Couch, PhD, RDN Professor and Department Chair Department of Nutritional Sciences University of Cincinnati Medical Center Cincinnati, Ohio. Dietetics and Nutrition School of Health Professions University of Kansas Medical Center Kansas City, Kansas.
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CONTENTS
Nutrition Assessment
Nutrition Diagnosis and Intervention
Nutrition in the Life Cycle
Geriatrics 5 The Spectrum of Aging, 368
Nutrition for Health and Fitness
Medical Nutrition Therapy
Medical Nutrition Therapy, 493 New Therapies, 503 Food Allergy Prevention, 503 Helpful Sites and Apps, 506 27 Medical Nutrition Therapy for Upper. Matarese, PhD, RDN, LDN, CNSC, FADA, FASPEN, FAND Physiology and Functions of the Liver, 560 Liver diseases, 562.
Pediatric Specialties
This section opens with a brief overview of nutrient digestion, absorption, transport, and excretion. Nutrigenomics is the study of the effects of foods and nutrients on gene expression and thus nutritional requirements.
THE GASTROINTESTINAL TRACT
The cells are not fully functional until the last 2 to 3 days as they migrate from the crypts to the distal third of the villi. About 45% of the energy needs of the small intestine and 70% of the energy needs of the cells lining the large intestine are supplied by nutrients passing through its lumen.
BRIEF OVERVIEW OF DIGESTIVE AND ABSORPTIVE PROCESSES
The large intestine and rectum absorb most of the remaining fluid excreted by the small intestine. The human receptor is found in the stomach and pancreatic ductal and acinar cells.
THE SMALL INTESTINE: PRIMARY SITE OF NUTRIENT ABSORPTION
The pyloric sphincter in the distal part of the stomach helps regulate the outflow of gastric contents, preventing backflow of chyme from the duodenum into the stomach. A damaged or dysfunctional ileocecal valve results in the entry of significant amounts of fluid and substrate into the large intestine and increases the possibility of microbial overgrowth in the small intestine (see Chapter 28).
THE LARGE INTESTINE
Most protein digestion occurs in the upper part of the small intestine, but it continues through the GI tract. The products of lipid digestion are rapidly dissolved in the central portion of the micelles and carried to the intestinal brush border (Figure 1-8).
USEFUL WEBSITES
Protein binding is specific (eg, transferrin, which binds to iron, or ceruloplasmin, which binds to copper) or general (eg, albumin, which binds to various minerals). Specific protein carriers are usually not fully saturated; reserve capacity can serve as a buffer against overexposure.
Proteins, fats and other carbohydrates are synthesized from this basic carbohydrate to meet the needs of the plant. The body uses energy from dietary carbohydrates, proteins, fats and alcohol; this energy is locked in chemical bonds within the food and released through metabolism.
ENERGY REQUIREMENTS
Through the process of photosynthesis, green plants capture some of the sunlight that reaches their leaves and trap it within the chemical bonds of glucose. Although all energy eventually takes the form of heat, which is dissipated into the atmosphere, unique cellular processes first make it possible to use it for all the tasks necessary for life.
COMPONENTS OF ENERGY EXPENDITURE
Energy expenditure may be higher in people who are obese (Dobratz et al, 2007) but depressed during starvation or chronic dieting and in people with bulimia (Sedlet and Ireton-Jones, 1989). Alternative methods of measuring energy consumption remain in the research community due to the need for specialized equipment and expertise.
ESTIMATING ENERGY REQUIREMENTS
Prediction equations include physical activity (PA) coefficients for all groups except infants and young children (see Box 2-1). PAL is physical activity level, which is the ratio of total energy expenditure to basal energy expenditure.
CALCULATING FOOD ENERGY
Energy expended during various activities and the intensity and impact of selected activities can also be determined for children and teenagers (see Box 2-1). Recommendations for macronutrient percentages vary depending on the goal of the client and any underlying or predominant disease process.
USEFUL WEBSITES/APPS
Jeor ST, et al: A new predictive equation for resting energy expenditure in healthy individuals, Am J Clin Nutr. Dobratz JR, et al: Prediction of energy expenditure in extremely obese women, J Parenter Enteral Nutr.
EPIDEMIC OF CHRONIC DISEASE
The fact of the increasing incidence of chronic diseases has pushed global civilian and government health care systems to seek new responses to this almost universal challenge. Global efforts to improve understanding of this chronic disease phenomenon bring with it the realization that these chronic diseases have long incubation periods (years to decades), so they may be undetectable during their early stages and may be present in an otherwise healthy life. looking person.
CONCEPTS OF CHRONIC DISEASE PATHOPHYSIOLOGY
There should be further identification of biomarkers, usually biochemical and phenotypic, that are indicative of early chronic disease and based on evidence. An example of application of the nutritional partner principle is the general recommendation for adults to take calcium supplements along with vitamin D.
INFLAMMATION: COMMON DENOMINATOR OF CHRONIC DISEASE
The longer the physiological damage lasts, the greater the loss of recognition. When assessing the overall inflammatory burden of an individual, the “antigen load” is important.
NUTRIENT MODULATORS OF INFLAMMATION
Series (PGE1): Antiinflammatory
PGE1 is particularly important for the effects of GLA and its conversion to DGLA to manage inflammation. GLA not only attenuates intracellular inflammation by converting to DGLA (Arm et al, 2013), but also reduces inflammation in the extracellular matrix present in diabetic nephropathy (Kim et al, 2012).
Series (PGE2): Pro-inflammatory When in Excess
PGE1 metabolites are part of the balancing act between prostaglandin groups to control inflammation, with a primary anti-inflammatory effect on the tissue microenvironment. Another physiological function of the fatty acids is that GLA, DGLA, EPA and DHA, when kept in balance, can function as inhibitors of tumor cell proliferation and migration under in vitro and in vivo conditions (Rahman et al, 2013; Wang et al, 2012; Yao et al, 2014).
Series (PGE3): Antiinflammatory
REDUCING INFLAMMATION IN THE BODY
More tools for assessing all the systems of the body's metabolism are becoming available. Polymorphisms of the vitamin D receptor gene (VDR) have been shown to be associated with several complex diseases, including osteoporosis.
PROLONGED INFLAMMATION EXPRESSION SPECIFIC TO MAJOR CHRONIC DISEASES
A patient's story is a term that includes the patient's entire history and current medical condition; is a collection of all data that can potentially contribute to the metabolic health of an individual. All cardiometabolic markers are sufficient to assess the endocrine risks of chronic disease together with markers specific to this condition.
SUMMARY
Karatzas PS, et al: DNA methylation profile of genes involved in inflammation and autoimmunity in inflammatory bowel disease, Medicine. He K, Liu K, Daviglus ML, et al: Magnesium intake and incidence of metabolic syndrome in young adults, Circulation.
NUTRITION SCREENING
Assessment of nutritional status is the foundation of nutritional care; it is the important basis for personalizing an individual's nutritional care in the context of the cause, prevention or management of disease or promotion of health. The tool is useful for the acutely hospitalized adult population and was the only one of the 11 evaluated by EAL to be found to be valid and reliable in identifying problems in acute care and hospital-based ambulatory care settings (OG, 2013b; Box 4 -1) .
NUTRITION ASSESSMENT
The Nutrition Risk Screening (NRS 2002) is a screening tool useful for medical-surgical hospital patients (AND, 2015). The information collected on individuals or populations is used as part of the assessment of nutritional status.
Mini Nutritional Assessment MNA ®
This process can be either active (i.e. the user captures an image before and after a meal) or passive (i.e. a wearable camera captures images during daily activities, including mealtime). For example, when the person relates that the person had cereal for breakfast, the nutritionist might ask, "What kind of cereal?" The next question might be, "How many did you have?" at the same time that the person is shown a bowl or measuring cup to jog the memory on portion size.
ANALYSIS OF DIETARY INTAKE DATA
S. Department of Agriculture
Department of Agriculture Healthy Eating Index http://www.cnpp.usda.gov/HealthyEatingIndex.htm http://www.cnpp.usda.gov/HealthyEatingIndex.htm.
S. Department of Agriculture Nutrient Content of the Food Supply
Skipper A, Ferguson M, Thompson K et al: Nutrition screening tools: an analysis of the evidence, JPEN J Parenter Enteral Nutr. Thompson FE, Subar AF, Loria CM, et al: The need for technological innovation in dietary assessment, J Am Diet Assoc.
Consequently, the promise of the molecular era is not only to manage chronic disease more effectively, but also to restore health and, ultimately, to prevent chronic disease from developing. This emerging subdiscipline of clinical nutrition provides the tools for identifying genetic variations that predict an increased susceptibility to developing chronic disease and the knowledge to modify lifestyle choices to promote health rather than disease.
THE HUMAN GENOME PROJECT AND THE “OMIC”
Understanding the root causes of these conditions and identifying the underlying mechanisms responsible for the development and maintenance of chronic conditions provides new approaches that hold the promise of restoring the health of people with chronic illness and, ultimately, preventing its development. However, chronic disease research tells us that environmental factors such as diet and other lifestyle choices made every day have a strong influence on which of the susceptible people will actually develop dysfunction and disease.
DISCIPLINES
Each of these disciplines is part of the larger picture of increasing focus in nutritional therapy at the molecular and biochemical level. Nutrigenomics, on the other hand, is the study of the interaction between genes and environmental factors that result in a change in gene expression.
GENOTYPE AND NUTRITION ASSESSMENT
Individuals with such a mutation in both copies of the MTHFR gene require the active form of folate for optimal health. The control of gene expression is the result of the epigenetic marks on the genetic material of that cell, the "epigenetic signature" of that cell type.
GENETIC FUNDAMENTALS
Individuals with X-linked recessive nephrogenic diabetes insipidus are unable to concentrate urine and exhibit polyuria and polydipsia.
Using restriction endonucleases (restriction enzymes) derived from bacteria, researchers could cut DNA at precise, reproducible sites along the nucleotide strand, isolate the fragments, and use polymerase chain reaction (PCR) technology to make unlimited copies of the DNA. for different applications. The overall methylation load can be determined and compared between samples, or specific regions of the genome can be analyzed and compared.
GENETICS AND NUTRITION THERAPY
In a study of sterol regulatory element-binding protein-1 (SREBP1) gene haplotypes in postmenopausal women, consumption of omega-6 PUFAs, but not omega-3 PUFAs, was associated with progression of atherosclerosis as measured by reduced artery diameter (Kalantarian et al, 2014). A SNP in the FTO gene is associated with an increased risk of obesity, and the effect was directly related to the number of copies of the SNP.
ETHICAL, LEGAL, AND SOCIAL IMPLICATIONS
Frayling TM, et al: A common variant in the FTO gene is associated with body mass index and susceptibility to childhood and adult obesity, Science. Joffe YT, et al: The -308 G/A polymorphism of the tumor necrosis factor-a gene modifies the relationship between saturated fat intake and serum.
BODY WATER
The average sum of the concentration of all cations in serum is approx. 150 mEq/L. Water intoxication occurs as a result of water intake that exceeds the body's ability to excrete water.
ELECTROLYTES
In the setting of hypoalbuminemia, serum calcium levels are not accurate because nearly 50% of calcium is protein bound. It is important to identify the cause of the fluid losses so that they can be corrected and prevented in the future.
ACID-BASE BALANCE
Approx. 80% to 90% of ingested potassium is excreted in the urine; the rest is lost in the stool. In cases of hypokalemia, aldosterone secretion is lower and the kidneys shift to reabsorb potassium and excrete sodium.
ACID-BASE DISORDERS
The acid-base balance is a complicated subject that requires a high understanding of many complex processes. In uncompensated and simple acid-base disorders, the pH and HCO32 move in the same direction.
USEFUL WEBSITES, TOOLS/CALCULATORS, AND APPS
Predictive values for compensatory responses are available to distinguish between primary acid-base imbalances and compensatory responses (Whitmire 2002). In uncompensated and simple acid-base disorders, pH and pCO2 move in opposite directions in respiratory disorders.
BIOCHEMICAL ASSESSMENT OF NUTRITION STATUS
Ankle test results should be evaluated in light of the patient's current medical condition. It is essential to monitor trends in test results and patterns of results in the context of genetic and environmental factors.
NUTRITION INTERPRETATION OF ROUTINE MEDICAL LABORATORY TESTS
Total cholesterol, 200 mg/dl; 5.20 mmol/L Decreased in those with malnutrition, malabsorption, liver disease, and hyperthyroidism. Glucose Not detected (2-10 g/dl in diabetes) Positive in subjects with diabetes; rarely in benign conditions.
ASSESSMENT OF HYDRATION STATUS
Serum levels do not reflect protein status or the effects of refeeding in the individual with depleted protein reserves. However, RBP levels also decrease in the presence of inflammatory stress and may not improve with refeeding.
ASSESSMENT FOR NUTRITIONAL ANEMIAS
The nutritional causes of macrocytic anemia are related to the availability of folate and vitamin B12 in the bone marrow and require evaluation of both nutrient levels. Folate and vitamin B12 are necessary for the synthesis of S-adenosylmethionine (SAM), the biochemical precursor involved in the transfer of one-carbon (methyl) groups during many biochemical syntheses.
FAT-SOLUBLE VITAMINS
The urinary MMA test is more sensitive than the serum B12 test because it indicates true tissue B12 deficiency. The urinary MMA test is the only B12 deficiency test that has been validated as a screening tool.
WATER-SOLUBLE VITAMINS AND TRACE MINERALS
CHRONIC DISEASE RISK ASSESSMENT Lipid Indices of Cardiovascular Risk
In other words, no one type of assay is likely to provide a global picture of the oxidative stress to which an individual is exposed. The second assay is the measurement of the compounds F2 isoprostanes either in plasma or urine (Harrison and Nieto, 2011).
PHYSICAL ASSESSMENTS Anthropometry
The percentage of weight loss is very indicative of the extent and severity of an individual's disease. The bar should be as close to horizontal as anatomically possible (ie, the bar line at the front of the neck will be at the same height as the bar line at the back of the neck) (Arnold, 2014 ).
NUTRITION-FOCUSED PHYSICAL ASSESSMENT
Adapted from White JV et al: Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus statement: recommended characteristics for identifying and documenting adult malnutrition (undernutrition), Diet J Acad Nutr. White JV, Guenter P, Jensen G, et al: Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus statement: recommended characteristics for identifying and documenting adult malnutrition (undernutrition), Diet J Acad Nutrition.
PHARMACOLOGIC ASPECTS OF FOOD-DRUG INTERACTIONS
Distribution occurs when the drug leaves the systemic circulation and travels to different parts of the body. One of the more important enzyme systems that accelerates drug metabolism is the cytochrome P-450 enzyme system.
RISK FACTORS FOR FOOD-DRUG INTERACTIONS
They are at higher risk of food-drug interactions due to physical changes associated with aging, such as the increase in the ratio of adipose tissue to lean body mass, a decrease in liver mass and blood flow, and deterioration of kidney function. Such individuals are at higher risk of adverse drug effects, as there is an increase in the amount of unbound or active drug.
EFFECTS OF FOOD ON DRUG THERAPY Drug Absorption
Various mechanisms may contribute to a reduction in the rate or extent of drug absorption in the presence of food or nutrients. The presence of food in the stomach increases the absorption of certain drugs, such as the antibiotic cefuroxime axetil (Ceftin) or the antiretroviral drug saquinavir (Invirase).
MEDICATION AND ENTERAL NUTRITION INTERACTIONS
Enzyme systems in the intestinal tract and the liver, although not the only sites of drug metabolism, are responsible for a large part of the drug metabolizing activity in the body. Competition between food and drugs such as propranolol (Inderal) and metoprolol (Lopressor) for metabolizing enzymes in the liver can alter the first-pass metabolism of these medications.
EFFECTS OF DRUGS ON FOOD AND NUTRITION
In the case of warfarin, higher levels of free drug lead to risk of excessive anticoagulation and bleeding. When food and drugs compete for the same metabolizing enzymes in the liver, more of the drug is likely to reach systemic circulation, which can lead to a toxic effect if dose titration occurs in the fasting state.
MODIFICATION OF DRUG ACTION BY FOOD AND NUTRIENTS
Some herbal products, such as dong quai, which contain substances similar to coumarin, or ginseng, which is a platelet inhibitor, also increase the effect of. Because of the hepatotoxic potential of ethanol, it should not be combined with other hepatotoxic medications such as acetaminophen (Tylenol), amiodarone (Cordarone), or methotrexate.
EFFECTS OF DRUGS ON NUTRITION STATUS
Examples of drugs that cause hepatotoxicity (liver damage), including hepatitis, jaundice, hepatomegaly, or even liver failure, include amiodarone, amitriptyline, antihyperlipidemic drugs, divalproex, carbamazepine (Tegretol), and methotrexate. Recently, the FDA added a labeling requirement on all second-generation antipsychotics to warn about the possibility of developing hyperglycemia and diabetes.
EXCIPIENTS AND FOOD-DRUG INTERACTIONS
Tyramine and other antihypertensives (dopamine, phenethylamine, histamine): Tyramine is the decarboxylated product of the amino acid tyrosine. Caffeine: A member of the methylxanthine family of CNS and cardiac muscle stimulants, cerebral vasoconstrictors, and diuretics.
MEDICAL NUTRITION THERAPY
S. Department of Health and Human Services (USDHHS)
Growing engagement and access to technology, especially social media, has created new opportunities and challenges in public health and community nutrition. The mission of community nutrition is to promote norms and conditions in which people can be healthy.
SOCIAL DETERMINANTS OF HEALTH
GMO or Genetically Engineered (GE) Foods in Chapter 26.) Historically, public health was defined as “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts” . In 1988, the Institute of Medicine published a landmark report promoting the concept that community nutrition outreach is a work in progress.
NUTRITION PRACTICE IN THE COMMUNITY
Each layer describes the spheres that affect community involvement in health services, including nutrition. Implementing interventions at each of the levels can achieve the greatest possible sustained public health.
NEEDS ASSESSMENT FOR COMMUNITY-BASED NUTRITION SERVICES
The expansion of community-based practice beyond the scope of traditional public health has opened new employment and outreach opportunities for nutrition professionals. At first glance, it may seem that some of the data collected during this process is not directly related to nutrition, but an experienced community nutritionist or an advisory group of public health experts can help connect this information to nutrition and nutrition. diets. issues.
NATIONAL NUTRITION SURVEYS
The USDHHS is responsible for sample design and data, while the USDA is responsible for the survey's collection and maintenance of the dietary data. The purpose of this act is to provide organization, consistency, and unification to the survey methods that measure the food habits and nutrition of the U.S.
NATIONAL NUTRITION GUIDELINES AND GOALS
The release of the DGA paved the way for a synchronized message to the community. The Recommended Dietary Allowance (RDA) was developed in 1943 by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences.
FOOD ASSISTANCE AND NUTRITION PROGRAMS
As the food supply and the nutritional needs of the population have changed, the intent of the RDAs has been adapted to the prevention of nutrition-related diseases. The ADAs always reflected gender, age and life stage differences: there were additions of nutrients and revisions of the age groups.
FOODBORNE ILLNESS
Infectious disease caused by the bacterium Yersinia; in the United States, most human diseases are caused by Y. As a result, security issues need to be addressed globally, as well as in the United States.
FOOD AND WATER SAFETY
In addition, food and water safety and foodborne illness are monitored by state and local health departments. National Institutes of Health http://www.nih.gov National Food Safety Database http://www.foodsafety.gov National Restaurant Association.
DISASTER PLANNING
Access to food and water can be limited, leading to social disruption and self-imposed quarantine. FEMA identifies food and water needs, arranges for delivery, and provides assistance with temporary housing and other emergency services.
HEALTHY FOOD AND WATER SYSTEMS AND SUSTAINABILITY
CDC has three operations related to food safety and disaster planning: PulseNet, FoodNet, and the Centers for Public Health Preparedness. The Centers for Public Health Preparedness funds academic centers that connect public health schools with state, local, and regional bioterrorism preparedness and public health infrastructure needs.
SUMMARY: A WORK IN PROGRESS
Department of Agriculture Farm to School Initiative http://www.fns.usda.gov/cnd/F2S/Default.htm http://www.fns.usda.gov/cnd/F2S/Default.htm. Department of Agriculture Nutrition Assistance Programs http://www.fns.usda.gov/fns/ http://www.fns.usda.gov/fns/.
THE NUTRITION CARE PROCESS
RDNs evaluate all of the information from the nutritional assessment to determine a nutritional diagnosis. The fourth step in the NCP involves monitoring and evaluating the effect of nutrition interventions.
DOCUMENTATION IN THE NUTRITION CARE RECORD
DBW, Desired Body Weight; Dx, diagnosis; EER, estimated energy requirement; F/U, follow-up; ht, height; hx, history; PO, by mouth; PRN, as required; pt, patient; Rx, prescription;. SOAP, subjective, objective, assessment, plan; TF, tube feeding; TPN, total parenteral nutrition; UBW, usual body weight; weight, weight.
INFLUENCES ON NUTRITION AND HEALTH CARE
One of the biggest influences on healthcare over the past decade has been changes in healthcare payment methods. Preferred Provider Organizations (PPOs) and Managed Care Organizations (MCOs) are also changing healthcare.
NUTRITION INTERVENTIONS
Many facilities have a selective menu that allows the patient certain choices; the suitability of the diet varies based on the patient's choices. Prevention of malnutrition in the health care setting requires observation and monitoring of the adequacy of.
NUTRITION FOR THE TERMINALLY ILL OR HOSPICE PATIENT
Discuss how the type of health insurance the patient has may affect this plan. Nutritional support should be continued as long as the patient is competent to make this choice (or as specified in the patient's advance directives).
DETERMINING NUTRIENT NEEDS
An appropriate diet is adequate and balanced and takes into account the characteristics of the individual, such as age and stage of development, taste preferences and eating habits. An adequate and balanced diet meets all the nutritional needs of an individual for maintenance, repair, life processes, growth and development.
WORLDWIDE GUIDELINES
In the United States, the MyPlate food guidance system, shown in Figure 11-1, replaced the earlier MyPyramid chart. For comparison, see Eating Well Canada's Food Guide as shown in Clinical Insight: Nutrition Recommendations for Canadians and Figure 11-2.
NUTRITIONAL STATUS OF AMERICANS Food and Nutrient Intake Data
See Table 11-1 and the DRI tables inside the front and back pages of this text. Each of the dietary recommendation categories in the DRI system is used for specific purposes among individuals or populations.
