Chapter 4: Nutritional Needs of the Adult Oncology Patient Flashcards
Cancers with higher energy expenditure
esophageal, gastric, pancreatic, and non-small cell lung
Long-term side effects of under-feeding
loss of lean body mass, immunosuppression, poor wound healing, and risk of hospital-acquired infections
Long-term side effects of overfeeding
respiratory failure due to increased CO2 production, hyperglycemia, azotemia, hypertriglyceridemia, electrolyte imbalances, immunosuppression, alterations in hydration status, and hepatic steatosis
DRI for protein for health individuals
0.8 g/kg/day
Protein needs for catabolic and metabolically stressed patients
C-1.2-2.0 g/kg/day
M- 1.5 g/kg/day
Uses of CHO and fat
CHO and fat spare protein for its essential functions and preserve lean muscle. RDA of CHO is 130 g/day for healthy adults
ASPEN guidelines for CHO and fat for nutrition support patients
CHO <7 g/kg/day
Fat <2.5 g/kg/day
Acceptable fluid intake in the palliative care setting
1000 mL/day
Methods for calculateing fluid needs
ASPEN: 20-40 mL/kg or 1-1.5 mL/kcal of energy expended
RDA: 1 mL/kcal consumed
Body Surface Area (BSA): 1500 mL/m2 or BSA x 1500 mL
Macronutrient Distribution Ranges for Adults
Fat: 20-35% total calories
CHO: 45-65% total calories
Protein 10-35% total calories
(Chol, trans fat, and sat fat as low as possible while consuming a nutitionally adequate diet)
Micronutirent dificencies common in ill patients
zinc, iron, selenium, and vitamins A, B, and C
Side effects of micronutrient dificencies in ill patients
organ dysfunction, muslce weakness, poor wound healing, and altered immunity
Unless otherwise indicated, cancer patients should aim for an intake of __ of the RDAs/AIs fro micronutrients
100%
RE thiamin, riboflavin, vitamin B12, and folate levels affected by inflammation?
Not usually. Low levels are usually associated with actual deficiencies
During inflammation, which micronutrients are decreased due to sequestration
selenium, copper, iron, and zinc
Micronutrient levels affected by alcoholic liver
decrease in folate, thiamine, pyridoxine, and vitamin A
Micronutrient levels affected by renal failure
decrease in pyridoxine, folic acid, and vitamin C
Micronutrient levels affected by GI fistulas and diarrhea
decrease in all vitamin, and multiple trace minerals, especially zinc and selenium
Micronutrient levels affected by loss of bile
decrease in fat solube vitamins (ADEK)
Micronutrient levels affected by pancreatitis
decrease absorption of B12
Micronutrient levels affected by chylous leaks and fistulas (with large protein-rich fluid loss)
decrease in all micronutrients
Micronutrient levels affected by gastrectomy or terminal ileum resection
decrease in iron and B12
Micronutrient levels affected by bariatric surgery
decrease in fat-soluble vitamins, water soluble vitamins, iron, and zinc
Micronutrient levels affected by critical illness
decrease in vitamin C despite supplementation
3 Methods of predicting energy requirements
Direct calorimentry: measures heat from macronutrient consumption released from the subject
Indirect calorimetry: oxygen consumption and carbon dioxide production
Predictive equations
Predictive equations for healthy populations
MSJ: using actual wt to predict RMR in non-obese and obese populations ages 20-82
Harris-Benedict: used to estimated energy needs taking into consideration both activity and stress levels. Should not be used to assess energy needs in the acutley or critically ill
MEN: 66.47+13.75 (kg)+5(cm)-6.78(age)
WOMEN: 655.1+9.65(kg)+1.85(cm)-4.68(age)
Predictive equations for acutely ill populations
MSJ
Ireton-Jones 1997: for spontaneously breathing patients
629-11(age)+25(kg)-609(O)
O-obesity factory; 1 if present, 0 if absent
Predictive equations for Critically ill populations
For patient who are septic, suffering traumatic injury, burns, major surgery
PENN State 2003b: ventilated patients
MSJ (0.96)+MV in L/min)(31)+(Tmax in C)(167)-6212
Modified Penn State:
MSJ (0.71)+(MV L/min)+(Tmax inC)(85)-3085
Swinamer Equation-ventilated patients. Uses BSA
Ireton Jones 1992-ventilated patients
1925-10(age)+5(kg)+281(1 for male, 0 for female)+292 (0 if no trauma, 1 if present)+851 (0 if no burns, 1 if present)
Populations for hypocaloric feeding
obese patients, COPD, respiratory distress syndrome, systemic inflammatory response syndrome, sepsis with hemodynamic instability, muclitple organ dysfunction, hyercapnia, herglycemia, and hypertriglyceridemia
Energy Needs for obese population
Ireton-Jones 1997: for spontaneously breathing patients
629-11(age)+25(kg)-609(O)
O-obesity factory; 1 if present, 0 if absent
11-14 kcal/kg ABW in hypometabolic states without renal or hepatic dysfunction
14-18 kcal/kg ABW without renal or hepatic dysfunction
22 kcal/kg IBW without renal or hepatic dysfunction
Estimated needs for cancer, repletion, wt gain
30-35 kcal/kg
Estimated needs for cancer, inactive, non-stressed
25-30 kcal/kg
Estimated needs for cancer, hypermetabolic, stressed
35 kcal/kg
Estimated needs for sepsis
25-30 kcal/kg
Estimated needs for hematopietic cell transplant
30-35 kcal/kg
Needs using adjusted body wt become increaseingly __ accurate with __ BMI
less; increased
Metobolic changes during starvation
insulin secretion decreases due to limited CHO intake and energy source is converted from glucose to ketons and fatty acids
Phos, mg, and potass are depleted from cells, but serum levels remain normal due to kidney regulation
Refeeding syndrome
Starts when CHO are reintroduced in the body after a period of starvation. The body releases more insulin, which drives phos, mg, and potass back into cells. Hypophosphatemia is a sign and occurs within 3 days of nutrition intervention
Conditions that increase risk of refeeding syndrome
anorexia, alcoholism, prolonged starvation, morbid obesity with substantial wt loss, cancer, and cirrhosis
Recommendations for starting feeds for populations at risk of refeeding syndrome
Start at 20 kcal/kg, or no more than 1000 kcal/day, and advance as tolerated while monitoring electrolytes
OR
start with 25% of estimated needs and advance to goal over 3-5 days while monitoring electrolytes
