Cancer Cachexia

Clinical features of cancer cachexia include host tissue wasting, anorexia, skeletal muscle atrophy, anergy, fatigue, anemia and hypoal-buminemia unresponsive to aggressive nutrition intervention 54, 55 . The cancer cachexia syndrome (CCS) involves a heterogeneous medley of physiological and metabolic derangements resulting in potentially life-threatening malnutrition 56, 57 . Cytokines, especially tumor necrosis factor (TNF), interferon-7 (IFN-7) and interleukins 1 and 6 (IL-1 and IL-6), are...

Nutrition assessment in the presence of liver disease

In early stages of liver disease, whether caused by alcohol, autoimmune processes, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), metabolic disorders or other causes, typical objective nutrition Role of the Liver in Nutrient Metabolism Synthesizes blood-clotting factors Deaminates transaminates amino acids Oxidizes the amino acids arginine, histidine, lysine, methionine, alanine, tryptophan and tyrosine Hydrolyzes triglycerides, cholesterol and phospholipids to fatty acids and...

Prevalence of Malnutrition

By Nutrition Assessment Parameters Malnutrition prevalence depends in part on the parameters that were chosen to determine nutritional status. For example, when 50 patients with cirrhosis were assessed according to subjective global assessment (SGA), prognostic nutritional index (PNI) and handgrip strength (HG), malnutrition was diagnosed in 28 based on SGA, 18.7 by PNI and 64 by HG. HG was superior in predicting poor clinical outcome when compared with SGA and PNI 4 . In another study,...

Screening for celiac disease

Because of concerns relating to the complications of not recognizing celiac disease and leaving it untreated, screening for celiac disease has been advocated. The disease itself does meet established criteria for screening, but there are issues related to resources and also ethical considerations that weigh against widespread screening programs for detecting celiac disease. Screening has been advocated in some settings including relatives of those with celiac disease and in type I diabetics,...

Plasma proteins

Plasma proteins, such as albumin, prealbumin, transferrin, ferritin and retinol binding protein, have all been used as nutritional markers (Table 1.1). In the past 30 years, there have been over 20,000 citations Fig. 1.3. Bedside anthropometric tools Lange calipers and tape measure. Fig. 1.3. Bedside anthropometric tools Lange calipers and tape measure. on albumin 20 . One-third of albumin is maintained in the intravascular compartment and two-thirds in the extravascular compartment. Serum...

Geriatric Nutritional Risk Index

The Geriatric Nutrition Risk Index (GNRI) is an adaptation to the Nutritional Risk Index (NRI). The GNRI is specifically designed to predict the risk of morbidity and mortality in hospitalized elderly patients (Table 1.7) 38 . Because the normal weight of the elderly patients is often difficult to determine, this tool substitutes ideal weight in place of usual weight used by the NRI. The GNRI is calculated using a special formula incorporating both serum albumin Malnutrition Universal Screening...

Low carbohydrate diets are they safe

Health care professionals continue to be concerned with the potential negative side effects of high dietary protein intake associated with low carbohydrate diets. Concerns include dehydration, fatigue, increased calcium excretion, colon cancer and increased renal burden 21 . Additionally, high saturated fat intake and increased risk of heart disease are associated with low carbohydrate, high protein diets 22 . Diabetics are one population in whom the use of low carbohydrate diets needs to be...

Enterostomy tubes

Percutaneous enterostomy tubes are indicated when long-term enteral access of 4 weeks is necessary these may be placed by endoscopic, fluoroscopic, or surgical techniques. The administration of a single dose of a broad-spectrum antibiotic pre-procedurally has been shown to reduce the risk of wound infection 60-68 and be cost-effective for percutaneous endoscopic gastrostomy. It is also recommended for other enterostomy placements as well 35 (Table 10.4). 3.1. Gastrostomy Tubes 3.1.1. Techniques...

Tube Feeding

Tube feeding (TF) should be considered for patients with liver disease when nutrient intake is inadequate and oral supplementation fails. There are some circumstances that warrant consideration when providing TF to patients with liver failure. The type of tube to be used is determined by the expected duration of feeding as well as the presence or absence of ascites. Typically, a small-bore nasoen-teral tube is selected for this group because it is more comfortable than a larger-bore nasoenteral...

Role of pharmacological management

The long-term use of antimotility and antisecretory agents is frequently necessary to control stool losses in SBS. Massive enterectomy is associated with a transient gastric hypergastrinemia and hypersecretion 51 . H2 receptor antagonists and proton pump inhibitors may be beneficial, particularly during the first year following resection, in reducing the volume of gastric secretions and, thus, stool losses. The acidity can also lead to peptic complications and or impairment in the function of...

Perioperative Feeding Considerations

Historically, oral and enteral feeding have been discouraged following GI surgical procedures, with bowel rest recommended to promote anastomotic healing and prevent nausea and vomiting 85 . More recently, it has become clear that GI function returns rapidly postop-eratively in most patients, and intraluminal nutrients promote bowel hypertrophy and anastomotic healing 85 . Even in the absence of peristalsis, the small intestine regains the ability to absorb nutrients quickly after surgery....

Role of diet and fluids

For reasons previously discussed, SBS patients would be expected to differ in their response to dietary manipulation depending upon their bowel anatomy, specifically, the presence or absence of a colon 36, 37 . Norgaard and colleagues compared the effect of a high carbohydrate (60 ), low fat (20 ) diet with a high fat (60 ), low carbohydrate (20 ) diet in a small number of SBS patients with a colon in continuity 37 . They found that the high carbohydrate, low fat diet reduced fecal calorie loss...

Nutrition as primary therapy in ibd

With the advent of total parenteral nutrition (TPN) came a surge of enthusiasm for placing patients with IBD on bowel rest and intravenous nutrition as primary treatment. This was particularly popular in the 1970s. Then in 1983 Muller recognized that while many patients could be put into remission of their Crohn's disease with exclusive use of TPN (aka bowel rest), the relapse rates were very high when oral intake was resumed 49 . TPN is certainly not without serious side effects and is very...

Usda and iom recommendations

The USDA and the IOM each have evidence-based approaches for addressing diet and lifestyle modification Dietary Guidelines for Americans 2005, released by the USDA and the US Department of Health and Human Services (DHHS) on 12 January 2005 25 and the Institute of Medicine's IOM's Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Table 9.4 IOM Report and USDA Guidelines Adults should consume 45 to 65 of their total calories from...

Gastric Cancer

A definite relationship exists between h-pylori colonization and distal gastric cancer risk. Many of the dietary components implicated as chemoprotective to the stomach exert their effect via the control of the H-pylori infection. For example, the acidic nature of wine 22 and the antioxidant capacity of vitamin C 23, 24 appear to impede H-pylori growth. Alcohol 12, 22, 25 , simple carbohydrates 26 and red meat 27, 28 appear to increase the risk of gastric cancer. Pickled and other salty foods...

Initiating Enteral Feeding 231 Selecting the Formula Type

The most important question upon initiation of enteral feeding is whether the disease process warrants the use of an immune-modulating formula. A recent US Summit on Immunonutrition helped identify those patients who were candidates for an immune-modulating formula 54 . Candidates were designated based on literature showing that use of an immune formula in that particular disease process would favorably impact outcome (compared to use of a standard enteral formula alone). Such candidates would...

References

Cancer Facts and Figures 2005. Atlanta American Cancer Society 2005. 2. Doll R, Peto R. The causes of cancer quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981 66 1191-1308. 3. Willett WC. Diet, nutrition, and avoidable cancer. Environ Health Perspect.1995 103 (Suppl) 8 165-170. 4. Vogelstein B, Kinzler KW. Cancer genes and the pathways they control. Nat Med. 2004 10 789-799. 5. August D, Huhmann M. Nutritional care...

Mechanisms of malnutrition

In virtually all disease states, the mechanisms of malnutrition fall under seven general categories (Table 3.1). These include decreased food intake, maldigestion, malabsorption, alterations in metabolism of nutrients, increased nutrient requirements, increased nutrient losses and drug-nutrient interactions. The effect of inflammatory bowel disease will be addressed with each of these causes individually (Table 3.2). Decreased food intake is commonly encountered in IBD, especially in Crohn's...

Pharmacologic options

Patients with a BMI > 30kg m2 or with a BMI > 27kg m2 with concomitant obesity-related diseases should be considered for adjuvant pharmacologic therapy. Pharmacotherapy is appropriate in individuals who have not responded to previous weight loss attempts (diet, exercise and behavioral changes) or have been unsuccessful with sustaining previous weight loss attempts. The two medications approved by the FDA for long-term weight loss are sibutramine (Abbott laboratories, Abbott Park, IL a...

Darlene G Kelly MD PhD Facg Facp

4 Diet in the Pathogenesis of IBD 6 Nutrition in the Treatment of IBD 8 Goals of Primary Therapy for IBD 9 Nutrition as Primary Therapy in IBD 10 Specialized Roles for Nutrition Support in IBD Discussed in this chapter are ways in which inflammatory bowel disease (IBD) and nutrition are intimately related. Both Crohns disease and ulcerative colitis can have a profound effect on the nutritional status of those afflicted with these diseases. This can occur as a result of decreased food intake,...

Malnutrition in ibd

The occurrence of malnutrition in both ulcerative colitis and Crohn's disease is common (Table 3.3). Weight loss in regional ileitis (Crohn's disease) was described in the early observations of Crohn 27 . Indeed, death as a result of malnutrition in those with Crohn's disease was not unusual in the first half of the last century. Protein-calorie malnutrition is still seen in up to 80 of those with Crohn's disease and in as many as 50-60 of those with ulcerative colitis. Hypoalbuminemia is...

Jeanette M Hasse PhD Rd Ld Fada Cnsd

2 The Liver and Nutrient Metabolism 3 Nutrition Assessment in the Presence of Liver Disease 4 Malnutrition and Liver Disease 6 Effect of Malnutrition on Patient Outcome 7 Effect of Nutrition Supplementation on Patient Outcome Because the liver performs hundreds of metabolic functions, nutritional status and nutrient metabolism are altered in individuals with liver disease. This chapter reviews relationships between nutritional status and liver disease, describes effects of malnutrition and...