Enteral/parenteral Nutrition And Fad Diets

Front 1

Atkins Diet

Back 1

high protein, low carb diet. reemerged in the late 1990s.
Scarsdale, enter the zone, protein power and sugar busters diets are also high protein and low carb.

Front 2

Body Mass Index

Back 2

normal: 18.5-24.9
overweight: 25-29.9
obese: 30-34.9
greater than 40 is extremely obese

Front 3

Carbohydrates requirement

Back 3

50-65 % of prepared food (parenteral/enteral).
150 g/day is necessary to prevent gluconeogenesis.
excess glucose causes fatty liver and increased CO2 production

Front 4

Elemental formulas

Back 4

for people with digestive problems, nutrients are broken down and easier to digest (small peptides, medium chain triglycerides, amino acids).
bad taste-- needs a feeding tube

Front 5

Enteral nutrition and its CI

Back 5

feeding into the luminal/gastrointestinal tract.
can be nasoenteric or percutaneous (gastric or jejunum)
CI: bowel ischemia, peritionitis, ileus or obstruction, fistulous disease, pancreatitis, malabsorption/severe diarrhea

Front 6

Harris-Benedict equation

Back 6

used to determine energy requirements
men: 66 + (13.7 x kg) + (5 x cm) - (6.8 x age)
women: 66.5 + (9.6 x kg) + (1.7 x cm) - (4.7 x age)

Front 7

Infection

Back 7

the major complication of parenteral nutrition
Other complications: venous thrombosis, nutrient excess/deficiency, refeeding syndrome, hepatobiliary (fatty liver, cholestasis, increased liver enzymes), osteomalacia, osteopenia, access abuse

Front 8

Lipid requirements

Back 8

15-30 % of total calores
iso-osmolar (soybean and safflower)
mostly essential fatty acids, linoleic and linolenic acids
must be at least 5 % of total calories in those totally dependent on IV nutrition.
hold lipids in those with serum TG > 400 mg/dl (helps mobilize fats and increase insulin sensitivity)

Front 9

Nasoenteric feeding

Back 9

short term enteral nutrition (< 30d).
AE: discomfort, sinusitis, pneumothorax, esophageal erosions/stricture, aspiration

Front 10

advantages of enteral nutrition

Back 10

provides nutrition to gut cells, avoids bowel edema, has trophic effect, stimulates mucosal blood flow, maintains normal pH and feedback, avoids gut atrophy, reduces septic complications, shortens hospital stays, decreases risk of multi-organ failure

Front 11

osmolality

Back 11

300-800 mOsm/L: if it's too high or too low, you get intolerance, diarrhea, or dumping syndroms

Front 12

parenteral nutrition and its indications

Back 12

intravenous-- central (better long-term, greater flexbility) or peripheral
indications: pre-operative (if malnutrition, for esophageal/gastric surgery, NPO for 7-10d), pancreatitis, IBD w/ severe disease/malnutrition, short bowel syndrom (hx of multiple resections), oncologic patients

Front 13

percutaneous-- gastric feeding

Back 13

enteral nutrition straight into stomach, placed endoscopically, surgically or radiographically.
more physiologic, allows bolus rather than continuous feeding

Front 14

percutaneous-- jejunal feeding (indications)

Back 14

better for pts with gastroesophageal reflux, large hiatal hernias, gastroparesis, history of aspiration and vomiting, history of prior gastric surgery

Front 15

What are some complications of percutaneous feeding?

Back 15

malposition of tubes, bowel perforation, aspiration, pneumonia, wond infection/abscess, diarrhea, tube related ulcers or bleeding

Front 16

protein requirements

Back 16

around 20% of total calories
0.8 - 1.5 g/kg/day depending on metabolic stress/illness

Front 17

re-feeding syndrome

Back 17

potassium and phosphorus and magnesium goes into cells with sudden provision of calories to a severely malnourished person, causes hypokalemia, hypocalcemia, fluid shifts, CHF, death.

refeed these patients slowly with low calorie solutions

Front 18

South Beach diet

Back 18

3 phases:
14 d lean protein, veggies, no carbs
bring back minimal complex carbs
maintenance: low fats okay, complex carbs okay in limited servings

Front 19

specialized formulas

Back 19

fructose for diabetics
branched-chain amino acid enrichment for hepatic failure
decreased carbs to reduce CO2 production for pulmonary pts
essential amino acids for renal failure
arginine, yeast RNA, fish oil for immune-enhancement (decreases infectious complications)

Front 20

venous thrombosis

Back 20

a risk of parenteral nutrition.
other risks: infection, nutrient excess/deficiency, refeeding syndrome, hepatobiliary (fatty liver, cholestasis, increased liver enzymes), osteomalacia, osteopenia, access abuse

Front 21

What are some health dangers of fad diets?

Back 21

ketosis with dehydration
vitamin/mineral deficiency, osteoporosis, gout (excess uric acid)
renal insufficiency, heart disease, hypertension
poor long-term weight control