Nutrition Therapy 2 - Midterm - PDF

Nutrition Therapy 2 - Midterm COMMON Diagnostic Tests -​ Patients can also recover through early and timely diagnosis, followed by early Diagnostic Tests implem...

Nutrition Therapy 2 - Midterm COMMON Diagnostic Tests -​ Patients can also recover through early and timely diagnosis, followed by early Diagnostic Tests implementation of treatment plans -​ It provides information that can ​ May also be called diagnostic benefit the patient as healthcare procedure professionals can choose the ​ Tests used to help figure out what appropriate preventive disease or condition a person (or interventions as well as patient) has based on their signs and providing vital prognostic data symptoms that allows for the optimization ​ These may also help plan treatment, of care pathways and find out how well a treatment is working, management and make a prognosis ○​ Laboratory tests (blood & urine -​ Data from these tests can also aid in test) reducing, shortening, and avoidance of ○​ Imaging tests (mammography hospitalization; decrease inappropriate & CT scan) medication use, and shorten the length ○​ Endoscopy (colonoscopy & of or prevent sick leaves (which brings bronchoscopy) economic value in terms of ○​ Biopsy ( tissue and cancer cell) cost-containment and fostering improved health outcomes, and ROLES OF DIAGNOSTIC TESTS ultimately enabling the efficient use of resources) IDENTIFICATION -​ After patient evaluation, a clinician will IMPORTANCE OF FOLLOWING order for diagnostic tests to confirm REQUIRED TEST DIETS a suspected condition or to exclude conditions 1. Accurate results ​ Ensures that their body is in the MONITORING optimal state for the diagnostic test -​ Following a diagnosis, further diagnostic tests can be requested to determine if the treatment is working 2. Clear Visualization effectively ​ Diets like clear liquid diet or low-fiber diets help in achieving a clear field of vision during medical imaging PROGNOSIS procedures -​ Diagnostic testing aid a doctor in reviewing the progression of a 3. Standardization disease and predict (or can be a basis) ​ Prescribed diets standardize for how long one will live conditions for testing, reducing variables that could affect results SIGNIFICANCE -​ It is important since it can help the 4. Diagnostic Sensitivity patients live longer and have healthier ​ Some diets, like fasting or specific lives when diseases progression is nutrient challenges, are designed to delayed or halted test the body's response to certain substances Nutrition Therapy 2 - Midterm 5. Identification of Trigger Factors Nurse ​ Diagnostic tests like FODMAP ​ Assists in patient preparation for elimination diet, help identify specific diagnostic tests, administers certain food triggers for conditions such as tests, and mont patients during Irritable Bowel Syndrome (IBS) procedures 6. Enhanced Patient Safety Pharmacist ​ Following the recommended diet ​ Collaborates with the healthcare team minimizes potential risks associated with to ensure that medications prescribed certain medical procedures based on diagnostic findings are appropriate, safe, and effective 7. Efficient Use of Resources ​ Adherence to diagnostic test diets Dietitian ensures that resources, including time ​ Offers dietary guidance for patients and equipment, are efficiently utilized undergoing certain diagnostic tests, such as glucose tolerance test or those requiring specific dietary preparations THE HEALTHCARE TEAM General Practitioner/Family Medicine Physician KEY ASPECTS TO A DIETITIAN'S ROLE ​ Initiates the diagnostic process, IN THE IMPLEMENTATION OF assesses the patient's overall health, DIAGNOSTIC TEST DIETS and determines the need for diagnostic tests ASSESSMENT Dietitians assess the patient's medical history, Specialist/Consulting Physician nutritional status,, and any pre-existing ​ Offers specialized expertise and conditions to understand specific dietary needs interprets diagnostic test results and restrictions relevant to the diagnostic tests within their field CUSTOMIZED DIET PLANS Radiologist Develop personalized diet plans tailored to the ​ Specialized in medical imaging, requirements of specific diagnostic tests, may interprets results from X-rays, CT involve creating custom and specialized bets, scans, MRIs, and other Imaging fasting instructions, or other dietary techniques modifications necessary for accurate test results Pathologist/Laboratory Medicine COLLAB WITH HEALTHCARE TEAM Specialist Works closely with physicians and other ​ Oversees the laboratory, analyzes healthcare professionals to align the diagnostic results from blood tests tissue test diet with the overall treatment plan and samples, and other diagnostic tests specific medical goals PATIENT EDUCATION Medical Technologist Educate patients on the importance of adhering ​ Conducts laboratory tests, including to the prescribed diagnostic test diet, provide Nood Tests and other diagnostic clear instructions on what food to consume or essays Nutrition Therapy 2 - Midterm avoid, timing of dietary changes, and any FASTING BLOOD GLUCOSE TEST potential impacts on the test results -​ Procedure: Measures blood glucose levels after fasting. MONITORING & FOLLOW-UP -​ Dietary Requirement: Overnight Monitor patients throughout the implementation fasting (usually 8-12 hours), no food of the diagnostic test diets, offering ongoing or drinks except water. support and addressing any challenges or concerns that may arise, conducts follow-up assessments to evaluate the impact of dietary ORAL GLUCOSE TOLERANCE TEST changes on the patient's health -​ Procedure: Evaluates the body's response to glucose. COLLAB WITH KITCHEN SERVICE -​ Dietary Requirement: Overnight Coordinated with hospital kitchen services to fasting; followed by consuming a ensure that prescribed meals align with the glucose solution. Blood samples taken dietary restrictions and requirements of the at intervals (fasting and post-glucose diagnostic test, this collaboration ensures consumption). patients receive appropriate and well-prepared meals. LACTOSE TOLERANCE TEST ADDRESSING PATIENT CONCERNS -​ Procedure: Assesses the body's Address patient concerns or questions related to ability to digest lactose. the diagnostic test diet, plays a crucial role in -​ Dietary Requirement: Lactose-free ensuring patients understand the significance of diet for 24 hours before the test. Then, dietary compliance for the success of the consume a lactose solution, and blood diagnostic procedure samples are taken to evaluate digestion. DOCUMENTATION & REPORTS Maintain accurate records of patient's dietary GASTRIC EMPTYING STUDY plans, adjustments, and responses to the -​ Procedure: Measures the rate at which diagnostic test diet, provide reports to the the stomach empties. healthcare team, contributing valuable insights into the patient's nutritional status and -​ Dietary Requirement Fasting for 8-12 adherence to dietary recommendations hours before the procedure. Patients may consume a meal with a Diagnostic procedures with dietary radiolabeled substance during the test. requirements GLUCOSE CHALLENGE TEST (FOR GDM) COLONOSCOPY -​ Procedure : Screens for gestational diabetes in pregnant women -​ Procedure: Examines the colon using a flexible tube. -​ Dietary Requirement: Fasting. -​ Dietary Requirement: Clear liquid diet followed by consuming a glucose solution. Blood samples are taken to or low-residue diet for 1-3 days before the procedure. Fasting may be required assess glucose handling. on the day of the procedure. Nutrition Therapy 2 - Midterm GI IMAGING (BARIUM SWALLOW, ULTRASOUND (ABDOMINAL, PELVIC) BARIUM ENEMA) -​ Procedure: Uses sound waves for -​ Procedure: Uses barium contrast for Imaging imaging the digestive system. -​ Dietary Requirement: Fasting may be -​ Dietary Requirement: Clear liquid diet necessary for certain abdominal or or specific dietary restrictions before the pelvic ultrasounds. procedure to enhance imaging quality CARDIAC STRESS TEST FECAL OCCULT BLOOD TEST (FOBT) -​ Procedure: Evaluates heart function -​ Procedure : Screens for hidden blood during physical stress. in the stool. -​ Dietary Requirement : Fasting may be -​ Dietary Requirement : Avoid certain required, and specific instructions foods (eg., red meat) and medications regarding caffeine intake may be given. before collecting stool samples for improved test accuracy DUAL-ENERGY X-RAY CELIAC DISEASE TEST (BLOOD TEST, ABSORPTIOMETRY SCAN (DEXA) BIOPSY) -​ Procedure: Measures bone mineral -​ Procedure: Tests for celiac disease, density. an autoimmune condition affecting -​ Dietary Requirement : Generally, no the small intestine. specific dietary restrictions. Patients -​ Dietary Requirement: Continue may be advised to avoid calcium consuming a gluten-containing diet supplements before the test. before testing for accurate results. HYDROGEN BREATH TEST LOW FODMAP DIET -​ Procedure: Detects abnormal FODMAP stands for fermentable bacterial growth in the small oligosaccharides, disaccharides, intestine. (For Small Intestinal monosaccharides, and polyols. Bacterial Overgrowth - SIBO) -​ Dietary Requirement: Follow a specific diet the day before the test, and overnight fasting. Breath samples are collected after consuming a substrate, MAGNETIC RESONANCE IMAGING (MRI; W/CONTRAST) -​ Procedure: Uses magnetic fields and radio waves for detailed imaging. -​ Dietary Requirement: Fasting may be required for certain types of MRI, especially those involving contrast agents. Nutrition Therapy 2 - Midterm CELLS AND FORMATION Blood _________________________________ A fluid tissue composed of two parts (plasma and blood cells) DISEASES OF THE HEMATOLOGICAL SYSTEM Plasma acts as medium for the transmission of nutrients, metabolites, salts, fats, glucose, and INTRODUCTION amino acids into tissues; medium for carrying away waste materials such as urea(nitrogen), The hematopoietic system is a widespread uric acid(purine), and some of the carbon collection of cells in the bone marrow, the dioxide lymphoid tissues, and the reticuloendothelial system including the circulating blood. Blood Contains the following proteins: transports oxygen, nutrients, waste ​ Albumin: responsible for osmotic products, and hormones from one place to pressure (maintains the blood volume another. Regulatory roles are buffers and and provides protein to the tissues) plasma proteins in them while protection ​ Globulin: important for the formation of function is through antibodies and phagocytic antibodies activities. ​ Fibrinogen: essential for blood coagulation The reticuloendothelial system is a generalized system of fixed and free cells The adult human body contains approximately strategically located within the body. It is 5L of blood (7-8% of body weight). responsible for functions such as Approximately 2.75L-3L of blood is plasma and immunological, cellular, and humoral the rest is the cellular portion defenses, phagocytosis, blood formations, and numerous intermediate functions. These cells have great powers of multiplication and are related both to lymphocytes and to the blood forming organs. It is here that the worn-out red blood cells are destroyed, and its hemoglobin are broken down. Lymphoid tissues are composed of lymphocytes and plasma cells, which are present throughout the body. Considerable quantities of lymphoid tissues are involved in the formation of the spleen, the mucous membranes, and the lining of the small intestine. In the intestine, it is contained in the mucous coat and in some parts, nodules of lump tissue are found. Nutrition Therapy 2 - Midterm ​ Much less numerous compared to Red Blood Cells RBCS (1:700) ​ In normal adult body's immune ​ Also known as erythrocytes system, the average WBC is 7000 per ​ The most numerous types in the microliter of blood blood ​ A part of the body's immune system ​ Gives blood its characteristic red color ​ Consists of an outer envelope or stoma ​ Its function is to react to injury particularly in protecting the individual, which encloses a mass of hemoglobin from invasion by foreign cells like (a complete protein rich in iron and an bacteria affinity for oxygen) ​ They circulate in the blood so that they ​ Originates in the bone marrow can be transported to an area where an ​ Manufactures hemoglobin until it infection has developed accounts for some 90% of the dry ​ Provides protection by phagocytosis weight of the cell (nucleus is squeezed (ingesting bacteria), production & out of the cell); thus, RBCs can never transport of antibodies, and rejection of divide foreign tissue ​ Lives for about 120 days then is ​ They have nuclei digested by phagocytic cells in the ​ Monocytes enters the tissue and liver and spleen becomes larger which turn into ​ Most iron in hemoglobin is reclaimed for macrophages reuse; remainder is broken down into ​ There they can phagocytize bacteria bile pigments and excreted by the liver throughout the body, they also destroy ​ It is deformable (as it squeezes single old, damaged, and dead cells in the file through the capillaries) body ​ Aids in removing carbon dioxide from the body; CO₂ enters the blood in the ​ Macrophages are found in the capillaries and is brought back to the following: lungs and released there and then ○​ liver exhaled ○​ Spleen ​ Contains an enzyme called carbonic ○​ Lungs anhydrase (helps the reaction of ○​ Lymph nodes carbon dioxide and water to occur ○​ Skin 5000 times faster) ○​ intestine ​ In men, there is an average of 5,200,000 RBC per mm ​ In women, an average of 4,600,000 RBC per mm³ ​ RBC's account for approximately 40-45% of the blood (hematocrit) ​ The ratio of cells in normal blood is 600 RBCs for each white blood cell and 40 platelets White Blood Cells ​ Also known as leukocytes Nutrition Therapy 2 - Midterm BLOOD FORMATION TYPES OF ANEMIA ​ Monocytes stay in the blood for an average of 10-20 hours and then go into Anemia due to decreased erythropoiesis the tissues, where they become tissue Deficiency anemia: iron deficiency anemia, macrophages and can live for months to vitamin B12 deficiency anemia, folic ace years deficiency anemia ​ Aplastic anemia (anemia due to ​ Lymphocytes continually pass back depressed bone marrow activity and forth between lymph tissue, lymph fluid and blood Anemia due to excessive rate of hemolysis Hemolytic anemia due intracorpuscular defects: ​ When present in the blood, they stay for congenital hemolytic jaundice, sickle cell several hours anemia, thalassemia ​ Lymphocytes can live for weeks, Hemolytic anemia due to extra corpuscular months, or years factors: certain infective agents autoimmune reaction, certain drugs and chemicals COMMON BLOOD DISORDERS TERMS RELATED TO ANEMIA ANEMIA ​ Microcytic anemia - red cells are A decrease in the circulating RBC mass and small in size a corresponding decrease in the oxygen-carrying capacity of the blood ​ Macrocytic anemia - red cells are larger than usual A condition wherein there is decrease in hemoglobin per unit volume of blood below ​ Megaloblastic anemia - large, the established normal levels for age and gender nucleated abnormal red blood cells. WHO Criteria: (Hemoglobin level; values differ due to androgen hormones) ​ Normocytic anemia - red cells are ​ Below 12g/100ml (women and of usual size but the number is children 6-14 years) inadequate ​ Below 13g/100ml (men) ​ Below 11g/100ml (children 6 months ​ Normochromia - blood with a to 6 years) normal color and level of ​ For pregnant women, hematocrit is hemoglobin below 34% Can be acquired hereditary abnormality of red ​ Hyperchromia - blood that is blood cells (or its precursor) or may be a excessively pigmented manifestation of a non-hematologic disorder ​ Hypochromia - blood condition in which there is a low level of hemoglobin Nutrition Therapy 2 - Midterm NUTRIENT-RELATED ANEMIA VITAMIN B12 DEFICIENCY ANEMIA ​ Due to lack of any of the nutrients Pernicious Anemia Intrinsic Factor & needed in the blood formation Vitamin B12 ​ Nutrients such as iron, vitamin C, ​ ETIOLOGY vitamin E, protein, vitamin B12, folic Caused by lack of intrinsic factor, a protein acid, vitamin B6, copper, and needed to absorb vitamin B12 in the riboflavin intestine; can result from autoimmune destruction of stomach cells or other ​ Most common dietary problem conditions affecting stomach or small intestine associated with anemia are iron, protein, folic acid, vitamin B12, and ​ MANIFESTATIONS vitamin C Fatigue, weakness pale or jaundiced, skin tingling, numbness in hands and feet, ​ Changes in vitamin E and riboflavin difficulty in walking, memory loss, mood status have also been linked to its changes, and glossitis development and control ​ NUTRITION Increased take of Vitamin B12 rich foods NUTRITIONAL ANEMIA such as meat, fish, poultry, eggs, dairy and fortified cereal, vitamin injection or high-dose IRON DEFICIENCY ANEMIA oral supplements may be necessary. ​ ETIOLOGY FOLATE DEFICIENCY ANEMIA occurs when the body doesn't have enough produce iron hemoglobin, to the substance in ​ ETIOLOGY red blood cells that enables them to carry Can result from inadequate intake, oxygen absorption, dietary poor or increased demand (like pregnancy, infancy, ​ MANIFESTATIONS adolescence or rapid growth) Fatigue (most common), along with weaknesses, pale skin, shortness of breath, ​ MANIFESTATIONS dizziness, headache, cold hands & feet, and Fatigue, weakness, pale skin, shortness of brittle nails breath, irritability, mouth sores, poor growth in children, and neural tube defects in babies ​ NUTRITION born to deficient mothers Increase intake of heme iron from animals like red meat, poultry fish, non-heme iron from ​ NUTRITION plant sources such as lent beans, spinach, Increase intake of folate rich foods such as and fortified cereals, consume from high in C GLV. citrus fruits, beans, Lentils, fortified supplements may be prescribed if dietary grains, and liver. Folic acid supplementation changes are insufficient is recommended for pregnant women or Individuals with confirmed deficiency Nutrition Therapy 2 - Midterm VITAMIN A DEFICIENCY ANΕΜΙΑ NON-NUTRITIONAL ANEMIAS ​ ETIOLOGY APLASTIC AΝΕΜΙΑ Occur due to inadequate dietary intake, impaired absorption (GI disorders), or ​ ETIOLOGY increased demand (pregnancy and lactation). Occur when bone marrow fails to produce enough RBCs, WBCs, and platelets; causes ​ MANIFESTATIONS include exposure to toxins, radiation, Fatigue, weakness, pale skin, decreased medications, certain autoimmune disorders, and immune function leading to increased viral infections susceptibility infections, to night blindness, dry eyes, skin dryness, and rough with ​ MANIFESTATIONS follicular hyperkeratosis Fatigue, weakness, pale skin, shortness of breath, frequent infections (due to low WBCs), ​ NUTRITION and easy bruising or bleeding (due to low Increase intake of vitamin A rich foods such platelet count) as liver, fish liver oil eggs, and dairy products as well as provitamin A carotenoids found in yellow ​ NUTRITION & orange vegetables, supplements if patient has Maintain overall health and support on severe deficiency strengthening the immune system a balanced diet rich in protein, vitamins (especially COPPER DEFICIENCY ANEMIA vitamin B12 and folate), and minerals (particularly iron and zinc) can aid in supporting ​ ETIOLOGY bone marrow function and improve symptoms Occur due to inadequate dietary intake, impaired absorption (as seen on Gl surgeries & disorders), or excessive zinc intake HEMOLYTIC ANEMIA (interfere with copper absorption) ​ ETIOLOGY ​ MANIFESTATIONS Occur when RBCS are destroyed faster than Fatigue, weakness, pale skin, shortness of they can be produced; causes can be breath, neurological symptoms (tingling or autoimmune disorders, inherited conditions, numbness). and osteoporosis due to copper's infections, medications, certain toxins and role in bone health ​ MANIFESTATIONS ​ NUTRITION Fatigue, weakness, jaundice, dark urine (due Increase intake of copper rich foods such as to breakdown of red blood cells), pale skins, organ meats, shellfish (oyster & crab), nuts & and enlarged spleen seeds, whole grains, DGLV: copper supplements may be necessary under medical ​ NUTRITION supervision for severe deficiency Maintaining adequate hydration provides nutrients necessary for RBC production and repair ( Iron, vitamin B12, folate and vitamin C supplement may be necessary in some cases) Nutrition Therapy 2 - Midterm blood vessels by sickled RBCs), acute chest syndrome, splenic sequestration crisis, and PARASITE ΑΝΕΜΙΑ increased susceptibility to infections ​ ETIOLOGY Occur when parasites infect the body and ​ NUTRITION feed Leading on RBCs, to destruction; Maintain hydration, adequate caloric intake, common parasites that cause anemia include balanced diet that is rich in nutrients that are malaria and hookworms. needed for RBC production and overall health supplementation of folic acid is recommended ​ MANIFESTATIONS las support on RBC production) May (depending parasite) includes vary on but fatigue weakness, fever, chills, jaundice, pale skin, and organ damage (in severe cases) THALASSEMΙΑ ​ NUTRITION ​ ETIOLOGY Focuses replenishing lost on nutrients due to the A group of inherited blood disorders infection such as iron, vitamin B12, and folate, characterized by reduced or absent treat the underlying parasitic infection with production of one of the globin chains that medication make up hemoglobin; this results in abnormal hemoglobin production and impaired RBC synthesis SICKLE CELL ANEMIA ​ MANIFESTATIONS Range from mild to severe anemia (depends on thalassemia type): common symptoms are fatigue, weakness, pale skin, jaundice, delayed growth & development and complications such as bone deformities & organ damage ​ NUTRITION Goal is to have an ove health and support RBC production, a balanced diet that is iron-rich (except if iron overload is present), vitamin B12 and folate, regularly monitor iron levels to ​ ETIOLOGY prevent iron overload in patients receiving blood An autosomal recessive genetic disorder transfusions) caused by a mutation in the gene that codes for hemoglobin, the said mutation leads to the production of abnormal hemoglobin (hemoglobin S) which causes RBCs to BLEEDING DISORDERS become sickle-shaped and rigid under certain ​ ETIOLOGY conditions Can be inherited or acquired; characterized by abnormalities in the blood clotting ​ MANIFESTATIONS process: examples are hemophilia (a Chronic anemia, episodes of vaso-occlusive deficiency in clotting factors), von Willebrand crisis (painful episodes due to blockage of Nutrition Therapy 2 - Midterm disease (dysfunction of von Willebrand POLYCYTHEMIA VERA factor), and platelet disorders ​ ETIOLOGY A rare blood disorder characterized by the ​ MANIFESTATIONS overproduction of RBCs in the bone marrow, Symptoms may depend on specific disorders, the exact cause is still unknown but is believed but common are easy bruising. prolonged to involve genetic mutations bleeding from cuts or injuries, frequent nosebleed, heavy menstrual periods, and ​ MANIFESTATIONS internal bleeding Headache, dizziness, blurred vision, itching (especially after having a hot bath), redness of ​ NUTRITION the face, fatigue, weakness, and an enlarged Goal is to have an overall health and support spleen blood clotting adequate consumption of vitamin K (has an important role in blood ​ NUTRITION clotting process) and Iron (to prevent anemia Goal is overall health and complications (such due to chronic bleeding) as CVD and blood clots) a balanced diet which is low in iron, adequate hydration, and avoidance of factors that can aggravate IRON OVERLOAD symptoms (HAEMOCHROMATOSIS) ​ ETIOLOGY THROMBOCYTOPENIA Occurs when excessive accumulation of iron is present, this leads to damaging tissues ​ ETIOLOGY and organ dysfunction; causes can be A condition characterized by low platelet hereditary, hemochromatosis, repeated count (which can lead to impaired blood transfusions, blood and excessive intake of clotting, thus having an increased risk of iron (dietary) bleeding); causes may be autoimmune disorders, infections, medications, and bone ​ MANIFESTATIONS marrow disorders Fatigue, weakness, joint pain, abdominal pain, darkening of the skin, Liver ​ MANIFESTATIONS enlargement, and organ damage (especially to Easy bruising, prolonged bleeding from cuts the liver, pancreas, and the heart) (or injuries), frequent nosebleeds, petechiae (small red/purple spots on skin), and internal ​ NUTRITION bleeding (in some severe cases) Reduce iron absorption from the diet by avoiding iron-rich foods, vitamin C ​ NUTRITION supplementation (iron absorption enhancer) Goal is overall health and support platelet and alcohol (increases iron absorption), production, a balanced diet rich in vitamin K, chelation therapy may be needed in order to folate, vitamin B12, and other nutrients remove excess iron in the body necessary for normal platelet function and repair Nutrition Therapy 2 - Midterm Those that require institutional or societal ___________________________________ control include the following: ​ workplace environments NUTRITION IN CANCER ​ air pollution ​ water pollution Introduction Cancer and other malignant neoplasms is It is not yet clear whether the cancer one of the most dreaded diseases in our susceptibility that runs in families is due more to country today. It is ranked as the third leading genetics or to the effects of similar lifestyle within cause of death in the Philippines. Statistics the family. from 2018 show that there are 141, 021 total cancer cases with 86,337 total cancer-related deaths. The top 10 most common cancers are breast, cervix uteri, colorectum, Corpus Uteri, leukemia, liver, lung, ovary, prostate, and thyroid cancer. Although cancer can occur at any age, people with advancing age are more often afflicted compared to the pediatric group. A lifestyle that includes little or no exercise is also an etiologic factor in cancers. Data from epidemiological and laboratory studies revealed an average of 35% of all cancer deaths may be linked to diet. Unhealthy eating habits that comprise mainly of red meats, high fat foods (especially saturated fats), excess alcohol. and salt-cured (with nitrites) foods are associated with increased cancer risk. Susceptibility to cancer scalates when this diet is poor in protective foods such as fruits and vegetables that are high in phytochemicals, antioxidant nutrients, and dietary fiber. PATHOGENESIS There are no known exact causes for cancer but scientists have theorized that environmental or lifestyle factors play a role in the development of cancer. Some of these are factors people can personally control like the following: ​ diet ​ smoking (cigarettes/e-cigarettes/vape) ​ drinking alcoholic beverages ​ excessive sun exposure Nutrition Therapy 2 - Midterm not spread to other parts of the body); its growth is usually slow, can usually be CARCINOGENESIS removed, and in most cases, they do not come back. However, the term benign is Cancer is a disease involving somewhat misleading, since a benign tumor uncontrolled cell growth, potentially also has a capacity to do harm. It would be affecting any organ. Cancer cells can better to refer to the tumors as spread through the body in a process non-malignant. called metastasis. On the other hand, a malignant tumor Carcinogenesis involves Initiation, grows either rapidly or slowly. They can promotion, and progression stages. invade and damage nearby tissues & Carcinogens activate within cells, binding to organs and can break away from a DNA in the Initiation stage. Cells try to malignant tumor and enter the repair damaged DNA; If not repaired before bloodstream & lymphatic system (the cell division, altered DNA passes to new process is as metastasis). This is how cells, potentially leading to cancer growth cancer spreads from the original (promotion stage). (primary) cancer site to form new (secondary) tumors in other organs. Transformed cells can be dormant until activated by a promoting agent. Factors Tumors, especially the malignant types, like diet can affect the speed of damaged could cause mechanical pressure and cells turning into cancer. Inhibitors like obstruction, destruction of tissues, phytochemicals and vitamins boost the hemorrhage, infection, anemia, cachexia, immune response, while enhancers like fat hormonal abnormalities, and other changes suppress it, promoting cancer development. such as muscle weakness, anorexia, and depletion and redistribution of the host The promotion stage of carcinogenesis components. The intermediate types are involves the growth of cancer cells into usually invasive but do not progress to malignant tumors, impacting bodily metastatic state. functions and causing pain. Cancerous growth leads to malnutrition as cancer cells Tumor classification is according to draw nutrients away from normal tissues the tissues in which they originate. ​ Carcinomas arise from the cells of the TUMORS AND CLASSIFICATIONS skin, the lining membranes of internal organs, and the glandular organs ​ Sarcomas develop in muscles, Tumors may either be benign, bones, cartilages, and connective intermediate, or malignant based on the tissues cell origin and their behavior. ​ Gliomas originate in the network of A benign tumor is confined to the area supporting connective tissues in the where it originated; it is not cancer, (does brain and central nervous system (a rapidly pigmented tumor) Nutrition Therapy 2 - Midterm ​ Lymphomas growths in the lymph early can prevent the likelihood of nodes and other tissues of the spread lymphatic system The recommended tests are the following: CANCERS BY CELL/TISSUE TYPE ​ yearly Pap smear and pelvic exam for those who are sexually active or 18 ​ Carcinomas: Epithelial cells (skin, years or older-endometrium (for the body cavities, organs) cervix) ​ Monthly breast self-exam (BSE) ​ Sarcomas: Bones and soft tissues starting at the age of 20 ​ a year or two on mammogram ​ Myelomas: Plasma cells (manufacture between ages 40 to 49 years and every antibodies) year starting the age of 50+ clinical breast exam (CBD) ​ Leukemias: Blood cells (originates in ​ every year starting the age of 50 of bone marrow) digital rectal exam (DRE) (for rectum & prostate) ​ Lymphomas: Immune system (lymph ​ yearly starting the age of 50 of fecal nodes, spleen stomach, testicles) occult blood test FOBT) for hidden blood (for colon and rectum) ​ Mixed types: Derive from multiple ​ every 3-5 years starting the age of 50 of callistus types sigmoidoscopy (for colon and rectum) monthly dental check-up SYMPTOMS/DIAGNOSIS Early diagnosis is important for cure. The following are warning signs and symptoms: CHAPTER 02 C: change in bowel or bladder habits CANCER TREATMENTS AND A: a sore that does not heal DIETARY IMPLICATIONS U: unusual bleeding or discharge T: thickening or lump in breast or elsewhere CANCER TREATMENTS I: indigestion or difficulty in swallowing O: obvious change in wart or mole Surgery N: nagging cough or hoarseness ​ An operation where surgeons cut U: unexplained anemia out tissues with cancer cells S: sudden unexplained weight loss Chemotherapy Symptoms/Diagnosis ​ Special drug/medicines that ​ Every individual should know and be shrink or kill cancer cells that we aware of his/her body ​ Periodic self-examinations of the skin, cannot see breast, mouth, and genitals are encouraged Radiation ​ More often than not, the individual can ​ Uses high-energy rays (which are identify changes in her/his body which similar to X-rays) to kill cancer when detected and interventions done cells Nutrition Therapy 2 - Midterm The nutritionist-dietitian has an important role Immunotherapy to play in the management of a cancer patient. ​ A treatment that works with your Her first job is to do a thorough nutritional body's immune system to help assessment. This provides baseline information used in the care plan, which fight cancer cells or to control side includes monitoring; evaluation and effects from other cancer treatments education. The components of the nutritional assessment are a medical history, physical examination, dietary history, anthropometric DIETARY IMPLICATIONS data, biochemical data if necessary to support observable symptoms and a socioeconomic Patients with cancer commonly face anorexia history. due to factors like taste changes, (including smell, saliva, nausea, and vomiting) The medical history should have information psychological stress, and toxins from cancer on the following: cells. These are due to changes in blood ​ duration and type of malignancy levels of glucose, free fatty acids, or appetite ​ type and severity of complications controlling hormones. ​ type and duration of therapy Impaired intake may also result secondary to ​ specific chemotherapeutic agents used. bowel obstruction. This leads to weight loss, ​ radiation sites undernutrition, and potential complications ​ surgical procedure used such as malabsorption and electrolyte ​ side effects of therapy (diarrhea, imbalances, impacting the ability to maintain anorexia, nausea and vomiting) desired weight. ​ concomitant medical conditions Not all of these have to be done by the dietitian but the information should be made available so NUTRITION MANAGEMENT she can review the data and identify the patients at high risk for nutritional problems. A person afflicted with cancer may experience nutritional deterioration. The dietary history should include the following: A poorly nourished individual may not be able to ​ at least a 24-hour recall respond well to the treatment & his quality of life ​ self-feeding ability may be affected. ​ special cancer diet prescribe if any ​ nutrient or supplementation any other The goals of nutritional care are as follows: ​ food idiosyncrasies or prohibitions ​ to improve or maintain patient's optimal based on religious reasons nutritional status and body weight to ​ food allergies or intolerances. minimize the effects of radiation and chemotherapy If the individual is out-patient, one may have to ​ to maintain patient's strength during consider the socio-economic history which therapy and reduce symptoms may include the following: secondary to therapy ​ the number of people living in the ​ to prevent or reverse household immunosuppression ​ kitchen facilities ​ to provide long or short-term measures ​ income to ensure survival. ​ how food is purchased and prepared Nutrition Therapy 2 - Midterm ​ and outside provision of meals. ​ Specialty products: are designed for patients with hepatic or renal failure or Nutritional intervention and counseling follow trauma These products vary considerably in terms of Survival of cancer patients depends on many specific amino acid, carbohydrate and fat factors. 2 of the most important are the site of content and are used to tailor to the specific the tumor and the degree to which it has spread needs of the patient based on metabolic when treatment is started. abnormalities that accompany major stress or organ failures. Natural foods which are Short-term goal include providing optimal blenderized can also be used for the provision of nutritional support by treating symptoms; adequate nutrition by the oral route or through maintaining desirable body weight; the tube. correcting vitamin and mineral abnormalities, and correcting fluid/electrolyte imbalances. TOTAL PARENTERAL NUTRITION Long-term goal should be based on long term medical goals. Patients with poor prognosis who are not receiving anti-cancer treatment ​ may be used when the Gl tract is not should be provided emotional support, both for functional or cannot handle the the patient and the family. volume needed to meet the patient's Oral nutrition is still the preferred route for nutritional demands feeding cancer patients. the treatment and the ​ nutrients are administered cancer itself often result in uncomfortable side intravascularly either peripherally or effects that affect the desire and the ability to through a central vein eat. The use of liquid nutritional supplements ​ indications: for therapeutic bowel rest, may be necessary for patients who are unable to ​ head and neck surgery, prolonged consume sufficient energy and protein to unconsciousness, hypermetabolism, maintain their weight and optimum nutritional and malnutrition as a result of status malabsorption ​ need for immediate repletion of nutrients Enteral nutrition support is more advantageous TUBE FEEDING than TPN (reduced incidence of infection, maintenance of gut structure & function, more There are four major types of commercial physiologic less serious complications, and less formulas: costly than parenteral nutrition ​ Complete products: they are essentially meal replacements that require The nutritionist-dietitian not only should attend digestion and absorption to the nutritional needs of the cancer patient but ​ Chemically defined products: require also should help cope with the side effects of minimal or no enzymatic activity prior to cancer, both physical and psychological. She/He absorption and are designed specifically should make the patient feel that she is for patients with digestion problems or genuinely interested in his welfare. She should severe malabsorption. These are be alert to changes in the clinical states that may designed for patients with pancreatic warrant a change in the method of therapy and cancer or who have pancreatic exocrine should always work hand in hand with the health insufficiency care team.. Malnutrition is common among hospitalized patients. By taking proactive Nutrition Therapy 2 - Midterm nutrition intervention, severe nutrition problems Children who are overly malnourished at the will be prevented and health care costs kept to a time of diagnosis are at higher risk for minimum protein-energy malnutrition. This situation may make tolerance to therapy more difficult and can affect growth. NUTRITION IN PALLATIVE CARE Children dread unfamiliar foods and unpleasant hospital routines. Nutritional supplements should Palliative care refers to the physical and be given orally if at all possible rather than using emotional care given to a patient whose tube feedings. However, if the child's catabolic disease does not respond to curative treatment state is such that depletion of body protein is or to patients who chose not to undergo such already occurring, total parenteral nutrition may treatment. be combined with enteral feeding at least during the first five weeks of treatment. The primary responsibility of the health providers is to relieve pain and suffering, The nutritional requirements of a pediatric cure is not the expected outcome but rather cancer patient are simitlar to that of normal improvement of the quality of life (lessening of children. However, adjustments should be made pain & other symptoms and reducing for activity and other factors that may increase psychological stress and distress nutrient and fluid need. Weight must be monitored closely to prevent weight loss. Food and drink have both psychological and physical functions that may play a significant role in palliative care. The dietitian has a responsibility to consider the cultural, social, and CHAPTER 04 psychological role of food in palliative and terminal care. Nutritional care must be in line CANCER PREVENTION STRATEGIES with the medical management goals of the patient. Patient prognosis, ethical considerations (respecting patient's decision), patient autonomy Cancer Prevention (informed preference for the type of nutrition support); benefits versus burdens of nutritional According to the WHO, 1/3 of all cancers are support, available resources, liberalization of preventable and about 30% aere curable when therapeutic diets and patient comfort are some diagnosed early and treated properly. A healthy of the issues in deciding dietary management lifestyle and a healthy diet will prevent most priorities. forms of cancers. The Philippine Cancer Society strongly suggests that by avoiding tobacco, betel quid chewing, sexual promiscuity, Hepatitis B infection, and over exposure to sunlight will CANCER IN CHILDREN prevent cancers of the lung, oral cavity, cervix, liver, and skin, respectively. Cancers of the Malignancies in children are not easily breast, cervix, rectum, thyroid, colon, oral, and recognized, thus, children should have regular prostate can be cured if detected early and medical check-ups and parents should be when treatment is institute properly. alerted to unusual signs and symptoms. The Philippine Cancer Control Program of the Children with cancer can suffer from malnutrition Department of Health specifies primary just like the adults. This may be the result of the prevention and early detection measures. disease process and the anti-tumor therapy. Nutrition Therapy 2 - Midterm However, the department said that the pancreas, and colon. A diet low in fat, high success of these programs require the in fiber and with at least S servings of fruits cooperation of Filipino people. Intensive and vegetables per day help reduce cancer public information and health education are risk. Raw vegetables, followed by allium also needed to achieve goals of the program. vegetables, carrots, green vegetables, cruciferous vegetables, and tomatoes are Cancer Control Program in the the types of vegetables and fruits that Philippines appear to have protective effects against cancer. Found to have potentially Primary Prevention Strategies anti-carcinogenic properties in vegetables and fruits ​ Lung cancer - Anti-smoking Campaign Possible anticarcinogenic mechanisms of ​ Liver cancer - Hepatitis B Infant these fruit and vegetables have been Vaccination postulated. Some of these are antioxidant ​ Cancer of the cervix - Safe Sex effects, effects on cell differentiation, ​ Oral cancer - Stop Betel Quid increased activity of enzymes that detoxify Chewing carcinogens, blocked formation of nitrosamines, altered estrogen metabolism, altered colon & ileum (including bacterial Secondary Prevention Strategies flora, bile acid composition, pH, fecal bulk), preserved integrity of intracellular matrixes ​ Breast cancer : Self-breast effects on DNA metabolism, maintenance of Examination and Health Worker normal DNA repair, increased apoptosis of Breast Examination cancer cells, decreased cell proliferation ​ Cancer of the cervix : Pap Smear (Steinmetz and Potter). ​ Cancer of the rectum : Rectal Examination Recent studies also suggest that whole ​ Prostate cancer : Transrectal digital grain foods contain strong anti-cancer examination agents. Fermented dairy foods like yogurt ​ Oral cancer : Oral Examination and cultured buttermilk contain probiotics that are also cancer-protective. Cancer Prevention ________________________________ Certain nutritional factors are being MNT IN HIV investigated to secure evidence that there is a diet-cancer connection. A review of the DEFINITIONS AND BACKGROUND specific literature on the relationship between vegetables and fruit consumption The Human immunodeficiency virus and risk of cancer showed consistent (HIV) infects T cells (CD4) and evidence that a greater intake of fruits and macrophages. Levels of CD41 (helper) vegetables provided a protective effects for and CD81 (non helper) subsets of T cells cancers of the stomach, esophagus, lung, are used to evaluate immunological oral cavity and pharynx, endometrium, competency. Nutrition Therapy 2 - Midterm Many people will develop acquired INTERVENTION immunodeficiency syndrome (AIDS) after a OBJECTIVE decade, following an opportunistic infection or a decline in the immune system. Improve nutrition-related immunity to Prognosis for AIDS ranges from 1 year, if prevent opportunistic infections, such as not treated with antiretroviral therapy (ART), oral candidiasis; cirrhosis or to 5 years, if treated. hepatocellular carcinoma from chronic HIV infection involves multiple organs. it infection with hepatitis B or C; and other targets the immune system and impairs the conditions such as immune reconstitution ability to mount an adequate immune inflammatory syndrome. response. Malnutrition and its complications further impair the body Prevent weight loss from fever, poor intake with oral pain, infection, nausea, diarrhea, HIV infection requires lifelong, vigilant malabsorption, swallowing difficulties, polypharmacy. Nutrition directly impacts effects of medications, inflammation, viral immune-cell triggering and indirectly load, and lipodystrophy, and vomiting; offer impacts DNA and protein synthesis in HIV early nutritional intervention progression. Decline in body cell mass and deficiencies in vitamins and minerals occur Manage altered Gl function including diarrhea, malabsorption, vomiting, and During starvation, there is generally a loss HIV-induced enteropathy. of adipose tissue with maintenance of lean body mass (LBM); in HIV/AIDS, there is loss If necessary, use CPN to prevent further of BM (wasting) while maintaining body fat. weight loss and potential malnutrition. CPN will stop weight loss, but it will not prevent Weight loss, fatigue, anorexia, diarrhea, and further immunodeficiency. low-grade fevers may occur. As long as an infection remains untreated, nutritional Keep body well hydrated. Fluids are critical support regimens will meet needs with only to prevent kidney stones and other limited success. complications. Support depleted levels of nutrients such as linoleic acid, selenium, and vitamin B12 HIV IS NOT EASILY TRANSMITTED EXCEPT BY Counteract problems such as dysphagia, ​ exchange of bodily fluids during mouth pain, taste alterations sexual contact (dysgeusia), or difficulty chewing ​ by receipt of infected blood through Alleviate nutritional effect of fatigue, anemia, a blood transfusion anorexia, depression, and dyspnea ​ by sharing contaminated needles Optimize nutritional status with intravenous drug injection, or from an HIV infected mother to Maintain fat intake at prudent levels neonate (30-35% total kcal) to maintain or achieve normal lipid levels. Nutrition Therapy 2 - Midterm A general multivitamin supplement should Encourage physical activity, which has been be recommended. Low serum shown to improve cardiopulmonary fitness micronutrient levels are common and and to reduce symptoms of depression have been associated with immune impairment, Use of vitamin A and beta INTERVENTION carotene may reduce some of the gut FOOD AND NUTRITION permeability and leste watery diarrhea Vitamin K deficiency is common with Maintain diet as appropriate for the antibiotics use patient's condition; use a high-energy/high-protein diet with Use nutrient-dense snacks, such as adequate nutritional supplements. Weight pudding, if tolerated, nonacidic juices for gain or maintenance is possible in sore mouth, ices made with tolerated juices, patients with HIV infection and early and sandwiches made with cold meat stages of AIDS by use of oral liquid salads. Add protein powders and glucose supplements. polymers, if desired. Use oral supplements when needed. From 2-2.5 g protein/kg and 35-45 kcal/kg are needed. Fever and infection may With bouts of diarrhea, use small meals further elevate need for these nutrients. and avoid extremes in temperatures; room Increase energy intake in cases of temperature is often best. Avoid excesses infection, fever, and pneumonia. of caffeine, alcohol, and fried and high-fat foods. Use soft cooked chicken, turkey, fish, Keep the body well hydrated. Estimate and lean beef. Replace electrolytes with 35-40 cc/kg unless there is a reason to foods such as broth soups or Gatorade for restrict fluids. Use TF, especially sodium, potassium, magnesium, and gastrostomy, if warranted. Low chloride lactose/low-fat TF products may need to be fed continuously to reduce Malabsorption can occur if antiretroviral gastroenteritis or reflux. CPN may be agents are taken improperly with regard to necessary if weight loss exceeds 20% of meals or if they are taken with certain other usual body weight drugs or herbal remedies. Suboptimal use of antiretrovirals because of noncompliance Increase use of omega-3 fatty acids and or malabsorption can result in viral decrease saturated fat intake. There may resistance. be advantages to using a medium-chain triglyceride formula in the presence of PATIENT EDUCATION-FOOD SAFETY AIDS-associated malabsorption Tips include the following: Small, frequent feedings (6-9 times daily) are usually better tolerated but may be ​ Separate raw meats from other raw difficult to achieve given complex foods such as fruits and medication regimens vegetables. Nutrition Therapy 2 - Midterm ​ Avoid cross-contamination from raw meats by storing and preparing Hypertension raw meat so it does not come in contact with fruits, vegetables, and Hypertension is persistently high arterial uncooked foods. blood pressure, the force exerted per unit area on the walls of arteries. ​ Use separate cutting boards and cooking utensils so that juices from The systolic blood pressure (SBP), the raw meats are not allowed to contact upper reading in a blood pressure uncooked foods. measurement, is the force exerted on the walls of blood vessels as the heart contracts ​ Keep hot foods hot (140F) and and pushes blood out of its chambers. cold foods cold (40F). Limit the amount of time that food is left at The lower reading, known as diastolic blood room temperature to prevent germs pressure (DBP), measures the force as the from growing in it. heart relaxes between contractions. ​ Wash all fruits and vegetables with Blood pressure is measured in millimeters warm water and a soft bristle brush. (mm) of mercury (Hg). Adult blood pressure is considered normal at 120/80 mm Hg. The ​ Thaw frozen meat or poultry in a blood pressure cutoffs for elevated blood refrigerator or under cold running pressure (formerly prehypertension) water, not at room temperature.. ​ Avoid raw fish or shellfish, unpasteurized juices or milk, and uncooked eggs (and dishes containing uncooked eggs). ________________________________ Nutrition Therapy in SYSTOLIC Cardiovascular Disorders In the systolic phase the heart contracts, Cardiovascular disease (CVD) is a group blood pressure rises and blood moves of interrelated diseases that includes out along the vessels. atherosclerosis, hypertension, ischemic heart disease, peripheral vascular DIASTOLIC disease, and heart failure (HF). These diseases are interrelated and often coexist. In the diastolic phase the heart relaxes, blood pressure falls and blood fills the heart. Nutrition Therapy 2 - Midterm moderating alcohol consumption particularly among heavy drinkers. ​ The ACC/AHA also included a strong recommendation for supplementation with potassium to lower blood pressure. Increased potassium intake should preferably be in the form of diet modification and may be contraindicated for Primary Prevention some patients with CKD. ​ Changing lifestyle factors have documented efficacy in the primary prevention and control of hypertension. ​ Guidelines made a strong recommendation (i.e., high benefit/risk ratio with supporting evidence) for reducing intake of dietary sodium in adults with elevated blood pressure and hypertension and for weight loss in adults with elevated blood pressure or hypertension who are overweight or obese. ​ A strong recommendation was also made for a heart-healthy dietary pattern such as the DASH diet rich in fruits, vegetables, whole grains, and low-fat dairy to lower blood pressure. ​ Combining a low-sodium DASH diet with weight reduction was recommended as the most efficacious approach to substantially lowering blood pressure in adults at high CVD risk. ​ Additional strong recommendations from both the ACC/AHA and the AND were made for increasing physical activity with a structured exercise program and for Nutrition Therapy 2 - Midterm SBP and DBP, especially in untreated hypertensive adults. Dietary Approaches to Stop Hypertension (DASH) ​ The DASH diet is used for preventing and controlling high blood pressure. Successful adoption of this diet requires many behavioral changes: eating twice the average number of daily servings of fruits, vegetables, and dairy products; limiting by one third the usual intake of beef, pork, and ham; eating half the typical amounts of fats, oils, and salad dressings; and eating one quarter the number of snacks and sweets. ​ Lactose-intolerant persons may need to incorporate lactase enzymes or use other strategies to replace milk. Assessing patients' readiness to change and engaging patients in problem solving, decision making, and goal setting are behavioral strategies that may improve adherence. ​ To achieve the 8 to 10 servings, Primary Prevention two to three fruits and vegetables should be consumed at each Fats meal. ​ Systematic reviews of RCTs that examined the effects of replacing ​ Importantly, because the DASH diet calories from one fatty acid class is high in fiber, gradual increases with another have generally shown in fruit, vegetables, and no or only a small effect on blood whole-grain foods should be made pressure. over time. Eight to 10 cups of ​ Supplementation with n-3 PUFAs fluids daily should be encouraged. (EPA + DHA) in doses higher than 2 Slow changes can reduce potential g/day showed modest reductions in short-term gastrointestinal Nutrition Therapy 2 - Midterm disturbances associated with a meal preparation (1 tsp salt = 2400 mg high-fiber diet, such as bloating and sodium), and use of alternative flavorings diarrhea. to satisfy individual taste. ​ Although the DASH diet is safe and The DASH eating plan is rich in fruits and currently advocated for preventing vegetables, which are naturally lower in and treating hypertension, the diet sodium that many other foods. is high in potassium, phosphorus, and protein, depending on how it is Calcium and Vitamin D planned. The fruit and vegetable diet without dairy ​ For this reason, the DASH diet may foods resulted in blood pressure reductions not be advisable for individuals with approximately half that of the DASH diet. end-stage renal disease with The AND practice guidelines recommend a high-normal or elevated serum diet rich in fruits, vegetables, and low-fat potassium and phosphorus dairy products for the prevention and levels. management of elevated blood pressure. Weight Reduction The DASH serving recommendation of 2 to 3 low-fat dairy foods per day would ​ There is a strong association provide the minimum calcium intake (~ 800 between BMI and hypertension mg) necessary to achieve a SBP lowering among men and women in all race of 4 mm Hg and DBP of 2 mm Hg in or ethnic groups and in most age adults with hypertension. groups. It is estimated that at least 75% of the incidence of Cross-sectional studies suggest lower hypertension is related directly to 25-hydroxy vitamin D (25[OH]D) levels are obesity. associated with higher blood pressure levels and higher rates of incident hypertension. ​ Weight gain during adult life is Mechanistically, vitamin D has been shown responsible for much of the rise in to improve endothelial function, reduce blood pressure seen with aging. RAS activity, and lower parathyroid hormone (PTH) levels. Sodium However, recent evidence suggests that The Dietary Guidelines for Americans supplementation with vitamin D is not recommend that young adults consume effective as a blood pressure-lowering less than 2300 mg of sodium per day. agent on its own and therefore is not recommended as an antihypertension In addition to advice on selection of agent. minimally processed foods, dietary counseling should include instruction on reading food labels for sodium content, avoidance of discretionary salt in cooking or Nutrition Therapy 2 - Midterm pressures at rest or during stress (definition Physical Activity according to the European Society of Cardiology, ESC 2016) Less active persons are 30% to 50% more likely to develop hypertension than Classifications of Heart Failure their active counterparts. Class 1 Exercise is beneficial to blood pressure. No undue symptoms associated with Increasing the amount of aerobic or ordinary activity and no limitation of dynamic resistance physical activity to a physical activity minimum of 90 to 150 minutes per week is an important adjunct to other blood Class II pressure-lowering strategies. Slight limitation of physical activity; patient comfortable at rest Alcohol Consumption Class III Excessive alcohol consumption is Marked limitation of physical activity; responsible for 5% to 7% of the patient comfortable at rest hypertension in the population. Class IV A three drink per day amount (a total of 3 Inability to carry out physical activity oz of alcohol) is the threshold for raising without discomfort; symptoms of cardiac blood pressure and is associated with a insufficiency or chest pain at rest 3-mm Hg rise in SBP. Pathophysiology For preventing high blood pressure, In HF the heart can compensate for poor alcohol intake should be limited to no cardiac output by (1) increasing the force of more than two drinks per day (24 oz of contraction, (2) increasing in size, (3) beer, 10 oz of wine, or 2 oz of 80-proof pumping more often, and (4) stimulating the whiskey) in men, and no more than one kidneys to conserve sodium and water. For drink a day is recommended for a time, this compensation maintains lighter-weight men and for women. near-normal circulation, but eventually the heart can no longer maintain a normal Heart Failure output (decompensation). Advanced symptoms can develop in weeks or months, Heart failure is a clinical syndrome and sudden death can occur at any time. characterized by typical symptoms (e.g., dyspnea, ankle swelling, fatigue) that Three symptoms - fatigue, shortness of may be accompanied by signs (e.g., breath, and fluid retention-are the hallmarks elevated jugular venous pressure, of HF. Shortness of breath on exertion, or pulmonary crackles, peripheral edema) effort intolerance, is the earliest symptom. caused by a structural and/or functional cardiac abnormality, leading to a reduced cardiac output and/or elevated intracardiac Nutrition Therapy 2 - Midterm The shortness of breath known as Medical Management orthopnea is breathlessness while lying down. For patients at high risk of developing HF (stage A), treatment of the underlying Fluid retention can manifest as pulmonary conditions (hypertension, dyslipidemia, congestion or peripheral edema. Evidence thyroid disorders, arrhythmias), of hypoperfusion includes cool forearms and avoidance of high-risk behaviors (tobacco, legs, sleepiness, declining serum sodium excessive alcohol, illicit drug use), and level caused by fluid overload, and lifestyle changes (weight reduction, worsening renal function. exercise, reduction of sodium intake, heart-healthy diet) are recommended. Decreased cranial blood supply can lead to mental confusion, memory loss, Medical Nutrition Therapy anxiety, insomnia, syncope (loss of oxygen to the brain causing brief loss of Excessive sodium intake is associated consciousness), and headache. with fluid retention and edema. A 2-g sodium restriction is regularly prescribed The latter symptoms are more common in for patients with HF. older patients and often are the only symptoms; this can lead to a delay in Chronic alcohol ingestion may lead to diagnosis. cardiomyopathy and HF. Although heavy drinking should be discouraged, there is no Often the first symptom in older adults is a evidence to support total abstinence from dry cough with generalized weakness and alcohol. anorexia. Until recently, caffeine has been considered Cardiac cachexia is the end result of HF in detrimental to patients with HF because it 10% to 15% of patients. It is defined as contributes to irregular heartbeats. involuntary weight loss of at least 6% of nonedematous body weight during a However, a study in the Netherlands 6-month period (Springer et al, 2006). suggests that moderate intake of either tea or coffee reduces ASCVD risk; tea actually Unlike normal starvation, which is reduces ASCVD deaths. characterized by adipose tissue loss, this cachexia is characterized by a significant Patients with HF are at increased risk of loss of lean body mass. developing osteoporosis because of low activity levels, impaired renal function, This decrease in lean body mass further and prescription drugs that alter calcium exacerbates HF because of the loss of metabolism. cardiac muscle and the development of a heart that is soft and flabby. Nutrition Therapy 2 - Midterm Energy The energy needs of patients with HF depend on their current dry weight, activity restrictions, and the severity of the HF. Overweight patients with limited activity should be encouraged to maintain an appropriate weight that will not stress the myocardium. However, the nutrition status of the obese patient must be assessed to ensure that the patient is not malnourished. When this happens, the tissues dependent this involved artery blood supply and Fats oxygen die (ischemia). The necrotic tissue of the dying tissue is called an infarct. Fish consumption and fish oils rich in omega-3 fatty acids can lower elevated If it involves the heart, then it is termed triglyceride levels and may prevent atrial myocardial infarction and if it affects the fibrillation in HF patients. brain, it is called a cerebrovascular accident (CVA or stroke). Atherosclerosis Some evidence suggests that high is the major underlying cause of CHD. saturated fat feeding in mild to moderate HF preserves contractile function and prevents the switch from fatty acid to glucose metabolism, thus serving a cardioprotective role. ___________________________________ Atherosclerosis is a disorder characterized by an accumulation of lipids in the intimal layer of the artery. These lipids include free cholesterol, cholesterol esters and triglycerides. When these lesions proliferate and enlarge, they encroach upon the lumen causing the formation of thrombi resulting in the thickening and loss of elasticity of the arterial walls. Nutrition Therapy 2 - Midterm LIPIDS CHOLESTEROL Fats and oils used in food are simple lipids. An important constituent of body cells These compounds are insoluble in water, and tissues including the brain, nerves, but soluble in fat solvents and are utilizable bile, kidney, spleen, liver, and skin. This by living organisms. may be produced endogenously or exogenously if large amounts of egg yolk, Triglycerides, glycolipids, fatty acids and butterfat, shellfish, milkfat and animal meats cholesterol belong to this classification. are taken. Hyperlipidemia is the general term used to denote an elevation of one or more lipids The steps to patient management are in the blood. summarized as follows: SATURATED AND UNSATURATED FATTY ​ Assess the patient's lipid profile. ACIDS ​ Assess and categorize the patient's CHD risk. The SFA are predominant in butterfat, ​ Establish treatment goals and animal fats, coconut oil and palm oil. The approaches high UFA are abundant in plant oils ​ Initiate therapeutic lifestyle changes. specifically in sunflower, soy bean, cotton ​ Initiate LDL-C lowering drug therapy seed, corn and safflower oils and in fish. ​ Consider other lipid factors Hydrogenation such as the process used High blood cholesterol can be treated by in the manufacture of margarine reduces diet and drugs. However, the first step the level of linoleic acid content of the fat should be by dietary means. Diet and make it saturated. significantly affects plasma cholesterol levels. The total blood cholesterol level is OMEGA FATTY ACIDS (OFA) the basis for initial patient classification. The following are based on non-fasting values ​ Omega-3 FA: alpha-linolenic, EPA, for adults: and DHA Less than 200 mg/dL. Desirable ​ Omega-6 FA: linoleic acid and AHA 200 to 239 mg/dL. Borderline-high 240 mg/dL. High ​ Omega-9 FA: oleic acid ○​ Omega-9 FA is a MUFA. The polyunsaturated omega-3 TLC recommendation seek to balance and omega-6 FA are caloric intake and physical activity to essential in the diet. achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of Nutrition Therapy 2 - Midterm saturated fat to