Nutrition I+II

nutrients

chemicals used by the body for cellular purposes and energy

• micronutrients→ vitamins, minerals

• macronutrients→ carbs, proteins, fats

• energy is measured in calories(c/kcal)→ energy needed to raise 1 kg of kg by 1 degree Celsius(varies by age)

• energy sources→ proteins + carbs=4 cal/g, fats=9 cal/g

• if energy is not used it is stored as fat

failure to thrive

inadequate nutrition to support growth and development

• organic cause→ cachexia(kuh·kek·see·uh) due to pathology→ e.g. cardiac, GI disease, cancer

• cachexia: wasting syndrome associated with chronic illness→ accelerated BMR, high cytokines affecting normal hunger triggers=low appetite

• non-organic causes: poverty and neglect(child abuse)

• neglect→ most predominant type of child abuse in North America

• tx: treat the cause, increase calories per mL, hydrate, vitamins and minerals

marasmus

deficient in calories and proteins

• person needs adequate protein, fats, and carbohydrates

• subcutaneous fat is not preserved

• ribs become very prominent, severe muscle wasting

• no fatty liver or edema

• voracious feeder→ very hungry

• common in infants under 1 year

kwashiorkor(kwaa·shee·or·kor)

develops in children ages 6 months to 3 years whose diets are deficient of protein

• patient requires adequate amounts of proteins

• subcutaneous fat is preserved

• ribs are not prominent, mild or absent muscle wasting

• enlarged fatty liver

• edema is present(protuberant belly)

• poor appetite→ because the child is eating but does not have enough protein

• common in children weaned off of breastmilk who lack protein→ low albumin(plasma protein) leads to fluid shift

testing and treatment for growth & development

• growth charts→ pediatric patients(measure head circumference too)

• weight

• BMI-adults

• serum albumin for protein intake assessment

• tx: increase or limit caloric intake

growth charts

trend=general direction of change

• it is expected to be a little below or above

• *know how to plot

enteral nutrition

use for patients who need to increase calories or who cannot eat regular food

• PO→ GI feeding tubes e.g. NG, NJ, nasoduodenal(ND) G-tubes

preparations:

• polymeric(proteins, lipids, carbs)= intact nutrients, high calorie e.g. pediasure, ensure

• oligomeric(easily digestible components e.g. amino acids, peptides)→ hydrolyzed nutrients

• specialized→ if organ disease is present

timing of enteral nutrition

• bolus: mimics normal meals, 3x per day

• intermittent→ similar to bolus but at a slower infusion e.g. 30-60 min

• continuous→ ideal for recovery, avoids dumping syndrome= osmotic shift

total parenteral nutrition

is patient specific delivered via central IV line

• goal→ increase nutritional intake

• s/e: fluid overload, infection, electrolyte imbalances, hyperglycemia, GI dysfunction

osteoporosis

fragile bones due to increased bone resorption

• most common cause=menopause→ decreasing estrogen at middle age for females

• bone cells have intracellular estrogen receptors which stimulate osteoblast bone building

• other causes→ thyroid hormone deficiency, genetics, very high ETOH and caffeine intake

• monitoring→ bone scan

tx:

• vitamin D and calcium

• bisphosphonates: suppress osteoblast activity, “-nate”

alendronate, risedronate

vitamin D and calcium

• Calcitriol(1.25-dihydroxyvitamin)→ active vitamin D3, given for vit D deficiency if at risk risk due to GI/liver/renal dysfunction

• calcium→ gluconate, acetate, citrate

• vitamin D3 can be overdosed because it is lipid soluble

• → S&S: fatigue, N&V, GI pain

breastmilk

• breastfeeding recommended exclusive 6 months up to 2 yrs of age

• 56% milk fat

• 70 calories per 100 mL

contains:

• fatty acids essential to brain development

• amino acids

• carbohydrates→ lactose

• essential minerals, vitamins, trace elements

• free water

• immunity components: IgA, EGF, leukocytes

• Iron→ bioavailability up to 100%

• is low in vitamin D, so this must be supplemented

breastfeeding physiology

female lactation hormones stimulation:

• prolactin(from anterior pituitary gland)→ milk synthesis

• oxytocin(posterior pituitary)→ milk excretion

• quantity and quality of breastmilk is hormone dependent and stimulated by infant’s suckling

• contraindications for breastfeeding: HIV infection, drug abuse, lactose intolerance

breastmilk

• colostrum→ 1-3 days post delivery, highly immunologic(IgA, EGF), low in lactose

• transitional milk→ 3-14 days post delivery, contains: lactose, protein, fat

• mature milk→ > 14 days post delivery:

◦foremilk→ higher in free water

◦ hindmilk→ higher calorie and fat

lactose intolerance

inability to breakdown(hydrolyze) milk sugar lactose due to lack of enzyme lactase

• lactase enzyme deficiency(brush border duodenum)

• lactose is broken down into glucpse and galactose

• high incidence, increasing with advancing age

• common in Asia, Africa, South America

types:

• congenital→ autosomal recessive trait

• primary→ decreasing levels of lactase with age(common after 2 yrs old)

• secondary→ associated with other illness→ crohn’s disease flare-up

S&S of lactose intolerance

unabsorbed lactose causes an osmotic shift

• fluid shifts into intestine creating watery stool + the fermentation of lactose by colony bacteria

• leads to diarrhea, gas, bloating/cramping and flatulence

galactosemia

inability to metabolize galactose with the enzyme GALT

• arginine supplementation does not help

treatment for lactose intolerance

stop + avoid milk intake(human or dairy)

• lactose free formula is available for babies

• drug: lactaid→ lactase enzyme supplement, not for infants