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Advanced Medical Nutrition Therapy II > Nutrition for IBD and the Integrated Care Model > Flashcards

Nutrition for IBD and the Integrated Care Model Flashcards

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USMLE® Step 1 flashcards
1
Q

IBD has an ____ etiology

A

Unclear

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2
Q

_____ trigger may include diet

A

Environmental

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3
Q

What are potential factors that may also impact IBD?

A

-Effect on the microbiome
-Stress
-Use of antibiotics/NSAIDs
-Use of food additives, emulsifiers, processing, etc.

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4
Q

_____ predisposed individuals may have IBD as a response to environmental factors

A

Genetically

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5
Q

Role of diet in the prevention of IBD:

A

-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

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6
Q

____ of the microbiota has the potential for involvement in the pathogenesis of IBD

A

Dysbiosis

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7
Q

What nutrition interventions have shown potential anti-inflammatory properties?

A

-Specific carbohydrate diet
-Mediterranean diet
-Anti-inflammatory diet for IBD
-Crohn’s disease exclusion diet

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8
Q

What should be included in the nutrition assessment for IBD?

A

-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

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9
Q

What are pertinent labs to look at in people with IBD?

A

-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

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10
Q

What increases the risk of malnutrition in those with IBD?

A

-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

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11
Q

What are negative effects of malnutrition on those with IBD?

A

-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

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12
Q

____% of those with Crohn’s Disease develop Sarcopenia and ____% of those with Ulcerative Colitis develop Sarcopenia

A

52; 37

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13
Q

People with a BMI over ____ can still be malnourished

A

25

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14
Q

19% of patients with sarcopenia have a BMI over 25 and ____% have a normal BMI

A

41

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15
Q

What are two possible screening tools for malnutrition?

A

-Malnutrition Screen Tool (MST)
-Malnutrition Universal Screening Tool (MUST)

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16
Q

What are examples of nutrition interventions for IBD?

A

-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

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17
Q

We should set up a consistent ___-___ frequency and do goal-setting with the patient to improve compliance

A

Follow-up

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18
Q

What are the goals of MNT for IBD?

A

-Optimize nutrition status
-Relief of digestive symptoms
-Reduction of inflammation
-Assess quality of life

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19
Q

MNT for IBD should be ____

A

Individualized

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20
Q

If someone with IBD has no strictures/obstructive disease, we should encourage _____ intake (we may need to adapt texture)

A

Fiber

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21
Q

We should promote a nutritionally ____ plate with whole foods

A

Balanced

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22
Q

We should also try to recognize and identify gut ____ and food ____

A

Irritants and intolerances

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23
Q

For someone with active IBD, the goal should be ____ calorie and protein diet; we can recommend small, frequent meals

A

High

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24
Q

For someone with active IBD, we should try to avoid over-restriction of foods like ____; we can make foods soft and encourage chewing

A

Fiber

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25
Q

If someone has active IBD, we should increase ____ fibers and decrease ____ fibers

A

Soluble; insoluble

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26
Q

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)

A

Triggers

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27
Q

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

A

ONS (oral nutrition supplements)

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28
Q

Someone with active IBD should get ___-___ g/kg of protein per day

A

1.2-1.5

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29
Q

If someone has anemia, they should receive ____ ____

A

IV iron

30
Q

If someone has inactive IBD, they should get about ____ g/kg of protein per day

A

1

31
Q

Calorie recommendations for someone with IBD should be ____ depending on goals

A

Individualized

32
Q

A Vitamin D deficiency would mean that there was less than ____ ng/ml in the serum

A

20

33
Q

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

A

50,000

34
Q

A vitamin D insufficiency would mean that there was between ___-___ mg/ml of serum

A

20-30

35
Q

If someone was diagnosed with vitamin D insufficiency they should get ____ IU of vitamin D3 daily and have their levels rechecked in 3 months

A

4,000

36
Q

Vitamin D maintenance is indicated if someone has over ___ mg/ml of vitamin D in the serum

A

30

37
Q

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)

A

2000-4000

38
Q

Toxicity of vitamin D occurs with levels of ____ ng/ml or more

A

100

39
Q

The goal for those with IBD should be over ____ micrograms/ml of vitamin B12

A

400

40
Q

What are examples of dosage forms of vitamin B12?

A

-IM
-Oral
-Sublingual

41
Q

Replacement method of B12 is based on preference and absorption; ___ and ___ forms are just as effective as replacement with injection

A

Oral and sublingual

42
Q

Oral B12 replacement would be ___-___ mcg daily, rechecking level in 3 months

A

1000-2000

43
Q

Injection of B12 replacement would be ____ mcg/ml weekly for 4 weeks and then monthly; recheck levels in 3 months

A

1000

44
Q

Vitamin B12 is ____ soluble, so it is tolerated at high doses

A

Water

45
Q

There is some evidence for use of probiotics like Visibiome for those with mild to moderate ___ ___ to induce remission

A

Ulcerative colitis

46
Q

Probiotic use has shown to be ____ in Crohn’s disease

A

Ineffective

47
Q

What are important eating behaviors to consider for those with IBD?

A

-Chewing thoroughly
-Spacing and size of meals
-Sitting up straight
-Eating slowly
-Mealtime environment

48
Q

What are two goals for therapeutic diets for Crohn’s disease?

A

-Whole foods, nutritionally balanced
-Identification/avoidance of gut irritants/food intolerances

49
Q

What are some examples of therapeutic diets for Crohn’s disease?

A

-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)

50
Q

What foods should be increased in those with Crohn’s disease?

A

-Vegetables
-Fruits

51
Q

What foods should be limited with Crohn’s disease?

A

-Saturated and trans fats
-Emulsifiers
-Carrageenans
-Artificial sweeteners
-Maltodextrins
-Titanium dioxide

52
Q

What foods should be increased in someone with ulcerative colitis?

A

-Omega 3 oils from fish and food

53
Q

What foods should be limited in someone with ulcerative colitis?

A

-Red meat, processed meat
-Dairy fat, palm, and coconut oil
-Saturated fat and trans fat
-Emulsifiers
-Carrageenan
-Artificial sweeteners
-Maltodextrins
-Titanium dioxide

54
Q

The ____ ___ diet is low in starchy vegetables, grains, processed/added sugars, lactose, and artificial ingredients

A

Specific carbohydrate

55
Q

The specific carbohydrate diet aims for diversity of…

A

-Produce
-Nuts
-Animal proteins
-Yogurt
-Aged cheese

56
Q

With the specific carbohydrate diet, there is a risk of insufficient intake of…

A

-Calcium
Vitamin D
-Vitamin A
-Potassium
-Thiamin, folate, pyridoxine
-Vitamin E

57
Q

The IBD ___-___ diet is modified from the specific carbohydrate diet

A

Anti-inflammatory

58
Q

The IBD anti-inflammatory diet contains more ____ and ___ foods, as well as omega ____ fats

A

-Prebiotic
-Probiotics
-3

59
Q

What types of foods are included in the IBD anti-inflammatory diet?

A

-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

60
Q

The IBD anti-inflammatory diet is low in ____ carbohydrates (refined sugars, grains with gluten)

A

Complex

61
Q

The anti-inflammatory diet restricts…

A

-Emulsifiers
-Maltodextrins
-Milk (unless fermented)
-Sweeteners

62
Q

There are ___ phases of the anti-inflammatory diet that allow for slow progression of textures and the progression depends on disease status

A

3

63
Q

Preliminary research shows improved ___ symptoms from the anti-inflammatory diet, but more research is needed

A

Clinical

64
Q

The Crohn’s disease exclusion diet decreases foods that may harm the ____ or ___ ___

A

Microbiome or intestinal barrier

65
Q

The Crohn’s disease exclusion diet has three phases that start with ____ ____nutrition and whole foods (progressed to just whole foods)

A

Partial enteral

66
Q

The Crohn’s disease exclusion diet avoids…

A

-Emulsifiers
-Coffee
-Alcohol
-Canned foods
-Dairy
-Soy
-Gluten
-Processed foods

67
Q

The Crohn’s disease exclusion diet encourages what foods?

A

-Fruits
-Vegetables
-Chicken
-Fish

68
Q

The Crohn’s disease exclusion diet shows promise to be comparable in efficacy to ____ ____ nutrition, but more compliance

A

Exclusive enteral

69
Q

Crohn’s disease exclusive diet has caused induction of ____ and decreased ____

A

Remission; inflammation

70
Q

The Crohn’s disease exclusion diet used whole foods and may be used as ____ therapy

A

Maintenance

71
Q

The Crohn’s disease exclusion diet showed improved _____ and reduction in intestinal permeability

A

Dysbiosis

72
Q

It has been shown that a low-fat diet (10% kcal from fat) decreased ____ markers and improved dysbiosis

A

Inflammatory

Advanced Medical Nutrition Therapy II (19 decks)

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