MNT for Inflammatory Bowel Disease Flashcards
____ ____ ____ is a collective term for chronic inflammatory diseases of the intestine
Inflammatory Bowel Disease
What two diseases are under the inflammatory bowel disease umbrella?
-Crohn’s Disease
-Ulcerative Colitis
Inflammatory Bowel Disease is characterized by periods of ____ and ____
Remission and exacerbations
The impact of Inflammatory Bowel Disease depends on the site and extent of _____
Inflammation
Inflammatory Bowel Disease often develops between ___-___
15-30
Inflammatory Bowel Disease is often confused with ____ ____ ____
Irritable Bowel Syndrome
Risk factors for Inflammatory Bowel Disease:
-Positive family history
-Jewish ancestry
-Caucasian
-Smoking increases the risk for Crohn’s Disease
-Antibiotic use
Possible dietary risk factors for Inflammatory Bowel Disease:
-Vitamin D deficiency
-High intake of sucrose
-Low intake of fruits and vegetables and dietary fiber
-Increased consumption of red meat and alcohol
-High intake of omega-6 fatty acids and low intake of omega-3 fatty acids
Crohn’s Disease results in chronic inflammation to the ____, resulting in ulcerations
Mucosa
With Crohn’s Disease, inflammation progresses to involve all ____ of the intestinal wall
Layers
Crohn’s disease usually occurs in the ___ and ___ ____ but can occur anywhere in the GIT
Large and small intestine
The most common site of Crohn’s disease is the ____ ____
Terminal ileum
The terminal ileum is where we absorb vitamin ____
B12
Crohn’s Disease is segmental with spared areas called “____ ____”
Skip lesions
Clinical manifestations of Crohn’s disease:
-Abdominal pain
-Diarrhea
-Anorexia
-Weight loss
What are complications of Crohn’s Disease?
-Strictures-> obstruction
-Malabsorption
-Abscesses
-Fistulas
-Possible short bowel syndrome
-Increased risk of intestinal cancer
Ulcerative colitis is a chronic inflammatory disease that causes ulceration of the ____ ____
Colonic mucosa
Ulcerative colitis begins in the _____ area and may extend proximally to affect the entire colon
Rectosigmoid
With Ulcerative colitis, the ____ is almost always involved
Rectum
Unlike Crohn’s, Ulcerative colitis usually only involves the ____ layer of the intestines
Mucosa
Ulcerative colitis causes deep ____ that bleed
Ulcers
The mucosal inflammation/destruction caused by ulcerative colitis leads to…
-Loss of absorptive surface area
-Large volumes of watery diarrhea
-Bleeding
-Cramping pain
-Tenesmus (constant feeling that you have to have a bowel movement)
Clinical manifestations of ulcerative colitis:
-Crampy abdominal pain
-Frequent bloody diarrhea
-Dehydration
-Anorexia and weight loss
-Anemia
Possible complications of ulcerative colitis:
-Severe bleeding
-Perirectal abscess
-Toxic megacolon
-Increased risk for colon cancer
Is malnutrition more common in Crohn’s disease or Ulcerative colitis?
Crohn’s Disease
Malnutrition with Inflammatory Bowel Disease is caused by…
-Decreased nutrient intake
-Malabsorption
-Increased enteric losses
Malnutrition further compromises ____ and _____ functions and may increase the permeability of the GIT to potential inflammatory agents
Digestive and absorptive
Decreased nutrient intake in someone with Inflammatory Bowel Disease may be due to…
-Avoidance behavior
-Disease-related anorexia
-Iatrogenic (restrictive diets recommended by healthcare professional)
Malabsorption of macro- and micronutrients is due to…
-Decreased functional absorptive surface area
-Medications
-Bacterial overgrowth
People with Inflammatory Bowel Disease may have secondary ____ _____
Lactose intolerance
Fat malabsorption with Crohn’s Disease may be due to ____ or ____ disease
Ileal or Jejunal
Ileal disease can cause fat malabsorption by causing a decreased ___ ___ pool due to malabsorption or deconjugation by bacteria
Bile salt
Jejnual disease can cause fat malabsorption by decreasing _____ surface area due to inflammation/disease
Absorptive
During periods of inflammation, people with Inflammatory Bowel Disease will have enteric leakage of…
-Fluid and electrolytes
-Blood
-Protein (protein-losing enteropathy)
Micronutrient deficiencies are caused by…
-Decreased intake
-Malabsorption
-Food-medication interactions
Fat-soluble vitamin deficiencies are due to…
-Ileal or jejunal resection or disease
-Meds: cholestyramine
Vitamin ____ deficiency is most common in those with Inflammatory Bowel Disease
D
What are two water-soluble vitamins that are commonly deficient in those with Inflammatory Bowel Disease?
-Vitamin B12
-Folate
People are commonly deficient in vitamin B12 due to ____ disease
Ileal
People are commonly deficient in folate due to…
-Decrease intake
-Sulfasalazine
Minerals like zinc, potassium, magnesium, and copper are commonly deficiency due to ____ and ____
Diarrhea and steatorrhea
People are commonly deficient in iron due to ___ ____
GI bleeding
People are commonly deficient in calcium due to…
-Avoidance of dairy
-Corticosteroids
-Fat malabsorption
Some additional nutritional consequences of Inflammatory Bowel Disease include…
-Nutritional anemia
-Osteoporosis and osteomalacia
-Growth impairment in children
In general, energy requirements in those with Inflammatory Bowel Disease are similar to those of the ____ population
Healthy
There is no evidence of ____ in those with inactive Inflammatory Bowel Disease
Hypermetabolism
There may be an increase in metabolic activity at times of acute severe disease activity, however, the increase in REE is likely offset by reduction in ____ ____
Physical activity
Energy needs for those with Inflammatory Bowel Disease should be _____
Individualized
In general, those with Inflammatory Bowel Disease should get between ___-___ kcal/kg
25-35
Protein requirements for those in remission from Inflammatory Bowel Disease:
1 g/kg
Protein requirements for those with active Inflammatory Bowel Disease:
1.2-1.5 g.kg
What are factors that would increase protein needs in someone with Inflammatory Bowel Disease?
-Active inflammation
-Malnutrition
-Post-operative healing
-Infection
-Corticosteroids
-Enteric losses: blood, protein-losing enteropathy
-Malabsorption
-Fistulas
We should provide fluid as per age recommendations and additional fluid to replace ____
Losses
What are some factors which increase fluid needs?
-Enteric losses (diarrhea, high ostomy output, fistulas)
-Fever
-Sulfasalazine
Dietary recommendations during an Inflammatory Bowel Disease flare-up:
-Small frequent meals
-Chew foods thoroughly
-Adequate fluids to replace losses
-Limit/avoid caffeine, prune juice, alcohol, sorbitol
-Limit specific foods, if needed, based on individual tolerance
What are some additional dietary interventions that may be used as needed?
-Lactose restriction
-Restriction of fructose
-Low fiber diet
-Confirmed steatorrhea
A low-fiber diet is only used for…
-Strictures (to avoid obstruction)
-S/p intestinal resection
-Increase fiber as tolerated during remission
If someone has confirmed steatorrhea, we should recommend…
-40 gram low fat diet
Those with Inflammatory Bowel Disease should be given a _____ with minerals
Multivitamin
If someone is deficient or at high risk of deficiency in vitamin B12, they should receive ____mcg/month IM
1000
If someone is deficient or at high risk of deficiency in calcium (usually due to corticosteroids or poor intake), they should get ___-___ g/day
1000-1200
If someone is deficient or at high risk of deficiency in vitamin D, they should get ___-___ IU daily for maintenance, as well as ____ IU weekly for 12 weeks for the treatment of deficiency
2000-4000; 50,000
If someone is deficient or at high risk of deficiency in folate (if on sulfasalazine), they should receive ___ mg/day
1
If someone has fat malabsorption, they should be given fat-soluble vitamins in ___-___ form
Water-soluble
If someone is deficient or at high risk of deficiency in zinc, they should be given ___ mg of zinc sulfate 1-2 times per day
220
People should be given oral nutrition ____ if needed
Supplements
If someone has fat malabsorption, we should recommend what type of oral nutrition supplement?
-Partially hydrolyzed, peptide-based with MCT oil
-Ex: Petamen with Prebio
More research is needed for the use of ____ supplements like probiotics, prebiotics, and omega-3 fatty acids
Nutraceutical
What are some indications of enteral nutrition for those with inflammatory bowel disease?
-Poor appetite
-Malnutrition
-Induction of remission of Crohn’s disease in children and adolescents
Enteral nutrition is preferred over parenteral nutrition due to…
-Lesser complications
-Ability to maintain GIT integrity and function
-Provide trophic nutrients
-Lower cost
If someone is on enteral nutrition, they should get ____ formula
Polymeric
If someone has confirmed fat malabsorption, we should recommend a ____-____ formula
Semi-elemental
Semi-elemental formulas contain ____ oil and the protein is hydrolyzed to peptides
MCT
Indications of parenteral nutrition:
-Complications (SBO, fistulas, SBS)
-Prolonged small bowel ileus after surgical resection
What are two examples of anti-inflammatory agents (aminosalicylates) used for those with inflammatory bowel disease?
-Sulfasalazine
-Masalamine
What are food-drug interactions with sulfasalazine?
-Inhibits folate absorption
-Can cause anorexia, N/V/D
-Drink 8-10 glasses of fluid/day to prevent kidney stones
Food-drug interactions with Mesalamine:
-Nausea
-Dyspepsia
-Diarrhea
-Anorexia
____ are also used for those with inflammatory bowel disease for anti-inflammatory and immunosuppressive properties
Corticosteroids
Food-drug interactions with corticosteroids:
-Decrease calcium absorption: osteoporosis
-Increase protein catabolism
-Increase blood glucose levels
An example of an immunosuppressive agent is ____
Azothioprine (Imuran)
What are food-drug interactions with Azathioprine (Imuran)?
-Anorexia
-N/V/D
-Steatorrhea
-Esophagitis
An example of an anti-tumor necrosis factor medication is _____
Infliximab (Remicade)
Infliximab is used in more severe cases of ____ ____
Crohn’s Disease
Side effects of anti-tumor necrosis factor medications like Infliximab:
-Abdominal pain
-N/V
-Serious infections
Some people may have _____ resections of diseased areas
Surgical
People with inflammatory bowel disease may require an ___ or ___
Ileostomy or colostomy
What surgery is curative for ulcerative colitis?
Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA)
After the IPAA surgery, someone’s diet should progress from a ___ ___ diet to a regular diet
Low-fiber
People who have had the IPAA surgery should follow the MNT for ____
Ileostomy
Those with IPAA may require vitamin ____ injections and need diet education
B12
