Nutrition Concepts and Controversies- Exam 3

What are the fluid needs?

30-40mL/kg/day 

What is the percentage of weight loss formula?

Percentage of weight loss= (Amount of weight loss divided by usual body weight) x 100 

What are the lab values and physical symptoms that indicate malnutrition?

<6 mg/dl- concern for malnutrition and <2.8 g/dl severe malnutrition indicated  

Low nitrogen levels in blood or low blood urea nitrogen or BUN may indicate what?

malnutrition

Low albumin is more of an indicator of what?

severe disease

What is the range of cancer for lab values?

1.2-1.5

What is the range for post-surgical/trauma lab values?

1.5-2.0

Feeding method- need to be able to consume at least what?

50% of their protein needs

Accurate BMI is dependent on what?

height and weight

What is the BMI range for being underweight?

< 18.5

What is the BMI range for a healthy weight

18.5-24.9

What is the BMI range for being overweight?

25-29.9

What is the BMI range for being obese

> or equal to 30

Therapeutic diet: Heart Healthy (cardiac)

• limited in saturated fats

• encourages whole grains, fruits, veggies, unsaturated fats, and appropriate calories to attain/maintain healthy weights

  • high serum low-density lipoprotein (LDL) cholesterol and prevention or treatment cardiovascular disease

Therapeutic diet: Consistent carbohydrate

• consistent daily carbs with heart-healthy choices

• high fiber intake is encouraged and sodium may be limited

Therapeutic diet: Fat Restricted- Liver, Gallbladder or pancreatic disease and GERD

Less than 20-50grams of fat /day

Therapeutic diets: High Fiber – Constipation, IBS, high cholesterol, obesity

25 – 35g /da

Therapeutic Diets: Low Fiber –inflammatory IBD, recently had intestinal surgery

Eliminated skins, less than 2g fiber, no nuts seeds and dried fruits and lactose may also be restricted

Therapeutic diet: High-calorie, high-protein – increased nutritional requirements

diet rich in calorie-dense and/or protein-dense foods

Therapeutic Diets: Gluten-free – Celiac disease - Dermatitis

Eliminating sources of gluten (any wheat product, rye or barley) adding
rice, potatoes, quinoa, encouraged as sources of complex carbohydrates

Therapeutic diets: Lactose Restricted- IBD, lactose intolerance

Limit foods with milk sugar – variable degrees

Aspiration is the most serious potential complication with what?

gastric feedings

Where is prepyloric located?

the feeding is in the stomach

where is postpyloric located?

the feeding is delivered beyond the pyloric sphincter

What is the downside of prepyloric feeding?

clients are high risk of aspiration and not appropriate for long time use

What is an advantage of post pyloric feeding?

lower risk of aspiration

What is aspiration?

when there are contents of food or liquid that enters the airways or lungs rather the esophagus

Prepyloric lets food into the what?

intestine and out into the stomach  

Post-pyloric is the feeding is through the what?

stomach and lands into the intestines  

What organs that need to be healthy to support increased protein needs  

Kidney and liver 

What are the tube feeding tolerance symptoms?

Abdominal discomfort, N/V, and Diarrhea

What is parenteral nutrition?

the delivery of nutrients by vein; parenteral literally means “outside the intestinal tract”

PN is used in adult clients when they are what?

malnourished or at risk for malnutrition when a contradiction to EN exists

Parenteral Nutrition complications

liver dysfunction and refeeding syndrome

What is refeeding syndrome?

Refeeding syndrome is a potentially fatal complication that occurs from an abrupt change from a catabolic state to an anabolic state and an increase in insulin caused by a dramatic increase in carbohydrate intake 

• Serum electrolyte levels can lead to fluid retention, heart failure, and respiratory failure 

What are the two objective components of obesity?

• Body Mass Index (BMI) 

• Wasit Circumference 

• >35 inches (women) and 40 inches (men)

What are the risk factors related to obesity?

• Obesity is associated with an increased risk of all-cause mortality  

• High BMI is a major risk factor for cardiovascular disease, diabetes, musculoskeletal disorders and some cancers 

Components of lifestyle therapy for weight management  

healthy, calorie-reduced eating plan, and increase in physical activity and behavioral interventions to facilitate adherence to eating and activity changes

Eating patterns that are proved through research for healthy weight loss 

From a weight-loss standpoint, calories matter more than the percent contribution of carbohydrates, protein, and fat. 

What are the recommendations for physical activity  

• Resistance training- with major muscle groups performed 2-3 times per week 

• Reduce sedentary lifestyle 

• 150 minutes/week or more performed on 3 to 5 separate days per week  

• Buddy system, trainer, small group, pedometers, and other activity monitors show improved progress 

Recommendations for pharmacotherapy and surgical interventions for weight loss 

• People with a BMI > or equal to.30 

• People with a BMI > or equal to .27 with comorbid conditions 

• People with waist circumference .35 inches (women) and 40 inches (men) are also candidates for pharmacotherapy if comorbidities 

• >35.5-39.9 with major co-morbidities  

From the YouTube Video, what are the 4 actions of GLP1 medications?

• 1. Hormones - Ozempic mimics the hormone in our body  

• 2. Works in the pancreas  

• 3. Stomach- slows the digestion in the stomach and do not eat as much 

• 4. Brain- in the hypothalamus 

What are the complications and risks factors for GLPI medications?

• The side of effects (like N/V, diarrhea) of Ozempic gives heart palpitation  

• Stomach is paralyzed takes a long time for the system to reset and the  

• GI tract is also a huge problem because it causes the digestion to be messed with

Eating disorder characteristics: Anorexia Nervosa (AN) 

• characterized by restriction of food intake, intense fear of gaining weight, and a distorted body image  

• Long term ramifications and relapse occurrence 

• Restore weight, normalize eating pattern, achieve normal perceptions of hunger and satiety, correct biological and psychological sequelae of malnutrition 

• Preoccupation with food 

• Irrational fear of normal body weight  

• Body image distortion 

• Self-worth based on size and shape  

• Compulsive pursuit of thinness 

• Terrified of gaining weight or becoming fat  

Eating disorder characteristics: Eating Disorders not otherwise specific

• Diet frequently, use unhealthy methods to lose weight, meet some but not all the criteria for the diagnosable eating disorders 

• Normalize, eating behaviors, education of nutrition 

• Emphasis on recognizing internal hunger and satiety cues

Eating disorder characteristics: Bulimia Nervosa

•  characterized as binge-eating episodes followed by behaviors to prevent weight gain, such as self-induced vomiting, fasting, or excessive exercise 

• Increased due to severe electrolytes and acid-base imbalances related to recurrent vomiting or stimulant laxative abuse  

• BN is less than associated with AN  

• People with BN are usually within their normal weight range although some may be overweight 

• To stabilize weight by decreasing bingeing and purging  

• Achieving normal perceptions of hunger, fullness, and satiety 

• Lack of sense of control  

• Preoccupation with food 

• Irrational fear of normal body weight  

• Body image distortion 

• Self-worth based on size and shape 

What is a stress response?

A stress response is a complex series of hormonal and metabolic changes that occur to enable the body to adapt to stressors  

What is a hormonal response?

• Stress hormones are catecholamines, glucagon, and cortisol react to what happens in the body 

• The metabolic effect from hormones is to release stored macronutrients to meet the increased demands for energy. Their combined effects contribute to hyperglycemia 

What happens from excess cortisol exposure  

Yes, excess cortisol is damaging especially when stress is prolonged. It inhibits protein synthesis even when protein intake is high promotes insulin resistance, contributes to hyperglycemia, and suppresses immune responses  

Describe the catabolic stage during the stress response 

Catabolic- Insulin resistance- increased cardiac output oxygen consumption, body temp, basal metabolic rate, total body protein catabolism, negative nitrogen balance length of this phase is dependent on the severity of injury or infection and whether complication develop 

Describe the anabolic stages during the stress response 

Anabolic- characterized by a positive nitrogen balance as protein synthesis begins. Adequate calories, protein, and nutrients are needed for anabolism 

What is acute-phase response?

is a trauma- or inflammation-induced release of inflammatory mediators that cause changes in the levels of plasma proteins and clinical symptoms of inflammation.

What is a positive acute phase protein?

• Positive acute phase proteins- such as C-reactive proteins, increase in concentrations, support defense, repair, and inflammation control  

• Inflammation causes positive acute-phase proteins such as C-reactive protein, to increase in concentration  

What are a negative acute phase protein?

Negative acute-phase proteins- such as albumin, prealbumin, and transferrin decrease in response to inflammation 

What is the role of cytokines?

prolonged production of proinflammatory cytokines promotes accelerated catabolism-responsible for regulating acute-phase proteins they also produce changes in other cells that cause systemic symptoms of inflammation, such as anorexia, fever, lethargy, and weight loss 

What is hypermetabolism?

higher than normal metabolism

What is indirect calorimetry?

• energy expenditure based on analysis of the oxygen and carbon dioxide of inspired and expired air. Lack of expertise in interpreting the results  

• Gold standard for determining calorie requirements, but it may not be routinely performed due to limited availability, lack of expertise for interpreting results, or costliness of the device  

What is refeeding syndrome (pt.2)

• aggressive nutrient replacement, either via a PN, EN, or oral diet 

• Seen in clients with chronic alcoholism, chronic undernutrition or malnutrition of calories and/or proteins, prolonged fasting, cardiac and cancer cachexia, long-term use of simple IV hydration, etc.  

What are the nutritional goals during a systemic inflammatory response and associated symptoms  

• Goals: minimize body protein catabolism, promote wound healing and provide apportion amount and combinations of nutrients to limit or modulate the stress response and complications  

• Oral diet fast as possible; maximize intake of eating high protein diet  

• Symptoms: anorexia (loss of appetite), fever, lethargy, and weight loss 

Micronutrient recommendations during critical illness/ nutrients for wound healing   

• Currently they know that the usage of antioxidant micronutrients and trace element vitamin C and E 

• Micronutrient supplementation after burns is common practice to fight oxidative stress, support the immune system, and promote wound healing

Discuss the specific nutrient needs for burn patients and those diagnosed with ARDS/ ALI 

Studies have shown that antioxidant vitamins (E and C) and trace minerals (like selenium, zinc, and copper) 

ARD/ALI EN products specially formulated for clients with pulmonary disorders are high in fat and low in carbohydrates based on the rational that lesser amounts of carbohydrates reduce (CO (2) productions 

The goal for ARDS is to provide calories and protein to prevent weight loss 

What is anorexia causes?

• Brain/stomach 

• Common symptom of many physical donations 

• Aim of nutrition therapy is to stimulate appetite to maintain adequate nutritional intake  

• Viral, bacteria, side effects of medication 

Nausea and vomiting – complications from short-term vs. intractable vomiting foods to avoid 

• Impact the brain and stomach/esophagus or mouth 

• Short-term concern of nausea and vomiting is fluid and electrolyte balance 

• With intractable or prolonged vomiting, dehydration, and weight loss are concerns  

• Clear liquids are offered 

• Avoid high-fat and spicy foods if they contribute to nausea 

• Nutritional goal: gut rest, BRAT diet, and restore electrolyte imbalance 

What is oropharyngeal dysphagia?

• occurs when there is difficulty in the initial stage of swallowing that involves transferring food from the mouth into the esophagus 

• Causes: neurologic or muscular disorders, such as stroke, myasthenia gravis, Parkinson's disease, multiple sclerosis, upper esophageal sphincter dysfunction, muscular dystrophy, radiation injury, amyotrophic lateral sclerosis, and head and neck tumors 

What is esophageal dysphagia?

• difficulty passing food down the esophagus; the sensation of food sticking in the throat or in the chest for several seconds after swallowing 

• Causes: Mechanical causes include obstruction, inflammation, edema, and surgery of the throat. 

What are the nutritional goals for dysphagia?

• The nutritional goal is to modify the texture of foods and/or viscosity of liquids to enable the patient to achieve adequate nutrition and hydration, while decreasing the risk of aspiration 

Gastroparesis – define, and list possible structural causes and foods to avoid  

• Involves the stomach and sometimes only involves the stomach 

• Chronic mortality disorder of the stomach 

• Causes: N/V, bloating, early satiety, and upper abdominal pain  

• Decrease fiber intake, carbonated beverages, avoid alcohol and smoking, increase fluid 

GERD- define and treatment options  

- Gastroesophageal reflux disease (GERD) 

• Caused by an abnormal reflux of gastric contents into the esophagus related to an abnormal relaxation of the lower esophageal sphincter 

• No singular treatment plain- patient specific 

• Lifestyle modification, including nutrition therapy  

• Drug therapy  

• Surgical intervention, if necessary 

How does Peptic Ulcer disease differ from GERD- causes of PUD- associated life-threatening concern

• Most peptic ulcers occur in the stomach or proximal duodenum  

• Helicobacter pylori infection 

• Second leading cause of peptic ulcers is the use of nonsteroidal anti-inflammatory drugs 

• The most common symptom is epigastric pain, described as gnawing or burning that is usually worse at night or when the stomach is empty  

• Seen mostly in athletic or people who use antibodies frequently to treat UTIs 

• The most common and severe complication of PUD is gastrointestinal (GI) bleeding, which can be life threatening  

• No evidence that diet causes PUD or speeds ulcer healing 

• Probiotics may be a helpful adjunct to antibiotic therapy is eradicating H. pylori 

Dumping syndrome: Early

• N/A, diarrhea, and abdominal pain 

• Weakness, dizziness, and a rapid heartbeat occur as the volume of circulating blood decreases 

• 10 to 20 minutes after eating 

Dumping Syndrome: Intermediate

• Occurs 20 to 30 minutes after eating 

• Digested food is fermented in the colon, producing gas, abdominal pain, cramping, and diarrhea 

Dumping Syndrome: Late

• Occurs 1 to 3 hours after eating  

• Rapid absorption of carbohydrate causes a quick spike in blood glucose levels 

• Shakiness, sweating, confusion, and weakness 

What is dumping syndrome?

When contents of food move rapidly from the stomach into the intestines

What are the nutritional recommendations for prevention?

Eat small, frequent meals, avoid concentrated sugars, consume liquid 1 hour before or after eating instead of with meals 

Constipation – nutritional and lifestyle intervention recommendations  

• Large intestine  

• Having fewer than three bowel movements per week, passing stools that are hard, and excessive straining during defection  

• Constipation is treated by treating the underlying cause 

• High-fiber diet, increase in drinking more fluid, aerobic exercise

What are the three types of diarrheas

Osmotic, Secretory, and Antibiotic-acquired diarrhea

Osmotic diarrhea

• occurs when there is an increase in particles in the intestine, which draws water in to dilute the high concentration 

• Causes include maldigestion of nutrients 

Secretory Diarrhea

Caused by infections, some medication, some GI disorders, and an excessive amount of bile acids or unabsorbed fatty acids in the colon 

Antibiotic-acquired diarrhea

• disruption in GI microbiota  

• Overgrowth of C. difficile is the most clinically significant form  

What electrolytes are at risk for deficiencies with diarrhea

sodium and potassium

Inflammatory Bowel Disease (IBD): 

• Serious inflammatory situation 

• Crohn disease (CD) 
  - more dangerous  

• - ileum and colon 

• Unknown cause; patches of inflammation in the entire GI tract  

• Ulcerative colitis (UC) 

• - rectum and colon 

• - exact cause unknown  

• - continious inflammation and abdominal pain-rectal bleeding 

• Abnormal immune response to a complex response 

• Exacerbation and remission 

• May require immunotherapy modulation pharmacology 

• Increases the risk of malnutrition, more so in clients with CD (patches of inflammation throughout GI track) than UC (continual inflammation in the colon and rectum) 

• Depends on the presence and severity of symptoms, the presence of complications, and the nutritional status of the patient  

• Acute exacerbation of IBD 

• Low fiber is recommended to minimize bowel stimulation  

• Diet modifications are made according to symptoms 

Celiac Disease

• Small intestine mucosa and autoimmune disorder characterized by chronic inflammation of the proximal small intestine mucosa- permanent intolerance to gluten- GI discomfort-growth restrictions 

• Genetic autoimmune disorder characterized by chronic inflammation of the proximal small intestine mucosa 

• Permanent intolerance to certain proteins found in wheat, barley, and rye  

• Classic symptoms in children: diarrhea, abdominal distention, and failure to thrive 

• Adults present: diarrhea, constipation, weight loss, weakness, flatus, abdominal pain, and vomiting 

• Only scientifically proven treatment for celiac disease  

• Develop celiac-like symptoms in response to eating gluten 

Irritable bowel syndrome: 

• Most frequently diagnosed digestive disorder in the US 
  Lower abdominal pain, constipation, diarrhea, alternating periods of constipation and diarrhea, bloating, and mucus in the stools  

• Dietary restriction of FODMAPS (low- fermentable oligo-, Di-, and Monosaccharides, and Polyols Diet) 

• Has been shown to be an effective treatment 

Lactose malabsorption/intolerance

• Occurs when the level of lactase is absent or deficient  

• Primary lactose intolerance occurs in “well” people who simply do not secrete adequate lactase. Need lactate tablets at meals with lactose 

• Lactose is fermented in the colon 

• Produces bloating, cramping, and flatulence 

• Missing the lactase secondary  

Secondary lactose malabsorption  

• Alter the integrity of function of intestinal villi cells  

• Nutrition therapy for lactose intolerance is to reduce lactose to the maximum amount tolerated by the individual 

• Nutrition therapy for lactose intolerance is to reduce lactose to the maximum amount tolerate by the individual  

Short bowel syndrome (SBS) 

• Occurs when the bowel is surgically shortened to the extent that the remaining bowel is unable to absorb adequate levels of nutrients to meet the individual's needs. 

• Nutrition complications experienced by people with short bowel syndrome depend on the amount and location of resected and remaining bowel  

• Massive malabsorption of micronutrients-weight loss- electrolytes imbalance, oral feedings if possible 

What are diverticula?

pouches that protrude outward from the muscular wall of the intestine usually in the sigmoid colon 

What is diverticulosis?

the presence of colonic diverticula, without inflammation or symptoms 

What is diverticulitis?

macroscopic inflammation of diverticula with related acute or chronic complications  

Increase the risk of diverticulitis include what?

red meat intake, particularly unprocessed red eats  

Some evidence suggests a high fiber diet may increase risk what

diverticulitis recurrence and/or symptomatic DD 

Hepatitis

• caused by virus's hepatitis A, B, C- fatty liver and alcohol- 

• Protein 1-1.2 g/kg/day 

• After absorption, almost all nutrients are transported to the liver  

• Liver damage can have profound and devastating effects of the metabolism of almost all nutrients  

• Fatty liver disease: abnormal fat deposition in the liver 

• Hepatitis is the inflammation of the liver that may be caused by viral infections, alcohol abuse, and hepatotoxic chemicals 

Cirrhosis

Cirrhosis is an irreversible liver disease that occurs when damaged liver cells are replaced by functionless scar tissue 

Hepatic encephalopathy

• Hepatic encephalopathy is protein restriction is contraindicated  

• CNS manifestations of advanced liver disease  

NAFLD

• NAFLD (Nonalcoholic fatty liver disease) is a fatty liver disease with abnormal fat deposition in the liver 

• A Mediterranean diet is the most recommended dietary pattern for NAFLD

Define function of gallbladder and nutritional implication that may cause disease 

• The gallbladder stores and releases bile  

• Not a vital role in digestion  

• Bile is held in the gallbladder; water is slowly removed making it more concentrated  

• Symptomatic gallstones are often advised to consume a low-fat diet (<30% total calories from fat) 

What causes the pain and inflammation of pancreatitis and what are the diet recommendations 

• Inflammation of the pancreas 

• May develop hyperglycemia and self-digestion of the pancreas  

• Clear liquid diets are not necessary; depends on the level of inflammation of the pancreas 

• Client specific 

• Low fat diets are often recommended to reduce abdominal pain, but consideration should be given to the long-term impact this can have on calorie intake and the client’s weight