Module 1 – Domain I - UH



Module 16 – Domain II: Medical Nutrition Therapy for Individuals (Part II)

After reviewing Module 16 lecture, you should be able to:

1. Describe planning and intervention for medical nutrition therapy.

Food Allergies and Intolerances

• Food Allergies are generally due to abnormal immune reaction to a protein food source that most people can consume.

1. The most common food allergens among adults are fish, shellfish, peanuts, and tree nuts.

2. Among children, eggs, fish/shellfish, milk, peanuts, tree nuts, and soy are the most common.

3. Treatment - avoidance of food allergen.  Label reading, contacting food manufacturers, asking questions in restaurants are all important.  Education on substitutions for these foods to ensure nutrients are not lost from the diet (ie: milk allergy substituting of other calcium sources) should be addressed.

• Celiac Disease - (also known as non-tropical sprue, celiac sprue) disease causing intolerance to gluten and/or gliaden; characterized by atrophy and flattening of intestine villi

1. symptoms include cramping and diarrhea

2. treatment includes elimination of all foods containing wheat, barley, rye, and oats

• lactose intolerance - inability to breakdown lactose due to insufficient amounts of lactase

1. most avoid milk and milk products; lactase pills or drops may allow some to tolerate dairy products; some may tolerate aged cheeses and yogurt due to bacteria in these products

2. dairy replacements should be chosen with care due to concerns of calcium and vitamin D deficiencies

Immune System disorders, infections, and fevers

• Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

o affects body weight partially due to increased needs from fever or infection

o digestion and absorption are often affected by fat and lactose intolerance as well as sores in mouth

o monitor albumin, prealbumin, TIBC, or transferrin for protein status

o dietary goals are to consume adequate diet to maintain/improve nutrition status and avoid malnutrition

o diet recommendations are as tolerated - food consistency and nutrients should be evaluated based on symptoms

o additional calories and protein may aid in resistance of infection

o Symptoms may lead to modifications of diet:

▪ nausea - small, frequent meals

▪ anorexia/poor appetite - small, frequent meals; nutrient dense foods

▪ dry mouth (xerostomia) - use of moist foods or including sauces, gravies with foods; increase beverages during and between meals

Malnutrition: protein, calorie

• kwashiorkor - long-term protein (KP) deficiency but adequate calories are present; characteristics include loss of visceral protein, distended abdominal area, fatty liver, edema, moon-shaped face

• marasmus - long-term calorie (MC) deficiency; characteristics include loss of somatic and visceral protein, emaciated appearance - low body weight and muscle wasting

Metabolic, endocrine, and inborn errors of metabolism

• Diabetes

1. Diagnosis –

▪ fasting blood glucose level of equal or greater than 126 mg/dl on two occasions

▪ random glucose test >200 mg/dl

▪ symptoms include excessive thirst, urination, and weight reduction

2. Glycemic Control –

▪ A1c of 8% action is recommended

▪ preprandial goal - 80-120 mg/dl

▪ 2 hour postprandial goal - ................
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