MNT Hematologic, bone disease, hepatic disorders, pulmonary conditions

Question 1

Hemotologic Disorders: Blood cancers: Leukemia

Answer 1

-Chronic lymphocytic leukemia (CLL)-Occurs in adults over 30
-Acute Lymphocytic leukemia (ALL)- Occurs in children and those under the age of 20
-Chronic myeloid leukemia (CML)- Accounts for 15-20% of all leukemias in adults
-Acute myeloid leukemia (AML)-Most common leukemia in adults

Question 2

Hemotologic disorders: Blood cancers: Leukemia:Nutrition Considerations

Answer 2

-reduction or elimination of processed meats
-consumption of high fruit and vegetable diet (organically grown)
-Anti-Cancer properties in green tea (lower risk of leukemia by 45%)
-Reduce alcohol intake

Question 3

HD/BC Lymphoma

Answer 3

non Hodgkins & Hodgkin

Nutritional considerations:
-Reduce red meat and poultry
-increase fruit and vegetable intake to increase soluble fiber
-increase intake of vitamin C and A
-Maintain a healthy weight
-Reduce refined sugar, grains, alcoholic beverages
-Eliminate gluten
-RDA vit. C 90 mg (M); 75 mg/day (W), 85 mg (pregnancy), Vit. A 900 Mg (M), 700 Mg (W); 770Mg (pregnancy )

Question 4

Megablastic or macrolytic anemia

Answer 4

Enlarged RBC making them too large to pass through the membrane out of the bone marrow

Question 5

Pernicious anemia

Answer 5

-B12 deficiency, can include iron deficiency and B6
-RDA for B12: 2.4 Mg/day (adults), B6 : 1.3 mg/day (Adults), Folate 400 mg/day (Adults);600mg/day (pregnancy), Iron 8 mg/day (men), 18 mg (women)
-Vitamin B12 and Folate B9 deficiencies

Question 6

Iron anemia

Answer 6

-Iron deficiency is due to menses, lack of intrinsic factor, divalent cation (DMT-1 transporter), and vitamin C deficiency.
-Transferrin IBC levels will range between 300-410 Mg/L when individuals are deficient (F <10 Mg, M<12 Mg) TICN levels should be between 250-460 Mg/dL reflects liver function

Question 7

Vegan and vegetarians (dont eat meat) supplement

Answer 7

cyanocobalamin

Question 8

Aplastic Anemia

Answer 8

Cessation of red blood cell synthesis
-Eat a diet plant based diet rich in fresh fruits, vegetables, whole grains, and minimal animal protein.
-Drink plenty of water
-Foods to avoid : Raw or undercooked

Question 9

sickle cell anemia

Answer 9

Genetic disorder prevalent in the AA affecting 1 in 500. Also seen in individuals of hispanic descent.
-Lifespan of the sickled RBC is between 10-20 days not the typical lifespan of undamaged RBC.
-Homocysteine levels are elevated in many children due to subclinical B6 levels.
-Nutrition considerations: Higher caloric needs are increased metabolic rates.
-monitor blood serum levels for folate(400-600 Mg/day)
-zinc, copper, Vitamin A, C, D, E, Calcium and dietary fiber
-*DO NOT supplement with iron

Question 10

Hepatic disorders: Non alcoholic fatty Liver disease

Answer 10

Fibrosis or cirrhosis of the liver caused by an excess of fat in hepatocytes which can lead to hepatocyte damage with/without fibrous tissue in the liver known as NASH. Disease state is exacerbated by type II diabetes and obesity.

Question 11

Hepatic disorder: Cirrhosis or chronic hepatitis:

Answer 11

If untreated will lead to end stage liver disease

Question 12

Hepatic Disorder: Hemochromatosis

Answer 12

Inherited condition known as iron overload, recommended medical treatment is regular phlebotomy

Question 13

Hepatic disorder: Alcoholic hepatitis

Answer 13

Most individuals have malabsorption issues with most micronutrient, especially B1, B6, A,C, D, E &K

Question 14

Hepatic Disorders Nutritional considerations

Answer 14

-Increased energy requirements (protein is well tolerated at 1.5 g/Kg)
-small frequent meals
-Supplementation of most micronutrients
-low carb diet (for hyperglycemia)
-Low sodium intake to control fluid retention

Question 15

Hepatitis A, B, C

Answer 15

-Hep A: transmitted through fecal/oral contact by person-person considered an acute viral infection
-Hep B & C: Viral infection transmitted through tainted blood, sexual contact

Question 16

Hepatitis A, B, C Lifestyle recommendations

Answer 16

-Increase and maintain sufficient sleep hygiene
-Increase PA
-Whole food diet with limited saturated fat.

Question 17

Nutrition considerations (Hep A, B, C)

Answer 17

-Hep A: Replenish fluids with broths, and vegetable juice, avoid dehydration, avoid alcohol consumption.
-Hep B, C: reduce obesity, alcohol consumption, decrease saturated fats, refined flour, and sugar. Focus on whole food diet with plenty of fruits and vegetables.
-Hep C: Blueberries (proanthocyanidins), inhibits the replication of the HCV virus.
-Grapefruit and other citrus fruits (flavanoids)with antiinflammatory and antioxidant,
-Naringenin (lipid lowering abilities)
-Grapefruit contain furanocoumarins and flavanoids (inhibit P450 drug metabolism pathway)
-caffeine, 2 or more cups of caffeinated beverages lower hepatic steatosis (fat storage in the liver).

Question 18

Bone Disorders: Osteopenia, Osteomalacia, Osteoporosis, pagets disease

Answer 18

1. Osteopenia: Bones are weaker than they should be this is a precursor to the onset of osteoporosis
2. Osteomalacia: impaired mineralization of bone due to calcium & vitamin D3 deficiency.
3. Osteoporosis: Two types sedentary (caused by drug & disease process causes bone loss) and estrogen androgen deficiency (occurs in perimenopausal women, and the cessation of ovarian function with estrogen synthesis)
4. Paget’s disease: disease of the bone occuring in the pelvis, skull, spine and legs, use of bisphosphonates.

Question 19

Nutrition Consideration Bone Disorders

Answer 19

-Cessation of cigarette smoking and alcohol consumption
-Increase weight bearing exercise (high reps/low weight)
-Consume a whole foods diet with special attention to limiting diet fiber for vegans/vegetarians due to low intestinal calcium absorption.
-Recommendations for Calcium (1000 mg/day) Vitamin D3 (800-1000 IUs/day)
-Other important micronutrients: Vitamin A, K & phosphate

Question 20

Pulmonary disorders : COPD

Answer 20

COPD (chronic obstructive pulmonary disease): Asthma, chronic bronchitis, emphysema make up COPD, causing coughs, build up of mucus and difficulty breathing.
-Asthma: Chronic disorder causing airway remodeling, chest tightening, and breathlessness. Can be triggered by dietary allergies or GERD.
-Bronchitis (chronic Bronchitis) Inflammationof mucosal membrane
-Emphysema: Damage to the alveoli (air sacs) within the lungs.
-Nutritional considerations: Increased antioxidants such as Vitamin A, C, E, D, with plant based diet, probbiotics suggested for those on antibiotics therapies, use of PUFAs (fish oil), +++Decrease food allergens such as dairy, gluten, chocolate, spicy foods.

Question 21

Acute Bronchitis and Pneumonia

Answer 21

lung inflammation caused by bacterial or viral infections with symptoms including chest pain, fever and cough .

Nutrition: Supplement with NAC (N-Acetylcysteine), Vitamin C, E, adjunct therapy with Bromelain (enhance antibiotic absorption), garlic

Question 22

Pleural effusion:

Answer 22

Water on the lungs, caused by lung infections such as CF, Lung cancer, pneumonia , injury or heart failure, and tuberculosis.

-Tuberculosis: caused by bacterial parasite. Not common in U.S. Common in HIV patients, Drug resistant strains.
-Cystic Fibrosis: autosomal recessive inherited disease that causes impaired transport of chloride, sodium and bicarbonate. Build up pf thick mucus like secretion in the lungs, liver, pancreas, and reproductive system.

Nutrition: increase caloric intake. Patients need increased energy: high fat, high calorie diet. Malabsorption of fat soluble vitamins is impaired.
Zinc and iron deficiency
electrolyte replenishment (excessive sweating)
Increase water from 2-4 L/day

Question 23

Lung Cancer

Answer 23

Small lung cell cancer (Adenocarcinoma) or small lung cell cancers (sqaumous cell carcinoma, Large cell carcinoma)

Nutrition: Malnutrition is common. Appetite decreased due to treatment (chemo/radiation), weight loss/malabsorption of vitamins, minerals, macronutrients.
-small frequent meals that meet or exceed REE, rest before meals.
Ghrelin (administered to increase hunger)