Chapter 4: Nutritional Needs of the Adult Oncology Patient

Question 1

What is “disease-related malnutrition”?

Answer 1

when the severity of persistence of inflammation results in a decrease in lean body mass, causing functional impairment.

Question 2

In chronic disease-related malnutrition, successful nutrition intervention must address ____ and ____.

Answer 2

the underlying health condition and its nutritional needs.

Question 3

Why do individuals with cancer have an increased requirements for macro- and micro nutrients?

Answer 3

Due to periods of under nutrition (before and after diagnosis) and because of the metabolic effects from the cancer and its treatment.

Question 4

Which cancers have the highest energy expenditures?

Answer 4

Esophageal, gastric, pancreatic and non-small cell lunch cancers.

Question 5

Which cancer showed no change in energy expenditure?

Answer 5

Colorectal cancer

Question 6

Longer-term consequences of under-feeding?

Answer 6

Loss of lean body mass, immunosuppression, poor wound healing and risk of hospital acquired infections.

Question 7

Longer-term consequences of over-feeding?

Answer 7

Respiratory failure d/t increased CO2 production, hyperglycemia, azotemia (high levels of nitrogen-containing compounds), hypertriglyceridemia, electrolyte imbalances, immunosuppression, alterations in hydration status and hepatic statosis.

Question 8

The DRI for protein for healthy adults?

Answer 8

0.8 g/kg/day

Question 9

Recommended protein range for catabolic individuals?

Answer 9

1.2-2.0 g/kg/day

Question 10

Protein for metabolically stressed individuals?

Answer 10

1.5 g/kg/day

Question 11

The RDA for carbohydrate?

Answer 11

130 g/day

Question 12

How can a person meet their essential fatty acid needs and with which fats?

Answer 12

Linoleic acid: 2-4% of total calories

Alpha linolenic acid: 0.25-0.5% of total calories

Question 13

A.S.P.E.N. guidelines for carbs and fat for those receiving nutritional support?

Answer 13

Carbohydrate: <7 g/kg/day
Fat: <2.5 g/kg/day

Question 14

Factors impacting hydration status in the elderly?

Answer 14

Impaired thirst mechanism, access issues and decreased mobility.

Question 15

In the palliative care setting, how many mL of fluid/day is acceptable?

Answer 15

1000 mL

Question 16

List three methods for fluid requirements?

Answer 16

A.S.P.E.N.: 20-40 mL/kg/day or 1-1.5 mL/kcal energy expenditure
RDA: 1 mL/kcal energy consumed
Body Surface Area (BSA): 1500 mL/M2 or BSA x 1500 mL

Question 17

Micronutrient goal?

Answer 17

100% of the RDAs

Question 18

Which minerals decrease during the inflammatory process?

Answer 18

selenium, copper, iron and zinc

Question 19

Which vitamins are usually not effected by inflammation?

Answer 19

B1, B2, B12 and folate

Question 20

what is sarcopenia?

Answer 20

the degenerative loss of skeletal muscle mass

Question 21

What are 3 ways to estimated energy needs?

Answer 21

Direct calorimetry, Indirect calorimetry, Predictive equations.

Question 22

What is the gold standard of measuring energy needs?

Answer 22

Indirect caloimetry

Question 23

Direct calorimetry

Answer 23

Used infrequently, and mostly a research method which measures heat from macronutrient consumption released from the subject.

Question 24

Indirect calorimetry (IC)

Answer 24

Uses oxygen consumption and carbon dioxide production but the equipment is not always available

Question 25

Predictive equations

Answer 25

developed for select patient populations and used to assess energy needs

Question 26

BEE

Answer 26

Basal Energy Expenditure: minimum amount of energy expended to be compatible with life.

Question 27

BMR

Answer 27

Basal Metabolic Rate: measurement of the baseline energy expended; measured early in the morning before activity and 10-12 h after ingestion of food, beverage or nicotine. Is measured in a temperate environment

Question 28

RMR

Answer 28

Resting Metabolic Rate: energy expended at rest; measured after fasting for at least 5 hours, generally 10-20% higher than BMR

Question 29

REE

Answer 29

Resting Energy Expenditure: energy needs to maintain normal body functions; measured after 30 min of recombinant rest

Question 30

EEE

Answer 30

Estimated Energy Expenditure: energy needed per day to maintain normal body functions

Question 31

EER

Answer 31

Estimated Energy Requirements: average predicted nutrition intake for maintenance of energy balance and good health based on age, gender, weight, height, and activity level

Question 32

PAL

Answer 32

Physical Activity Level: 4 levels: sedentary, low active, active, and very active

Question 33

RQ

Answer 33

Respiratory Quotient: calculation derived from IC using carbon dioxide expended and oxygen consumed

Question 34

What does an RQ below 0.7 indicate?

Answer 34

hypoventilation or prolonged fasting

Question 35

What does an RQ over 1.0 indicate?

Answer 35

hyperventilation, overfeeding or inaccurate gas collection.

Question 36

Mifflin-St Jeor Equation is best for?

Answer 36

(using actual wt) Best at predicting RMR in non-obese and obese populations age 20-82 years

Question 37

Harris-Benedict Equation?

Answer 37

Estimated energy needs in healthy adults. Not to be used in acutely or critically ill pts.

Question 38

Best equations to use to assess energy needs for acutely ill populations?

Answer 38

Mifflin-St Jeor and Ireton-Jones Equations

Question 39

Best equations to use to assess energy needs for critically ill populations?

Answer 39

Penn State Equation and the Swinamer equation and the Ireton-Jones equation

Question 40

Which equation is best to estimate the needs of the mechanically ventilated critically ill pt?

Answer 40

Swinamer Equation

Question 41

Which equation is best to estimate the needs of the ventilator-dependent critically ill pt?

Answer 41

Ireton-Jones Equation

Question 42

Best equations to assess energy needs of obese?

Answer 42

11-14 kcal/kg of actual wt in hypometabolic disease (without renal or hepatic dysfunction) 11-18 kcal/kg of actual body wt (without renal or hepatic dysfunction) 22 kcal/kg IBW (without renal or hepatic dysfunction)

Question 43

Energy needs for cancer (for weight gain)

Answer 43

30-35 kcal/kg

Question 44

Energy needs for cancer (inactive, non-stressed)

Answer 44

25-30 kcal/kg

Question 45

Energy needs for cancer, hypermetabolic, stressed

Answer 45

35 kcal/kg

Question 46

Energy needs for sepsis

Answer 46

25-30 kcal/kg

Question 47

Energy needs for Hematopoietic cell transplant

Answer 47

30-35 kcal/kg

Question 48

What is best to use: actual wt, adjusted wt or IBW?

Answer 48

Actual wt

Question 49

What is one sign that a pt is suffering from re-feeding syndrome?

Answer 49

3 days after the start of re-feeding, they may get hypophosphatemia.

Question 50

Energy needs for re-feeding?

Answer 50

20 kcal/kg or no more than 1000 kcal per day and advance as tolerated while monitoring electrolytes. (or start with 25% of estimated needs and increase over 3-5 days).