MNT Review I Obesity - GI Diseases

Question 1

Why is the Roux-en Y Gastric Bypass Surgery an effective treatment for Obesity?

Answer 1

It limits consumption of food as well as nutrient absorption.

Question 2

MNT of Roux-en Y Gastric Bypass Surgery (BONE)

Answer 2

(BONE) 1) Begin with clear liquids and gradually add foods as tolerated 2) Often adverse to red meat (may be short term or long term) 3) No white bread (unless toasted) for first few months 4) Emphasize consuming protein, iron, vitamin B12, folate, and calcium (will often need to supplement)

Question 3

What effects do the sleeve gastrectomy and adjustable banding have on the patient?

Answer 3

Both only restrict the size of the stomach, while retaining the ability of the GI tract to absorb nutrients.

Question 4

What are three goals of the American Heart Association and the American College of Cardiology and Lifestyle Management?

Answer 4

1) Reduce the risk of CVD to include heart disease 2) Focus on lowering cholesterol and blood pressure levels- two major risk factors for heart disease 3) Focus on Diet and physical activity.

Question 5

Physical activity recommendations

Answer 5

3-4 times/week with each session lasting 40 minutes

Question 6

Sodium recommendations for those with high blood pressure

Answer 6

2400 mg of sodium/day and ideally reducing to 1500 mg/day

Question 7

What is the major goal for patients recently suffering from Myocardial infarction of a CABG?

Answer 7

Reduce the workload of the heart

Question 8

Protocol For MI and CABG (Initial diet, restriction, and healing)

Answer 8

1) Liquid diet for first 24 hours 2) Progress to regular foods 3) smaller more frequent meals to better tolerate and reduce the workload of the heart. 3) possibly restrict Na, saturated fats, and fluids 4) Increase protein intake to encourage healing.

Question 9

What is the goal for CHF?

Answer 9

Minimize the consequences of Edema

Question 10

MNT for edema for CHF (Sodium, Fluids, Meals)

Answer 10

1) Reduce sodium (2g) 2) Reduce fluids ( x less than 2000 ml) 3) small frequent meals.

Question 11

What is the major goal for cystic fibrosis patients?

Answer 11

Meet high energy/protein needs, replacement of pancreatic enzymes, replace sodium lost in sweat.

Question 12

MNT for Cystic Fibrosis (Salts and Fluid, Vitamins, Enzyme, Macronutrients)

Answer 12

Liberal salts and fluid, multivitamins (especially fat soluble), pancreatic enzyme replacements with meals, may need to utilize protein, and carbohydrate supplements to boost energy and protein intake.

Question 13

COPD/Emphysema Goal (Nutrition Status, Stores, Lung muscle, RQ)

Answer 13

1) Minimize weight loss and malnutrition 2) Replete nutrient stores or at a minimum maintain current nutrient stores 3) Maintain lung muscle to maintain function and prevent lung infections 4) Avoid raising RQ.

Question 14

MNT for COPD/Emphysema (Calories & Protein, Replacement, Minerals)

Answer 14

1) High-Calorie/High-protein without overfeeding 2) May need to replace carbohydrate calories with fat calories 3) adequate intake of Mg, Ca, and phosphorus to maintain muscle contraction and relaxation.

Question 15

What is the major goal for patients experiencing achalasia?

Answer 15

Enhance the ability to eat/management of pain/discomfort

Question 16

MNT for Achalasia ( Composition of food, size of meals, speed, avoidance)

Answer 16

1) Semisolid food or liquid foods as tolerated (thickened liquids work the best 2) small, frequent meals tolerated 3) Eat Slowly 4) Avoid citrus juices/spicy foods

Question 17

What is the major goal for patients with GERD/ Hiatal Hernia?

Answer 17

Prevent pain/reflux/decrease acidity of gastric secretions

Question 18

MNT for GERD/Hiatal Hernia (Avoidance and Behaviors)

Answer 18

Avoid (alcohol, high pH foods and drinks, fat, mint, chocolate, caffine, smoking, lying down after meals, wait 3H before bed, raise upper portion of bed 4-8 inches).

Question 19

What is the goal of Gastritis and Peptic Ulcer Disease?

Answer 19

Minimize pain and discomfort/decrease acidity of gastric secretions

Question 20

MNT for Gastritis and Peptic Ulcer Disease (Avoidance)

Answer 20

1) Decrease consumption of alcohol, coffee, caffeine, black and red pepper if cause discomfort. 2) Food avoidance. (Ones that cause discomfort).

Question 21

What is the goal for Dumping Syndrome?

Answer 21

Minimize the symptoms of abdominal fullness and nausea, diarrhea, and hypoglycemia

Question 22

MNT for Dumping Syndrome (Size of meals, protein/carbohydrates, behavior, liquids, fats, and time)

Answer 22

1) Small meals 2) High protein/complex carbohydrates 3) Lie down after eating 4) Liquids 30-45 minutes before or after meals and not with meals 5) MCT may be necessary 6) Fiber supplements reduce upper GI transit time and decrease rate of glucose absorption.

Question 23

MNT for constipation ( Fiber and Fluids)

Answer 23

1) 14g of fiber/1000kcal/day adults (insoluble and soluble) 2) minimum of 2 quarts per day of fluid 3) Physical movement

Question 24

MNT Diarrhea (Fluids, gut, Foods, and Limit)

Answer 24

1) Fluids ( replace fluids and electrolytes) 2) Do not rest the gut-need to be fed to repair 3) Foods such as bananas, rice, applesauce, tea, toast, and yogurt are often well tolerated 4) Limit lactose, fructose, and sucrose

Question 25

What is the goal for malabsorption/steatorrhea?

Answer 25

Correct nutritional deficiency

Question 26

MNT for Malabsorption/Steatorrhea ( Fat restriction, TAGs, Enzyme, vitamins and minerals, and weight)

Answer 26

1) 25-50 g Fat restriction 2) Use of medium chain triglycerides 3) Supplement vitamins and minerals (Fat soluble Vitamins and Calcium/Zinc/Magnesium) 4) Enzyme: Pancreatic lipase 5) Minimize weight loss.

Question 27

What is the main goal for celiac disease?

Answer 27

Address the primary cause/support regeneration of villi

Question 28

MNT for celiac disease (Gluten-sensitive enteropathy, non- tropical sprue)

Answer 28

Gluten free diet (eliminate wheat, rye, oats, and barely). and secondary lactose intolerance common

Question 29

Goal for lactose intolerance

Answer 29

Avoid or at least minimize symptoms. Does not cause damage to the GI tract.

Question 30

MNT for lactose Intolerance

Answer 30

1) Consume small amounts of lactose with food as tolerated 2) whole milk and chocolate milk better tolerated ( Fat slows down digestion and absorption) 3) aged cheeses are low in lactose 4) Unpasteurized yogurt 5) Lactaid added to products.

Question 31

Goal Fructose malabsorption

Answer 31

Avoid or at least minimize symptoms. Does not cause damage to the GI tract

Question 32

MNT for fructose malabsorption

Answer 32

1) Avoid honey 2) avoid fruit and vegetable servings. Choose vegetables with lower levels of fructose 3) Limit HFCS beverages

Question 33

Goal for IBD/Crohn’s/And Ulcerative Colitis

Answer 33

Alleviate symptoms and correct nutritional deficiencies MNT depends on the disease process.

Question 34

Exacerbation MNT (IBD/CD/UC)

Answer 34

Low Fiber, small frequent feedings, liquid oral supplements, MCT if steatorrhea, Lactose restriction if secondary lactose intolerance, Acute attacks may require elemental tube feeding or PN to allow complete bowel rest, TF with MCT oil, glutamine, and arginine may also be beneficial.

Question 35

Remission MNT (IBD/CD/UC)

Answer 35

increased diet as tolerated, maximize energy and protein intake, consumption of foods high in antioxidants and omega-3 fatty acids may protect against inflammation pre/probiotics

Question 36

Goals for Irritable Bowel Syndrome

Answer 36

Reduce Colon spasms/normalize bowel movements

Question 37

IBS MNT

Answer 37

FODMAP elimination diet, elimination of specific carbohydrate containing foods with re-introduction as tolerated (fructose, lactose, fructans, galactans, and polyols).

Question 38

Phases of FODMAP

Answer 38

1) Eliminate 2) Challenge 3) Maintenance

Question 39

Diverticulosis MNT

Answer 39

High Fiber, 10 cups of fluid/day, may want to avoid seeds, nuts, skins if cause problems

Question 40

Diverticulitis MNT

Answer 40

Low Fiber, avoid nuts, seeds, and fibrous vegetables

Question 41

Short Bowel Syndrome MNT (Meal number, supplement types, fluid recommendations)

Answer 41

1) 4-6 meals/day 2) Soluble fiber supplements and mineral supplements (Ca, Mg, Zn) in chewable or liquid forms

Question 42

Hemochromatosis goal (Iron)

Answer 42

Control iron intake and maintain serum ferritin level below 50 mg/dL in order to prevent damage to various organs including the liver.

Question 43

Hemochromatosis MNT

Answer 43

1) No alcohol, no iron supplement or fortified cereal, and moderate intake of iron containing foods.

Question 44

Goals for Liver MNT vitamin/mineral deficiencies)

Answer 44

correct/prevent vitamin and mineral deficiencies. (especially thiamin and vitamin B)

Question 45

Goals for Liver MNT (Protein)

Answer 45

1) Provide adequate protein to promote liver regeneration and to prevent catabolism of body protein tissue (Increase BCAA and decrease AAA) if Hepatic encephalopathy is present utilize Hepatic-Aid II enteral feeding

Question 46

Goals for Liver MNT (Weight)

Answer 46

Prevent/control weight loss

Question 47

Goals for Liver MNT (Carbohydrate intake)

Answer 47

carbohydrate intake should be adjusted to account for hyperglycemia or hypoglycemia (Avoid NPO status for longer than 6-8 hours to prevent hypoglycemia)

Question 48

Goals for Liver MNT (Steatorrhea)

Answer 48

Prevent or treat steatorrhea (May need to restrict fat or provide MCT sources)

Question 49

Goals for Liver MNT (ascities)

Answer 49

Control ascities