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Nutrition and Dietetics in the Normal Patient

Nutrition and Dietetics in the Normal Patient. Study Aims. Definition Malnutrition Actual body weight Ideal body weight Predicted body weight Nutritional assessement Calculation of nutritional needs Complications of overfeeding. Introduction. Malnutrition common

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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

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