Chapter 4: Nutritional Needs of the Adult Oncology Patient

Question 1

Cancers with higher energy expenditure

Answer 1

esophageal, gastric, pancreatic, and non-small cell lung

Question 2

Long-term side effects of under-feeding

Answer 2

loss of lean body mass, immunosuppression, poor wound healing, and risk of hospital-acquired infections

Question 3

Long-term side effects of overfeeding

Answer 3

respiratory failure due to increased CO2 production, hyperglycemia, azotemia, hypertriglyceridemia, electrolyte imbalances, immunosuppression, alterations in hydration status, and hepatic steatosis

Question 4

DRI for protein for health individuals

Answer 4

0.8 g/kg/day

Question 5

Protein needs for catabolic and metabolically stressed patients

Answer 5

C-1.2-2.0 g/kg/day

M- 1.5 g/kg/day

Question 6

Uses of CHO and fat

Answer 6

CHO and fat spare protein for its essential functions and preserve lean muscle. RDA of CHO is 130 g/day for healthy adults

Question 7

ASPEN guidelines for CHO and fat for nutrition support patients

Answer 7

CHO <7 g/kg/day

Fat <2.5 g/kg/day

Question 8

Acceptable fluid intake in the palliative care setting

Answer 8

1000 mL/day

Question 9

Methods for calculateing fluid needs

Answer 9

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

Question 10

Macronutrient Distribution Ranges for Adults

Answer 10

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)

Question 11

Micronutirent dificencies common in ill patients

Answer 11

zinc, iron, selenium, and vitamins A, B, and C

Question 12

Side effects of micronutrient dificencies in ill patients

Answer 12

organ dysfunction, muslce weakness, poor wound healing, and altered immunity

Question 13

Unless otherwise indicated, cancer patients should aim for an intake of __ of the RDAs/AIs fro micronutrients

Answer 13

100%

Question 14

RE thiamin, riboflavin, vitamin B12, and folate levels affected by inflammation?

Answer 14

Not usually. Low levels are usually associated with actual deficiencies

Question 15

During inflammation, which micronutrients are decreased due to sequestration

Answer 15

selenium, copper, iron, and zinc

Question 16

Micronutrient levels affected by alcoholic liver

Answer 16

decrease in folate, thiamine, pyridoxine, and vitamin A

Question 17

Micronutrient levels affected by renal failure

Answer 17

decrease in pyridoxine, folic acid, and vitamin C

Question 18

Micronutrient levels affected by GI fistulas and diarrhea

Answer 18

decrease in all vitamin, and multiple trace minerals, especially zinc and selenium

Question 19

Micronutrient levels affected by loss of bile

Answer 19

decrease in fat solube vitamins (ADEK)

Question 20

Micronutrient levels affected by pancreatitis

Answer 20

decrease absorption of B12

Question 21

Micronutrient levels affected by chylous leaks and fistulas (with large protein-rich fluid loss)

Answer 21

decrease in all micronutrients

Question 22

Micronutrient levels affected by gastrectomy or terminal ileum resection

Answer 22

decrease in iron and B12

Question 23

Micronutrient levels affected by bariatric surgery

Answer 23

decrease in fat-soluble vitamins, water soluble vitamins, iron, and zinc

Question 24

Micronutrient levels affected by critical illness

Answer 24

decrease in vitamin C despite supplementation

Question 25

3 Methods of predicting energy requirements

Answer 25

Direct calorimentry: measures heat from macronutrient consumption released from the subject

Indirect calorimetry: oxygen consumption and carbon dioxide production

Predictive equations

Question 26

Predictive equations for healthy populations

Answer 26

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)

Question 27

Predictive equations for acutely ill populations

Answer 27

MSJ

Ireton-Jones 1997: for spontaneously breathing patients
629-11(age)+25(kg)-609(O)
O-obesity factory; 1 if present, 0 if absent

Question 28

Predictive equations for Critically ill populations

Answer 28

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)

Question 29

Populations for hypocaloric feeding

Answer 29

obese patients, COPD, respiratory distress syndrome, systemic inflammatory response syndrome, sepsis with hemodynamic instability, muclitple organ dysfunction, hyercapnia, herglycemia, and hypertriglyceridemia

Question 30

Energy Needs for obese population

Answer 30

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

Question 31

Estimated needs for cancer, repletion, wt gain

Answer 31

30-35 kcal/kg

Question 32

Estimated needs for cancer, inactive, non-stressed

Answer 32

25-30 kcal/kg

Question 33

Estimated needs for cancer, hypermetabolic, stressed

Answer 33

35 kcal/kg

Question 34

Estimated needs for sepsis

Answer 34

25-30 kcal/kg

Question 35

Estimated needs for hematopietic cell transplant

Answer 35

30-35 kcal/kg

Question 36

Needs using adjusted body wt become increaseingly __ accurate with __ BMI

Answer 36

less; increased

Question 37

Metobolic changes during starvation

Answer 37

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

Question 38

Refeeding syndrome

Answer 38

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

Question 39

Conditions that increase risk of refeeding syndrome

Answer 39

anorexia, alcoholism, prolonged starvation, morbid obesity with substantial wt loss, cancer, and cirrhosis

Question 40

Recommendations for starting feeds for populations at risk of refeeding syndrome

Answer 40

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