Nutrition for IBD and the Integrated Care Model Flashcards
IBD has an ____ etiology
Unclear
_____ trigger may include diet
Environmental
What are potential factors that may also impact IBD?
-Effect on the microbiome
-Stress
-Use of antibiotics/NSAIDs
-Use of food additives, emulsifiers, processing, etc.
_____ predisposed individuals may have IBD as a response to environmental factors
Genetically
Role of diet in the prevention of IBD:
-A diet rich in fruit and vegetables, omega-3 fatty acids, and low in omega-6 fatty acids is associated with a decreased risk of developing CD or UC and is therefore recommended
-Breastfeeding can be recommended because it is the optimal food for infants and it reduces the risk of IBD
____ of the microbiota has the potential for involvement in the pathogenesis of IBD
Dysbiosis
What nutrition interventions have shown potential anti-inflammatory properties?
-Specific carbohydrate diet
-Mediterranean diet
-Anti-inflammatory diet for IBD
-Crohn’s disease exclusion diet
What should be included in the nutrition assessment for IBD?
-Remission vs acute disease
-Chron’s disease vs UC
-Location in GI tract, severity, strictures
-Surgical history
-Food-drug interactions (corticosteroids, methotrexate, sulfasalazine)
-Social history/food access
-Review of pertinent labs
-NFPE
-Diet recall
-Food allergies
-Chewing/swallowing
-Food fear
-Changes in GI function
What are pertinent labs to look at in people with IBD?
-Vitamin D and B12
-CBC, CMP
-Iron
-If increased fluid loss (diarrhea, ostomy output), zinc and urine sodium
-Thiamine, folate, B6, B12, vitamin C, Selenium, Magnesium
What increases the risk of malnutrition in those with IBD?
-Decreased oral intake
-Increased metabolic needs from inflammation/active disease
-Difficulty absorbing nutrients (ex: B12)
-Surgical alteration of GI tract
-Medication side effects
-Sarcopenia
-Food insecurity
What are negative effects of malnutrition on those with IBD?
-More likely to be hospitalized after ED visit
-Increased rates of hospital admission due to infection
-While hospitalized, increased risk of blood clots, non-elective surgery, increased length of stay, and increased mortality
____% of those with Crohn’s Disease develop Sarcopenia and ____% of those with Ulcerative Colitis develop Sarcopenia
52; 37
People with a BMI over ____ can still be malnourished
25
19% of patients with sarcopenia have a BMI over 25 and ____% have a normal BMI
41
What are two possible screening tools for malnutrition?
-Malnutrition Screen Tool (MST)
-Malnutrition Universal Screening Tool (MUST)
What are examples of nutrition interventions for IBD?
-Therapeutic diets
-Identification of food intolerances/restrictions (assessment of ARFID)
-Diet education: verbal and written
-Micronutrient supplementation
-Motivational interviewing, goal setting
-Need for EN/PEN
-Referral to resources
We should set up a consistent ___-___ frequency and do goal-setting with the patient to improve compliance
Follow-up
What are the goals of MNT for IBD?
-Optimize nutrition status
-Relief of digestive symptoms
-Reduction of inflammation
-Assess quality of life
MNT for IBD should be ____
Individualized
If someone with IBD has no strictures/obstructive disease, we should encourage _____ intake (we may need to adapt texture)
Fiber
We should promote a nutritionally ____ plate with whole foods
Balanced
We should also try to recognize and identify gut ____ and food ____
Irritants and intolerances
For someone with active IBD, the goal should be ____ calorie and protein diet; we can recommend small, frequent meals
High
For someone with active IBD, we should try to avoid over-restriction of foods like ____; we can make foods soft and encourage chewing
Fiber
If someone has active IBD, we should increase ____ fibers and decrease ____ fibers
Soluble; insoluble
For someone with active IBD, we should try to decrease food-related digestive symptoms by recognizing common ____ like lactose, sugar alcohols, spicy/hot foods, greasy foods, alcohol, caffeine, etc)
Triggers
If someone has active IBD, we should recommend adequate calories, protein, and nutrients; we can recommend over-the-counter _____ and/or vitamin and mineral supplements
ONS (oral nutrition supplements)
Someone with active IBD should get ___-___ g/kg of protein per day
1.2-1.5
If someone has anemia, they should receive ____ ____
IV iron
If someone has inactive IBD, they should get about ____ g/kg of protein per day
1
Calorie recommendations for someone with IBD should be ____ depending on goals
Individualized
A Vitamin D deficiency would mean that there was less than ____ ng/ml in the serum
20
If someone was diagnosed with vitamin D deficiency, they should get ____ IU of vitamin D2 weekly for 12 weeks and have their levels rechecked in 3 months
50,000
A vitamin D insufficiency would mean that there was between ___-___ mg/ml of serum
20-30
If someone was diagnosed with vitamin D insufficiency they should get ____ IU of vitamin D3 daily and have their levels rechecked in 3 months
4,000
Vitamin D maintenance is indicated if someone has over ___ mg/ml of vitamin D in the serum
30
If someone has over 30 ng/ml of vitamin D in their serum, they should get ___-___ IU of D3 daily (depending on weight, race, and pregnancy)
2000-4000
Toxicity of vitamin D occurs with levels of ____ ng/ml or more
100
The goal for those with IBD should be over ____ micrograms/ml of vitamin B12
400
What are examples of dosage forms of vitamin B12?
-IM
-Oral
-Sublingual
Replacement method of B12 is based on preference and absorption; ___ and ___ forms are just as effective as replacement with injection
Oral and sublingual
Oral B12 replacement would be ___-___ mcg daily, rechecking level in 3 months
1000-2000
Injection of B12 replacement would be ____ mcg/ml weekly for 4 weeks and then monthly; recheck levels in 3 months
1000
Vitamin B12 is ____ soluble, so it is tolerated at high doses
Water
There is some evidence for use of probiotics like Visibiome for those with mild to moderate ___ ___ to induce remission
Ulcerative colitis
Probiotic use has shown to be ____ in Crohn’s disease
Ineffective
What are important eating behaviors to consider for those with IBD?
-Chewing thoroughly
-Spacing and size of meals
-Sitting up straight
-Eating slowly
-Mealtime environment
What are two goals for therapeutic diets for Crohn’s disease?
-Whole foods, nutritionally balanced
-Identification/avoidance of gut irritants/food intolerances
What are some examples of therapeutic diets for Crohn’s disease?
-Mediterranean diet (whole foods, increase physical activity, antioxidants)
-Specific carbohydrate diet
-Anti-inflammatory diet for IBD
-Crohn’s disease exclusion diet
-Exclusive enteral nutrition (pediatrics)
What foods should be increased in those with Crohn’s disease?
-Vegetables
-Fruits
What foods should be limited with Crohn’s disease?
-Saturated and trans fats
-Emulsifiers
-Carrageenans
-Artificial sweeteners
-Maltodextrins
-Titanium dioxide
What foods should be increased in someone with ulcerative colitis?
-Omega 3 oils from fish and food
What foods should be limited in someone with ulcerative colitis?
-Red meat, processed meat
-Dairy fat, palm, and coconut oil
-Saturated fat and trans fat
-Emulsifiers
-Carrageenan
-Artificial sweeteners
-Maltodextrins
-Titanium dioxide
The ____ ___ diet is low in starchy vegetables, grains, processed/added sugars, lactose, and artificial ingredients
Specific carbohydrate
The specific carbohydrate diet aims for diversity of…
-Produce
-Nuts
-Animal proteins
-Yogurt
-Aged cheese
With the specific carbohydrate diet, there is a risk of insufficient intake of…
-Calcium
Vitamin D
-Vitamin A
-Potassium
-Thiamin, folate, pyridoxine
-Vitamin E
The IBD ___-___ diet is modified from the specific carbohydrate diet
Anti-inflammatory
The IBD anti-inflammatory diet contains more ____ and ___ foods, as well as omega ____ fats
-Prebiotic
-Probiotics
-3
What types of foods are included in the IBD anti-inflammatory diet?
-Soluble fibers such as ground flax, lentils, or oats
-Beans, nuts, avocado, fish
-Probiotic foods such as kefir, miso, yogurt, sauerkraut
-Prebiotic foods such as leeks or artichokes
The IBD anti-inflammatory diet is low in ____ carbohydrates (refined sugars, grains with gluten)
Complex
The anti-inflammatory diet restricts…
-Emulsifiers
-Maltodextrins
-Milk (unless fermented)
-Sweeteners
There are ___ phases of the anti-inflammatory diet that allow for slow progression of textures and the progression depends on disease status
3
Preliminary research shows improved ___ symptoms from the anti-inflammatory diet, but more research is needed
Clinical
The Crohn’s disease exclusion diet decreases foods that may harm the ____ or ___ ___
Microbiome or intestinal barrier
The Crohn’s disease exclusion diet has three phases that start with ____ ____nutrition and whole foods (progressed to just whole foods)
Partial enteral
The Crohn’s disease exclusion diet avoids…
-Emulsifiers
-Coffee
-Alcohol
-Canned foods
-Dairy
-Soy
-Gluten
-Processed foods
The Crohn’s disease exclusion diet encourages what foods?
-Fruits
-Vegetables
-Chicken
-Fish
The Crohn’s disease exclusion diet shows promise to be comparable in efficacy to ____ ____ nutrition, but more compliance
Exclusive enteral
Crohn’s disease exclusive diet has caused induction of ____ and decreased ____
Remission; inflammation
The Crohn’s disease exclusion diet used whole foods and may be used as ____ therapy
Maintenance
The Crohn’s disease exclusion diet showed improved _____ and reduction in intestinal permeability
Dysbiosis
It has been shown that a low-fat diet (10% kcal from fat) decreased ____ markers and improved dysbiosis
Inflammatory
