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NUTRITION AND NUTRITIONAL STATUS IN DISEASE

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NUTRITION AND NUTRITIONAL STATUS IN DISEASE CM Viviers (RDSA) Department of Human Nutrition – PowerPoint PPT presentation

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Title: NUTRITION AND NUTRITIONAL STATUS IN DISEASE


1
NUTRITION AND NUTRITIONAL STATUS IN DISEASE
  • CM Viviers (RDSA)
  • Department of Human Nutrition

2
NUTRITION AND NUTRITIONAL STATUS IN ILLNESS
  • ILLNESS

Altered food intake
Altered digestion
Altered metabolism
Altered excretion
MALNUTRITION
3
CHRONIC LUNG DISEASE (e.g. cystic
fibrosis)Nutritional-related problems
  • ? Increased energy needs (?work of breathing,
    infections, fever)
  • ? Increased nutrient losses (maldigestion
    malabsorption of protein/fat)
  • ? Decreased food intake (infections, other
    illnesses, breathing, cramps)
  • ? Impaired feeding skills
  • ?Outcomes of malnutrition
  • Growth retardation (FTT, delayed puberty)
  • Malabsorption (steattorrhoea)
  • Poor immune status (recurrent infections)
  • Increased lung disease
  • More rapid progression of disease
  • Increased morbidity

4
CHRONIC LUNG DISEASEDietary treatment
  • Goals
  • ? Improve growth, development, resistance to
    infection
  • ? Reduce excessive losses from maldigestion/malabs
    orption
  • ? Prevent progressive pulmonary
    disease/complications (glucose intolerance,
    intestinal obstruction)
  • Strategies
  • ? Increase intake of energy and protein
  • Supplement breast fed baby with high energy
    formula
  • Regular and enjoyable mealtimes
  • Larger food portions
  • Extra snacks
  • Select food with high nutrient density
  • Fortify foods/beverages

5
CHRONIC LUNG DISEASEDietary treatment (cont)
  • MCT oil
  • O-3 fatty acids
  • Nocturnal feeds
  • Regular re-evaluation of intake
  • ? Replace enzymes
  • Insufficient replacement ? poor tolerance of
    starch fat
  • ? Monitor
  • - Tolerance of lactose, fats, gas forming foods,
    food consistency
  • Hydration status
  • Micronutrient status
  • ? Provide adequate micronutrients
  • Vitamins A, D, E, K
  • Zinc
  • Iron
  • Calcium

6
CANCERNutritional-related problems
  • ? Altered energy expenditure
  • Alterations in REE ? cachexia/weight gain
  • Tumor growth
  • Infections
  • ? Digestion and absorption of nutrients affected
  • ? Changes in CHO, fat, protein metabolism
  • Glucose intolerance
  • Body fat depletion, ? HDL, ? VLDL
  • Protein depletion, ? muscle mass, ? muscle
    breakdown, ? rates of synthesis
  • ? Decreased intake
  • Alterations in taste and smell
  • Position of tumor
  • Side-effects of cancer treatment

7
CANCERNutritional-related problems
  • ? Symptoms with a nutritional impact
  • Nausea and vomiting
  • Bowel changes (diarrhoea/constipation)
  • Dysphagia, dry mouth, chewing/swallowing
    difficulties, abdominal gas
  • Anorexia/early satiety
  • Pain, fatigue

8
CANCERDietary treatment
  • Goals
  • ? Prevent/reverse nutrient deficiencies
  • ? Sustain and promote normal growth and
    development
  • ? Minimise nutrition-related side-effects
  • ? Maximise quality of life
  • Strategies
  • ? Increase energy and protein intake
  • Small frequent meals
  • Energy dense foods
  • ? Decide on route of feeding
  • Oral, enteral, parenteral
  • ? Individual food preferences/aversions

9
CANCERDietary treatment
  • ? Prevent further weight loss
  • ? Control glucose intolerance
  • Complex carbohydrate, limit simple sugars
  • Regular meals
  • ? Provide adequate micronutrients
  • - Vitamin B6, pantothenic acid, folic acid,
    Vitamins A, E, C, ß-carotene

10
CANCERDietary treatment
  • ? Treat side-effects of chemo-/radiation therapy
  • Loss of appetite/early satiety High protein,
    high energy supplements
  • Limit high fat foods
  • Avoid liquids with meals
  • Nausea and vomiting Frequent, small meals
  • No strong odours
  • Cool/room temperature foods
  • Sore mouth/throat Increase fluid intake
  • Decrease fibre and roughage
  • Select soft, moist food, add gravy/sauces
  • Abdominal gas Decrease fibre/roughage
  • Limit high fat foods
  • Exclude gasforming foods

11
HEART (e.g. Heart failure) Nutritional-related
problems
  • ? Stunted growth
  • Increased needs
  • Catabolic
  • ? Increased energy expenditure rapid breathing
  • ? Decreased intake of food
  • Difficulty in breathing
  • Quickly tired
  • ? Insufficient/excessive weight gain (oedema)
  • Fluid retention/? circulation
  • ? Iron deficiency

12
HEARTDietary treatment
  • Goals
  • ? Promote growth and development
  • ? Reduce/eliminate oedema
  • ? Avoid distention of diaphragm
  • ? Correct nutrient deficits
  • Strategies
  • ? Increase energy, protein and fat intake
  • HBV protein sources
  • ? CHO and ? fat content to reduce RQ
  • Energy dense meals (1T fat ? 135 kcal/1T sugar ?
    60 kcal)
  • Food with soft texture reduces chewing

13
HEARTDietary treatment (cont)
  • ? Restrict fluid and salt intake with fluid
    retention
  • Monitor input/output
  • Sodium restricted diet (? dietary sources of Na)
  • 1t salt ? 2400 mg Na
  • 250 mL milk ? 120 mg Na
  • 1 slice bread ? 150 mg Na
  • Inclusion of K rich foods
  • ? Avoid abdominal distention
  • Small frequent meals
  • Use bland low roughage foods
  • ? Ensure adequate intakes of food sources of
    vitamins E, B6, B12, folic acid, riboflavin,
    thiamine, iron

14
GASTRO-INTESTINAL TRACTNutritional-related
problems
  • ? Medical conditions can affect functions in any
    part of the GIT intake of food, digestion,
    absorption of nutrients and excretion of waste
    products
  • ? Malnutrition affects digestion and absorption
    of nutrients
  • Villi atrophy ? ? absorptive area
  • Enzyme deficiencies (lactase, sucrase, maltase)
  • ? Intolerances
  • Lactose
  • Gluten

15
GASTRO-INTESTINAL TRACTNutritional-related
problems (cont)
  • ? Food-induced symptoms
  • Carbohydrate-induced symptoms
  • Hypertonicity
  • Bloating (Gastric surgery)
  • Diarrhoea (Antrectomy)
  • Poor absorption
  • Gas (Malabsorption)
  • Bloating (Coeliac disease)
  • Diarrhoea (SBS)
  • Abdominal pain (Dietary fibre)
  • Fat-induced symptoms
  • Dyspepsia (GERD)
  • Bloating, early satiety (Gastric surgery)

16
GASTRO-INTESTINAL TRACTNutritional-related
problems (cont)
  • ? Symptoms with a nutritional impact
  • - Diarrhoea - ? nutrient loses
  • Nausea and vomiting - ? intake, ? losses
  • Pain, bloating avoiding important foods, ?
    intake

17
GASTRO-INTESTINAL TRACTDietary treatment
  • Goals
  • ? Correct malnutrition/nutritional deficits
  • ? Provide sufficient nutrients for growth and
    development
  • ? Monitor GI function (intolerances,
    malabsorption)
  • ? Replace losses
  • Strategies
  • ? Provide sufficient energy protein
  • Small frequent meals
  • Energy dense foods

18
GASTRO-INTESTINAL TRACTDietary treatment
  • ? Replace losses
  • ORT
  • Soluble fibre (apples, bananas, carrots)
  • Potassium
  • MCT
  • Vitamins and minerals
  • ? Adjust consistency of foods / preparation
    methods
  • ? Withheld foods leading to problem/discomfort
    (depends on disease condition)
  • ? Add foods to relieve problem
  • Soluble fibre (apples, banana, carrots)
  • Insoluble fibre (whole wheat, bran)

19
LiverNutritional-related problems
  • ? Inadequate intake
  • Anorexia, nausea vomiting (liver disease)
  • Early satiety (ascites, enlarged liver / spleen)
  • Restricted / unpalatable diets (low in fat /
    protein / salt)
  • ? Impaired nutrient digestion and absorption
  • Steatorrhoea (bile salt deficiency)
  • Essential fatty acid deficiency
  • All nutrients (malnutrition related villous
    atrophy)
  • ? Increased nutritional requirements
  • Hypermetabolism
  • Accelerated protein breakdown
  • Insufficient protein synthesis

20
LiverNutritional-related problems
  • ? Altered nutrient metabolism
  • Carbohydrate glycogenesis, glycogenolysis,
    gluconeogenesis (low glygogen stores, fasting
    hypoglycaemia)
  • Protein transamination oxidative deamination
    (synthesis of serum protein low albumin levels,
    poor blood clotting)
  • Fat energy production synthesis of
    lipoproteins (fatigue, catabolic)
  • ? Vitamin mineral deficiencies
  • - Storage of fat soluble vitamins, Vit B12, Zn,
    Fe, Cu, Mg
  • Transport of Vit A, Fe, Zn, Cu
  • Conversion of carotene, folate, Vit D
  • ? Increased ammonia levels risk of hepatic coma

21
LIVERDietary treatment
  • Goals
  • ? Correct malnutrition/nutritional deficits
  • ? Promote growth and development
  • ? Support residual liver function
  • ? Prevent fat stasis steatorrhoea, bone
    disease, anaemia, coma
  • ? Provide supportive treatment for complications
  • Strategies
  • ? Provide sufficient energy
  • - Small frequent meals
  • Energy dense foods
  • ? Provide sufficient protein
  • HBV protein
  • ? BCAA and ? AAA
  • Vegetable protein ? methionine ammoniagenic AA
    and ? fibre
  • Casein vs meat protein

22
LIVERDietary treatment (cont)
  • ? Steatorrhoea
  • - Modify fat intake
  • MCT vs LCT
  • monitor Ca vit D
  • ? Ascites
  • Restrict fluid salt intake
  • ? Renal insufficiency
  • Alter fluid, Na, K, PO4 intake
  • ? Adjust consistency of foods (oesophagaeal
    varices)
  • ? Withheld foods leading to problem / discomfort
    (depends on disease condition)

23
TYPE 1DIABETES MELLITUSNutritional-related
problems
  • ? Under-/overweight
  • Energy not utilised
  • Obesity insulin administration
  • Physical activity / exercise
  • ? Hyperglycaemia
  • Poor balance between amount of CHO / timing of
    eating insulin regimen
  • ? Hypoglycaemia
  • Brain development
  • Illness / infection food intake / absorption
  • ? Dehydration (polyuria)
  • ? Long-term complications
  • Macrovascular
  • Microvascular

24
TYPE 1DIABETES MELLITUSDietary treatment
  • Goals
  • ? Provide appropriate energy and nutrients for
    optimal growth and development
  • ? Achieve and maintain ideal body weight
  • ? Attain maintain optimal metabolic outcomes on
    an individual basis
  • Blood glucose
  • Lipids
  • ? Prevent hypo- and / or hyperglycaemia
  • ? Reduce risk of long-term micro- and
    macrovascular complications
  • ? Improve health through food choices physical
    activity
  • ? Address individual needs
  • Personal / cultural preferences
  • Lifestyle
  • Willingness to change

25
TYPE 1DIABETES MELLITUSDietary treatment
  • Strategies
  • ? Determine food meal plan then integrate
    insulin regimen into usual eating habits
    physical activity schedule
  • ? Issues regarding CHO
  • Carbohydrate sources (fruits, grains, starchy
    vegetables, milk, sugars)
  • Consistency in timing (distribution) amount
    (portion sizes)
  • Glycaemic Index vs Glycaemic Load
  • Sweeteners
  • Blood glucose monitoring
  • Adjustments for exercise
  • ? Issues regarding protein
  • Requirements
  • Plant vs animal protein

26
TYPE 1DIABETES MELLITUSDietary treatment
  • ? Issues regarding dietary fat
  • Saturated trans fats
  • Unsaturated fats
  • ? Other dietary components
  • Salt
  • Vitamins dietary antioxidants
  • Non-starch polysaccharides (fibre)
  • ? Diabetic products

27
CHRONIC RENAL DISEASENutritional-related problems
  • ? Growth retardation
  • Restrictive diets
  • Poor food intake (uraemia ? ? appetite)
  • Increased losses (? permeability of basement
    membrane ? proteinuria)
  • ? Oedema
  • ? Excretion
  • ? Protein intake ? ? albumin
  • ? Hyperkalemia
  • ? Hypertension
  • ? Renal bone disease
  • ? PO4 ? Ca resorption from bones ? Ca
    absorption from GIT
  • secondary hyperthyroidism renal osteodystrophy
  • ? Activation of vit D
  • ? Anaemia

28
RENAL Dietary treatment
  • Goals
  • ? Provide adequate energy
  • ? Regulate protein intake
  • ? Manage fluid balance electrolytes
  • ? Regulate Ca PO4 intakes
  • ? Provide adequate micronutrient iron intakes
  • Strategies
  • ? High energy, low protein foods (CHO, PUFA/MUFA)
  • ? Control protein intake
  • Optimal growth
  • HBV 65 70 total protein intake
  • Blood urea
  • PO4 content

29
RENAL Dietary treatment
  • ? Reduce Na intake if hypertensive
  • No added salt/salt restriction
  • Fresh foods
  • ? K modified diet if hyperkalaemia occurs
  • ? Fluid restriction individualised if necessary
  • ? Limit dietary PO4 without compromising protein
    intake
  • ? Supplement Ca
  • ? Provide foods rich in iron, folic acid, vit C
    B12
  • Haem iron vs non-haem iron
  • Components affecting absorption (phytates,
    polyphenols, Ca)
  • ? Modify dietary fats for prevention of
    cardiovascular disease

30
DIALYSISNutritional-related problems
  • ? ? Protein losses
  • ? Electrolyte changes (K)
  • ? Fluid retention
  • ? ? Glucose intake (PD)
  • ? Steroid treatment
  • ? Appetite
  • Weight gain

31
DIALYSIS Dietary treatment
  • Strategies
  • ? Monitor weight gain between dialysis sessions
  • ? Monitor changes in urea / creatinine
  • ? Monitor changes in electrolytes
  • ? Monitor fluid intake output

32
HIV and AIDSNutritional-related problems
  • ? Underweight
  • - Increased energy expenditure
  • - Malabsorption
  • Altered macronutrient metabolism
  • ? Loss of lean body mass
  • ? Dietary intake
  • Preferential loss of body protein
  • Opportunistic infections
  • ? Growth faltering
  • ? Gastrointestinal complications
  • Food intolerance, malabsorption, constipation,
    diarrhoea
  • ? Lipodystrophy syndrome
  • Insulin resistance
  • Impaired glucose tolerance
  • Dyslipidaemia

33
HIV and AIDSDietary treatment
  • Goals
  • ? Provide optimal nutrition
  • ? Support regeneration of immune system
  • ? Maintain growth, development activity
  • ? Help adherence to medication
  • ? Preserve lean body mass
  • ? Prevent overweight obesity
  • ? Encourage cardioprotective diet
  • ? Encourage healthy eating
  • ? Provide advice on food safety hygiene
  • Strategies
  • ? Increase energy protein intake
  • Adjust energy intake for mobility, infection,
    weight loss, malabsorption
  • Energy nutrient dense meals snacks (full
    cream milk, cheese, PUFA / MUFA, ?-3 fats, sugar,
    jam)
  • HBV protein

34
HIV and AIDSDietary treatment
  • ? Optimise food intake
  • Delayed weaning Appropriate milk intake for age
  • Neuro-developmental delay Modify food
    consistency, finger foods, daily routine
  • Eating difficulties Soft non-acidic foods, avoid
    spicy food drink, straws to bypass lesions,
    suck ice lollies
  • Growth faltering Space drinks snacks away from
    meals, avoid excessive fluid intake
  • ? Food intolerance
  • Lactose-free
  • ? Constipation / diarrhoea
  • ? HAART Interactions between drug food,
    nutritional side effects
  • ? Lipodystrophy syndrome
  • Impaired glucose tolerance CHO distribution
  • ? Total cholestrol ? SFA, ? PUFA / MUFA, ?-3
    fatty acids
  • ? TG ? Refined CHO, ?-3 fatty acids, fruit
    vegetables
  • ? Hygienic storage, preparation, serving of food

35
Critically ill children (ICU)Nutritional-related
problems
  • ?
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