Nutrition and Dietetics in the Normal Patient - PowerPoint PPT Presentation

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Nutrition and Dietetics in the Normal Patient

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  1. Nutrition and Dietetics in the Normal Patient

  2. Study Aims • Definition • Malnutrition • Actual body weight • Ideal body weight • Predicted body weight • Nutritional assessement • Calculation of nutritional needs • Complications of overfeeding

  3. Introduction • Malnutrition common • Defined as 10% of USUAL body weight • Predisposition to • Delayed healing • Post-operative Infection • Added Morbidity and Mortality • Recognition thus important • Preventable disease • Treatable disease

  4. Introduction (cont . . .) • Usual / actual body weight • As measured by scale • Ideal body weight • Male H2 * 20 • Female H2 * 25 • Predicted body weight • Male50 + 0.91 (Height in cm – 152.4) • Female45.5 + 0.91 (Height in cm – 152.4)

  5. Nutritional Assessment • History and examination • Anthropological markers • Biochemical markers • Calculations of energy and protein requirements

  6. Nutritional Assessment History • Pre- morbid conditions • Estimates the risk of malnutrition • Hepatic and renal failure • IBD • Cancer and HIV/AIDS • Burns and head injuries • Conditions that limit intake or increase output • History of recent weight loss • Dietary Hx • Intake concerning calory (energy), protein, vitamin and trace elements

  7. Nutritional Assessment Physical Examination • Caloric intake • Subcutaneous fat of buttocks and extremities • Protein status • Extremity muscle bulk and strength • Temporal wasting • Vitamin intake • Changes in skin, mucosa and skin appendages • Skin texture change • Cheilosis and glossitis • Peripheral neuropathy ect

  8. Nutritional Assesement Physical Examination (cont . . . ) • Trace elements • Sx similar to vitamin def + menal changes

  9. Nutritional Assessment History and physical examination • The above determines the risk for malnutrition • Guidelines for identifying patients at risk • Weight • Overweight (BMI 30) and underweight (BMI < 18) • Weight loss more than 10% actual weight • Alcoholics • NPO more than 5 days • Medication with anabolic effect / antinutrient porp

  10. Nutritional AssessmentAnthropological Markers • Body Mass Index (BMI) • Weight (kg) / height 2 • < 18 underweight • < 10 Severely malnouraged • Gross overweight is a risk for malnutrition • Skinfold thickness (SFT) • Measures subcutaneous fat and thus energy reserve (10 - 13 mm) • Midarm circumference (MAC) • Muscle bulk and therefore somatic protein status (22 – 23 cm)

  11. Nutritional AssessmentAnthropological Markers (cont . . . ) • Bio-electrical Impedance Analysis • Single frequency models unreliable • Dual frequency modes in current clinical assessment • Expensive initial outlay • Accurate measurement of body composition

  12. Nutritional AssessmentBiochemical anlysis • Serum proteins • Estimates visceral protein reserve • Overall poor reliability due to complex factors • Overall markers include • Total serum protein, albumin, tansferrin and total lymphocyte count • Due to long half live reflects chronic malnutrition • More sensitive markers due to shorter half live • Pre-albumin, retinol binding protein, ceruloplasmin • Reflects acute changes in nutritional status

  13. Nutritional AssessmentBiochemical anlysis • Nitrogen balance • Measures protein synthesis and breakdown • Protein intake is the sum of all nitrogen intake (Enteral and parenteral) • Protein breakdown is measured by nitrogen excretion in urine, faeces, fistula ect • Calculations • N intake = g protein / 6.25 • N output = (urine urea * urine volume/day(l) * 0.028) + losses (3 – 6g) • Balance • Positive = anabolism • Negative = catabolism • Mild 5 – 10g • Moderate 10 – 15g • Severe 15g

  14. Calculation of nutritional needs • Energy requirements • TE = NPE + PE TE = Total energy requirements, NPE = Non-protein energy,PE = protein energy • NPE = Carbohydrate + Lipids • PE = 1.2 – 2 g/kg IBW • NPE = 25 – 30 Kcal/kg IBW • Carbohydrates = 5 g/kg • Lipids = 1 – 1.5 g/kg or 20kcal/kg

  15. Complications of overfeedingCarbohydrates • Glucose oxidation rate • No more than 5 mg/kg/min • Delivers 4 cal / g or • Complications • Hyperglycemia and hyper-osmolar states • Hapaic steatosis due to lipogenesis • Increased CO2 and lactate production

  16. Complications of overfeeding Lipids • Lipid infusions • Maximum rate 1 – 1.5 g/kg • Given as short, medium and long chain • Delivers 9cal / g • Complications of overfeeding • Hiperlipedaemia and pancreatitis • Fat overload syndrome • Immiunological supression • HSR

  17. Complications of overfeedingProteins • Amino-acid and protein infusion • 1.2 – 2 g / kg • Delivers 4 cal / g • Given as variaty of amino-acids • Complication • Azothemia