Clinical Nutrition Overview by Dr. Elbanna

Speaker Information

• Speaker: Dr. Nefisa H. Elbanna
• Profession: Professor of Clinical Nutrition
• Degree: PhD from University of Illinois, USA
• Affiliation: Home Economics, Helwan University

Enteral and Parenteral Nutrition Support

• Enteral nutrition: Delivers nutrition to the gastrointestinal tract via a tube or catheter when oral intake is insufficient.
• Parenteral nutrition: Delivers nutrients intravenously.

Dietary Supplementation

• Defined as a product intended to supplement a diet.
• Contains one or more dietary ingredients such as vitamins, minerals, herbs, amino acids.
• Also includes concentrates, metabolites, extracts, or combinations of these components.
• Provides additional nutrients to the diet by increasing total daily intake.
• Often administered in pill, capsule, tablet, or liquid form.
• Not a substitute for a normal meal or diet.
• Should be labeled as a "dietary supplement" and contain a dietary supplement facts label.

Potential Plants

• Leaves, flowers, stems, and roots are used for medicinal purposes.
• Formulations include teas, infusions, and concentrated beverages (from boiling roots).

Enteral Access Selection Factors

• Predicted duration of enteral feeding
• Risk of aspiration or tube displacement
• Normal digestion/absorption status
• Planned surgical intervention
• Formula viscosity and volume in administration

Nasogastric Route

• Used for short-term enteral nutrition (up to 3-4 weeks).
• Tube inserted through the nose into the stomach.
• Suitable for patients with normal gastrointestinal function.
• Feeding can be administered by bolus injection, intermittent or continuous infusions.

Nasoduodenal/Nasojejunal Route

• Used for short-term enteral nutrition support (up to 3-4 weeks).
• Suitable for patients with gastric motility disorders like esophageal reflux or persistent nausea/vomiting.

Percutaneous Endoscopic Gastrostomy/Jejunostomy (PEG/PEG-J)

• Nonsurgical procedure for inserting a tube directly into the stomach/jejunum.
• Performed endoscopically with local anesthesia.
• Preferred for continuous enteral feeding beyond 3-4 weeks.

Formula Composition

• Numerous commercial enteral feeding products are available.
• Formula suitability assessed based on:
  • Patient's gastrointestinal status
  • Formula characteristics (osmolarity and viscosity).
  • Energy and nutrient content
  • Patient's digestion/absorption capability
  • Clinical considerations (fluid/electrolyte status and organ/system function), and cost-effectiveness.

Nutritional Solutions Composition

• Commercial solutions formulated using:
  • Essential amino acids
  • Some non-essential amino acids (like cystine).

Carbohydrates

• Percentage of total enteral formula calories varies from 30% to 90%.
• Sources such as pureed fruits, vegetables, maltodextrins, sucrose, fructose, and glucose.

Lipids

• Contribute 1.5% to 55% of total kilocalories.
• Most formulas contain 30% to 40% of calories from lipids.
• Lipid emulsions (e.g., soybean, safflower oil) are available in 10% and 20% concentrations.

Vitamins, Minerals, and Electrolytes

• Most, though not all available formulas, aim to support recommended dietary intakes for these nutrients provided a sufficient volume is consumed.

Parenteral Nutrition

• Delivers nutrients directly to the bloodstream in a solution
• Candidates require a choice between central (e.g., superior vena cava) or peripheral (arm veins) access.

Fluid

• Fluid requirements for both enteral and parenteral nutrition are calculated using similar methods.

Explore the fundamentals of enteral and parenteral nutrition support as discussed by Dr. Nefisa H. Elbanna. This quiz covers key concepts such as dietary supplementation, including types of supplements and their roles in enhancing nutrition. Test your understanding of these essential topics in clinical nutrition.