Medical Nutrition Therapy for Selected Metabolic Disorders PDF

Summary

This document provides information on medical nutrition therapy for selected metabolic disorders. It covers topics such as metabolic syndrome, hypoglycemia, adrenocortical insufficiency, and hypothyroidism. It also discusses nutrition therapy objectives and considerations for various conditions.

Full Transcript

MEDICAL NUTRITION THERAPY FOR SELECTED METABOLIC DISORDERS Metabolic Syndrome Metabolic Syndrome is a clustering of components that reflect overnutrition , sedentary lifestyles , and resultant excess adiposity. Alternatively called Insulin Resistance Syndrome ; recognized in 1988 as syn...

MEDICAL NUTRITION THERAPY FOR SELECTED METABOLIC DISORDERS Metabolic Syndrome Metabolic Syndrome is a clustering of components that reflect overnutrition , sedentary lifestyles , and resultant excess adiposity. Alternatively called Insulin Resistance Syndrome ; recognized in 1988 as syndrome X, metabolic syndrome is accompanied by insulin resistance , hypertension and, glucose intolerance , and dyslipidemia. Determinants of Metabolic Syndrome Postmenopausal with history of low birth weight and adult obesity Genes Stress-related hormones High calorie diets Sedentary activity Excess weight with “apple-shaped figure” Smoking Clinical Identifiers for Metabolic Syndrome Identifier Defining Level Abdominal obesity Waist Circumference : men over 40 in; women over 35 in Hypertriglyceridemia Above 50 mg/dl Low HDL cholesterol Below 40 mg/dl in men; below 50mg /dl in women Abnormal blood pressure Equal to over 130/85mmHg Fasting glucose Equal to or greater than 110mg/dl Nutrition Therapy It is well established that weight loss is beneficial for treating all of the components of metabolic syndrome. Primary goals of nutrition therapy are aimed at – Reducing underlying factors such as obesity and physical inactivity – Achieving and maintaining normal glucose levels – Lowering lipid risk factors – Controlling blood pressure to less than 135/85 – Long term goals include prevention of complication such as diabetes and cardiovascular disease. Nutrition Therapy Calories Fat Carbohydrate Vitamins and Minerals HYPOGLYCEMIA Hypoglycemia is a condition where blood sugar levels drop too low, typically below 40 mg/dL. It is most common in people with diabetes who take insulin or certain medications but can also occur due to skipping meals, excessive exercise, or other medical conditions. HYPOGLYCEMIAS Types of Hypoglycemia Fasting Hypoglycemia: Occurs when blood sugar levels drop after a prolonged period without eating (e.g., overnight or between meals). It is often linked to underlying health conditions such as hormonal imbalances, liver disease, or tumors in the pancreas that produce excess insulin (e.g., insulinoma). Postprandial Hypoglycemia Happens within a few hours after eating a meal. It is caused by the body releasing too much insulin in response to food, leading to a rapid drop in blood sugar levels. This is more common in individuals with certain conditions, such as prediabetes, or after surgeries affecting the stomach. Nutrition Therapy Fasting hypoglycemia can be resolve quickly by administration of meals with simple sugars after which, a constant, regular supply of glucose through small, frequent feedings and well-balanced diet will prevent future hypoglycemic episode. On the other hand postprandial hypoglycemia is controlled by providing adequate, balanced meals. Protein and fat should be taken whenever carbohydrate is consumed to delay gastric emptying and to blunt the postprandial insulin response to carbohydrates. Small frequent feeding High fiber diet Adrenocortical Insufficiency ( Addison’s Disease) Adrenocortical Insufficiency (Addison’s Disease) is a rare condition where the adrenal glands do not produce enough of certain hormones, specifically cortisol and aldosterone. These hormones are essential for maintaining blood pressure, metabolism, and the body’s response to stress. Common causes include autoimmune disorders, infections, or damage to the adrenal glands. Symptoms often develop gradually and include fatigue, weight loss, low blood pressure, darkening of the skin, and salt cravings. If untreated, it can lead to an adrenal crisis, a life-threatening condition requiring immediate medical attention. Proper management involves hormone replacement therapy and a carefully balanced diet. Adrenocortical Insufficiency ( Addison’s Disease) The mainstay of treatment is continued administration of corticoid dugs and replacement of glucocorticoid and mineralocorticoid functions primarily with prednisone or prednisolone and fludcortisone respectively. Other objectives of nutrition therapy include – The prevention of hypoglycemia by avoiding fasting – Prevention of weight loss through improved appetite and strength – Modification of sodium according to drug therapy – Prevention of hyponatremia especially in warm weather as well as prevention of dehydration and shock. Nutrition Therapy A high protein, moderate carbohydrate diet is given to meet the nutritional needs of the patient. Diet alterations must be highly individualized and tailored according to clinical problems that manifest. Blood glucose, sodium and potassium levels are monitored. Ensure that sodium intake is high unless drugs are used to retain sodium. Beware of foods high in potassium unless drugs are used to control the potassium. Supplementation of B complex and Vitamin C may be needed for increased metabolic requirements. Hypothyroidism Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones (T3 and T4) to meet the body's needs. These hormones regulate metabolism, energy production, and many other bodily functions. When thyroid hormone levels are low, the body's metabolism slows down, leading to various symptoms and health effects. Hypothyroidism When hypothyroidism becomes severe, it can lead to a condition called myxedema, which is a life-threatening complication. Myxedema is characterized by an extreme slowing of metabolism and can result in significant health issues if left untreated. Cretinism ( Infantile Myxedema) – A condition caused by thyroid hormone deficiency during fetal development or early infancy, leading to impaired growth and brain development Iodine Deficiency as contributing cause of subclinical hypothyroidism is often undertreated. Extreme fatigue Swelling (edema) in the face, hands, and feet due to mucopolysaccharide deposition in tissues Slow heart rate, cold intolerance, and low blood pressure Dry skin, hair thinning, and hoarseness In severe cases, myxedema coma, a life- threatening emergency characterized by hypothermia, confusion, and respiratory failure. Thyroprivic Hypothyroidism (Thyroidal Hypothyroidism) – Cause: This type of hypothyroidism occurs due to the loss or atrophy of thyroid tissue, leading to insufficient production of thyroid hormones. Goitrous Hypothyroidism (Goitrous or Defective Hormone Biosynthesis) – Cause: This form of hypothyroidism results from compensatory goitrogenesis, where the thyroid gland becomes enlarged (a goiter) due to defective hormone biosynthesis. Trophoprivic Hypothyroidism (Pituitary or Hypothalamic Hypothyroidism) – Cause: This occurs when there is insufficient stimulation of an intrinsically normal thyroid gland due to hypothalamic or pituitary disease. Nutrition Therapy In hypothyroidism, a variety of changes occur in the metabolism of fat, protein and carbohydrate. An overall decrease in the rate of energy utilization gives rise to moderate weight gain, thus, most of the patients suffering from myxedema are overweight. A low caloric deficit with increased protein is prescribed. The amount of decrease in calories under normal requirements should be in accordance with the low metabolic rate. Nutrition Therapy Hypertriglyceridemia and hypercholesterolemia are usually present so that dietary cholesterol is restricted. Gastrointestinal hypomotility commonly results in constipation such that nutritional care during rehabilitation should include serving high fiber, natural laxative foods such as prunes and encouraging the patient to drink 6 to 8 glasses of water a day. Nutrition Therapy Natural goitrogens may be used in moderation or cooked. Goitrogens in cabbage, cassava, peanuts, turnips, cauliflower, broccoli, soybeans, and rapeseeds may interfere with the utilization of iodine by body cells; heating and cooking of these foods inactivate goitrogens. Hyperthyroidism Hyperthyroidism, a condition that exists predominantly in women (eight times more common in females), is an excessive secretion of thyroid hormones with a consequent elevation of the cells' metabolic activity. Severe forms are called Grave's disease (toxic goiter) or thyrotoxicosis. The chief symptoms are weight loss, sometimes to the point of emaciation, excessive nervousness, prominence of the eyes and a generally enlarged thyroid gland. Appetite is often increased and signs of cardiac failure may be present. Practically all the metabolic processes in the body are accelerated in hyperthyroidism. The basal metabolic rate is increased by 50 % or more in severe cases and the serum protein-bound iodine values are elevated. T he BMR test and the serum protein-bound iodine (PBI) values are used as diagnostic tests for hyperthyroidism aside from serum total T4 and T3 resin uptake, thyroid-stimulating hormone (TSH)- releasing hormone test, radioactive iodine uptake test and thyroid scan. Disorders of carbohydrate metabolism (with glucosuria and abnormal blood sugar curves) and increased protein metabolism occur. Unless both protein and caloric levels are adequate, there may. be continuous rapid weight loss. Calcium imbalance, disorder of 240 Jamorabo-Ruiz, Claudio and De Castro 2011 Hyperthyroidism Hyperthyroidism, a condition that exists predominantly in women (eight times more common in females), is an excessive secretion of thyroid hormones with a consequent elevation of the cells' metabolic activity. Severe forms are called Grave's disease (toxic goiter) or thyrotoxicosis. The chief symptoms are weight loss, sometimes to the point of emaciation, excessive nervousness, prominence of the eyes and a generally enlarged thyroid gland. Appetite is often increased and signs of cardiac failure may be present. Practically all the metabolic processes in the body are accelerated in hyperthyroidism. The basal metabolic rate is increased by 50 % or more in severe cases and the serum protein-bound iodine values are elevated. Nutrition Therapy A high calorie, liberal protein, liberal carbohydrate diet with calcium, phosphorous, and vitamin D and B- complex supplementation is recommended. The basic goal of the diet is to compensate for the increased metabolic rate, correct negative nitrogen balance ( due to tissue catabolism) and prevent bone mineralization. The increase of calories over the normal allowances should be in accordance with the accelerated metabolic rate. In mild cases, the increase may be 10-30% above normal while in advanced cases, 50-60% increase is needed. Ensure high intake of carbohydrates and protein in range of 1-2 g/kg body weight Hyperthyroidism Hyperthyroidism, a condition that exists predominantly in women (eight times more common in females), is an excessive secretion of thyroid hormones with a consequent elevation of the cells' metabolic activity. Severe forms are called Grave's disease (toxic goiter) or thyrotoxicosis. The chief symptoms are weight loss, sometimes to the point of emaciation, excessive nervousness, prominence of the eyes and a generally enlarged thyroid gland. Appetite is often increased and signs of cardiac failure may be present. Practically all the metabolic processes in the body are accelerated in hyperthyroidism. The basal metabolic rate is increased by 50 % or more in severe cases and the serum protein- bound iodine values are elevated. The BMR test and the serum protein-bound iodine (PBI) values are used as diagnostic tests for hyperthyroidism aside from serum total T4 and T3 resin uptake, thyroid-stimulating hormone (TSH)-releasing hormone test, radioactive iodine uptake test and thyroid scan. Disorders of carbohydrate metabolism (with glucosuria and abnormal blood sugar curves) and increased protein metabolism occur. Unless both protein and caloric levels are adequate, there may. be continuous rapid weight loss. Calcium imbalance, disorder of 240 Jamorabo-Ruiz, Claudio and De Castro 2011 Gout Gout is a monosodium urate, monohydrate crystal deposit disease. It is a disorder of purine metabolism characterized by high uric acid levels in the blood and deposits of sodium urate as tophi in soft and bony tissues such as joints, cartilage and tendons. Nutrition Therapy 1. Limit High-Purine Foods: Avoid: Organ meats (liver, kidney), red meat, shellfish, and oily fish like sardines and anchovies. Limit: Poultry and certain types of seafood (e.g., tuna, trout). 2. Avoid Alcohol: Alcohol, especially beer and spirits, increases uric acid production and reduces its excretion. 3. Reduce Fructose Intake: Fructose-sweetened beverages (like sodas) and high-sugar foods increase uric acid levels. 4. Focus on Low-Purine Foods: Include more fruits, vegetables, whole grains, and low-fat or non-fat dairy products, as they are low in purines. Nutrition Therapy 5. Stay Hydrated: Drink plenty of water (at least 8-10 glasses daily) to help flush out uric acid through the urine. 6. Maintain a Healthy Weight: Losing weight gradually can reduce uric acid levels, but rapid weight loss should be avoided as it may trigger a gout attack. 7. Incorporate Anti-Inflammatory Foods: Foods rich in vitamin C (oranges, strawberries), cherries, and omega-3 fatty acids (flaxseeds, walnuts) may help reduce inflammation and uric acid levels. 8. Use Caution with Protein Sources: Choose plant-based proteins (lentils, beans, tofu) over animal proteins to reduce purine intake.

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