Chapter 4: Nutritional Needs of the Adult Oncology Patient Flashcards
What is “disease-related malnutrition”?
when the severity of persistence of inflammation results in a decrease in lean body mass, causing functional impairment.
In chronic disease-related malnutrition, successful nutrition intervention must address ____ and ____.
the underlying health condition and its nutritional needs.
Why do individuals with cancer have an increased requirements for macro- and micro nutrients?
Due to periods of under nutrition (before and after diagnosis) and because of the metabolic effects from the cancer and its treatment.
Which cancers have the highest energy expenditures?
Esophageal, gastric, pancreatic and non-small cell lunch cancers.
Which cancer showed no change in energy expenditure?
Colorectal cancer
Longer-term consequences of under-feeding?
Loss of lean body mass, immunosuppression, poor wound healing and risk of hospital acquired infections.
Longer-term consequences of over-feeding?
Respiratory failure d/t increased CO2 production, hyperglycemia, azotemia (high levels of nitrogen-containing compounds), hypertriglyceridemia, electrolyte imbalances, immunosuppression, alterations in hydration status and hepatic statosis.
The DRI for protein for healthy adults?
0.8 g/kg/day
Recommended protein range for catabolic individuals?
1.2-2.0 g/kg/day
Protein for metabolically stressed individuals?
1.5 g/kg/day
The RDA for carbohydrate?
130 g/day
How can a person meet their essential fatty acid needs and with which fats?
Linoleic acid: 2-4% of total calories
Alpha linolenic acid: 0.25-0.5% of total calories
A.S.P.E.N. guidelines for carbs and fat for those receiving nutritional support?
Carbohydrate: <7 g/kg/day
Fat: <2.5 g/kg/day
Factors impacting hydration status in the elderly?
Impaired thirst mechanism, access issues and decreased mobility.
In the palliative care setting, how many mL of fluid/day is acceptable?
1000 mL
List three methods for fluid requirements?
A.S.P.E.N.: 20-40 mL/kg/day or 1-1.5 mL/kcal energy expenditure
RDA: 1 mL/kcal energy consumed
Body Surface Area (BSA): 1500 mL/M2 or BSA x 1500 mL
Micronutrient goal?
100% of the RDAs
Which minerals decrease during the inflammatory process?
selenium, copper, iron and zinc
Which vitamins are usually not effected by inflammation?
B1, B2, B12 and folate
what is sarcopenia?
the degenerative loss of skeletal muscle mass
What are 3 ways to estimated energy needs?
Direct calorimetry, Indirect calorimetry, Predictive equations.
What is the gold standard of measuring energy needs?
Indirect caloimetry
Direct calorimetry
Used infrequently, and mostly a research method which measures heat from macronutrient consumption released from the subject.
Indirect calorimetry (IC)
Uses oxygen consumption and carbon dioxide production but the equipment is not always available
Predictive equations
developed for select patient populations and used to assess energy needs
BEE
Basal Energy Expenditure: minimum amount of energy expended to be compatible with life.
BMR
Basal Metabolic Rate: measurement of the baseline energy expended; measured early in the morning before activity and 10-12 h after ingestion of food, beverage or nicotine. Is measured in a temperate environment
RMR
Resting Metabolic Rate: energy expended at rest; measured after fasting for at least 5 hours, generally 10-20% higher than BMR
REE
Resting Energy Expenditure: energy needs to maintain normal body functions; measured after 30 min of recombinant rest
EEE
Estimated Energy Expenditure: energy needed per day to maintain normal body functions
EER
Estimated Energy Requirements: average predicted nutrition intake for maintenance of energy balance and good health based on age, gender, weight, height, and activity level
PAL
Physical Activity Level: 4 levels: sedentary, low active, active, and very active
RQ
Respiratory Quotient: calculation derived from IC using carbon dioxide expended and oxygen consumed
What does an RQ below 0.7 indicate?
hypoventilation or prolonged fasting
What does an RQ over 1.0 indicate?
hyperventilation, overfeeding or inaccurate gas collection.
Mifflin-St Jeor Equation is best for?
(using actual wt) Best at predicting RMR in non-obese and obese populations age 20-82 years
Harris-Benedict Equation?
Estimated energy needs in healthy adults. Not to be used in acutely or critically ill pts.
Best equations to use to assess energy needs for acutely ill populations?
Mifflin-St Jeor and Ireton-Jones Equations
Best equations to use to assess energy needs for critically ill populations?
Penn State Equation and the Swinamer equation and the Ireton-Jones equation
Which equation is best to estimate the needs of the mechanically ventilated critically ill pt?
Swinamer Equation
Which equation is best to estimate the needs of the ventilator-dependent critically ill pt?
Ireton-Jones Equation
Best equations to assess energy needs of obese?
11-14 kcal/kg of actual wt in hypometabolic disease (without renal or hepatic dysfunction)
11-18 kcal/kg of actual body wt (without renal or hepatic dysfunction)
22 kcal/kg IBW (without renal or hepatic dysfunction)
Energy needs for cancer (for weight gain)
30-35 kcal/kg
Energy needs for cancer (inactive, non-stressed)
25-30 kcal/kg
Energy needs for cancer, hypermetabolic, stressed
35 kcal/kg
Energy needs for sepsis
25-30 kcal/kg
Energy needs for Hematopoietic cell transplant
30-35 kcal/kg
What is best to use: actual wt, adjusted wt or IBW?
Actual wt
What is one sign that a pt is suffering from re-feeding syndrome?
3 days after the start of re-feeding, they may get hypophosphatemia.
Energy needs for re-feeding?
20 kcal/kg or no more than 1000 kcal per day and advance as tolerated while monitoring electrolytes.
(or start with 25% of estimated needs and increase over 3-5 days).
