nutritional therapy

Introduction

also see nutrition

Indications

• nutritional disorder
  • malnutrition
  • vitamin deficiency
  • mineral deficiency

Management

• Daily recommendations: (also see recommended daily allowance)
  • total calories: 30-35 kcal/kg day (BMI > 20)
  • 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
  • carbohydrate
  • fat - omega-3 fatty acids
  • fluid 30-35 mL/kg/day or 1 mL/kcal diet
  • vitamins & minerals
• Meeting nutritional needs:
  • to improve a poor appetite try
    • frequent, small meals, snacks, food preferences
    • food from home
    • Megace, Marinol
  • 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
  • social isolation
    • encourage eating in common diet area
  • polypharmacy
  • changing taste perception
    • chemotherapy, radiation therapy
    • aging process
      • decreased # of taste buds/ papillae
      • changes in olfaction
• critical illness
  • hypocaloric vs full enteric nutrition with similar outcomes (ventilator-free days & mortality)
    • burns may be exception
• nutrition & cancer
  • limit or avoid dairy products to reduce the risk of prostate cancer
  • limit or avoid alcohol to reduce the risk of
    • head & neck cancer
    • esophageal cancer
    • colorectal cancer
    • breast cancer
  • avoid red meat & processed meat to reduce the risk of colorectal cancer [3[
  • avoid grilled, fried, & broiled meats to reduce the risk of
    • colorectal cancer
    • breast cancer
    • prostate cancer
    • kidney cancer
    • pancreatic cancer
  • consumption of soy products during adolescence reduces risk of breast cancer in adulthood & risk of recurrence & mortality for women previously treated for breast cancer
  • fruits & vegetables to reduce risk of several common forms of cancer
    • cruciferous vegetables reduce risk of colorectal cancer
• patient family satisfaction
  • nutritional supplement to diminish weight loss in demented patients is comforting to the family

More general terms

• nutrition
• clinical procedure

More specific terms

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

Additional terms

• disease-nutrition interactions
• nutritional assessment
• nutritional deficiency
• nutritional supplement