Review

1
Review

• JAMA Kidney Stone Risk Weight
• Significant Risk if Gain Over 20 Years of Age
• Men with weight gain 11
• Women with weight gain 20
• Test is this week
• Open for 1 week, no class 12/29
• Review in class 12/6 same time/same place
• MNT for Wounds
• Acute chronic stress features
• Clinical Nutrition Staff meeting TCU West 12/2-12
  noon (RSVP 737-2683)

2
Ch. 28 Energy and Protein-Modified Diets for
Wasting Syndrome

• Chronic Disease VS. Acute Stress
• Similarities between the two include
• Loss of appetite
• Altered metabolism
• Accelerated nutrient losses
• Differences between acute stresses and chronic
  diseases reviewed from the perspective of an
  antelope

3
Differences between Acute Stress and Chronic
Diseases

• ACUTE STRESS
• High metabolic needs for short period
• Immediate reversal of imbalances
• CHRONIC DISEASE
• Develop slowly and persist
• Requires long-term treatment
• Vulnerable to acute stressesinfections
• Promote quality of life

4
Chronic Disease Nutritional Needs

• Goals for stress and wasting diseases
• Limit loss of lean body mass
• Preserve nutrient stores organ function
• Prevent PCM
• Symptoms include unintentional weight loss
• Nutritional therapy
• Energy--120-150 of normal needs
• Protein1.5-2.0 gm per kg of body wt
• Individualized!
• Vitamin/Mineral Supplements
• How to Help Clients Handle Food-Related Problems
  Handouts

5
Handling Food-Related Problems

• Lack of Appetite
• Too tired to fix meals and eat
• Foods dont taste right
• Nauseated
• Dislike of some foods
• Problems chewing and swallowing
• Sores in mouth

6
Food-Related Problems

• Mouth is dry
• Trouble with Diarrhea
• Trouble with Constipation
• Taste Alterations
• Need for weight gain/dyslipidemia
• Need to eat more energy and protein foods

7
COPD

• COPD (Chronic Obstructive Pulmonary Disease)
  Bronchitis Emphysema
• Consequence of the disease
• Anorexia and poor food intake
• High energy needs
• Medications alter nutrient needs
• Repeated infections raise nutrient needs
• Oxygen masks interfere with food intake
• Weight loss increases metabolism
• Often still smoking /or O2 dependent

8
COPD

• Nutritional Support
• Weight loss if neededearly in disease
• Refeed gradually?
• High-kcalorie, high protein diet
• Carbo content monitored
• Easy-to-eat foods
• Enteral formulas PO or tube
• Increase fluids

9
Cancer

• Anorexia and Reduced Food Intake
• Nausea and Early Satiety
• Fatigue
• Pain
• Psychological Stress
• Obstructions occurring in digestive tract
• Cancer therapychemo, radiation, bone marrow
  transplants
• Metabolic alterationsnutrients used
  inefficientlygreater energy demand

10
Cancer

• Causes of wasting from Chemo and Radiation p.
  715
• Medications to stimulate appetite and promote
  weight gain
• Nutritional Therapy
• Need to bolster immune system
• Early intervention necessary
• Nutrient-dense formula supplements
• Tube-feedings and TPNPEM or aggressive cancer
  treatments

11
Cancer

• Helping Clients Handle Food-Related Problems
• Initial f/u RD assessment intervention
• Combat bitter or metallic tastes in foods
• Brush teeth or rinse mouth before eating
• Serve meats cold or at room temperature
• Add sauces and seasonings to meat
• Use eggs, fish poultry, dairy in place of meats
• Experiment with herbs and seasonings
• Use plastic rather than metal utensils

12
Cancer

• Causesmutations in the genes causing tumor
  growth
• Genetic, immune system, environmental and dietary
  conditions contribute to cancer development
• Cancer Cachexia syndrome that accompanies many
  types of cancer
• Results in weight lossanorexia
• Depletion of lean body mass
• Accelerated metabolism
• Decreased appetite
• Tumor driven

13
HIV Infection

• Causes of wasting and malnutrition in AIDS
  clients
• Involuntary weight loss and wasting a continuing
  problem
• Lipodystrophy
• Alterations in fat metabolism and distribution of
  fat (central fat)
• Elevated triglycerides
• Insulin resistance

14
HIV/AIDS

• Causes of nutritional losses in HIV
• Anorexia resulting from poor intake
• Altered metabolismnutrient losses
• Oral infections and thrush
• Respiratory infections
• GI tract complicationsDiarrhea resulting in
  malabsorption
• Kaposis Sarcomalesions and obstructions in
  esophagus
• Medical treatment

15
HIV

• Treatments for HIV
• HAARTdrug therapy
• Medications helps restore LBM and improve
  appetite
• Nutritional Therapy
• Evaluation of body fat
• High-kcalorie, high protein
• Easy-to-eat foods, liquid formulas

16
HIV

• Nutritional Therapy
• Vitamin B and Iron deficiencies common
• Fat malabsorption leads to fat-soluble vitamin
  deficiencies
• Multiple vitamin/mineral supplements that
  supplies 100 of requirement
• Food Safety critical
• Tube feedings when GI tract functional
• Lactose restricted
• Experimentation with glutamine

17
Sample Question

• Enzyme replacements a fat-restricted diet would
  be recommended for
• Neck Cancer
• Brain/Nervous System Cancer
• Pancreas Cancer
• Liver Cancer

18
Sample Question

• Oral infections and mouth sores in people with
  HIV infection are usually due to
• A. Thrush
• B. Cryptosporidiosis
• C. Herpes virus
• D. A C

19
Sample Question

• Weight loss in people with COPD is attributed to
  all of the following except
• Increased energy expenditure
• Poor food intake anorexia
• Malabsorption
• Use of oxygen masks