Lecture 3 Flashcards
(24 cards)
What are the factors affecting food intake in patients?
Illness Feelings Income Ability to get, prepare, store food Different foods/meals than pt is used to Meal presentation and preparation Eating in different place Personal likes and dislikes Acceptability of foods Timing of meald Food allergy/intolerance Ability to select food from hospital menu Ability to self feed Med side effects Acceptance and compliance to diet Rx
Why do diets require modification?
- Texture and consistency modifications for dysphagia and other conditions associated with difficulty chewing and swallowing
- Clear liquid diets or full liquid diets: Diets consisting of broth, juice, cream soups, and milk
- Nutritional intake may be modified to prepare patients for a specific medical test
What is fluid osmolality?
A measure of osmotic pressure exerted by a solution; number of water-attracting particles per weight of water in kg.
What is osmolality determined by?
◦ Determined by # and size of electrolytes, minerals,
urea/AA & CHO
◦ Osmolality will affect amount of free water available for metabolic function
• More particles the higher the osmolarity
What is osmolality proportional to?
▪proportional to [substances dissolved]
▪inversely proportional to molecular weight of substances dissolved
Larger molecules have less surface area and as they break down they break down into smaller molecules
-More sugars the more osmolarity youll have
What is osmosis?
water flows from lower to high concentration
when do we control the osmolality of liquids?
▪GI function is compromised
▪No enteral nutrition (EN) for a long period
-increase osmolality, increase risk intolerance
How do you increase osmolarity tolerance?
▪Dilute hyperosmolar liquids to <400 mOsm/kg
▪Drink slowly
▪Small quantities at regular intervals
What is the difference between clear liquid and full liquid diet?
Clear: Intended to supply fluid and energy in a form that requires minimal digestion and stimulation of the GI tract
Full liquid: Transition between clear liquids
and solid food
When is a nutrient dense high energy high protein diet needed/useful?
✓underweight ✓unintended weight loss ✓poor appetite ✓increased PRO & energy requirements -Cystic fibrosis (CF), cancer, liver disease, wound healing etc ✓nutrient dense vs volume dense -approach varies by conditions
What are nutrient dense approaches to improve intake?
- Small, frequent meals
- Eat largest meal when appetite best
- High protein, energy dense snack before bed
- Make drinks count
- Encourage a few bites even if patient is not hungry -Encourage foods and drinks patient enjoys
- Oral nutritional supplements
What are some ways to increase energy content?
• Add butter or margarine to cooked cereals, soups, vegetables, or casseroles
• Add jam, jelly, or honey to toast or other breads and crackers
• Use whole milk or cream with soups, casseroles, creamed
vegetables, or shakes and smoothies
• Add sour cream or yogurt to soups, casseroles, creamed vegetables, or shakes and smoothies
• Add nut butters or cream cheese to raw vegetables, bread, or crackers
How do we increase protein content?
• Add powdered milk to any beverage, soup, or casserole
• Add liquid egg substitutes to shakes, soups, vegetables, or
casseroles
• Wherever possible, add nuts, nut butters, chopped meats, cooked eggs, cheese, or yogurt to prepared foods
• Add tofu or soy crumbles to any prepared vegetable, soup, or casserole
What are nutritional supplements?
Commercial or prepared foods or beverages intended to supplement energy, protein, carbohydrate, fibre, and/or fat intake
What are the different forms of nutritional supplements?
• Modified foods and beverages
• Adding single nutrients (protein, CHO or fat) via
modular products
• Nutritional supplements
Why are vitamin and mineral supplements used?
- Taken to meet recommendations
* To correct deficiencies
What are bioactive substance supplements?
• Food substances added to a food product or taken as supplements that have a specific intended health purpose
-Include plant stanol or sterol esters, pro-/prebiotics, soy protein, psyllium, and beta-glucan
What are the 3 forms of commercial oral nutritional supplements and formulas?
Complete nutritional formulas (full meal replacement)
Non-complete nutritional formulas (not all nutrients)
Nutrient supplements (modular formulas) (just one or 2)
What are some examples of oral nutritional supplements?
Lactose-containing
◦ Breakfast Essentials,
Nestlé Texture modified
◦ Ensure Puddings, Abbott
What are polymeric formulas?
Standard, complete
formulas
▪Low-residue, lactose-free or fibre- containing or clear fruit-flavoured
Many variations
▪Many flavours
▪Enriched in energy
▪Enriched in nitrogen (protein) ▪Enriched in energy and nitrogen ▪Disease specific
What are oligomeric formulas?
• Oligo- partially hydrolyzed= semi elemental all mean the same thing
- Means they are all partially broken down and easier fro digestion and absorption
What are monomeric formulas?
Completely hydrolyzed
-its completely broken down for the easiest absorption
Why do people use oligo/monomeric formulas?
Useful for individuals with impaired digestion or absorption (e.g. inflammatory bowel disease (IBD), severely malnourished, short bowel syndrome (SBS), pancreatitis, etc.)
What are modulars?
One or 2 nutrients together
