Contents

Search

nutritional therapy

also see nutrition Indications: - nutritional disorder - malnutrition - vitamin deficiency - mineral deficiency Management: 1) Daily recommendations: (also see recommended daily allowance) a) total calories: 30-35 kcal/kg day (BMI > 20) b) dietary protein: - 0.8 g/kg/day (normal adults) - > 1.5 g/kg/day (stress) - 2.0 g/kg/day (severe burns) - nitrogen balance probably attained at 0.5 g/kg/day (of high quality protein, i.e. egg albumin) - protein restriction for - hepatic encephalopathy - end-stage renal disease c) carbohydrate d) fat - omega-3 fatty acids e) fluid 30-35 mL/kg/day or 1 mL/kcal diet f) vitamins & minerals 2) Meeting nutritional needs: a) to improve a poor appetite try - frequent, small meals, snacks, food preferences - food from home - Megace, Marinol b) diseases affecting food intake - arthritis - need assistance in feeding - cannot open containers - finger foods - Parkinson's disease, tardive dyskinesia - stroke - difficulty self-feeding - dysphagia - speech therapy to help stage diet (3 stages of thickened liquids/textures) - aspiration precautions - Alzheimer's disease - may forget about eating - may hold food in mouth, not swallow - depression, despair c) social isolation - encourage eating in common diet area d) polypharmacy e) changing taste perception - chemotherapy, radiation therapy - aging process - decreased # of taste buds/ papillae - changes in olfaction 3) critical illness - hypocaloric vs full enteric nutrition with similar outcomes (ventilator-free days & mortality) [1] - burns may be exception 4) nutrition & cancer a) limit or avoid dairy products to reduce the risk of prostate cancer [3] b) limit or avoid alcohol to reduce the risk of - head & neck cancer - esophageal cancer - colorectal cancer - breast cancer [3] c) avoid red meat & processed meat to reduce the risk of colorectal cancer [3[ d) avoid grilled, fried, & broiled meats to reduce the risk of - colorectal cancer - breast cancer - prostate cancer - kidney cancer - pancreatic cancer [2] e) consumption of soy products during adolescence reduces risk of breast cancer in adulthood & risk of recurrence & mortality for women previously treated for breast cancer [3] f) fruits & vegetables to reduce risk of several common forms of cancer [3] - cruciferous vegetables reduce risk of colorectal cancer [3] 5) patient family satisfaction - nutritional supplement to diminish weight loss in demented patients is comforting to the family [2]

Related

disease-nutrition interactions nutritional assessment nutritional deficiency nutritional supplement

Specific

calorie restriction; dietary restriction; food restriction dietary therapy for diabetes mellitus enteral nutrition total parenteral (intravenous) nutrition (TPN)

General

nutrition clinical procedure

References

  1. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Initial trophic vs full enteral feeding in patients with acute lung injury: The EDEN randomized trial. JAMA 2012 Feb 22/29; 307:795 PMID: 22307571 - Griffiths RD. Nutrition for critically ill patients: How much is enough? JAMA 2012 Feb 22/29; 307:845 PMID: 22307570
  2. Hanson LC, Ersek M, Gilliam R, Carey TS. Oral feeding options for people with dementia: a systematic review. J Am Geriatr Soc 2011; 59:463-472 PMID: 21391936
  3. Gonzales JF, Barnard ND, Jenkins DJ et al Applying the Precautionary Principle to Nutrition and Cancer. J Am Coll Nutr. 2014 May 28:1-8. PMID: 24870117
  4. McClave SA, Martindale RG, Vanek VW et al Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316 PMID: 19398613
  5. John BK, Bullock M, Brenner L, McGaw C, Scolapio JS. Nutrition in the elderly. Frequently asked questions. Am J Gastroenterol. 2013 Aug;108(8):1252-66; quiz 1267. Review. PMID: 23711624
  6. Anello J, Feinberg B, Heinegg J et al Nutritional Support in Critically Ill Pediatric Patients. Guidelines on nutritional support for pediatric critically ill patients by the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition. Medscape: New Guidelines and Recommendations, August 2017. http://reference.medscape.com/viewarticle/884517