Nutrition in Crohn's Disease and Intensive Care

10 Questions

What is the primary goal of modular feeding in patients with specific nutritional requirements?

To allow variation in the ratio of nutrients without affecting the quantity of other substances

What is the approximate percentage of energy derived from carbohydrate in these formulas?

50-55%

What is the benefit of using formulas with a low glycemic index?

Better blood sugar control

In which patient population may these formulas be used to provide adequate nutrition in a smaller volume?

Patients with fluid restrictions

What is the approximate percentage of energy derived from protein in these formulas?

15-20%

What is the primary advantage of using formulas with a high lipid content?

Increased energy density

In which patient population may these formulas be used to improve compliance?

Patients with mobility issues

What is the approximate water content of these formulas?

80-85%

What is the primary indication for using these formulas in patients with renal disease?

To provide adequate nutrition in a smaller volume

What is the approximate energy density of these formulas?

1 Kcal/Kg

Study Notes

Nutritional Support in Specific Conditions

In Crohn's disease, use enteral nutrition as sole therapy for the acute phase, and use oral nutritional supplements in case of persistent intestinal inflammation.
In ulcerative colitis, enteral nutrition is recommended if the patient is malnourished.
In intensive care, use enteral nutrition in all patients who are not expected to be on a full oral diet within 3 days from admission.

Non-Surgical Oncology

In general, use nutritional support in patients with weight loss due to insufficient nutritional intake, especially if under-nutrition already exists or is anticipated.
If the patient will be unable to eat more than 7 days or if intake is less than 60% of estimated requirements for more than 7 days, initiate nutritional support without delay.
During radio or chemotherapy, use intensive dietary advice and oral nutritional supplements to increase dietary intake and prevent therapy-associated weight loss and interruption.

Organ Transplantation

Before transplantation, use additional oral nutritional support or even tube feeding in under-nutrition, and assess nutritional status regularly while monitoring patients on the waiting list.
After transplantation, initiate early normal food or enteral nutrition, and even after small intestine transplantation, nutritional support can be initiated early but should be increased very carefully.

Pancreatic Disease

In mild acute pancreatitis, initiation of enteral nutrition is not necessary if the patient can consume normal food within 5-7 days.
In severe necrotizing pancreatitis, enteral nutrition is the first line, but in some cases, can be supplemented by parenteral nutrition.
In chronic pancreatitis, 10-15% of patients require oral nutritional support, and tube feeding is indicated only in 5% of patients.

Monitoring of EN

Monitor EN for two reasons: when capacity for absorption is severely impaired, and in the initial phase after prolonged starvation.
Hepatic formulas are commonly used, which are low in aromatic amino acids and high in branched chain amino acids.
Diabetic feeds have lower overall carbohydrate content and different types of carbohydrate from standard formulas.
Modular feeding allows variation in the ratio of nutrients without affecting the quantity of other substances.
Special indications include specific organ dysfunctions, metabolic errors, fluid restriction, diabetes mellitus, respiratory and cardiac failure, and major electrolyte disorders.