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[Mine] core curric - 2016 > Ch 11: EN Formulations > Flashcards

Ch 11: EN Formulations Flashcards

1
Q

CHO sources in standard and hydrolyzed TFs

A
  • Polymeric: corn syrup solids as CHO source
  • Hydrolyzed: maltodextrin or cornstarch as CHO source
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2
Q

CHO in TFs

A
  • 40-70% of energy in most formulas
  • Primary macronutrient
  • Contributes to osmolality, digestibility, and sweetness of enteral formulas
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3
Q

Common sources of fiber in TF:

A

guar gum and soy fiber

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4
Q

Soluble fiber may help control diarrhea by

A

increasing sodium and water absorption via fermentation byproducts (SCFAs)

Soluble fiber → SCFA in colon (energy for colonocytes) → increase intestinal mucosal growth and promote water and sodium absorption

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5
Q

Insoluble fiber:

A

may decrease transit time by increasing fecal weight

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6
Q

ASPEN/SCCM guidelines for fiber in TFs:

A
  • Consider fiber-containing formula if patient with persistent diarrhea
  • Avoid both types of fiber if patients are at high risk for bowel ischemia and have severe dysmotility

Cases of bowel obstruction from fiber containing formulas have been reported in critically ill patients

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7
Q

Fat in TFs

A

Concentrated energy source and provides EFAs (linoleic and linolenic acid). Mix of LCT and MCTs
* LCTs: corn and soybean oil most common
* MCTs: palm kernel and coconut oil

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8
Q

Advantages/disadvantages of MCT:

A
  • Absorbed directly into portal circulation & don’t require chylomicron formation for absorption
  • Do not require pancreatic enzymes or bile salts for digestion/absorption
  • Cleared from the bloodstream rapidly
  • Cross the mitochondrial membrane without need for carnitine (where they are oxidized to CO2 and water, therefore not stored)
  • Do not provide EFAs (which is why there is a mix of LCT/MCT)
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9
Q

Intact proteins:

A

Whole protein or protein isolates –
require normal levels of pancreatic enzymes
* Mostly used- casein, soy
* Clso used- lactalbumin, whey, and egg

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10
Q

TF & Vitamins & DRI

A

Most formulas have enough vit/min to meet DRI at 1000 to 1500 mL/d of formula

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11
Q

Water in TF formulas

A
  • 70-85% water by volume
  • Not intended to meet total fluid needs
  • Adequate hydration is needed to maintain tissue perfusion and electrolyte balance

1.0 = 83% – 85% per liter
1.2 = 81% – 82% per liter
1.5 = 76% – 78% per liter
2.0 = 69% – 72% per liter

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12
Q

Osmolality

A

The concentration of free particles, molecules, or ions in a given solution
* Expressed mOsm/kg

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13
Q

Osmolality of TF formulas ranges

A

280-875 mOsm/kg

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14
Q

Which is higher in osmolality?
* Sucrose, cornstarch, maltodextrin
* Single AA, di- and tripeptides, intact protein

A
  • Sucrose mOsm/kg > cornstarch or maltodextrin
  • Single AA or high amounts of di- and tripeptides mOsm/kg > intact protein
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15
Q

What happens when hyperosmolar formulas containing sucrose are fed to the SB?

A

Dumping syndrome

Unlikely to occur when peptide of single AA are provided in a similar manner

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16
Q

Other than simple sugar hyperosmolality, the osmolality of an enteral formula:

A

has little to do with formula tolerance

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17
Q

Food Allergies and Intolerances - TF formulas

A
  • May contain milk, soy, con, or egg products
  • Most formulas are lactose and gluten free
18
Q

A clinician must evaluate available research before recommending specialized formula:

A
  • In vitro (animal) vs in vivo (human) study
  • Quality of study design:
    ——Prospective RCT
    ——Retrospective review
    ——Case reports
  • Similarity of pt pops studied to pts being cared for (demographics, clinical status, clinical environment)
  • Generalizability of results
19
Q

Hyperglycemia, hypoglycemia, and glycemic variability have each been associated with

A

morbidity and mortality

20
Q

DM formulas vs standard

A

DM formulas are:
* Lower in CHO (33-40%)
* Higher in monounsaturated fat and total fat (42-54%)
* Provide more fiber (14-16 g/L)

21
Q

What is the goal of DM formulas?

A

Slow gastric emptying and lead to better glycemic control

22
Q

Patients with DM and gastroparesis may have difficulty tolerating DM formulas because

A

higher fat and fiber content

23
Q

Recommendations for DM formula use:

A

Standard formulas used in conjunction with appropriate energy provision and insulin therapy are promoted for patients with DM or stress-induced hypoglycemia

24
Q

GI d/o and malabs TF formula

A

Formulas usually contain: hydrolyzed proteins, MCTs, omega 3s, FOS, prebiotics, and inulin

25
Q

What does the research say about peptide-based formulas in GI issues?

A

Contradictory research for peptide-based formulas, but it may reduce diarrhea

26
Q

ASPEN & ESPEN rx for elemental formulas

A
  • ESPEN recommends against routine use of elemental formulas in IBD and SBS
  • ASPEN recommends against routine use of elemental formulas in critically ill patients (no clear benefit in patient outcome shown in literature)
27
Q

TF & Hepatic Failure

A

BCAAs (leucine, valine, and isoleucine) have been promoted in this population in the past because they clear ammonia in the skeletal muscle, thus decreasing cerebral ammonia levels and reducing the uptake of AAAs across the blood brain barrier

28
Q

Of BCAA trials, what were the results?

A

BCAA supplementation was found to have a beneficial effect on hepatic encephalopathy, but it didn’t lead to improvements in mortality, QOL, or nutrition-related outcomes

29
Q

BCAA supplementation (ie orally)

A

increases N/V

30
Q

Recent systematic review and meta-analysis: arginine-enriched formulas administered to H&N CA pts undergoing surgery

A

Associated with reduction in fistulas and hospital LOS

Metabolism of arginine differs in surgical patients vs non-surgical

31
Q

Numerous reviews on IMF use in surgical/critical care populations:

A

decreased risk of infection, reduced length of stay, and reduced mortality

32
Q

ASPEN/SCCM 2016 guidelines for IMF:

A
  • Does not recommended routine use of IMFs with severe sepsis (arginine metabolism releases Nitric Oxide which fuels sepsis)
  • Reserve IMF for post-op patients in SICU
33
Q

ASPEN and SCCM recommendations for ARDS and ALI

A

do not recommend use of specialized formulas for ARDS/ALI

High doses of omega 6’s are not recommended in critically ill population due to pro-inflammatory properties

34
Q

Optimal nutrition management in AKI includes:

A
  • Adequate macronutrient support to correct underlying conditions
  • Prevent ongoing loss of organ function
  • Supplement micronutrients and vitamins during RRT
  • Adjust electrolyte replacement based on degree and extent of renal dysfunction
35
Q

Routine use of renal-specific EN formulas is

A

not necessary in CKD or AKI

36
Q

2016 ASPEN/SCCM guidelines for critically ill:

A
  • Recommend use of standard high protein formulas for patients with AKI
  • Hyperkalemia or hyperphosphatemia may require a renal-specific formula
37
Q

wasting conditions

Proteolysis-inducing factor causes

A

protein catabolism and leads to cachexia in cancer patients

38
Q

wasting syndrome

Conditionally essential AA glutamine and arginine are associated with

A

improving immune function and wound complications when supplemented at pharmacological levels

39
Q

HMB (metabolite of BCAA leucine) results in

A

positive patient outcomes when provided with or without arginine and glutamine

Promotes anabolism by increasing protein synthesis and inhibiting pathway that controls protein degradation

Trauma patients receiving HMB had less negative nitrogen balance

40
Q

wound healing

What nutrients are associated with improved patient outcomes?

A

Glutamine, arginine, omega 3s, zinc, selenium, and vitamins A/C/E

41
Q

Provision of IMFs (containing arginine, omega 3 FA, antioxidants, and sometimes glutamine) decreases the incidence of

A

Patient complications including anastomotic dehiscence
* Effects demonstrated in GI surgery and trauma populations

42
Q

Multiple reviews suggest _ _ _ can assist pts at risk for PIs (NH residents, SCI, wounds) as long as other protective behaviors (weight control, exercise, healthy lifestyle) are involved)

A

a high protein diet and adequate serum levels of Vitamin A and zinc

[Mine] core curric - 2016 (22 decks)

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