Nutrition Flashcards
- Digestion starts in the mouth (Salivary amylase
- continues in the small bowel (salivary amaylase inhibited by gastric acid)
- pancreatic amylase
- brush border enzymes
- absorption in small bowel- monosaccharides rapidly prior to terminal ileum
Carbohydrates
- Minimal digestion in the mouth
- major site digestion in stomach (requires acidity, pepsin breaks down, b12 cleaved)
- continues in small bowel (pancreatic peptidase)
- absorption in small bowel (carrier mediated)
Protein
- Digestion starts in mouth (lingual lipase)
- continues in small bowel (pancreatic lipase; bile acid needed to emulsify)
- end products- fatty acids, glycerol, monoglycerids, fat soluable vitamins (A,D,E,K)
- Absorption in small bowel- most in the ileum
Fat
Constipation nutrition therapy
Adequate fiber intake
- adult women- goal 21-25g/d
- adult men- gol 35-38 g/d
- gradually increase intake
Adequate hydration
- general recommendation 30ml/kg or 1ml/kcal
- needs are proportional to muscle mass
Physical activity
- consider fiber supplementation (wheat bran, psyllium, methlycellulose
Establish regular pattern of eating and stooling
Diarrhea Nutrition therapy
- Restore fluid/electrolyte balance (oral rehydration solutions)
- review meds/supplements
- evaluate for diertary triggers
- thicken stool and slow motility
- consider vitamin/mineral supplementation
- ensure nutrition adequacy
- probiotic?- depends
what is considered a trigger for diarrhea?
- caffeine
- FODMAPs
- high fat meals
- alcohol
- Lack/reduction in lactase enzymes resulting in gastrointestinal symptoms
- presents as bloating, flatulence, cramping, pain, diarrhea (symptoms depend on level of lactase activity and lactose load
Lactose intolerance
what is primary and secondary lactase deficiency?
Primary lactase deficiency
- genetically programmed
- irreversible
- occurs in 80-90% african and asian americans
Secondary lactase deficiency
- Surgical resection
- inflammation
- radiation
- medications
- may reverse
Lactose intolerance nutrition therapy (no need to cut all dairy)
- limit or avoid high lactose containing foods (spread intake throughout day)
- consume low lactose dairy products (lactose free milk, cheddar and swiss, most yogurts
- lactase enzymes
- consider calcium supplementation if not meeting needs (requires adequate vitamin D)
- therapy option for IBS (more recent studies in queiscent IBD, fecal incontinence
- short term, learning, phasic diet
- not intuitive or simple, strongly advise dietitian guidance
FODMAPs diet
who is the FODMAP diet inappropriate for?
- non-confirmed IBS
- hx of eating disorders
- significant weight loss
- people that don’t eat FODMAPs
- people who cannot cook or limited access
- not a low fiber diet
GERD nutrition therapy
- weight reduction when appropriate
- avoid/reduce foods that lower LES pressure (alcohol, spearmint, peppermint, chocolate, coffee)
- avoid/reduce foods that increase gastric acidity (alcohol, caffeine, pepper)
- low fat diet About 50-60 grams daily
- small frequent meals
- upright after eating
- mindfulness eating behaviors
- may help to avoid spicy and acidic foods but as clear
* loose fitting clothing, appropriate sleep conditions, smoking cessa.
- Autoimmune digestive disease in response to gluten ingestion that results in intestinal mucosa damage
- results in malabsorption of nutrients (macros, calcium, iron, folate, vitamin D and B12, electrolytes with persistent diarrhea)
- only treatment is gluten free diet
Celiac disease
intestinal symptoms of celiac disease?
- diarrhea or constipation
- abdominal pain
- bloating/gas
- cramping
- steatorrhea
extraintestinal signs and symptoms of celiac disease?
- fatigue
- anemia
- neurological disorders
- joint pain
- skin rash- dermatitis herpetiformis
- osteoporosis
- amenorrhea
- infertlity
diagnosis of celiac’s disease
duodenal biopsy- (6-8 samples) Gold standard
- patient must consume gluten for at least 2 weaks prior, 4-6 is ideal
serology is supportive
- tTG- IgA (tissue transglutaminase antibodies)
- total IgA recommended to avoid false negative result
Genetic testing is supportive but not diagnostic
resolution of symptoms on GFD is not a diagnosis of CD
Celiac disease nutrition therapy
Lifelong avoidance of gluten
- relief of sx typically after 2-4 weeks GFD
- resolution of maldigestion and malabsorption
What about oats
- restict frist 6 months on GFD
- recommend “certified” gluten free oats
Assess anthropometric changes, NFPE
Educate/ counsel
Test and Treat nutrient deficiencies
- (iron, folic acid, vitamin D, B12, A, Zn, Cu; BMD rec’d
Long term follow up
common nutritional consequences on GFD?
- Lactose intolerance (likely to resovle)
- constipation (lack of fiber)
- weight gain (improved dietary intake, improved absorption)
- nutrient deficiency
symptoms of IBD?
- Loss of appetite
- reduced intake
- weight loss
- altered metabolism
- increased energy needs
- nutrition deficiences
inflammatory bowel disease nutrition therapy
- There is no single diet proven for IBD
- balanced diet with individualized features
general guidelines
- high protein diet, may be high calorie
- possibly reduced lactose
- small frequent meals
- adequate fluids
can help maintain healthy weight, nutrition status, prevent/man. SX
Nutrition therapy for IBD during active disease/flares
- Low Fat usually helpful
- continue high protein
- limit lactose intake
- limit fructose
- limit sorbitol and other sugar alcohols (medications - liquid tylenol, gum, sugar-free beverages
Low residue diet
- may be beneficial with strictures
- avoidance of nuts, seeds, corn, potato skins, raw vegetables, skins of fruits
HYDRATION
- electrolytes are lost, gatorade and juice may not be well tolerated
- choose pedialyte, drip drop, or low sugar ensure/boost
what micronutrient deficiencies should you be aware of in IBD?
- calcium- if avoiding dairy, chronic corticosteroid use
- Vitamin D- fat soluable, consider area affected
- iron- blood loss in stool, decreased intake
- potassium- diarrhea, prednisone therapy
- zinc, magnesium- diarrhea or surgery
- folate- decreased intake, sulfasalazine & methotrexate therapy
- b12- absorption requires functioning ileum, decrease intake
- imperative for digestion and absorption of food
- exocrine portion responsible for secretion of: amylase, lipase, carbohydrase etc
- produces 1.0-2.5L of exocrine solutions per day
- output decreased during fasted state, though there is basal flow
Pancreatic exocrine insufficiency
Pancreatic exocrine insufficiency nutrition therapy
- low fat diet may help control pain but can further caloric deficit
- insufficient evidence regarding MCTs
- use of pancreatic enzyme supplementation: Aid in digestion of fat so no need to limit, alleviate diarrhea, maintain normal nutrition, make sure to take with meals
indications of enteral nutrition
oral intake unsafe
- dysphagia, GI obstruction, aspiration
Oral intake insufficient
- acute pancreatitis, chronic liver disease, chron’s, diabetic gastroparesis, neoplasm, anorexia
Oral intake impossible
- Coma or unresponsive, respiratory failure, critical illness
GI TRACT MUST BE FUNCTIONAL
benefits and drawbacks of enteral nutrition?
Benefits
- supports gut functional integrity
- maintain gut associated immune function
- reduced infectious complications
- cost is less than parental
Drawbacks
- may not be well tolerated
- requires great commitment and safety measures as an outpatient
indications for parenteral nutrition
- failed EN
- GI tract inaccessible or unsafe
- non-functional GI tract:
- bowel rest: graft vs. host, severe persistent colitis
- DO NOT USE WHEN THE GUT WORKS!
Benefits and drawbacks of parenteral nutrition?
Benefits
- may be necessary in certain clinical situations to improve markers of nutritional status
Drawbacks
- rarely shown to improve patient outcomes
- metabolic complications
- mechanical complications
- increased risk infection
- more time and resources vs EN
