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Ch. 22: CHO and FatModified Diets for Malabsorption


Which nutrients and degree of malabsorption dependent on amount and location of ... resulting from inflammatory bowel, cancer, obstructions, diverticulitis, etc. ... – PowerPoint PPT presentation

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Title: Ch. 22: CHO and FatModified Diets for Malabsorption

Ch. 22 CHO and Fat-Modified Diets for
  • Take Handouts of Diets
  • Malabsorption Syndromes
  • Which nutrients and degree of malabsorption
    dependent on amount and location of the intestine
    that is affected.
  • Multiple nutrients can be affected by
  • Restrictive diets add to risk of nutrient

90-95 of Nutrient Absorption takes place in the
first half of the Small Intestine
Malabsorption Syndromes affect Fat more
Frequently than Carbohydrate or Protein
Fat Malabsorption
  • Caused by multiple disorders
  • Nutritional results of fat malabsorption
  • Loss of kcalories weight
  • Loss of fat soluble vitamins and EFA
  • Loss of calcium and magnesium
  • Increases nutrient needs
  • Kidney stones from Ca malabsorption

Fat-modified Dietsfor Malabsorption Syndromes
  • The Four Fs of Steatorrhea
  • Pancreatic Enzyme Replacements
  • Medium-chain triglycerides (MCT) portal vein
  • Refer to Handout on Low Fat Diet

Possible Causes of Malnutrition in Malabsorption
Carbohydrate Restricted Diets - Lactose
  • More of the Worlds population are Lactose
    intolerant than not
  • Deficiency of enzyme lactase
  • Lactase activity decreases with age
  • Temporary r/t ABT therapy, surgery, etc.
  • Undigested Lactose draws in water to the gut
    results in
  • Cramping
  • Distension
  • Diarrhea
  • Flatulence

MNT for Lactose-Restricted Diets
  • Check medications - they may contain lactose!
  • Give milk with other foods
  • Rx for Lactaid
  • Use of Commercial Products sweeter
  • Some foods may be better tolerated chocolate
    milk, ice cream hard cheeses
  • Fermented milk products - yogurt
  • Refer to Handout on Low Lactose Diet

Hidden Sources of Lactose
  • Clients unable to tolerate even small amounts of
    lactose need to avoid foods containing any of the
    following ingredients
  • Buttermilk
  • Cheese flavors
  • Curds
  • NFDM
  • Lactose
  • Malted milk
  • Milk or milk solids
  • Sweet or sour cream
  • Whey but not Whey Protein Concentrate

Typical Gastric Surgery Resections
MNT s/p Gastrectomy
  • Immediately following surgery NPO
  • NCS Clear Liquid Diet - broth, unsweetened
    decaff coffee or tea, sugar-free gelatin water
  • Stage 1 NCS Puree Diet blenderized foods, no
    bread, focus on protein fluid needs
  • Stage 2 NCS Soft Diet soft grains, canned
    fruits, cooked vegetables, soft moist meats,
    limited fats
  • Stage 3 NCS Regular Diet focus on nutritious
    foods that are tolerated avoid soda, sugars

The Dumping Syndrome
Nutritional SEs of Gastrectomy
  • Dumping Syndrome
  • Reactions after eating foods high in sugar
  • Sweaty, shaky, nauseated, cramps, diarrhea
  • Prevention - pg. 549
  • Possible Nutrient Deficiencies
  • Vitamin B-12
  • Iron
  • Calcium
  • PCM

Gluten-Free Diets
  • Celiac (SEE-lee-ack) disease a sensitivity to a
    part of the protein gluten that causes flattening
    of the intestinal villi and malabsorption also
    called gluten-sensitive enteropathy or celiac
  • Gluten (GLUE-ten) major protein found in wheat.
  • Gliadin (GLY-ah-din) the fraction of gluten that
    causes the toxic effects in celiac disease.
  • Other grains - B.R.O.W. not tolerated

Gluten-free Diet
  • Disorder had been underdiagnosed
  • Blood test vs. biopsy now available
  • Several specialty products available in stores
  • Can have potatoes, corn, tapioca
  • Review handout on Gluten-free diet

Fat Malabsorption
  • General modifications
  • Treat underlying cause surgery, drugs
  • Fat modificationlow-fat products
  • Enzyme replacement
  • MCT replacement
  • Small meals
  • Water soluble forms of fat-sol vitamins
  • Limit foods high in oxalates
  • Modify for increased acceptability

Fat-Modified Diets Surgery
  • Intestinal Surgeries and Short-Bowel Syndrome
  • Removal of part of small intestine resulting from
    inflammatory bowel, cancer, obstructions,
    diverticulitis, etc.
  • Short-bowel or short-gut syndrome
  • Remaining portion gets longer, thicker and wider
    to increase absorptive surface and becomes more
    efficientmay take up to a year
  • High carbohydrate50--60 and limited in simple
  • lower in fat20 at first
  • Blind Loop Syndrome
  • Bacterial Overgrowth

Summary CHO Restricted Diets for Malabsorption
  • Diets used to treat malabsorption include the
    lactose-restricted diet, the postgastrectomy
    diet, and the gluten-free diet.
  • Lactose-restricted diets, help control the
    diarrhea and pain associated with lactose
  • Postgastrectomy diets limit simple carbohydrates
    to minimize malabsorption following gastric
  • Gluten-free diets eliminate wheat, barley, rye,
    and possibly oats.
  • Strict adherence to a gluten-free diet reverses
    the intestinal damage that leads to malabsorption
    in celiac disease.

Summary - Fat Restricted Diets for Malabsorption
  • Fat-modified diets can help minimize fat
    malabsorption and its consequences.
  • For extra kcals, some of the fat can be supplied
    as MCT, which are easier to digest and absorb
    than LCT.
  • Bacterial overgrowth leads to fat malabsorption
    by altering the bile salts necessary for their
  • Fat malabsorption is more likely to occur from
    intestinal surgery when the ileum and ileocecal
    valve must be resected.

Sample Test Question
  • Which of the following is NOT eliminated on a
    gluten-restricted diet?
  • A. Rye
  • B. Barley
  • C. Rice
  • D. Wheat