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Chapter 6: Metabolism, Energy Balance, Body ConsumptionCarbohydrate, dietary fat, & protein are energy-yielding nutrients that when consumed in excess can lead to fat production and fat gain by the body.Metabolically, fasting and starvation are identical. In both states, the body is forced to switch to a wasting metabolism, using glycogen (stored carbohydrates), fat, and protein (as lead body mass) to fuel the body’s energy needs. The body uses stored macronutrients in the order of glucose, fat, and then protein. Glucose from liver’s glycogen stores fuels work, but is depleted within a day. Next, the body depends on fatty acids to provide fuel. But because fat stores can not provide the glucose needed by the brain and nerves, protein is used to fuel the body’s energy needs last.During periods of fasting/starvation, the body reduces its metabolic rate and conserves both fat and lean tissue, causing energy use to fall to a bare minimum.The four hazards of fasting are wasting of lean tissues, impairment of disease resistance, lowering of body temperature, and disturbances of the body’s fluid and electrolyte balance.In general, 1 pound of body fat is equal to 3500 kcalories.The three components of energy expenditure are the thermic effect of food, physical activities, and basal metabolism. Factors that increase BMR are taller height, being younger or being pregnant, being male, fever, stresses, heat and cold, premenstrual hormones, smoking, and caffeine. Factors that decrease BMR are old age, being female, fasting/starvation, malnutrition, and during sleep.Males typically have more lean tissue than women causing them to have a higher BMR than females. Also, menstrual hormones influence the BMR in women, raising it just prior to menstruation.Pregnant and lactating women, infants, children, and adolescents typically have a higher BMR, and therefore energy needs, compared to adults and older adults because they are undergoing growth.Older adults typically have a lower BMR, and therefore energy needs, compared to younger adults because BMR declines during adulthood as lean body mass diminishes. Physical activities tend to decline as well, bringing the average reduction in energy expenditure to about 5% per decade.The relationship between physical activity and estimated energy needs is that the greater the amount of physical activity, the greater the energy need. The number of kcalories spent on physical activities is dependent on muscle mass, body weight, and type of activity.The formula for BMI is weight/(height)^2 x 703.The weight classifications are underweight (below 18.5), healthy weight (18.5-24.9), overweight (25-25.9), and obese (greater than 30).An individual with a BMI classified as healthy weight (18.5-24.9) is typically at the lowest risk for chronic disease and premature death.BMI values fail to provide how much of the weight is fat and where the fat is located, two valuable pieces of information used in assessing disease risk.The distribution of fat on the body may influence health as much as, or more than, the total fat alone.Visceral fat contributes to heart disease, cancers, diabetes, and related deaths, while subcutaneous fat is not usually associated with chronic disease. Subcutaneous fat is harder the lose and more essential to the body in cases of starvation or childbearing. Visceral fat is the most dangerous to health because it affects organ functionCentral obesity, or upper body fat, significantly and independent of BMI contributes to heart disease, cancers, diabetes, and related deaths. In central obesity, a shift occurs in the balance of adipokines (hormones released by adipose tissue), favoring those that increase both inflammation and insulin resistance of tissues. The resulting chronic inflammation and insulin resistance contribute to diabetes, atherosclerosis (a cause of heart disease), and other chronic diseases.A waist circumference greater than 35 inches for women and greater than 40 inches for men is associated with high risk for central obesity-related health problems. Waist circumference is a better predictor of chronic disease risk than BMI. Waist circumference is an independent predictor of disease risk such as type 2 diabetes, hypertension, and cardiovascular disease.Central/android obesity- excess fat around abdomen and waistApple shapeDue to androgen hormones in malesIncreased lipoprotein lipase action in abdomenHighest association with chronic disease risksEasier to lose weight hereGynoid obesity- excess fat around lower bodyPear shapeDue to estrogen in femalesIncreased lipoprotein lipase action in gluteofemoral areaHarder to lose weight hereIndividuals who are underweight are at increased risk for health-related chronic diseases, such as malnutrition and osteoporosis.Fat mass vs. fat-free massFat mass: white and brown adipose tissueWhite adipose tissue makes up the main fat cells. The majority of fat in the body is white. It is not an inert substance, meaning it is considered metabolically active because it produces inflammatory cytokines and stimulates macrophage production.Brown adipose tissue makes up only 1-2% of tissue in adults. It is mainly in adrenal glands at the base of the neck. It is also metabolically active, but has a more positive standpoint in that it contains mitochondria which produce ATP to help us burn energy.Fat-free mass: anything else that makes up the body that is not fat- mineral content, muscle mass/protein/skeletal/somatic/visceral muscleLean body mass includes cardiac, skeletal, and smooth muscle. It is higher in men than women, increases with exercise, and decreases with age. It is the primary determinant of resting metabolic rate.Adipose tissue hyperplasia is the creation of new fat cells, increasing in number. Adipose tissue hypertrophy is when a fat cell already exists, and is then filled with fat, increasing in size. Once a fat cell is created it can never be destroyed. Therefore, once a person begins to lose weight it becomes challenging for them to maintain that weight loss, because the fat cells are still there ready to be refilled. Fat cells will shrink if you lose weight. With pediatric weight management, it is important to make sure children have healthy habits so that they can carry good habits into adulthood. Essential fat is needed for survival for hormone production and cell production. Women also need fat to support pregnancy. Men need 2-5% essential body fat on their body, while women need 10-15% body fat. Non essential fat is excess fat that is not needed for survival.Insulin is produced by beta cells of the pancreas and helps take glucose out of the bloodstream and into cells, is a storage hormone, stimulates satiety, is released in response to glucose increase, and decreases hunger. Leptin is produced by white adipose cells and stimulates satiety by letting the body know it is full (an “anorexigenic” hormone). In some cases of excess adipose tissue, the body is leptin resistant and the body can produce excess leptin, but cells do not recognize this. Ghrelin is produced by the stomach cells when the body needs food and tells the body it is hungry (an “orexigenic” hormone). TEE (total energy expenditure), TDEE (total daily energy expenditure), BMR (basal metabolic rate), BEE (basal energy expenditure), RMR (resting metabolic rate), REE (resting energy expenditure)The components of total energy expenditure are basal metabolism, thermic effect of food, and physical activity thermogenesis. Basal metabolism is approximately 1,200 kcal/day and accounts for 60% of TEE. Thermic effect of food is approximately 200 kcal/day and accounts for 10% of TEE. Factors that effect thermic effect of food are regular meal consumption, eating every couple of hours, cold environments, cold foods, spicy foods, protein, alcohol consumption, age, exercise, and weight. Physical activity thermogenesis is approximately 600 kcal/day or 30% of TEE. Factors that affect this are exercise or non-exercise activity thermogenesis (NEAT) like walking to class, climbing stairs, cleaning house, etc.Factors that increase BMR are tall and thin people, children, adolescents, pregnant women, lean tissue, fever, stresses, heat and cold, nicotine and caffeine. Factors that decrease BMR are aging, fasting/starvation, malnutrition, and sleep.Chapter 7: Weight ManagementBoth overweight and underweight result from energy imbalance. Overweight results from excess energy. Underweight results from insufficient energy.Obesity is defined as an excess of body fat.The amount of fat in adipose tissue reflect both the number and the size of fat cells. Obesity develops when fat cells increase in number, size, or both.With fat loss, the size of fat cells shrink, but their numbers cannot. In essence, once a fat cell is created, it can not be destroyed. It can increase and decrease in size but not in number.Hunger is a drive programmed into people by their heredity. Appetite is learned and can lead people to ignore hunger or to over-respond to it. Hunger is physiological, whereas appetite is psychological. Satiety is the feeling of fullness and satisfaction that occurs after a meal and inhibits eating until the next meal.Modest, sustained weight loss of 3-5% body weight can help reduce the risk of diabetes and heart disease.To lose weight, individuals with overweight or obesity should reduce their usual daily kcalorie intakes by 500 to 750 kcalories in order to lose on average 1 to 1.5 pounds of body weight (ideally fat weight) per week.Unless under medical supervision, an individual should not consume fewer than 1200 kcalories per day. Diets that provide fewer than 1200 kcal can lead to nutritional inadequacy. Key benefits of physical activity as part of a weight-management program are energy expenditure, appetite control, and an elevated basal metabolic rate.Key strategies for promoting healthful weight gain in an individual who is underweight are physical activity to build muscles, three meals daily, and energy-dense foods.The criteria that must be met before being prescribed an FDA-approved weight loss drug are having a BMI greater than or equal to 30 (or greater than or equal to 27 with weight-related health problems), and have no medical contradictions.The criteria that must be met before a patient is considered for bariatric surgery are that an obese individual must have a BMI greater than 40 or a BMI between 35-40 accompanied by severe weight-related problems such as diabetes, hypertension, or debilitating osteoarthritis. In addition, the patient should have attempted a variety of nonsurgical weight-loss measure prior to seeking treatment.Following bariatric surgery, protein intake is emphasized at 1.0 to 1.5 g/kg ideal body weight per day through liquid protein supplements and high-protein foods.The key principles of safe, effective, healthy weight loss as defined by the AND and through which any weight management approach should be evaluated states “It is the position of the Academy of Nutrition and Dietetics that successful treatment of overweight and obesity in adults requires adoption and maintenance of lifestyle behaviors contributing to both dietary intake and physical activity. These behaviors are influenced by many factors; therefore, interventions incorporating more than one level of the socioecological model and addressing several key factors in each level may be more successful than interventions targeting any one level and factor alone.”The key principles of safe, effective weight loss are to aim for gradual and steady weight loss and not rapid weight loss/starvation. For a BMI of 27-35, 0.5-1.0 lb/week (less 250 to 500 kcal) is recommended. For a BMI greater than 35, 1.0-2.0 lb/week (less 500-1000 kcal) is recommended. It is recommended to alternate between weight loss for 6 months and weight maintenance for 6 months. Nutritionally adequate, except energy, means intaking 1200 kcal/day with CHO, protein, and fat. The functions of exercise to assist weight loss/maintenance are that it helps to balance lean body mass and basal metabolic rate with weight loss, it is the most variable component of energy expenditure, it is crucial in the prevention of weight regain, it is important to combine aerobics with resistance in training. It is recommended to have 30 minutes 5 days/weeks for health benefits and 50 minutes 5 days/week for substantial health benefits.The three main classes of weight loss medications are stimulants, pancreatic lipase inhibitors, and laxatives/diuretics. Stimulants help to increase the basal metabolic rate by 100-200 calories/day. Pancreatic lipase inhibitors block fat digestion/absorption from lipase, must be used with moderate/low-fat diet, and you are at risk for fat-soluble vitamin deficiency. It increases metabolism, increases satiety, and decreases hunger by triggering centers of the hypothalamus, which can lead to depression/suicidal thoughts. Laxatives/diuretics are weight loss supplements that are over the counter and not regulated by the FDA.Considerations to be evaluated if a person is using a prescribed or OTC weight loss medication are to use in combination with diet and exercise, not to be used long term, re-evaluate effectiveness after 12 weeks, side effects for OTC such as not losing fat and that there are not regulated by the FDA and caffeine or steroids could be added in, and side effects for prescribed diet pills such as causing heart palpitations, cardiac arithmias, heart valve problems, fat soluble vitamin deficiency, excess and uncontrollable stool, and severe depression and suicide and mental instability if they trigger the hypothalamus.The key criteria for candidacy for bariatric surgery are clinically severe obesity (BMI greater than 40 or 35 with comorbidities), documented failure or non-surgical weight loss (tried diets and exercise), good surgical candidate (heart and lungs are strong enough for surgery, no blood clots), between ages of 14-75, clearance by healthcare team (including psychological evaluation), and commitment to follow post-surgery diets.The three main bariatric surgical procedures currently used in the U.S. today are restrictive, restrictive and malabsorption, and hormonal regulating. Restrictive decreases the amount of food that enters the GI tract (decreasing the volume of the stomach to 1-2 oz in size) and can be gastric banding or vertical sleeve gastrectomy. Restrictive and malabsorption decrease the amount of food that enters the GI tract and decreases absorption and can either be Roux-en-Y gastric bypass or biliopancreatic diversion-duodenal switch. Hormonal regulating increases satiety and decreases hunger via alteration of GI hormones and neuropeptides. Post surgery diet modifications for a patient that has undergone bariatric surgery are diet composition that is high in protein, low in CHO, and low in fat. Protein supplementation of 20-30 g liquid protein/day. Sugar free, non carbonated, non caffeinated, non alcoholic beverages. Daily fluid intake of 80 fl oz/day because they are at great risk for dehydration (important to separate fluids and liquids). 6 meals/day of 2-4 oz in size. Foods that are not well tolerated are dry/tough meat, bread/starchy products, fruits/vegetables with skins, dried fruit, and corn. Chew foods 25-30 times before swallowing. No beverages at meals, wait 30 minutes to an hour before and after. No straws for drinking, drink by sips. No chewing gum or smoking (air can fill the lungs, we don’t want them filling up). Only sugar free condiments and products. No pregnancy for at least 18 months post-op. Chewable multivitamin mineral supplement daily for life that should provide calcium citrate.Chapter 14: Illness and Nutrition Care (Nutrition Screening & Assessment)25-50% of hospitalized patients demonstrate malnutrition. Anorexia due to illness, nausea and vomiting, pain with eating, mouth ulcers or wounds, difficulty chewing or swallowing, depression or psychological stress, and inability to feed oneself can all lead to reduced food intake. This can be treated through restrictive diets, bowel rest, surgical restriction of head, neck, mouth, or esophagus, preparation for surgery or diagnostic tests, surgical wounds, or side effects or medication (which can cause anorexia or gastrointestinal distress). Inflammation associated with bowel conditions, insufficient secretion of digestive enzymes or bile salts, or altered structure or function of intestinal mucosa can all lead to impaired digestion and absorption. This can be treated through radiation therapy, gastrointestinal surgeries, or side effects of medication on gastrointestinal structure or function. Elevated metabolic rate, muscle wasting, changes in hydration, prolonged immobilization, nutrient losses due to excessive bleeding, diarrhea, or frequent urination can all lead to altered nutrient metabolism and excretion, however this can be treated through chemotherapy or diuretics.The role that nurses play in addressing nutrition problems and providing nutrition are to patients is to screen patients for nutrition problems and they may participate in nutrition and dietary assessments. They may also provide direct nutrition care, such as encouraging patients to eat, finding practical solutions to food-related problems, recording a patient’s food intake, and answering questions about special diets.According to the Joint Commission, a nutrition screening should be conducted within 24 hour of a patient’s admission to a hospital or other extended-care facility.The four steps of the nutrition care process are nutrition assessment (collection and analysis of health-related information), nutrition diagnosis (PES statement- problem, cause, signs and symptoms of problem), nutrition intervention (counseling or education about appropriate dietary/lifestyle practices), and nutrition monitoring and evaluation (progress monitored and assessment data updated). ADIMEThe three parts of the PES statement are problem (statement that includes specific problem), etiology (cause), and signs and symptoms (provide evidence of the problem).Anthropometric measures of length and height. Length is measured in infants and children younger than 24 months of age, and height is usually measured in older children and adults. Length can also be measured in adults and children who cannot stand unassisted due to physical or medical reasons. In adults who are bedridden or unable to stand, height can be measured/estimated from equations that include either the knee height or the full arm span, both of which correlate well with height. The anthropometric measurement used to assess brain growth and malnutrition in children up to 3 years of age is head circumference. In adults, unintentional weight loss of greater than 5% body weight in 1 month or greater than 10% body weight in 6 months suggests protein-energy malnutrition (PEM).Unintentional weight gain in adults could indicated fluid retention rather than actual muscle tissue or adipose tissue gain.Signs of malnutrition tend to appear most often in parts of the body where cell replacement occurs at a rapid rate, such as the hair, skin, and digestive tract (including the mouth and tongue).Clinical signs of malnutrition can be seen for each of the following nutrients. Lack of vitamin B can result in redness at the corners of the eyes, dry, cracked lips with sores in the corners, smooth or magenta tongue, dry, rough, lack of fat under skin, dementia, peripheral neuropathy. Vitamin C deficiency can result in corkscrew hair, bleeding gums, poor wound healing, bruising or bleeding under skin. Vitamin D deficiency can result in bowed legs. Iron deficiency can result in pale membranes of eyes, pale skin, spoon shaped and pale nails. Zinc deficiency can result in poor taste sensation and poor wound healing. Protein deficiency can result in dull, brittle, dry, loose, falling out hair, poor wound healing, dry, rough, lack of fat under skin, ridged nails, swollen glands at the front of the neck.A regular diet is a diet that includes all foods and meets the nutrient needs of healthy people and may also be called a standard diet or house diet. A modified diet is a diet that contains food altered in texture, consistency, or nutrient content or that includes or omits specific foods and may also be called a therapeutic diet.Tube feedings (enteral nutrition) are liquid formulas delivered through a tube placed in the stomach or intestine. Parenteral nutrition is the provision of nutrients by vein, bypassing the intestine.NPO means nothing by mouth, so the patient can not be given anything at all- food, beverages, or medications. An NPO would be used during certain acute illnesses or diagnostic tests involving the GI tract.To help a patient/client implement long-term dietary change, an emphasis should be placed on foods to include in the diet rather than on foods to restrict from the diet.To help a patient/client implement long-term dietary change, no more than 2 changes should be suggested at a time.In order to help hospital patients improve their food intakes to help reduce the risk of malnutrition and support recovery/proper wound healing a nurse can empathize with the patient, help them select foods they like, suggest foods that require little effort to eat for patients that are weak, help patients prepare for meals, check to make sure food that arrives is correct, and help with eating when necessary.The difference between a nutrition diagnosis and a medical diagnosis is that a medical diagnosis deals with disease and illnesses but a nutrition diagnosis cannot say someone has diabetes but rather discuss the actual or potential health problems and life processes (similar to nursing diagnosis). Every nutrition problem receives a separate diagnosis which is formatted in a PES statement. Nutritional diagnosis changes during the course of an illness.Foods permitted on a clear liquid diet are tea, broth, ginger ale, clear fruit juices, and gelatin. Foods permitted on a full liquid diet are clear liquid diet items plus dairy products like milk, yogurt, cream soups, and ice cream/sherbet.Chapter 21: DiabetesDiabetes mellitus refers to metabolic disorders characterized by elevated blood glucose concentrations and disordered insulin mon symptoms of diabetes mellitus are frequent urination (polyuria), dehydration and dry mouth, excessive thirst (polydipsia), weight loss, excessive hunger (polyphagia), blurred vision, increased infections, and fatigue.Glycated Hemoglobin (HbAa1c) is a measure of hemoglobin’s exposure to glucose over a period of 2-3 months and is an indirect assessment of blood glucose levels.The current criteria used to diagnose diabetes are the plasma glucose concentration is 125 mg/dL or higher after a fast of at least 8 hours (normal fasting plasma glucose levels are 75-100 mg/dL), plasma glucose concentration of a random blood sample is 200 mg/dL or higher, plasma glucose concentration measured two hours after a 75-gram glucose load is 200 mg/dL or higher, or the HbA level is 6.5% or higher. Only one of the four must be present for a diagnosis.Type 1 diabetes can be caused by an autoimmune disease, viral infection, or inherited factors and is the destruction of pancreatic beta cells that causes insulin deficiency. There is little or no insulin secretion and the age of onset is typically less than 30 years of age. Type 2 diabetes results from obesity, aging, inactivity, inherited factors, and in this type insulin resistance causes insulin deficiency relative to needs that may be normal, increased, or decreased insulin secretion. The typical age of onset is greater than 40 years of age. Gestational diabetes is when pregnancy can lead to abnormal glucose tolerance which often resolves after pregnancy but is a risk factor for type 2 diabetes.Macrovascular complications associated with diabetes can include impaired blood circulation in the limbs, which increases pain while walking and can contribute to the development of foot ulcers which if left untreated can lead to gangrene, or tissue death. Microvascular complications include damage to capillaries in the retina leading to visual impairments and in some cases, blindness. Prevention of adequate blood filtration by the kidneys and kidney failure can also develop.The main goal of diabetes treatment is to maintain blood glucose levels within a desirable range to prevent or reduce the risk of complications.Diabetes treatment is evaluated by monitoring glycemic status either through self-monitoring of blood glucose or through continuous glucose monitoring.Long-term glycemic control is evaluated by measuring glycated hemoglobin or HbA.For non-diabetics, their HbA1c should be less than 5%. For diabetics, their HbA1c should be less than 7%. These values indicate good long-term glycemic control.The total gram amount intake of carbohydrate has the greatest influence of blood glucose levels after meals, therefore the dietary management of diabetes focuses on controlling the amount and types of carbohydrate consumed.People with diabetes do not have to avoid all types and amounts of sugar in their diet.Counting carbohydrates can be done through counting the grams of carbohydrates provided by foods or by counting the carbohydrate portions, expressed in terms of servings that contain about 15 grams of carbohydrate each.1 serving (portion size) of carbohydrate= 15 grams of carbohydrate.Steps for treating hypoglycemia are immediate intake of glucose or a glucose-containing food containing 15-20 grams of carbohydrate that can relieve hypoglycemia in about 15 minutes, although patients should monitor their blood glucose levels in case additional treatment is necessary.If blood glucose in less than 100 mg/dL before exercise, a patient with diabetes should consume carbohydrates in order to prevent hypoglycemia during exercise.Risk of gestational diabetes is highest in women who have a family history of diabetes, are obese, are in a high-risk ethnic group (African American, Asian American, Hispanic American, Native American, or Pacific Islander), or have previously given birth to an infant weighing over 9 pounds.During pregnancy, women are tested for gestational diabetes between 24 and 28 weeks of gestation.HbA1c (glycated hemoglobin) is a measure of hemoglobin’s exposure to glucose over a period of 2-3 months and is an indirect assessment of blood glucose levels. eAG corresponds to the % with the mg/dL.The key principle of nutrition management of DM are to control what is eaten (focusing on nutrient-dense foods), to control how much is consumed (serving sizes/portion control), to control when to eat (eat at regular intervals, don’t go long period without eating), manage weight (weight gain will increase insulin resistance and decrease insulin sensitivity), and participate in regular exercise (stimulates uptake of glucose out of blood stream and into muscles).Alcohol can cause hypoglycemia if taken without food. Drink alcohol with meals to prevent this.Chapter 22: Cardiovascular DiseaseCardiovascular disease is a group of heart and blood vessel disorders that primarily affects females, meaning more women than men die from CVD each year.Cardiovascular disease is the leading cause of death worldwide and in the United States.Atherosclerosis begins in men older than 45 and women older than 55 years of age (higher risk). For women, this is after menopause because the decline in estrogen has unfavorable effects on lipoprotein levels and arterial function.Hypertension (high blood pressure) causes atherosclerosis by causing stress of blood flow along artery walls which can cause physical damage to arteries. Abnormal blood lipids like elevated LDL levels are actively taken up and retained in susceptible regions in the artery wall. Cigarette smoking has chemicals that are toxic to endothelial cells and can contribute to arterial injury. Diabetes Mellitus increases tendencies for vasoconstriction, blood clotting, and plaque rupture. Age causes arterial cells to degenerate and risk factors for CVD accumulate. Women are more at risk than men because a woman’s risk increases after menopause when estrogen levels decline.Non-modifiable risk factors for CHD are blood lipid status and presence of atherosclerosis.The major modifiable risk factors for CHD are dietary and lifestyle modifications. Dietary recommendations include reducing saturated fat, trans fat, and cholesterol, increasing soluble fiber, and incorporating plant sterols, plant stanols, and fish into the diet.Total blood cholesterol should be less than 200 mg/dL. LDL cholesterol should be less than 100 mg/dL. HDL cholesterol should be greater than 60 mg/dL. Fasting triglycerides should be less than 150 mg/dL. Blood pressure (systolic/diastolic) should be less than 120/ less than 80. BMI should be between 18.5-24.9.The relationship between LDL levels and atherosclerosis is that elevated levels of VLDL can promote atherosclerosis, either by influencing the production of other atherogenic lipoproteins or by causing molecular changes in endothelial cells and macrophages that promote inflammation or plaque development.The relationship between HDL levels and atherosclerosis is that HDL removes cholesterol from the circulation and contains proteins that inhibit inflammation, LDL oxidation, and plaque accumulation, so HDL levels can contribute to the development of atherosclerosis as well.For ideal cardiovascular health, an individual should limit saturated fat intake to about 5-7% of total kcalories, consume less than 200 mg of cholesterol per day, replace saturated fats with monounsaturated and polyunsaturated fats, avoid products that contain trans fat, choose foods high in soluble fiber, adopt a low sodium diet to reduce blood pressure, engage in moderate-to-vigorous aerobic activity for 40 minutes per session at least 3 or 4 days per week, and lose 5-10% original body weight if overweight or obese. Of the dietary lipids, the one that has the strongest effect on blood cholesterol levels is low density lipoprotein (LDL).Soluble fibers reduce LDL cholesterol levels in the body by inhibiting cholesterol and bile absorption in the small intestine and reducing cholesterol synthesis in the liver.EPA and DHA, from fatty fish, reduce the risk of CHD by suppressing inflammation, lowering blood triglyceride levels, reducing blood clotting, and stabilizing heart rhythm.The use of fish oil supplements has not been shown to reduce the occurrence of heart attacks and heart-related deaths.While light to moderate alcohol consumption may help reduce overall CHD risk, because other health concerns (such as increasing risk for certain types of cancers), women should consume on average no more than 1 drink per day and men should consume on average no more than 2 drinks per day.Some dietary interventions to improve hypertriglyceridemia are limiting intake of refined carbohydrates, especially sweetened beverage and food items made with white flour and added sugars.CHD medications work to lower LDL levels. Statins reduce cholesterol synthesis in the liver. Bile acid sequestrants reduce LDL levels by interfering with bile acid reabsorption in the small intestine. Fibrates and nicotinic acid lowers triglyceride levels and increases HDL, while lowering LDL and liporprotein(a) levels.Diet-drug interactions are prevalent for some CVD medications. Anticoagulants, like warfarin, require a consistent vitamin K intake to maintain effectiveness. When taking statins, avoid grapefruit juice because it may enhance drug effects. When taking calcium channel blockers (for HTN), avoid grapefruit juice because it may also enhance the drugs effects.Desirable blood pressure is anything less than or equal to 120/80. Prehypertension is 120-139/80-89. Hypertension is greater than 140/greater than 90.The kidneys play a role in regulating blood pressure by controlling the secretion of hormones involved in vasoconstriction and retention of sodium and water.Risk factors for hypertension include age (risk increases with age), genetics (risk is similar among family members), obesity (reduce weight to achieve a healthy body weight), salt sensitivity (no more than 2400 mg sodium per day), alcohol (men limit to 2 drinks per day and women limit to 1 drink per day), and diet (adopt a diet that emphasizes vegetables, fruit, and whole grains; includes low-fat milk products and limits sugars and red meat like the DASH eating plan).The DASH eating plan encourages vegetables, fruit, whole grains, and low-fat milk products.The DASH eating plan discourages sugars and red meat.The DASH eating plan recommends that sodium intake be reduced to no more than 1500 mg per day.Nutrition therapy for heart failure includes modest sodium restriction of less than or equal to 2000 mg per day, fluid restriction of less than or equal to 2 liters per day, adequate fiber intake to reduce the risk of constipation, and restricting or avoiding alcoholic beverages.The 7 primary risk factors for CVD according the the American Heart Association Life Check Screening System are to get active, eat better, lose weight, stop smoking, control cholesterol, manage blood pressure, and reduce blood sugar.LDL cholesterol is bad cholesterol and dumps cholesterol places that can lead to hardening of arteries. HDL is good cholesterol that pulls cholesterol away from cells, out of arteries, and back into liver. Try to get cholesterol from animal products- blood cholesterol is more impacted by saturated fat intake than by dietary fat intake (animal product is saturated fat). Eat more MUFAs and PUFAs than saturated fats and try to avoid all trans fat. Overall healthy diet. High in potassium, low in sodium, good amount of magnesium, phosphorus, and calciumThe Mediterranean diet emphasized fresh fruits, vegetables (root and green), whole grains, fatty fish, lean meat, low-fat dairy, vegetable oil (non-solid), nuts, and reduced red meat, high-fat dairy, and saturated fats. Increase fiber to 27-37 g.Alternatives to alcohol that demonstrate stronger and safer benefits in the long-run to reducing risk for CVD are antioxidants (fresh fruits and veggies), impact on platelets (omega-3s and daily baby aspirin), impact on HDL (physical activity, changes in dietary fat intake, weight loss), & insulin sensitivity (weight loss and healthy diet).Ace-inhibitors decrease potassium excretion so you can have a buildup of potassium leading to heart palpitations and cardiac arrest. Avoid salt substitutes.Spirolactone increases excretions of sodium and calcium and decreases potassium excretion so you can have a buildup of potassium leading to heart palpitations and cardiac arrest. Avoid salt substitutes. Thiazide Diuretics increase excretion of potassium and magnesium and increase renal resorption of calcium (caution with calcium supplements). Loop Diuretics can become potassium depleted if supplements are prescribed increasing excretion of potassium, magnesium, sodium, and calcium. Chapter 23: Renal DiseaseThe primary function of the kidneys is that they are responsibly for filtering the blood and removing excess fluid and wastes for elimination in urine.Nephrotic Syndrome results in significant losses of protein through the urine. Losses of protein in the urine can result in lower vitamin D and calcium (mineral) levels and lead to protein-energy malnutrition.Medical nutrition therapy principles related to managing nephrotic syndrome consist of protein intake at 0.8 to 1.0 gram per kilogram body weight, at least half of protein intake should come from high-quality protein sources, adequate energy intake at 35 kcalories per kilogram body weight, emphasize a heart-healthy diet low in saturated fat, trans fat, cholesterol, and refined sugar, sodium should be limited to 1000 to 2000 mg per day, and supplementations of iron (mineral), calcium (mineral), and vitamin D (vitamin) may be required.Acute kidney injury results in reduced blood flow to the kidneys, resulting in reduced urine output and a build-up of nitrogenous waste in the blood.Normal urine volume is 1000 to 1500 mL per day.In the treatment of acute kidney injury (as well as chronic kidney disease), sodium, potassium, phosphate, and magnesium may need to be restricted. The two most common causes of chronic kidney disease are diabetes mellitus and hypertension. Glomerular filtration rate (GFR) or the rate at which the kidneys form filtrate is used to measure overall kidney function.Key dietary interventions for patients on dialysis are increased energy intake, increased protein intake to compensate for increased protein losses during dialysis, follow a heart-healthy diet (reduced total fat, saturated fat, trans fat, cholesterol), fluid restriction, sodium restriction, potassium restriction, phosphorus restriction, and adequate calcium.Most kidney stones are made of crystalline masses.People who form kidney stones should drink 12-16 cups of fluid per day.People who form calcium oxalate stones should consume 800-1200mg dietary calcium per day to reduce oxalate absorption.High intakes of protein and sodium can increase urinary calcium excretion. Protein intake should be moderated and sodium intake should not exceed 2300 mg/day.With predialysis, a low protein diet is required because you don’t want the body having excess nitrogen that it can’t filter out of the blood. With hemodialysis and peritoneal dialysis you need to increase protein because they are going to have protein loss as they go through dialysis (20-40% increase). Hemodialysis has very restricted fluid, sometimes peridialysis if they are putting out a lot of urine. No fluid restriction in peritoneal dialysis. Calcium, phosphorus, and potassium restricted in all types of dialysis because the kidney can not filter them out.Phosphate binders need to be taken with meals or they will not work. They bind phosphate in the digestive tract to prevent it from being absorbed. Cheaper forms are tums, in which calcium binds phosphorus. Side effects include GI upset.Chapter 24: Metabolic StressChanges that occur as a response of the stress response include energy is of primary importance, energy nutrients (which include epinephrine, norepinephrine, and cortisol) are mobilized from storage and made available in the blood, heart rate and respiration increase to deliver oxygen and nutrients to cells, and blood pressure rises.During the stress response an increase in metabolic rate is due to cetecholamines. Glycogen breakdown (release of glucose) from liver and/or muscle is due to catecholamines, glucagon, and cortisol. Glucose production from amino acids is due to catecholamines, glucagon, and cortisol. Release of fatty acids from adipose tissue is due to catecholamines, glucagon, and cortisol. Sodium reabsorption in the kidney is due to aldosterone. Water reabsorption in the kidneys is due to antidiuretic hormone. Protein degradation is due to cortisol. The metabolic actions of epinephrine, norepinephrine, and cortisol result in increased glucose in blood, or hyperglycemia, a symptom that often accompanies critical illness. The primary steps of the inflammatory response are that when tissues are damaged, immune cells release histamine, which dilates some blood vessels, increasing blood flow to the damaged area. Fluid leaks out of capillaries (causing swelling), and phagocytes escape between the small gaps in the blood vessels. Phagocytes engulf bacteria and disable them with hydrolytic enzymes and reactive forms of oxygen.Classic signs on inflammation are heat (from the influx of warm arterial blood), redness (from the increase in blood in the injured area), swelling (from the accumulation of fluid and immune cells at the site of injury), and pain (from the swelling and the actions of chemical mediators that stimulate pain receptors).Eicosanoids are produced by the body from dietary fatty acids. The major precursor for the eicosanoids is arachidonic acid which is an omega-6 fatty acid.Noteable metabolic changes in patients undergoing metabolic stress include hypermetabolism (a higher than normal metabolic rate), negative nitrogen balance (intake of nitrogen into the body is greater than loss of nitrogen from the body), insulin resistance (cells fail to respond normally to the hormone insulin), and hyperglycemia (excess of glucose in the bloodstream).In critical-care and intensive-care patients, indirect calorimetry should be used to determine energy requirements.Rather than indirect calorimetry or a predictive equation, energy needs during acute illness in normal or overweight patients may be estimated by multiplying a person’s actual body weight by 25-30 kcal. For patients with obesity, their actual body weight may be multiplied by 11 to 14 kcal.The intake of protein is increased during acute stress, often to levels above the DRI.Nonobese critically ill patients required 1.2 to 2.0 grams of protein per kilogram body weight per day. Most energy requirements for acutely ill patients should be provided through carbohydrate and fat.For acutely ill patients with a functional GI tract, enteral feedings should be started in the first 24 to 48 hours after initial hospitalization to reduce the rate of complications and shorten the duration of hospital stay.Two main types of COPD are chronic bronchitis and emphysema.The primary risk factors for COPD are cigarette smoking and genetic factors like Alpha-1-antitrypsin deficiency.The primary objectives of COPD medical treatment are to prevent the disease from progressing and to relieve major symptoms (dyspnea and coughing).The main goals of nutrition therapy for COPD are to correct malnutrition, promote the maintenance of a healthy body weight, and prevent muscle wasting.Chapter 25: CancerObesity alters the level of hormones that influence cell growth, such as insulin, the sex hormones, and several kinds of growth factors. Alcohol correlates strongly with cancers of the head and neck, liver, colon, rectum, and breast. High temperature cooking (including grilling and smoking food) may cause carcinogens to form these foods. Fruit and vegetables intake may contain carcinogens. These nutrition-related factors positively or negatively influence cancer risk.Factors that contribute to anorexia, reduced food intake, and thereby malnutrition associated with cancer are mental illness (distress, anxiety, depression may reduce appetite), chronic nausea and early satiety (premature feeling of fullness after eating small amounts of food), fatigue (tire easily and lack the energy to prepare and eat meals), & pain (particularly if eating makes the pain worse). The 5 main signs/symptoms of cancer cachexia are anorexia, weight loss, muscle wasting, anemia, and fatigue.The 3 primary medical treatments (either alone or in combination) for cancer are surgery, chemotherapy, and radiation therapy. Chemotherapy affects not only cancer cells but also healthy cells throughout the body, negatively affecting the GI tract, skin, and bone marrow in patients and leading to poor dietary intake/malnutrition, hair loss, anemia, and increased risk of infection.Nutrition related side effects of chemotherapy include reduced nutrient intake due to abdominal pain, anorexia, nausea and vomiting, oral mucositis, reduced taste sensation and increased nutrient losses due to diarrhea, GI inflammation, malabsorption, & vomiting. Nutrition related side effects of radiation therapy include reduced nutrient intake due to anorexia, damage to teeth, dysphagia, esophagitis, nausea and vomiting, oral mucositis, reduced salivary secretions, reduced taste sensation and increased nutrient losses due to blood loss from intestine and bladder, diarrhea, fistulas, intestinal obstructions, malabsorption, radiation enteritis, and vomiting. Nutrition related side effects of cancer surgeries can lead to dry or sore mouth, acid reflux, dumping syndrome, diarrhea, and diabetes mellitus.The goals of nutrition therapy for cancer patients are to maintain a healthy weight, preserve muscle tissue, prevent or correct nutrient deficiencies, and provide a diet that patients can tolerate despite the complications of illness.Cancer patients require 1.0 to 1.6 grams of protein per kg body weight per day.Ways to increase kcalories and protein in meals for cancer patients include choosing high-fat meat instead of lean meat, choosing high-fat grain products, eating avocado, melting butter or margarine on pasta or vegetables, and including cheese in sandwiches. Acceptable food on a low microbial, or neutropenic, diet include well-cooked meats and eggs, pasteurized milk products, well-washed fruits and vegetables, and shelf-stable packaged foods. Foods that must be avoided include unwashed raw fruits and vegetables, unpasteurized juices and milk products, leftover luncheon meats, and foods from salad bars or street vendors. Because of the low white blood cell count, you are more prone to infection so a low microbial diet is necessary.There are a variety of food related problems frequently experienced by cancer patients. Loss of appetite can be treated by eating small meals and snacks at regular times each day and eating the largest meal at the time of day when you feel the best. When foods don’t taste right you can brush your teeth or use mouthwash before you eat and save your favorite foods for times when you are not feeling nauseated. Persistent nausea and vomiting can be treated by consuming liquids throughout the day to replace fluids and consume your largest meal at a time when you are least likely to feel nauseous. Problems chewing and swallowing food can be treated by adding sauces and gravies to dry foods and drinking fluids during meals to ease chewing and swallowing. Mouth sores can be treated by eating chilled or frozen foods because they are soothing and cutting foods into smaller pieces so they are less likely to irritate the mouth. Dry mouth can be treated by drinking small amounts of liquid frequently between meals and using sour candy or chewing gum to stimulate the flow of saliva. Constipation can be treated by engaging in physical activity regularly and drinking plenty of fluids especially warm fluids in the morning. Diarrhea can be treated by eating small, frequent meals instead of large ones and avoiding fatty foods if you are fat intolerant.Chapter 16: Nutrition SupportEnteral nutrition provides nutrients through the use of the GI tract or a feeding tube. Parenteral nutrition uses an IV if the patient does not have enough GI function. Enteral nutrition requires GI function, while parenteral nutrition is used if patient does not have enough GI function. Complication risk is associated more with parenteral nutrition than enteral nutrition.Some popular liquid oral supplements sold in pharmacies and grocery stores for home use by patients are Ensure, Boost, and Carnation Breakfast Essentials (these same products are also often provided to patients in healthcare facilities, such as hospitals and nursing homes/long-term care facilities).Tube feedings are typically recommended for patients who are at risk of developing protein-energy malnutrition who are unable to consume adequate food and/or oral supplements to maintain their health.Medical conditions or treatments associated with the need for tube feedings are severe swallowing disorders, impaired motility in the upper GI tract, GI obstructions and fistulas that can be bypassed with a feeding tube, certain types of intestinal surgeries, little or no appetite for extended periods especially if the patient is malnourished, extremely high nutrient requirements, mechanical ventilation, mental incapacitation due to confusion, neurological disorders, or coma.Besides GI function, the patient’s medical condition, the expected duration of tube feeding, and the potential complications of a particular route are used to determine which tube feeding route should be chosen.If a patient requires a tube feeding for less than 4 weeks, then a nasogastric or nasoenteric route is chosen. If a patient requires tube feeding for longer than 4 weeks, then an enterostomy or jejunostomy is chosen. If a patient has a broken nose that prevents transnasal insertion, then an enterostomy or jejunostomy is chosen. If a patient had a severe injury to the stomach preventing gastric access, then nasoduodenal and nasojejunal and jejunostomy is chosen. If a patient is at high-risk for aspiration, either a jejunostomy, nasoduodenal, or nasojejunal route is chosen. If a patient is receiving intermittent feedings, then a gastronomy route is chosen.A standard (polymeric) formula would be used for individuals who can digest and absorb nutrients without difficulty. An elemental (hydrolyzed) formula would be used for patients who have compromised digestive or absorptive functions. Specialized (disease-specific) formulas are intended to meet the nutrient needs of patients with particular illnesses. Carbohydrate and fat provide most of the energy in enteral formulas.The energy density of most enteral formulas is 1.0 to 2.0 kcalories per milliliter of fluid.An open feeding system poses the greatest risk to contamination, which could result in food-borne illness and other infections.It is important to remember that enteral formulas are food, which means they are susceptible to pathogenic bacteria and virus contamination leading to a food-borne illness. Formula can lids should be cleaned before opening. Unused formula should be stored properly. Open formula not used within 24-48 hours should be discarded. New feeding container and tubing is necessary every 24 hours. Closed systems should hang for no more than 24-48 hours.With enteral feedings, the patient’s upper body should be elevated to 30-45 degree angle during feeding and for 30-60 minutes after feeding to reduce the risk of aspiration.Tube feedings should be withheld and the patient evaluated if the gastric residual volume exceeds 500 milliliters.If a patient is receiving a tube feeding and is prescribed the medication phenytoin, the tube feeding should be stopped for at least one hour before and after medication administration.Diarrhea that accompanies tube feedings are often associated with the concurrent administration of sorbitol-containing medications, laxatives, and some types of plications of tube feedings include gastrointestinal problems, such as constipation and diarrhea, mechanical problems related to the tube feeding process, and metabolic problems, such as nutrient deficiencies and changes in the body’s biochemistry. Parenteral nutrition is typically recommended to patients who are unable to digest or absorb nutrients and who are either malnourished or likely to become so.The main source of energy in parenteral nutrition solutions is glucose which is provided in the form of dextrose monohydrate, in which each glucose molecule is associated with a single water molecule. In the U.S., lipid emulsions as part of parenteral nutrition solutions come from olive oil, soybean oil, egg phospholipids to serve as emulsifying agents, and glycerol to make the solutions isotonic.A 2-in-1 parenteral solution excludes lipids. Catheter-related complications of parenteral nutrition include air embolism, blood clotting at catheter tip, clogging of catheter, dislodgement of catheter, improper placement, infections, sepsis, phlebitis, and tissue injury. Metabolic complications include electrolyte imbalance, gallbladder disease, hyperglycemia, hypoglycemia, hypertriglyceridemia, liver disease, metabolic bone disease, nutrient deficiencies, and refeeding syndrome.Too manage glucose intolerance (hyperglycemia) associated with parenteral infusion, insulin is often added to the solution.To reduce the risk for fatty liver disease in patients receiving long-term parenteral infusion, cyclic infusions should be delivered because there is a reduced risk of infection, reduced stress on the liver, and allows rest in between feedings.Nestle and Abbott are companies that make formulasA feeding tube should be flushed with warm water only if a tube obstruction develops.Chapter 17, 18, & 20: GI DiseasesMechanically Altered Diets are liquid, pureed, ground, chopped, minced or soft in texture.Foods permitted on a clear liquid diet are clear or pulp-free juices, carbonated beverages, clear meat and vegetable broths, fruit-flavored gelatin, fruit ices made from clear juices, frozen juice bars, and plain hard candy.Foods permitted on a full liquid diet are milk and other opaque liquids (such as fruit nectars, yogurt, and oral supplements).Medications that can cause xerostomia, or dry mouth, are antidepressants, antihistamines, antihypertensives, antineoplastics, and bronchodilators.Diseases or treatments that can cause dry mouth are poorly controlled diabetes, conditions that directly affect salivary gland function, radiation therapy, and excessive mouth breathing. Suggestions for managing dry mouth include taking frequent sips of water or another sugarless beverage, chew sugarless gum to help stimulate salivary flow, use OTC saliva substitutes, oral hygiene, and medication prescribed by a physician.Oropharyngeal dysphagia is a neuromuscular disorder that inhibits the swallowing reflex or impairs the strength or coordination of the muscles involved in swallowing. It’s symptoms are inability to initiate the swallowing, coughing during or after swallowing (due to aspiration), and nasal regurgitation, gurgitation, gurgling noise after swallowing, a hoarse or “wet” voice, or a speech disorder. Esophageal dysphagia is usually due to an obstruction in the esophagus or a motility disorder. It’s symptoms are sensation of food “sticking” in the esophagus after it is swallowed.Untreated dysphagia can result in malnutrition, weight loss, dehydration, aspiration that can lead to choking, airway obstruction, or respiratory infections including pneumonia.The National Dysphagia diet consists of 3 levels. Level 1 is pureed foods and is for patients with moderate to severe dysphagia and poor oral and chewing ability. Level 2 is mechanically altered foods and is for patients with mild to moderate dysphagia because some chewing ability is required. Level 3 is advanced and foods should be moist and in bite-sized pieces when swallowed. This diet is for patients with mild dysphagia and adequate chewing ability.The four liquid consistencies of the National Dysphagia Diet are thin liquids (watery fluids, milk, coffee, tea, juices, carbonated beverages), nectar thick liquids (fluids thicker than water that can be sipped through a straw, buttermilk, eggnog, tomato juice, cream soups), honey thick liquids (fluids that may be eaten with a spoon but do not hold their shape, honey, some yogurt products, tomato soup), and spoon thick liquids (fluids that may be eaten with a spoon and can hold their shape, milk pudding, thickened applesauce).Diet and lifestyle modifications used to manage/treat GERD are to consume only small meals and drink liquid between meals, limit foods that increase gastric acid secretion, avoid citrus and juices, avoid eating bedtime snacks or lying down after meals, elevate head when sleeping, avoid bending over and wearing tight-fitting garments, and avoid smoking and using nonsteroidal anti-inflammatory drugs.One class of medication used to treat GERD is proton-pump inhibitors (PPIs) which is a class of drugs that inhibit the enzyme that pumps hydrogen ions (protons) into the stomach; examples include omeprazole (Prilosec) and lansoprazole (Prevacid). Another class of medication used to treat GERD is histamine-2 receptor blockers (H2 blockers) which is a class of drugs that suppress acid secretion by inhibiting receptors on acid-producing cells; examples include cimetidine (Tagamet, ranitidine (Zantac), and famotidine (Pepcid).Fatty foods and high-fat meals, alcohol, chocolate, coffee, peppers, spices and spicy foods, and citrus fruits can exacerbate symptoms of dyspepsia and should be reduced/avoided in patients experiencing frequent dyspepsia.Excessive gas and bloating can be caused by gum chewing, smoking, rapid eating, drinking carbonated beverages, and using a straw.Dietary interventions advised to reduce nausea are restoring hydration, taking medication with food, dry and starchy foods, drinking fluids between meals and not with meals, and cold or room temperature foods.The two most common causes of gastritis and peptic ulcer disease are Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAISs).Untreated chronic gastritis can lead to the deficiency of nonheme iron and vitamin B12 as a result of hypochlorhydria or achlorhydria.The use of antisecretory drugs such as PPIs and H2 blockers can result in diarrhea, constipation, nausea and vomiting, abdominal pain & decrease in iron, calcium folate, and vitamin B12 absorption.The most metabolically active organ in the body is the liver.Bile is produced in the liver, but stored in the gallbladder.The main functions of the liver in the human body are to produce bile, synthesize most of the proteins that circulate in plasma, detoxify drugs and alcohol, & process excess nitrogen so that is can be safely excreted as urea.The primary risk factor for fatty liver disease not caused by excess alcohol intake is insulin resistance.Treatment recommended in obese or diabetic patients with fatty liver disease is weight reduction, increased physical activity, or medications that can improve insulin sensitivity.Hepatitis A, B, C, D & E are all caused by virus infections.Hepatitis A is transmitted by the fecal-oral route and there is a vaccination available. Hepatitis B is transmitted by blood, needles, sexual contact, or from the mother to infant during birth and there is a vaccine available to prevent this. Hepatitis C is transmitted through blood or needles and there is no vaccine available for prevention.The primary causes of liver cirrhosis in the U.S. are chronic hepatitis C infection and alcoholic liver disease, followed by nonalcoholic fatty liver disease and chronic hepatitis B infection. The physical and nutritional consequences (signs/symptoms) of cirrhosis are physical changes in liver tissue that may interfere with blood flow, causing fluids to accumulate in blood vessels and body tissues. Advanced cirrhosis can disrupt kidney, lungs, and brain function, and is usually associated with malnutritionNutrition therapy for cirrhosis is increased energy needs and adequate protein intake. Protein restriction is not recommended because an inadequate protein intake can worsen malnutrition and wasting. Branched-chain amino acids should be selected over aromatic amino acids because branched-chain amino acids may improve neurological functioning in patients with hepatic encepthalopathy. Sodium should be restricted to less than 2000 mg per day.Gallstones are composed primarily of compounds in bile like water, bile salts, cholesterol, phospholipids, proteins, and the bile pigment mon risk factors for developing cholesterol gallstones include rapid weight loss or fasting, gastric bypass surgery, or long-term parenteral nutrition, and it can also occur during pregnancy.The small intestine and the large intestine comprise the lower GI tract. Common fiber-rich foods are whole grains, legumes, nuts and seeds, and fruits and vegetables. The DRI for fiber for men is 38 grams per day and the DRI for women is 25 grams per day. Foods that can increase the production of intestinal gas and may need to be reduced in the diets of those who suffer from excessive gas include apples, artichokes, asparagus, beans and peas, beer, broccoli, Brussel sprouts, cabbage, carbonated beverages, carrots, cauliflower, corn, fructose-sweetened products, fruit juices, green beans, leeks, milk products, onions, peanuts, pears, turnips, and wheat. Common causes of constipation are low-fiber diets, low food intake, inadequate fluid intake, or a low level of physical activity.The primary treatment for constipation, particularly in individuals with low fiber intake is a gradual increase in fiber intake to at least 25 grams per mon causes of osmotic diarrhea are high intakes of poorly absorbed sugars (such as sorbitol, mannitol, or fructose) and lactose deficiency (which causes lactose malabsorption).The common cause of secretory diarrhea is foodborne illnesses but can also be caused by intestinal inflammation and various chemical substances (such as medications or unabsorbed bile acids).The dietary treatment that is often recommended for diarrhea, primarily osmotic diarrhea, is a low-fiber, low-fat, lactose-free diet. Inflammatory bowel diseases are Crohn’s Disease and Ulcerative Colitis. Crohn’s Disease consists of inflammation in the small intestine and the pattern of inflammation is skip lesions. Ulcerative Colitis consists of inflammation in the rectum and colon and the pattern of inflammation is continuous along the length of the intestine affected. The diet that is often prescribed for the treatment of IBDs is a high-kcalorie, high-protein diet.Diverticulosis is an intestinal condition characterized by the presence of small herniations (called diverticula) in the intestinal wall. Diverticulitis is an inflammation or infection involving diverticula.Low-fiber diets increase the risk for developing diverticulosis.Nutrition therapy for diverticulosis and diverticulitis is a gradual increase in fiber and emphasis on insoluble fiber sources such as wheat bran, whole grains, fruits, and vegetables.Key nutrition interventions for patients with ostomies are clear liquids to regular foods, low-fiber diets, small-frequent meals FODMAP diet is fermentable oligio-, di, monosaccharide, and polyols. You want short-chain sugars that are more easily digestible. General foods include lactose-free, gluten-free, and low fiber options. No milk and cheese, no legumes, no apples, apricots, avocados, mushrooms, sorbitol, and mannitol. Best foods are bananas, grapefruit, lemons, limes, green beans. Dietary management of celiac disease is to avoid wheat, rye, oats, and barley for life in order to avoid the response to protein of gluten. Consider sources of hidden gluten like toothpaste, mail, lotions, and chapstick. Must read food labels and be aware of food preparation. Damage to intestinal mucosa anytime gluten is ingested (8 week lag time). Body’s failure to respond to gluten-free diet if diet frequently started and stopped can lead to cancer. Basically, don’t start and stop a gluten free diet. Maintain the diet for life with no interruptions. ................
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