Med nutrition skim of notes for ch 16-23
Cancer is the
second leading cause of death in the United States
Acute infectious diarrhea is the
second most common cause of death among children in developing countries
For high- intensity or endurance exercise lasting more than 1 hour,
30 to 60 grams of carbohydrate per hour are recommended; for ultra-endurance events longer than 2.5 hours, up to 90 grams of carbohydrate per hour may be needed
Because athletes have an increased dietary need for energy
a larger kilocalorie intake from nutrient-dense foods would automatically boost their general intake of vitamins and minerals.
mechanical soft diet
a meal plan that consists of foods that have been chopped, blended, ground, or prepared with extra fluid to make chewing and swallowing easier.
enteral
a mode of feeding that makes use of the gastrointestinal tract through oral or tube feeding When a patient's gastrointestinal tract is functioning but he or she cannot consume food orally,
polymeric formula
a nutrition support formula that is composed of complete protein, polysaccharides, and fat as medium-chain fatty acids.
elemental formula
a nutrition support formula that is composed of simple elemental nutrient components that require no further digestive breakdown and are thus readily absorbed; these formulas include protein as free amino acids and carbohydrate as the simple sugar glucose.
refeeding syndrome
a potentially lethal condition that occurs when severely malnourished individuals are fed high-carbohydrate diets too aggressively; a sudden shift in electrolytes and fluid retention and a drastic drop in serum phosphorus levels cause a series of complications that involve several organs.
medical nutrition therapy
a specific nutrition service and procedure that is used to treat an illness, injury, or condition; it involves an in-depth nutrition assessment of the patient, nutrition diagnosis, nutrition intervention (which includes diet therapy, counseling, and the use of specialized nutrition supplements), and nutrition monitoring and evaluation.
Diarrheal disease is the
fourth leading cause of death globally.
Barrett's esophagus
complication of severe gastroesophageal reflux disease in which the squamous cell epithelium of the esophagus changes to resemble the tissue lining the small intestine; increases the risk of esophageal adenocarcinoma.
ascites
fluid accumulation in the abdominal cavity.
MNT also includes any needed modifications in
food texture or specific nutrients, depending on the site of the surgery or the function of the organ involved.
According to the American Heart Association, approximately one in three adults in the United States has
hypertension.
The Physical Activity Readiness Questionnaire has been designed to
identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice regarding the type of activity that is most suitable for them
Crohn's disease and ulcerative colitis are the two most common forms of inflammatory bowel disease; both of these are
idiopathic diseases.
Exercise reduces the risk for heart disease in several ways, including
improved heart function, decreased blood cholesterol levels, and improved oxygen transport.
consuming small amounts of carbohydrates during exercise improves
improves whole-body carbohydrate oxidation and metabolic efficiency, especially when a high-carbohydrate meal has not been consumed immediately before exercise.
The Academy of Nutrition and Dietetics defines etiology as
"a factor gathered during the nutrition assessment that contributes to the existence or the maintenance of pathophysiological, psychosocial, situational, developmental, cultural, and/or environ- mental problems."
The Nutrition Care Process is
"a systematic problem-solving method that dietetics professionals use to critically think and make decisions to address nutrition-related problems and provide safe and effec- tive quality nutrition care."3 It is composed of the fol- lowing four distinct and interrelated nutrition steps: (1) assessment; (2) diagnosis; (3) intervention; and (4) monitoring and evaluation.
A nutrition diagnosis involves the
"identification and labeling of an existing nutrition problem that the food and nutrition professional is responsible for treating independently."
Nutrition interventions are
"purposefully planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status for an individual, target group, or the community at large."
Two major cell populations provide the immune system's primary
"search and destroy" defense for detecting and killing non-self substances that propa- gate potential disease. These two populations of lymphocytes, which are special types of white blood cells, develop early during life from a common stem cell in the bone marrow. The two types are T cells, which are derived from thymus cells, and B cells, which are derived from bursal intestinal cells
Nutrition care for food aller- gies is focused on two aspects:
(1) avoiding offending foods; and (2) substituting nutritionally appropriate alternatives for the excluded foods
IBS displays three major types of symptoms:
(1) chronic and recurrent pain in any area of the lower abdomen; (2) small-volume bowel dys- function that varies from constipation or diarrhea to a combination of both; and (3) excess gas formation with increased distention and bloating that is accom- panied by rumbling abdominal sounds, belching, and flatulence.
Exercise is extremely beneficial for weight manage- ment in the following ways:
(1) it helps to regulate appetite; (2) it increases the basal metabolic rate; (3) it reduces the genetic fat deposit set point level; and (4) it is critical for weight-loss maintenance. Together with a well-planned diet, physical exercise improves the energy balance in favor of increased energy output
Lesion generally results from an imbalance among some or all of the following three factors:
(1) the amount of gastric acid and pepsin secretions; (2) the extent of Helicobacter pylori infection; and (3) the degree of tissue resistance and mucosal integrity.
Irritable bowel syndrome (IBS) is the most commonly diagnosed GI disorder. The exact prevalence is hard to determine because
(1) the definitions of IBS have varied throughout epidemiologic studies, (2) many people with symptoms do not seek medical attention, and (3) it often overlaps other GI-associated and non-GI disorders (e.g., psychiatric disorders, chronic fatigue syndrome, anxiety, mood disorders).
Fitness level—and thus oxygen and fuel use—is influenced by two major factors:
(1) the fitness of the lungs, heart, and blood vessels; and (2) body composition.
Mouth ulcers may develop from three infectious sources:
(1) the herpes simplex virus, which causes mouth sores on the inside mucous lining of the cheeks and lips or on the external portion of the lips, where they are commonly called cold sores or fever blisters; (2) Candida albicans, which is a fungus that causes similar sores on the oral mucosa and results in a con- dition called candidiasis or thrush; and (3) hemolytic Streptococcus, which is a bacteria that causes the mucosal ulcers that are commonly called canker sores. Mouth ulcers are usually self-limiting and short lived.
Fluid needs depend on the following:
(1) the intensity and duration of the exercise; (2) the sur- rounding temperature, altitude, and humidity; (3) the individual's fitness level and metabolic rate; and (4) the pregame or preexercise state of hydration.
Inflammation of the gallbladder
(cholecystitis) usually results from a low-grade chronic infection or obstruction. Gallstone formation (choleli- thiasis) is attributed to impaired metabolism of choles- terol, bile acid, phospholipids, and bilirubin. The risk for cholelithiasis increases with age and is three to four times more likely to develop in women than men during the reproductive years. Other risk factors for cholelithiasis include genetics, overweight/obesity, rapid weight loss, diabetes, certain medications (e.g., corticosteroids, oral contraceptives), pancreatic disease, and liver disease
For accurate results, patients should be weighed at consistent times
(e.g., early morning after the bladder is emptied and before breakfast). If the patient is wearing the same cloth- ing each time that he or she is weighed (e.g., an examination gown), a more consistent weight mea- surement will be obtained.
Steroids are synthetic sex hormones that have two actions:
1) anabolic (i.e., tissue growth) and (2) androgenic (i.e., masculinization).
Advances in knowledge and therapy have provided physicians with the following four types of drugs for the management of PUD:
1. Antibiotics, which address the H. pylori infection (e.g., amoxicillin, clarithromycin, tetracycline, met- ronidazole). 2. Antacids, which counteract or neutralize the acid. Magnesium and aluminum compounds (e.g., Mylanta, Maalox) are the typical antacids of choice for the treatment of PUD. 3. Hydrochloric acid secretion controllers: • HistamineH2-receptorantagonists(H2-blockers) reduce hydrochloric acid production and secre- tion. These medications are available over- the-counter and include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). • Proton pump inhibitors reduce hydrochloric acid production by inhibiting the hydrogen ion secretion that is needed to produce hydrochloric acid. These drugs include lansoprazole (Pre- vacid), omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and rabepra- zole (AcipHex). 4. Mucosal protectors, which deactivate pepsin and produce a gel-like substance to cover the ulcer and to protect it from acid and pepsin while it heals itself (e.g., bismuth subsalicylate, sucralfate [Carafate]).
The most recent expert panel publications recommend the following lifestyle factors to reduce the risk of cancer
1. Be as lean as possible within the normal range of body weight throughout life. • Balance caloric intake with physical activity. • Avoid excessive weight gain at all ages. For over- weight or obese individuals, losing even a small amount of weight is helpful. 2. Adopt a physically active lifestyle. • Children and adolescents: participate in at least 60 minutes every day of moderate to vigorous physical activity, with vigorous intensity activity included at least 3 days per week. • Adults: engage in at least 150 minutes of moder- ate intensity or 75 minutes of vigorous physical activity each week; preferably spread throughout the week. • Examples of moderate activity include walking, skating, yoga, softball or baseball, downhill skiing, gardening, and lawn care. Examples of vigorous activities include running, aerobics, fast bicycling, circuit weight training, soccer, singles tennis, basketball, cross-country skiing, and heavy manual labor. • Limit sedentary behaviors. 3. Consume a healthy diet that has an emphasis on plant sources. • Become familiar with standard serving sizes and read food labels to become more aware of actual servings consumed. Choose foods that will help achieve and maintain a healthy body weight. • Limit the consumption of salty foods and foods that are processed with sodium. • Limit the consumption of energy-dense foods, particularly processed foods that are high in added sugar, low in fiber, or high in fat. Avoid sugary drinks. • Eat at least 2.5 cups of vegetables and fruits every day. • Choose whole grains instead of processed (refined) grains and sugars. Avoid moldy grains and legumes. • Choose fish, poultry, and beans as alternatives to beef, pork, and lamb. Select lean cuts and small portions, and prepare the meat by baking, broil- ing, or poaching rather than frying. Avoid pro- cessed meats. 4. If alcoholic beverages are consumed, limit their intake. Limit alcohol intake to two drinks per day for men and one drink per day for women. One drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof distilled spirits. 5. Aim to meet nutritional needs through diet alone; do not rely on supplements. 6. Aim to breastfeed infants exclusively for 6 months and continue to breastfeed while offering comple- mentary food after 6 months.
Nutrition components of the oral diet may be modified in the following ways:
1. Energy: The total energy value of the diet, expressed in kilocalories, may be increased or decreased. 2. Nutrients: One or more of the essential nutrients (i.e., protein, carbohydrate, fat, minerals, vitamins, and water) may be modified in amount or form. 3. Texture: The texture or seasoning of the diet may be modified (e.g., liquid and low-residue diets).
Successful nutrition therapy can occur only when the diet is personalized to meet individual needs. This can be done best by planning with the patient and his or her family. The following four areas must be explored together:
1. Personal needs: What personal desires, concerns, goals, or life situation needs must be met? 2. Disease: How does the patient's disease or con- dition affect the body and its normal metabolic functions? 3. Nutrition therapy: Prioritize diagnoses on the basis of urgency, impact, and resources. How and why must the diet change to meet the needs created by the patient's particular disease or condition? 4. Food plan: How do these necessary nutritional modi- fications affect daily food choices? Write a nutrition prescription that is focused on the etiology to meet these needs.
An adult nonstressed cancer patient with good nutritional status needs from
1.0 to 1.2 g/kg/day of protein to meet maintenance requirements, with an emphasis on high- quality protein sources
For highly trained endurance and strength-trained athletes, the protein requirement may increase to
1.2 to 1.7 g/kg/day.
The earliest known case of AIDS was identified in a blood sample collected in
1959 from a Bantu man living in what is currently the Democratic Republic of Congo, an area from which the current world epidemic is believed to have originated
An adult patient with good nutritional status needs approximately
25 to 30 kcal/kg of body weight for maintenance requirements
To build aerobic capacity, the level of exercise must raise the pulse rate to within
60% to 90% of an individual's maximal heart rate. An acceptable way
General training needs are usually met with 5 to 7 g/kg body weight per day of carbohydrate. Endurance athletes have higher needs of
7 to 10 g/kg body weight per day, with ultra-endurance athletes requiring up to 12 g/kg body weight per day.
it is estimated that
70% of the people who are older than 80 years of age will develop diverticulosis, while only 5% of those individuals will experience acute diverticulitis.
There are four basic goals for the treatment of patients with PUD
: (1) alleviate or minimize the symptoms; (2) promote healing; (3) prevent recurrences by eliminat- ing the cause; and (4) prevent complications.
Gastric cancer
A diet rich in fruits and vegetables such as the Mediterranean diet appears to be protec- tive against gastric cancer compared with the typical Western diet that is rich in starchy foods, sweets, meat, and fat.28 Specifically, the intake of carot- enoids, retinol, α-tocopherol, and cereal fiber is pro- tective. The intake of total meat, red meat, and processed meat are risk factors.29
The terminal stage of HIV infection, which is designated as
AIDS, is marked by rapidly declining T-lymphocyte counts and the presence of opportunistic illnesses . Kaposi's sarcoma is the most common AIDS-associated cancer, and it is characterized by malignant and rapidly growing tumors of the skin and mucous linings of the GI and respiratory tracts; these tumors may cause severe internal bleeding. Low-dose radiation therapy or anticancer drugs may be used to slow the spread of tumors.
To maximize performance and to avoid the compli- cations of dehydration, athletes are advised to do the following:
Before exercise: Establish euhydration at least 4 hours before exercise by drinking 5 to 7 mL/kg body weight of water or a sports beverage. Void excess fluid before competition, and do not attempt hyperhydration. During exercise: Drink during exercise to avoid excessive water loss, which is defined as a loss of more than 2% of body weight from water. The amount of fluid that is necessary to accomplish this will be highly individualized. After exercise: Replace fluid loss after the completion of exercise by drinking 16 to 24 oz of fluid for every pound of body weight that is lost
The Physical Activity Guidelines for Americans are as follows
Children and adolescents: Children and adolescents should engage in 60 minutes or more of physical activity each day. • Aerobic: Most of the 60 or more minutes per day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity at least 3 days a week. • Muscle strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week. • Bone strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week. • Adults: Adults should avoid inactivity on all days of the week. Some physical activity is better than none, and adults who participate in any amount of physi- cal activity gain some health benefits. (Note that the following recommendations for adults are given as minutes per week.)
Iron-deficiency anemia is particularly of concern among patients with
Crohn's disease due to the additional issue of blood loss. Protein-energy deficiency is also problematic because the protein needs are higher than normal to allow for tissue healing.
The pancreas is a key organ in normal digestion and metabolism, and it acts as both an exocrine gland and an endocrine gland.
Digestive enzymes and bicarbonate, which are necessary for the breakdown of the macronutrients, are excreted by the pancreas under hormonal control during digestion. The endocrine functions of the pancreas are primarily related to blood glucose level regulation by glucagon and insulin.
The following is an example of a nutrition diagnostic PES statement:
Excessive caloric intake (problem) related to frequent consumption of large portions of high-fat meals (etiology) as evidenced by average daily intake of calories exceeding recommended amount by 500 kcal and 12-pound weight gain during the past 18 months (signs)
Guided by personal food preferences and symptom patterns, a reasonable food plan can be devised with the patient. In general, the food plan should give attention to the following basic principles
Follow a regular diet with an optimal energy and nutrient composition. Assess the need for vitamin and mineral supplementation. • Eliminate food allergens and intolerances. Along with any known allergens or intolerances, foods that contain the following should be specifically evaluated for tolerance: fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs). • Omit foods that increase gas and flatulence. Some foods are recognized gas formers as a result of known constituents (e.g., indigestible short chains of glucose [oligosaccharides] as in the case of legumes). Others may cause gaseous discomfort on an individual basis. • Consider the use of probiotics and prebiotics. • Consider the use of food diaries. Tracking nutrient intake, environment, emotions, activity, and symptoms may help to narrow instigating factors for future avoidance.
to estimate the maximal heart rate is to subtract the person's age from 220.
For aerobic benefits, 70% of maximal heart rate should then be maintained for ≥10 minutes, accumulating 150 minutes per week
Protein needs, even for highly trained athletes, can usually be met through diet alone.
For example, a 170-lb (77-kg) strength-training male athlete may have protein needs of 1.5 g/kg body weight: 77 kg × 1.5 g of protein/kg = 115.5 g of protein per day.
The two most common causes of peptic ulcer disease (PUD) are
H. pylori infection and the long-term use of nonsteroidal antiinflammatory drugs (NSAIDs)
After feverish research, the underlying infectious agent was finally discovered in May 1983. The French scientist Luc Montagnier, a leading pioneer in AIDS research, reported that he and his team at the Pasteur Institute in Paris had isolated the viral cause, which is now known as
HIV
According to the CDC, about 50,000 people are infected with
HIV every year in the United States alone, ≈80% of which are male.
The Physical Activity Guidelines for Americans are based on the following three components
Intensity: how hard a person works to do the activity • Moderate intensity is equivalent in effort to brisk walking. • Vigorous intensity is equivalent in effort to running or jogging. • Frequency: how often a person performs aerobic activity • Duration: how long a person performs an activity during any one session
Colorectal cancer:
It has been estimated that 70% to 90% of colorectal cancer is due to dietary factors. Diets rich in vitamin D, calcium, folate, polyphenols, and fish appear to be protective against colorectal cancer. Red meat and processed meat intake, abdominal obesity, high body mass index, and alcohol consumption are risk factors for colorectal cancer
Breast cancer:
Overweight/obesity increases the risk for breast cancer through several metabolic and inflammatory pathways.26 Women following the World Cancer Research Fund and the American Institute for Cancer Research Guidelines signifi- cantly reduce their risk for breast cancer.27 The dietary factors with the strongest protective associa- tion are avoiding high energy-dense foods and excess alcohol and consuming predominantly plant- based foods.
All cancer patients should be evaluated for malnutrition. There are several validated and reliable assessment tools available to screen for malnutri- tion, such as the
Patient-Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST), Malnutrition Screening Tool for Cancer Patients (MSTC), and the Malnutrition Universal Screening Tool (MUST).
Examples of biochemical tests pertinent to nutrition include, but are not limited to, the following:
Plasma proteins: serum albumin and prealbumin evaluate for protein status • Liver enzymes: evaluate liver function • Blood urea nitrogen and serum electrolytes: evaluate renal function Urinary urea nitrogen excretion: estimate nitrogen balance • Creatinine height index: evaluate protein tissue breakdown • Complete blood count: evaluate for anemia • Fasting glucose: evaluate for hyper- and hypo- glycemia • Total lymphocyte count: evaluate immune function
A nutrition diagnosis statement will have three distinct and concise elements:
Problem, Etiology, and the Signs/symptoms. This is often referred to as a PES statement.
Several tests may be used, especially with older patients, to determine the status of bone integrity and possible osteopenia or osteoporosis.
Some tests that are commonly used are x-rays, dual-energy x-ray absorptiometry, and bone scans.
HIV-infected adults and adolescents ≥6 years of age. In addition to stages 1 to 3, there are also stages 0 and unknown as follows:
Stage 0: Early HIV infection, inferred from a negative or indeterminate HIV test result within 6 months of a confirmed positive test • Stage unknown: HIV test positive but no CD4+ T-lymphocyte count available After the patient has been staged by their CD4+ T-lymphocyte count, the patient's clinical category is determined on the basis of symptomatic conditions.
Basic mouth care includes the following:
Visiting the dentist before treatment begins • Examining the mouth daily for sores or irritation • Brushing and flossing regularly with a soft-bristled toothbrush • Ensuring that dentures fit correctly • Using mouthwash that does not contain alcohol, which dries out the mouth
The Academy of Nutrition and Dietetics Nutrition Care Manual notes a potential benefit from the supple- mentation of the following nutrients for patients with specific types of cancer
Vitamin E: patients with breast cancer who are receiv- ing radiation; patients with head and neck cancer • Omega-3 fatty acid supplements: patients with pancre- atic cancer • Arginine: patients with breast cancer; patients with head and neck cancer • Eicosapentaenoic acid: patients with oral and laryn- geal cancer • Honey: patients who are receiving radiation on the head or neck Glutamine: patients undergoing hematopoietic cell transplantation • Antioxidants at levels higher than the Tolerable Upper Intake Level: patients with non-small-cell lung cancer who are receiving chemotherapy
Older adults: The guidelines given for adults also apply to older adults. In addition, the following guidelines are specific to older adults:
When older adults cannot perform 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. • Older adults should do exercises that maintain or improve balance if they are at risk of falling. • Older adults should determine their level of effort for physical activity relative to their level of fitness. • Older adults with chronic conditions should understand whether and how their conditions affect their ability to perform regular physical activity safely
Cirrhosis is
a chronic state of liver disease in which the liver is damaged beyond repair with scar tissue and fatty infiltration (Figure 18-10). Progressive cirrhosis and end-stage liver disease is one of the top seven leading causes of death from chronic disease in the United States
hepatic encephalopathy
a condition in which toxins in the blood lead to alterations in brain homeostasis as a result of liver disease; this results in apathy, confusion, inappropriate behavior, altered consciousness, and eventually coma.
The Nutrition Care Process provides
a consistent structure and framework for nutrition professionals to use to provide individual- ized care for patients.
achalasia
a disorder of the esophagus in which the muscles of the tube fail to relax, thereby inhibiting normal swallowing.
Cheilosis:
a dry, scaling process at the corners of the mouth that affects the lips and the corner angles, thereby making opening the mouth to eat uncom- fortable
Crohn's disease may affect any portion of the GI tract from the esophagus to the anus, but it is most commonly localized to the ileum and the colon. Risk factors include
a family history of the disease, Jewish ancestry, and smoking. Inflammation may skip sections of the GI tract and affect more than one section at a time
kinesiotherapist
a health care professional who treats the effects of disease, injury, and congenital disorders through the application of scientifically based exercise principles that have been adapted to enhance the strength, endurance, and mobility of individuals with functional limitations or for those patients who require extended physical conditioning.
allergy
a state of hypersensitivity to particular substances in the environment that works on body tissues to produce problems in the functioning of the affected tissues; the agent involved (i.e., the allergen) may be a certain food that is eaten or a substance (e.g., pollen) that is inhaled or touched.
Exercise:
a subcategory of physical activity that is planned, structured, repetitive, and with the purpose of improving or maintaining one or more component of physical fitness
laparoscopic fundoplication
a surgery that is used to treat gastroesophageal reflux disease; the upper portion of the stomach (i.e., the fundus) is wrapped around the esophagus and sewn into place so that the esophagus passes through the muscle of the stomach; this strengthens the esophageal sphincter to prevent acid reflux.
nutrition care process model
a systematic approach to providing high-quality individualized nutrition care. The model consists of the following steps: assessment, diagnosis, intervention, and monitoring and evaluation.
symptoms of crohn's disease include
abdominal pain, fever, fatigue, anorexia, weight loss, painful and urgent defecation, and diarrhea. Patients may experience long asymptomatic periods between flare-ups, or they may experience continuous and progressive attacks.
steatosis
accumulation of fat in the liver cells.
Preventive therapy to avoid additional discomfort from constipation should focus on
adequate fluids, soluble fiber, and regular physical activity (even short walks can help)
Only 21% of Americans are meeting the recommended guidelines for
aerobic and muscle-strengthening activity, and half (50%) of adults participate in 30 minutes of moderate physical activity five or more times per week, which is the minimum recommendation
Cardiovascular fitness is defined in terms of
aerobic capacity, which depends on the body's ability to deliver and use oxygen in sufficient quantities to meet the demands of increasing levels of exercise.
The pathology of CD is
an autoimmune response to a specific sequence of amino acids found in wheat, barley, and rye proteins. The CD-activating proteins are collectively known as gluten.
Ulcerative colitis (UC) is
an inflammatory disease that is limited to the colon. However, it is discussed along with Crohn's disease under the section of Small Intestine Diseases because both dis- eases are inflammatory bowel diseases with similar manifestations. Symptoms include urgent diarrhea with blood and mucus, abdominal pain, weight loss, fever, and rectal pain. The inflammation does not skip sections of the bowel; rather, it is progressive from the anus
NSAIDs are widely used medications. This drug class includes ibuprofen (Advil, Motrin) and aspirin (acetylsalicylic acid). Prolonged or excessive use of NSAIDs irritates the gastric mucosa, decreases the mucosal integrity,
and may result in erosion, ulceration, and bleeding. The NSAIDs, including at least a dozen antiinflamma- tory drugs, are so named to distinguish them from steroid drugs, which are synthetic variants of natural adrenal hormones.
A major function of B cells is to produce
antibodies, which also kill antigens.
neoplasm
any new or abnormal cellular growth, specifically one that is uncontrolled and aggressive.
antibodies
any of numerous protein molecules produced by B cells as a primary immune defense for attaching to specific related antigens.
Within a nutrition diagnostic PES statement, the signs and symptoms should be preceded by the words
as evidenced by.
A CSSD is a qualified nutrition professional who can
assess an athlete's energy needs based upon the details of an athlete's training and competition needs and provide appropriate energy recommendations.
When planning a personal exercise program, first
assess an individual's health status, present level of fitness, personal needs, and resources necessary for equipment or cost. Discussing an exercise program with a medical practitioner is always recommended, and getting medical clearance before beginning an exercise program is especially important for older persons and those with chronic diseases
The nursing process is a specific process by which nurses deliver care to patients and includes the follow- ing steps:
assessment, diagnosis, outcome/planning, implementation, and evaluation.
The goal of nutrition management is to
avoid all dietary sources of gluten and to prevent malnutrition through healthy meal alterna- tives. Wheat, rye, and barley are eliminated from the diet, and a variety of other grains are used instead
Acute hepatitis is an inflammatory condition that is caused by
bacteria, viruses, parasites, or toxins (e.g., chloroform, alcohol, drugs). Viral infections and alcohol abuse are the most common forms of hepatitis. Viral infections are often transmitted via the oral-fecal route (i.e., hepatitis A), which is common for many epidemic diseases that involve contaminated food or water. In other cases, the virus may be transmitted by transfusions of infected blood or by contaminated syringes or needles (i.e., hepatitis B). Symptoms of hepatitis include anorexia and jaundice with underly- ing malnutrition.
Physical activity
bodily movement produced by the contraction of skeletal muscles that substantially increases energy expenditure above the basal level
Protein requirements are influenced
by sex, age, and intensity, duration, and type of exercise as well as by energy intake and carbohydrate availability.
Guidelines for MNT will vary depending on the
cancer site, the stage of disease, the treatment modality, and the current nutritional status of the patient. Guidelines for MNT must meet specific nutrient needs and goals related to the accelerated metabolism and protein- tissue synthesis.
The American College of Sports Medicine is one of the leading authorities for
certifying professionals as Health Fitness Specialists, Certified Personal Trainers, Clinical Exercise Specialists, and Registered Clinical Exercise Physiologists
Gallstones are composed primarily of
cholesterol, bilirubin, and fatty acids; and they are classified as either cholesterol stones, pigment stones, or mixed stones.
The most common symptoms of malabsorption disorders are
chronic diarrhea and steatorrhea.
Carbohydrate fuels come from two sources
circulating blood glucose and glycogen stored in muscle and liver tissue.
If dehydration continues, athletes may experience problems such as
cramps, delirium, vomit- ing, hypothermia, or hyperthermia cramps, delirium, vomit- ing, hypothermia, or hyperthermia
Two specific conditions triggering malabsorption—
cystic fibrosis (CF) and inflammatory bowel disease (IBD)
A nursing diagnosis may include several issues that are nutrition related, such as
diarrhea, malnutrition, failure to thrive, and fluid volume deficit
Note that diet-drug interactions may be expressed in several different ways, such as
drug-diet interactions, food-medication interactions, drug-nutrient interactions, and drug-food interactions.
moderate intensity aerobic exercise has been shown to increase
e high-density lipoprotein levels, and when intensity level is increased, low-density lipoprotein and triglyceride levels were lowered.6 Both exercise effects (i.e., improved heart function and cholesterol profile) lower the risks for diseased arteries.
Patients with hiatal hernias are advised to
eat small amounts of food at a time, to avoid lying down after meals, and to sleep with the head of the bed elevated to prevent the reflux of acidic stomach contents.
The most common food allergens include the proteins found in
egg, cow's milk, peanut, tree nuts, wheat, crustacean shellfish, and soy.
If a patient shows signs of an allergic reaction, the following methods are recommended as diagnostic measures to be used in conjunction with a patient history and physical exam:
elimination diet, a skin prick test, allergen-specific serum IgE immunoassays, or an oral food challenge.
fat and protein slow the rate of
emptying in the stomach and thus should not be consumed in high quantities immediately before a workout or competition
Exercise stimulates the production of
endorphins. These natural chemicals decrease pain and improve mood, which may include an exhilarating type of "high."
Starches break down gradually,
help to maintain blood glucose levels more evenly (thus avoiding hypoglycemia), and maintain glycogen stores as a constant primary fuel.
portal hypertension
high blood pressure in the portal vein.
The ideal pregame meal depends on the tolerance of the athlete. It usually is a light to moderate meal eaten 3 to 4 hours before the event. This meal should be
high in carbohydrates (approximately 1-4 grams of carbo- hydrate per kilogram of body weight), low in fat and fiber, and moderate in protein; it should also provide sufficient fluid and be familiar to the athlete. Appropriate food choices include pasta, bread, bagels, lowfat muffins, and cereal with nonfat milk
Fat accumulates in the liver in response to
high levels of fatty acids in the circulation, exaggerated lipogenesis, and impaired lipolysis. In other words, more fat is made and stored in the liver than is burned or oxidized by the liver.
The most common symptoms of food allergies are
hives, nausea, diarrhea, abdomi- nal pain, and respiratory symptoms such as wheezing.
An ideal resistance program should
include 8 to 10 separate exercises (with 8 to 12 repetitions of each) focusing on all major muscle groups and that are performed 2 to 3 days per week.
Forms of exercise that can be sustained at a necessary level of intensity to provide aerobic benefits
include activities such as swimming, running, jogging, bicycling, and aerobic dancing routines and similar workouts
General symptoms of PUD include
increased gastric muscle tone and painful contractions when the stomach is empty. With duodenal ulcers, the amount and con- centration of hydrochloric acid secretions are increased; with gastric ulcers, the secretions may be norma
The dietary management of diverticulosis includes
increasing dietary fiber (particularly insoluble fiber) to 6 to 10 g/ day above the normal recommendations of 20 to 35 g/ day along with adequate fluid intake.
Exercise also enhances the circulatory system by
increasing the oxygen-carrying capacity of the blood. As training continues, a person's efficiency of oxygen use and uptake (VO2max) will improve.
Exercise improves the action of a person's naturally produced insulin by
increasing the sensitivity of insulin receptor sites. Exercise also enhances glucose uptake without requir- ing insulin by skeletal muscle cells clearing glucose from the blood. When managing type 1 diabetes mel- litus, the type of exercise and timing must be balanced with food and insulin injections to prevent reactions caused by drops in blood glucose levels
Gingivitis:
inflammation of the gums that involves the mucous membrane and its supporting fibrous tissue that circles the base of the teeth
Stomatitis:
inflammation of the oral mucous lining of the mouth
Glossitis:
inflammation of the tongue
Parenteral nutrition therapy is administered
intravenously and thus carries risks associated with its invasive nature.
Inflammatory bowel disease (IBD)
is a general term that is used to describe chronic inflammation of the GI tract and the persistent activation of the mucosal immune system against the normal healthy gut flora.
Promotion
is caused by an agent that triggers the mutated cell to grow and reproduce.
Carcinogenesis
is often described as having three phases: initiation, promotion, and progression.
Progression
is the phase during which the cancer cells advance and become a malignant tumor that is capable of metastasizing.
Initiation
is the point at which a mutagen causes irre- versible damage to the DNA.
Body composition is a reflection of the four body compartments that make up the total body weight:
lean body mass, fat, water, and bone
Lean body mass is more
metabolically active (i.e., requires more fuel) than other body tissues such as adipose tissue.
Cancer continues to be a prevalent cause for
morbidity and mortality in the United States.
Cachexia greatly increases
morbidity, mortality, length of hospi- tal stays, medical costs, and contributes to poor quality of life
Resistance training creates and maintains
muscle and bone strength, improves blood pressure in prehypertensive/hypertensive individuals, and increases insulin sensitivity.
prebiotic
nondigestible foods that promote the growth of beneficial microorganisms within the gut.
One of the earli- est findings in the drug research for HIV has been a group of compounds called
nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) that inhibit the virus's necessary enzyme for copying itself, thereby effec- tively preventing viral increase. Multiple toxic side effects have been reported (Table 23-4), but some of these (e.g., nausea) may be helped by dietary modifica- tions or antinausea medications.
The U.S. Department of Health and Human Services has set
nutrition and physical fitness goals for Americans—among many other health-related goals—in its Healthy People 2020 report.
A hearty intake of dietary antioxidants and avoidance of foods/supplements known to increase
oxidative stress (e.g., trans fats, excessive supplementation with iron or copper, high alcohol intake) help to restore gastrointestinal well- being
Excessive alcohol consumption is the major causative factor of
pancreatitis in the United States.
If patients are unable to tolerate any nutrient deliv- ery into the gastrointestinal tract, health care providers must consider
parenteral nutrition therapy.
The fuel sources required for energy are the basic energy nutrients:
primarily carbohydrate (glucose and glycogen) and some fat
A well-balanced exercise program incorporates
resistance training, aerobic activities, flexibility and stretching exercises, and an assortment of activities of daily living.
The most important aspect of the treatment and prevention of constipation is
risk assessment to identify the potential causes of constipation. Improved diet, exercise, and bowel habits may help remedy the situation. Dependency on laxative or enema use should be avoided. The diet should include increased soluble fiber, fruits that contain natural laxatives (e.g., dried prunes, figs), and adequate fluid intake
Resistance training programs have improved blood lipid profiles by
significantly raising high-density lipoprotein level and by lowering the total cholesterol level, the low-density lipoprotein level, the total cholesterol to high-density lipopro- tein ratio, and the triglyceride level
Three major forms of therapy are used today as medical treatment for cancer:
surgery, radiation, and chemo- therapy. Each requires nutrition support. Drug-nutrient interactions are also a complication that may happen with any form of treatment.
There are two classification systems that are used for staging HIV:
the CDC Classification System and the World Health Organization Clinical Staging and Disease Classification System. The CDC Classification System assesses HIV stages on the basis of the lowest documented helper T white blood cell count (i.e., CD4 cell count stages 0, 1, 2, 3, and unknown) and the pres- ence of specific HIV-related conditions (i.e., clinical categories A, B, and C).39 The World Health Organization Staging System is generally used in areas where labo- ratory values of CD4 cell counts are unavailable. This system relies on clinical manifestations to stage the severity of HIV.
immunocompetence
the ability or capacity to develop an immune response (i.e., antibody production or cell-mediated immunity) after exposure to an antigen.
The underlying cause of cancer is
the fundamental loss of cell control over normal cell reproduction. Several factors may contribute to this loss and change a normal cell into a cancer cell, including chemical carcinogens, radiation, oncogenic viruses, epidemiologic factors (e.g., race, region, age, heredity, occupation), psycho- logic stress, and dietary factors.
diverticulitis
the inflammation of pockets of tissue (i.e., diverticula) in the lining of the mucous membrane of the colon. When pressures become sufficiently high in a segment with weakened bowel walls, small diverticula may develop.
The extent of dehydration depends upon
the intensity and duration of the exercise, the environmental conditions, the level of fitness, and the pre-exercise hydration status.
Three major accessory organs
the liver, the gallblad- der, and the pancreas—produce important digestive agents that enter the intestine and help with the diges- tion and absorption of food
VO2max
the maximal uptake volume of oxygen during exercise; this is used to measure the intensity and duration of exercise that a person can perform.
In reaction to the ingestion of a CD-activating protein,
the mucosal surface of the small intestine is damaged; this leaves villi that are malformed and with few remaining functional microvilli
The metabolic defect of CF inhibits
the normal movement of chloride and sodium ions in body tissue fluids . These ions become trapped in cells, and this causes thick mucus to form and clog ducts and passageways. Involved organ tissues are damaged so that they no longer function normally.
Protein is only used as an energy source when
the other fuels are exhausted and it is not a very efficient energy source.
People with stage 1 hypertension (i.e., a systolic pressure of 140 to 159 mm Hg or a diastolic pressure of 90 to 104 mm Hg) represent
the overwhelming majority of hypertensive individuals in the general population, and exercise has become one of the most effective nondrug treatments for this condition.
esophageal varices
the pathologic dilation of the blood vessels within the wall of the esophagus as a result of liver cirrhosis; these vessels can continue to expand to the point of rupturing
The most profound limit to exercise is
the person's ability to deliver oxygen to his or her tissues and to then use that oxygen for energy production
anthropometric measurements
the physical measurements of the human body that are used for health assessment, including height, weight, skin fold thickness, and circumference (i.e., of the head, hip, waist, wrist, and mid-arm muscle).
effects of steroids
the physiologic side effects can be devastating, including masculinization and gynecomastia; liver abnormalities such as dysfunction, tumor, and hepatitis; an increased risk of atherosclerosis; and the atrophy of the testicles and decreased sperm production. Psychologic effects vary from mood swings to depression and mania or hypomania.
ergogenic
the tendency to increase work output; various substances that increase work or exercise capacity and output.
Malignancies are identified by
their primary site of origin, their stage or tumor size, the presence of metastasis, and their grade (i.e., how aggressive the tumor is).
A major function of T cells is
to activate the phagocytes, which are the cells that destroy invaders and kill disease-carrying antigens
One of the main functions of the liver is
to remove ammonia—and hence nitrogen—from the blood by converting it to urea (via the urea cycle) for urinary excretion.
The most common worldwide food intolerance is
to the disaccharide lactose.
Radiation therapy is often used by itself or in conjunc- tion with other treatments. This type of therapy involves
treatment with high-energy radiography that is targeted to the cancer site to kill or shrink tumors. Radiation may be administered to the body by an external machine (Figure 23-2) or by implanted radio- active materials at the cancer site.
Chemotherapeutic agents destroy rapidly growing cancer cells. Unlike radiation therapy, chemotherapy is administered
via general blood circulation throughout the body. Because chemotherapeutic medications are highly toxic, they also affect normal, healthy cells. This accounts for their side effects on rapidly growing tissues (e.g., bone marrow, GI tract, hair follicles) as well as the problems that they cause for nutrition management.
Weight-bearing exercises such as
walking, jogging, aerobic dancing, and jumping rope are important for bone structure and strength. In these exercises, muscles are working against gravity. The load put on bones during weight-bearing exercises stimulates them to become more dense. This decreases the risk of falls, which can be very debilitating for aging individuals.
Fat is used efficiently as the primary fuel source during lower-intensity aerobic exercise such as
walking, jogging, swimming, and light cycling, though moderate to higher intensity excise will result in higher caloric expenditure within the same time frame
Chronic dry mouth, which is called
xerostomia, some- times occurs in middle-aged and elderly adults, and it is often associated with rheumatoid arthritis or radia- tion therapy, or it may occur as a side effect from many drugs that are taken on a long-term basis
Cancer generally causes the following three basic sys- temic effects with regard to nutrition status:
• Anorexia, or loss of appetite, which results in poor food intake • Increased metabolism, which results in increased nutrient and energy needs • Negative nitrogen balance, which results in lean tissue catabolism
Dietary restrictions are not usually necessary during acute hepatitis, but they may be required for chronic cases. The following requirements govern the goals of nutrition therapy
• Avoidsubstancesthatarehepatotoxic(e.g.,alcohol, drugs, toxins). • Consume a diet that is adequate in energy, macro- nutrients, and micronutrients. • Consume 4 to 6 small meals per day. Most patients will tolerate oral feedings, but enteral feedings may be warranted. • Protein: Protein is essential for regenerating new liver cells and preventing damage from fatty infil- tration in liver tissue. The diet should supply 1.0 to 1.2 g/kg of body weight of high-quality protein daily if no complications are present. • Carbohydrates: Available glucose restores protective glycogen reserves in the liver. It also helps to meet the energy demands of the disease process and prevents the breakdown of protein for energy, thus ensuring its use for tissue regeneration. The diet should supply about half of the total kilocalo- ries as carbohydrates. Glucose intolerance and hypoglycemia are sometimes problematic in patients with liver disease. Therefore, the amount of carbo- hydrates in the diet depends on individual needs and any co-morbidity (e.g., diabetes). • Fat: In cases of steatorrhea, the diet should not exceed 30% of total kilocalories from fat. • Sodium is limited to 2000 mg per day to avoid fluid retention. • As a patient's appetite and food tolerance improve, a full diet is acceptable while observing his or her likes and dislikes and planning ways to encourage optimal food intake.
General complications of chemo include the following:
• Bone marrow: Interference with the production of specific blood factors causes a reduced red blood cell count and anemia, a reduced white blood cell count and lowered resistance to infections, and a reduced blood platelet level that may prevent the formation of blood clots when needed to stop bleeding. • GI tract: Numerous problems may develop that interfere with food tolerance, such as nausea and vomiting, a loss of normal taste sensations, anorexia, diarrhea, ulcers, malabsorption, and mucositis. • Hair follicle: Interference with normal hair growth results in general hair loss.
The qualified health claims about cancer risk for use on food labels in the United States link the following nutrients with reduced risk
• Dietary fat (lipids) and cancer. An example claim approved for use: "Eating a healthful diet low in fat may help reduce the risk of some types of cancers. Development of cancer is associated with many factors, including a family history of the disease, cigarette smoking, and what you eat." • Fiber-containing grain products, fruits, vegetables, and cancer. An example claim approved for use: "Devel- opment of cancer depends on many factors. Eating a diet low in fat and high in grain products, fruits, and vegetables that contain dietary fiber may reduce your risk of some cancers." • Fruits and vegetables and cancer. An example claim approved for use on broccoli: "Low fat diets rich in fruits and vegetables (foods that are low in fat and may contain dietary fiber, vitamin A, and vitamin C) may reduce the risk of some types of cancer, a disease associated with many factors. Broccoli is high in vitamins A and C, and it is a good source of dietary fiber."
Malabsorption results from a dis- turbance in the normal digestive process or absorptive pathway, and the defect may include any of the follow- ing processes:
• Digestion of macronutrients:Carbohydrates,proteins, and fats are broken down in the small intestines into their basic building blocks (i.e., monosaccharides and disaccharides, amino acids, and fatty acids and glycerol, respectively) with the help of salivary and pancreatic enzymes, hydrochloric acid, and bile acid. • Terminal digestion at the brush border mucosa: Disaccharides and peptides are hydrolyzed by disaccharidases and peptidases for the final step of digestion. • Absorption: The end products of macronutrient digestion, micronutrients (i.e., vitamins, minerals, and electrolytes) and water are absorbed across the epithelium of the small intestine into the general or lymphatic circulation.
Only the following few food-related habits are thought to affect acid secretion:
• Food quantity: To avoid stomach distention, do not eat large quantities at meals. Avoid eating immedi- ately before going to bed, because food intake stim- ulates acid output. • Irritants: Individual tolerance is the rule, but some food seasonings such as hot chili peppers, black pepper, and chili powder may irritate an already weakened mucosal layer. Caffeine, chocolate, and alcohol may increase acid secretions or prevent healing in some patients. Patients will need to inde- pendently determine which foods are tolerated and which foods worsen symptoms. • Smoking: Complete smoking cessation is best, because smoking provokes GI mucosal injury and hinders ulcer healing in several biochemical and physiologic pathways.20,21 It also affects gastric acid secretion and hinders the effectiveness of drug therapy.
Nutrition therapy for cases of mild to moderate pancreatitis includes the following measures
• Nothing by mouth with hydration support during acute phases. This allows for pancreatic rest while providing fluids and correcting for electrolyte and acid-base disturbances. • Advance to liquid or solid foods as tolerated. For patients with severe acute pancreatitis, a continu- ous infusion of enteral nutrition is indicated. For patients who cannot tolerate oral or enteral feed- ings, parenteral nutrition must be considered (see Chapter 22). • Provide adequate energy and nutrient needs when acute symptoms subside. Energy needs should be based on patient requirements to prevent weight loss. Assess the need for vitamin and mineral sup- plementation, especially during periods when oral intake is insufficient to meet basic needs. • The diet should be relatively high in protein and low in fat. • Avoid alcohol and smoking.
Current recommendations for preventing food allergies are as follows
• Pregnant women should strive for a well-balanced healthy diet and not avoid any specific allergens during gestation (unless she has allergies). • Exclusively breastfeed infants for a minimum of 4 months. The mother should not avoid eating food allergens during lactation (unless she has allergies). • Introduce solid foods to infants between 4 and 6 months. Include allergenic foods after the initial period of weaning. • Include probiotics and prebiotics in the diet.
The basic objectives of the nutrition intervention plan for patients with cancer are as follows
• Prevent weight loss, even among overweight patients • Maintain lean body mass • Prevent unintentional weight gain, particularly in certain groups of patients (e.g., those with hormone- related cancers such as prostate or breast cancer, those taking long-term high-dose steroids) • Identify and manage treatment-related side effects Nutrient specifics of the plan are outlined in the
Nutrition and cancer care focus on the following two fundamental areas:
• Prevention, in relation to the environment and the body's natural defense system • Therapy, in relation to nutrition support for medical treatment and rehabilitation
The individual clinical course of HIV infection varies substantially, but the following three distinct stages mark the progression of the disease:
• Primary HIV infection and extended latent period of viral incubation • HIV-related diseases • AIDS
The typical CF symptoms include the following:
• Thick mucus in the lungs: causes damaged airways, more difficult breathing, persistent coughing, and pulmonary infections (e.g., bronchitis, pneumonia) • Pancreatic insufficiency: leads to a lack of normal pancreatic enzymes to digest macronutrients and a progressive loss of insulin-producing β cells and eventual diabetes mellitus in approximately 15% of adult patients (see Chapter 20) • Malabsorption: food is left undigested and unabsorbed, with consequential malnutrition, stunted growth, delayed puberty, and infertility • Liver and gallbladder disease: clogged bile ducts lead to a progressive degeneration of functional liver tissue • Inflammatory complications: including arthritis, finger clubbing, and vasculitis • Increased salt concentration: in body perspiration, thereby leading to salt depletion
Adequate fluid intake must be ensured for the follow- ing reasons:
• To replace GI losses from fever, infection, vomiting, or diarrhea • To help the kidneys dispose of metabolic break- down products from destroyed cancer cells and from the drugs that are used in chemotherapy Some chemotherapeutic drugs (e.g., cyclophospha- mide [Cytoxan]) require hyperhydration by forced fluids daily to prevent hemorrhagic cystitis.
rinciples of continuing dietary management of IBD include the following: During periods of inflammation:
• Use enteral or parenteral nutrition feedings, if necessary. • Progress to low-fat, high-protein, high-kilocalorie, small, frequent meals when returning to a normal diet as tolerated. • The diet should be low in fiber only during acute attacks or with strictures. Otherwise, fiber should be increased gradually. • Vitamin and mineral supplementation should include vitamin D, zinc, calcium, magnesium, folate, vitamin B12, and iron. During periods of remission: • Meet energy and protein needs that are specific for weight, and replenish nutrient stores. • Avoid foods that are high in oxalates for patients with Crohn's disease. • Increase antioxidant intake, and consider supple- mentation with omega-3 fatty acids and glutamine. • Consider the use of probiotics and prebiotics.
