Human Nutrition Exam 3

How is the FDA involved in disease treatment?

approves sale of new drugs and inspects drug manufacturing facilities

regulates labels on OTC drugs to make sure they provide accurate information about drugs' appropriate uses, dosage, and potential side effects

What are generic drugs?

after 20 years, brand-name drugs can be sold as a less expensive drug

What are oral medication administrations?

first pass elimination--> incomplete absorption or metabolism

what are injected medication administrations?

vein (intravenous)

muscle (intramuscular)

beneath the skin (subcutaneous)

what are other routes of medication administration?

under the tongue (sublingual)

into the rectum

across the skin (transdermal)

inhalation

what are adverse reactions/events associated with the use of medicine?

life-threatening event, incapacitation, hospitalization, birth defect, and death

what are side effects of medications (in general)?

revealed in large scale clinical trials

FDA monitors adverse events once drug is marketed

mandatory reporting of known AE by manufacturers and retailers

related to dietary supplements and OTC medications as well

providers are not mandatory reporters but are strongly encouraged to report AE

individuals using medications are encouraged to report AEs- reported to FDA medwatch website

what are barriers associated with AE reporting?

most not reported or not reported correctly

downplaying significance, reporting where/ how unknown, embarassment

What can lead to medication error?

any preventable error that causes inappropriate drug use or patient harm due to mistake made by the health professional, patient, or caregiver

typically involves the use of incorrect drugs or improper dosages

similar packaging, names, misread prescription, misinterpreted prescriptions

what are some policies to reduce medication error?

bar codes, patient ID bracelets, eliminate use of medical abbreviations

What patients are at high risk of adverse effects of medications?

pregnant women, children, and people with medical conditions are not the main focus of clinical trial/ studies that determine product safety

what are the drug effects on foot intake?

makes food intake difficult or unpleasant

suppresses or stimulates appetite and/ or encouraging weight gain

significant only if it continues for a long period of time

what are some physiological effects of drugs on food intake?

mouth dryness, alters taste, inflammation or lesion in mouth or GI tract, induce nausea and vomiting

What are drug effects on nutrient absorption?

often stems from drugs that upset the GI function or damage intestinal mucosa

drug nutrient binding

altered stomach acidity

direct inhibition

What drugs are the most harsh on the GI system?

antineoplastic and antiretroviral drugs

NSAIDS/ antibiotics typically more mild

what do bile acid binders do?

reduce cholesterol levels--> may bind to fat-soluble vitamins

what do antibiotics do with nutrient binding?

can bind several mineral--> calcium, iron, magnesium, zinc (use dairy products and mineral supplements ~2 hrs before or after the medication)

how can stomach acidity be altered by drugs?

impaired absorption of Vit B12, folate, and iron (e.g. antiacids and antiulcer drugs)

what are the major influences of drug absorption?

stomach's emptying rate, stomach acidity, interaction with dietary components (mineral, fiber, high-fat, acidity)

other: drug formulation

How does stomach's emptying rate affect dietary effects on drug absorption?

medication with meals may delay absorption

delayed stomach emptying- absorption sites are less likely to be saturated so absorption may be enclosed

slow drug absorption rate may be problematic with high concentrations of a drug are necessary to illicit a response

how does stomach acidity affect dietary effects on drug absorption?

may enhance or digress absorption rates

damage of drugs in acidic solution- coated medications

what are the drug effects on nutrient metabolism?

drugs and nutrients share similar enzyme systems in the SI and liver

drugs may enhance or inhibit the activities of enzymes/ co-enzymes needed for nutrient metabolism

e.g. methotrexate--> designed to interfere with folate metabolism of cancer cells; pre-activated form of folate is often prescribed with it

what are the dietary effects on drug metabolism?

food components may alter enzyme activity--> interference with drug metabolism, counteract drug effects (ex: grapefruit juice)

warfarin (coumadin)--> vitamin K, interaction w popular herbs

what are the drug effects on nutrient excretion?

drug that increase urine excretion--> reduce nutrient reabsorption in kidney= loss of nutrients in urine (e.g. diuretics)

corticosteroids (used as anti-inflammatory agents and immunosuppressants)--> promote sodium and water retention and increase urinary potassium excretion--> long term use effects include muscle wasting, bone loss, weight gain, hyperglycemia

What are the dietary effects on drug excretion?

inadequate excretion--> toxicity

excessive losses--> reduced therapeutic effect

food components may influence drug reabsorption in kidneys (e.g. sodium)

urine acidity--> influenced by food

what increases urine's acidity?

beans, caffeinated drinks, red meat, sugar

what makes alkaline urine?

vegetables, dairy, herbs, and spices

What is an example of a diet-drug interaction and its toxicity?

Tyramine (food component) and monoamine oxidase inhibitors (MAOIs)

how would one prevent diet-drug interactions?

healthcare providers should list the type and amount of OTC drugs, prescription drugs, and dietary supplements the patient uses

make note of administration method, administration instructions (w/ w/o food, empty stomach, etc.),side effects

what percentage of Americans use herbal supplements?

20%

improve general health/ prevent or treat specific diseases or conditions

what are the most popular herbal supplements?

echinacea, garlic, ginkgo, ginseng, and St. John's wort

why are herbal supplements not considered reliable treatments during illness?

"suggestive claims" can be a problem- creates possibly toxicity effects/ contaminations

limited large scale clinical studies- lack of rigorous testing

compounds in herbal supplements may vary between species, growing conditions, preparation methods

No FDA approval-AE rarely on labels (not regulated)

limited information exists

Why do individuals use herbal supplements during illness?

herbal remedy is less stressful than a visit to PCP--> delays appropriate treatment 00> illness progresses or worsens

what is complementary and alternative medicine (CAM)

therapies that have not been scientifically validated and therefore are not promoted by conventional health professionals (encompasses any and all therapies that are not normally part of conventional medicine)

what does complementary mean in CAM?

used in conjunction with traditional medicine

what does alternative mean in CAM?

used in place of traditional medicine

What is the NCCAM?

National Center for Complementary and Alternative Medicine

established in 1998, parts of national institute of health (NIH)

what percent of adults report use of some form of CAM therapy?

38%

what are alternative medical system?

ayurveda, hemeopathic medicine, naturopathic medicine, traditional Chinese medicine

what are biologically based therapies?

aromatherapy, dietary supplements, foods and special diets, herbal products, hormones

what are energy therapies?

bioelectrical therapies (including electrical and magnetic fields)

biofield therapies (including acupuncture, qi going, and therapeutic touch)

what are manipulative and body-based methods?

chiropractic, massage therapy, osteopathic manipulations, reflexology

what are mind-body innervations?

biofeedback, faith healing (prayers), meditation, mental healing (including hypnotherapy), music/art/dance therapy

what is enteral nutrition?

the provision of nutrients using the GI tract; often refers to the use of tube feedings

What is paraenteral nutrition?

intravenous provision of nutrients that bypass the GI tract (Par: beside, entero: intestine)

what is oral nutrition support?

nutrition care that allows a malnourished patient to meet nutritional requirements by mouth; may include oral nutritional supplements, nutrient-dense foods and snacks, or fortified food

what are the benefits of oral supplements used to meet energy and nutrient intake needs?

easier to consume than an actual meal for weak, frail, or debilitated patients (added energy and protein-reliable source of nutrients)

more ideal feeding option over tube feedings (tube feedings can lead to complications, added stress and expense)

allows patients to use digestive muscles (e.g. mastication)

what is an important consideration for patient acceptability?

taste

what patients may benefit from tube feeding?

swallowing disorders

impaired motility in upper GI tract

GI obstructions

intestinal surgeries

mechanical ventilation

mental incapacitation

what determines what route used for a feeding tube?

based on medical condition, expected duration of tube feeding, and potential complications

what is the route for a feeding tube if it is a less than 4 week duration?

nose (nasogastric or nasointestinal)

What is the route if the feeding tube is placed in the stomach, duodenum, or jejunum?

nasogastric, nasoduodenal, or nasojejunal respectively

what is the route in infants for feeling tube placement?

orogastric placement-placed in stomach via mouth- preferred over transnasal, allowing for more efficient breathing during feedings

what route is the feeding tube when a longer duration is needed/ obstruction?

routes to stomach (enterostomy) or jejunum (jejunostomy) from opening in the abdominal wall

when is gastric feeding avoided?

avoided in patients with high risk of aspiration (risk of aspiration pneumonia)

what are feeding tubes?

soft, flexible materials

come in various lengths and diameters

choice based on patient age and size, and formula viscosity

what are the standard enteral formulas?

polymeric formulas

provided to individuals who can digest and absorb nutrients without difficulty

blenderized formulas- produced from whole foods (e.g. chicken, vegetables, fruit, and oil + V&M)

what are elemental formulas

require less digestion

may provide fat from medium-chain triglycerides

what are specialized formulas?

disease-specific- intended to meet needs of individuals with specific diseases

expensive and controversial

What are the advantages of transnasal feeding sites?

does not require surgery or incisions for placement; tubes can be placed by a nurse or trained dietician

what are disadvantages of transnasal feeding sites?

easy to remove by disoriented patients; long-term use may irritate the nasal passages, throat, and esophagus

what are advantages of nasogastric feeding sites?

easiest to insert and confirm placement; least expensive method; feedings can often be given intermittently and without an infusion pump

what are disadvantages of nasogastric feeding sites?

highest risk of aspiration in compromised patients; risk of tube migration to the small intestine

what are advantages of nasoduodenal and nasojejunal feeding sites?

lower risk of aspiration in compromised patients; allows for earlier tube feedings than gastric feedings during acute stress; may allow enteral feedings even when obstructions, fistulas, or other medical conditions prevent gastric feeding

what are disadvantages of nasoduodenal and nasojejunal feeding sites?

more difficult to insert and confirm placement; risk of tube migration to the stomach; feedings require an infusion pump for administration

what are advantages of tube enterostomies feeding sites?

allow the lower esophageal sphincter to remain closed, reducing the risk of aspiration; more comfortable than transnasal insertion for long-term use; site is not visible under clothing

what are disadvantages of tube enterostomies feeding sites?

tubes must be placed by a physician or surgeon; general anesthesia ay be required for surgically placed tubes; risk of complications from the insertion procedure; risk of infection at insertion site

what are advantages of gastrostomy feeding sites?

feedings can often be given intermittently and without a pump; easier insertion procedure than a jejunostomy

what are disadvantages of gastrostomy feeding sites?

moderate risk of aspiration in high-risk patients; for surgically placed tubes, feedings are often withheld for 12-24 hours before and 48 to 72 hours after the procedure

what are advantages of jejunostomy feeding sites?

lowest risk of aspiration; allows for earlier tube feeding than gastrostomy during critical illness; may allow enteral feedings even when obstructions, fistulas, or medical conditions prevent gastric feedings

what are disadvantages of jejunostomy feeding sites?

most difficult insertion procedure; most costly method; feedings require an infusion pump for administration

what are modular formulas?

provide specific nutrient combinations

what are characteristics of enteral formulas?

-vary in nutrient and energy densities

-macronutrient composition: protein 12-20% of total kcal, energy coming from fat and carbohydrates

-energy density: ranges from 1-2 kcal/mL of fluid

-fiber is typically avoided

Standard formula: what are the protein sources?

intact proteins, such as casein, whey, lactalbumin, and soy protein isolates

milk protein concentrate

Standard formula: what are the carbohydrate sources?

corn syrup solids, hydrolyzed cornstarch, maltodextrin, sucrose, fructose, sugar alcohols

Standard formula: what are the fat sources?

vegetable oils (such as corn oil, soybean oil, and canola oil), fish oil, MCT, palm kernel oil

Elemental formula: what are the protein sources?

hydrolyzed casein, whey, lactalbumin, or soy protein crystalline amino acids

Elemental formula: what are the carbohydrate sources?

hydrolyzed cornstarch, maltodextrin fructose

Elemental formula: what are the fat sources?

vegetable oils (such as corn oil, soybean oil, and canola oil), fish oil MCT

what factors influence formula selectrion?

Nutrient and energy needs

Fluid requirements

Need for fiber modifications

Individual tolerances

Availability

what are considerations involved in providing tube feeding?

safe handling, initiating, and advancing tube feeding, choosing deliver method, meeting water needs, managing complications, providing medications

what is a benefits of safe handling in individuals with a suppressed immune system?

Suppressed immune system = greater susceptibility to infection from foodborne illnesses

Reduce risk of formula contamination (nurses station)

Reduce risk of bacterial infections: (e.g., change feeding container and tubing every 24 hours (at bedside)

what are safety guidelines in tube feeding?

protocols through Hazard analysis and Critical Control Points (HACCP) system -discussed in more detail in a later lecture

what is an open feeding system?

formula delivery system that requires the transfer of the formula from its original packaging to a feeding container

what is a closed feeding system?

a formula delivery system in which the sterile formula is prepackaged in a container that can be attached directly to the feeding tube for administration

how is placement of a feeding tube confirmed?

with an x-ray

what are common delivery methods in terms of feeding tubes?

intermittent feedings, bolus feedings, and continuous feedings

what are intermittent feedings?

Tolerated when delivered to stomach

250-400 mL delivered over 30-45 minute period

Similar to usual pattern of eating

what are bolus feedings?

Rapid and large volume delivery

250-500 ml delivered over a 5 to 15 minute period

Used in non critically ill patients

what are continuous feedings?

Preferred method for intestinal delivery

Slow, constant rate over 8-24 hour period

Limits patients ability to be mobile

what is the purpose of measuring gastric residual volume?

volume of formula and gastric secretions remaining in stomach- ensures proper stomach emptying

why might an individual's water needs increase?

normal: 30-40 mL per kg of body weight per day

additional if patient presents with diarrhea, vomiting, fever, sweating, high urine output, blood loss, and open wounds

what is thirst (determining water needs)?

more efficient indicator of water needs in alert adults but not older adults

what is dehydration (determining water needs)?

monitor through changes in body weight, blood pressure, fluid intake and output, lab tests (blood urea nitrogen, urine specific gravity, blood levels of creatinine, sodium)

What percentage of formula is water content?

70-85%

what are water flushes (determining water needs)?

provision of water to meet or exceed an individuals water needs (consider water intake through intravenous fluids, medications, and blood products)

why is it important to consider medication delivery?

Diet-drug interactions are considered

Medications may clog the feeding tubes

Medications may need acidic environment

Medication administration through tube feeding is often associated with diarrhea

when are continuous feedings suspended?

during medication administration

what percentage of the body is free fat mass (FFM) or Lean Body Mass (LBM)?

75%

what is free fat mass (FFM) or Lean Body Mass (LBM) made up of primarily?

water+protein+minerals

metabolically active--> essential for survival