• Gastric emptying
• Chelation of drug to minerals in food
• Herbs

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Pharmacokinetic InteractionsDrug Metabolism

• Drugs are metabolized by cytochrome P450 enzyme
  system in liver
• Food can inhibit or enhance metabolism of drug by
  inhibiting or inducing CYP
• e.g. Grapefruit juice inhibits CYP.

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Pharmacokinetic InteractionsDrug Distribution

• Serum albumin is main determinant of distribution
• Low albumin means higher free fraction of drug
• May have increased toxicity in someone with low
  albumin

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Pharmacokinetic InteractionsDrug Excretion

• Renal tubule reabsorption of drug can be altered
  by food or food components
• Indinavir can cause renal stones if not enough
  fluids are consumed

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Causes of Food-Drug Interactions

• Alcohol or street drugs
• Malnutrition, low albumin, altered body
  composition
• Non-nutrient components in food
• Herbal medicine
• Special diets, tube feeding
• Poor adherence to medications

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Nutrition Status Affected by Food-Drug
Interactions

• Side effects cause decreased intake
• Gastrointestinal side effects cause increased
  losses
• Drugs that must be taken on an empty stomach
  cause decreased intake

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Conclusion

• Adherence to food recommendations can make the
  drug have the strongest effect with the least
  amount of side effects.
• Treatment failure may be linked to non-adherence
  to dietary recommendations
• Nutritional status is linked to medication
  profile and side effects

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Conclusion

• Appropriate dietary changes can help to manage
  ARV side effects and reduce its impact on
  nutritional status
• It is important for health care workers remain
  informed and render assistance where necessary

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• The End

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• Questions ?