MNT Hepatic Flashcards
Chronic Liver disease (cirrhosis)
Includes Hep C and B, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis
-Malnutrition- inadequate oral intake, early satiety, dysgeusia (dysfunction of sense of taste), nausea, vomiting, maldigestion, malabsorption, restricted diet.
-Metabolic abnormalities
Nutrition Management/Requirements
-Increased energy intake from small, frequent meals
-1-1.8 g/kg protein/day (preferably plant protein)
-NA restriction for fluid retention
-Fluid restriction for hyponatremia (concentration of sodium is very low)
-CHO-controlled diets for hyperglycemia
-Vitamin mineral supplements (Zn, Mg, BCAA, probiotics, L-carnitine, acetyl-L-carnitine, K2, D taurine, PUFAs, E, A, B12, B6, Choline, Thiamine, Se.
-Oral liquid supplements
Coma
-Medical critical care
-Enteral or parenteral feedings sufficient to maintain nutritional status
Colorectal Cancer
Risk factors/Primary issuea
-obesity
-chlorinated water
-Grilled, well done meat, poultry, fish
-Alcohol
-Protein calorie malnutrition
-Micronutrient deficiencies
Nutrition Management:
-Protective: Fruits, vegetables, dietary fiber, green tea, soy, garlic, vitamin C, se, Zn, vitamin A, Mg, CoQ10, K2, Vitamin D, Vitamin E
-W/Chemotherapy- antioxidants, N-Acetyl-Cysteine, glutamine, vitamin E
-Prebiotics/probiotics,- increase SCFAs in GI
-Reduce beef, alcohol, hydrogenated PUFAs, lard, insoluble dietary fiber, corn oil- these stimulate diamine oxidase
- Ca, rice, fruits, beans, vegetables, fish oils, folic acid-inhibits diamine oxidase
-Increase exercise- maintain bone density
Constipation
Primary issue/Risk Factors
-Insufficient water intake
-medications
-inactivity
-Imbalance gut microbiome
-Laxative abuse
-ignoring urge to defecate
-Inadequate fiber
-Hypothyroidism
-Hypochlorhydria
Nutrition:
-Increase fluid intake
-Increase physical activity
-Increase dietary fiber-prebiotics/probiotics
-Evaluate for diary sensitvity
-prunes
-flaxseed
-Mg, vitamin C, Bile salts
Diabetes mellitus, CHO, Intolerance
Primary Issue/Risk Factors
-Type I-poor glycemic control, no insulin, autoimmune–Inflammation, minimize triggers
-Type II- poor glycemic control–decreased cell sensitivity, Increased insulin resistance, stop producing insulin, Obesity, physical activity, processed /refined foods
-Metabolic abnormalities
-Free radicals
-protein glycation
-sorbitol accumulation
Nutrition:
-Primary interventions: Diet, exercise, weight loss
-smaller, more frequent meals
-cooking methods- low heat
-Restrice: alcohol, simple sugars, saturated fats
-Promote: whole foods, garlic, onions, legumes, dietary fiber
-Supplements: Cr, biotin, B6, B12, Mg, ALA, thiamine, Zn, vitamin E, vitamin C, Vitamin D, pancreatic enzymes.
Osmotic diarrhea
Primary issues/risk factors:
Osmotically active solutes present in intestinal tract and poorly absorbed. Certain types of Mg, lactose, dumping syndrome
Exudative diarrhea
Mucosal damage- mucus, fluid, blood, plasma proteins, electrolytes, and water in the gut. Associated with Crohn’s, UC, radiation enteritis
Secretory Diarrhea
Intestinal epithelium secrete electrolytes, water- bacterial exotoxins, viruses, increased hormone secretion
limited mucosal contact diarrhea
Inadequate mixing of chyme, insufficient contact of chyme with intestinal epithelium. Bacterial overgrowth. Crohn’s
Nutrition Management for Diarrhea
- Id and treat underlying problem- look for food allergies/sensitivities, hypochlorhydria, candidiasis, parasite, gut imbalance
-Replace fluid, electrolytes (broths, coconut water)
-Probiotics
-soluble fiber
-Increase healthy fats
-Consider folate, B12 supplementation
-Remove intake of sugar alcohols, lactose, fructose, sucrose, coffee
Diverticular disease
risk factors/primary issues
-Saclike herniations in colonic wall
-Increased age, colonic structure, slow mobility, low fiber intake.
Nutrition:
-High fiber diet-increase gradually to minimize bloating/gas
-2-3 liters/day water
-During a flare- low residue diet may be necessary, followed by gradual return to high fiber
-There are no data to support restriction of seeds, nuts, plant skins- although most patients are told to do this.
Dumping syndrome
Primary issues/risk factors
-Stomach empties rapidly - incorporately acidified food into small intestine
-Maldigestion
-Diarrhea
Nutrition:
-small meals more frequently
-less solid, more crushed foods
-increased soluble fiber
- High protein, moderate fat, low starch
-Avoid high liquid intake with food, simple sugars, milk (osmotic)
-Supplement with MCTs, pectin, digestive enzymes, MVMs
Gallbladder issues
Risk Factors
-Cholecystitis (Inflammation of gall bladder)
-Cholelithiasis (gallstones)
-Obesity
-Excess Fat
-Weight cycling, fasting, very low calorie diets
- Fat maldigestion
-Malabsorption of fat soluble vitamins
Nutrition:
-Check for food allergies, sensitivities
-Check for hypochlorhydria (deficiency of stomach acid)
-Vegetarian diet high in fiber
-Reduce refined carbs, saturated fat, cholesterol, animal protein
-Healthy fats- 25-30% of calories
-Elimination diet
-Increase physcial acitivity
-vitamin C, water soluble forms of fat soluble vitamins
Hyperlipidemia
Borderline: C=170-199, LDL-C=110-129
HIgh: C=>=200, LDL-C>=130
Nutrition:
Reduce saturated fat, Trans Fat, Dietary cholesterol, XS body weight, refined sugar, refined CHO
-Increase PUFAs, dietary fiber, (esp. Water soluble) plant stanols?sterols, soy protein, legumes, vegetarian diet
-Eat breakfast, regular meals
-Ca, Mg, Cr, low dose niacin
Hypertension
Normal: < 120/<80
-Prehypertension: 120-139/80-89
-Stage 1: 140-159/90-99
-Stage 2: >=160/>=100
Nutrition:
Emphasize raw foods, fruits, veggies, nuts, seeds, legumes, whole grains, fish, olive oil, onions, garlic
-Decrease sodium chloride, weight, caffeine
-K, Mg, Ca balance, CoQ10, Vitamin D, Vitamin C, B-Complex, fish oil
-Evaluate for food allergies, sensitivities
