Nutrition in Respiratory Care Practice PDF

Nutrition in respiratory Care Practice Presented by Dr. Ayman Tosson Aly Obesity Overweight It is related to an excessive body weight, not necessarily excessive body fat. Obesity is a chronic complex disease defined by excessive fat deposits that can impair health And is divide...

Nutrition in respiratory Care Practice Presented by Dr. Ayman Tosson Aly Obesity Overweight It is related to an excessive body weight, not necessarily excessive body fat. Obesity is a chronic complex disease defined by excessive fat deposits that can impair health And is divided into 3 classes Causes of Obesity 1.Obesogenic Environment : encourages energy intake and discourages energy expenditure low-cost, palatable, high-calorie foods in large portions soft drinks and snacks Eating food away from home The increasing portion size of restaurant meals devices, such as remote-control devices and motorized walkways sedentary activities, such as watching television, cellphone games, and sitting in front of a computer. 2.Genetics Affects how likely a person gains or loses weight in response to changes in calorie intake by influencing basal metabolic rate, where body fat is distributed, and response to overeating. also affects the differences in weight loss that occur in response to calorie restriction 3.Behavior increased food intake , decreased activity. TYPES Based on the shape of the body. Has two main types:  Android: In this the fat accumulates in the center, giving the apple like appearance of the abdominal. (abdominal obesity)  Gynoid: In this, the body fat is more accumulated below the waist giving the pear-shaped appearance of it.  Waist circumference assess Abdominal obesity as part of the metabolic syndrome Complications of Obesity  Metabolic Syndrome: A cluster of symptoms, including obesity, insulin resistance, hypertension, and dyslipidemia,    increase the risk of cardiovascular disease and diabetes. Goals of Treatment Reduce weight to a healthy BMI category. improvements in blood pressure, plasma lipid and blood glucose levels Prevent or delay the complications For clients unable to lose weight the goal is to prevent additional weight gain. Evaluating Motivation to Lose Weight weight loss is not likely to occur in people who are not motivated or not ready to change 1st assess reasons and motivation for weight loss. readiness to make a lifestyle change. Set goal. previous history of successful and unsuccessful attempts at weight loss and reasons. social and family support. education about the causes of obesity and its complications. current level of physical activity (frequency, intensity, duration). In what physical activities the client can participate? Financial support and health insurance? A. Nutrition Therapy Decrease calorie intake, usually by 500 to 1000 cal/day to achieve a weekly weight loss of 0.454 to 0.9 Kg. subtracting 500 to 1000 calories from the client’s TEE. The National Institutes of Health (NIH) recommends low-calorie diets of 1000 to 1200 cal/day for women and 1200 to 1600 cal/day for men and heavier (75Kg) or more active women. This level of calorie restriction can promote up to an 8% loss of body weight when followed for 3 to 12 months. A multivitamin and mineral supplement is recommended whenever calorie intake ≤ 1200 calories in a day. TYPES of weight loss diet o Low-Carbohydrate Diets When carbohydrate intake is very low (e.g., 20 g/day), may decreases micronutrients, particularly thiamin, folic acid, vitamin C, and magnesium o Low-Fat Diets Require supplementation with vitamins E (found in oils) and B12 and zinc. o Balanced Diets calorie distribution of approximately 50% carbohydrate, 30% fat, and 20% protein. The Zone diet, is approximately 40% carbohydrate, 30% fat, and 30% protein, includes higher intakes of vitamins A, C, and E lean muscle mass is better preserved provide greater satiety recommending eat 4--- 5 meals and snacks, including breakfast. BEHAVIOR MODIFICATION IDEAS Make a list of reasons why you want to lose weight. Set long-term goals; an upcoming event or occasion. Give yourself a nonfood reward (e.g., new clothes, a night of entertainment) for losing weight. Enlist the support of family and friends. Plan Ahead Keep food only in the kitchen Stay out of the kitchen Avoid tasting food while cooking; Place the low-calorie foods in the front of the refrigerator; keep the high-calorie foods hidden. Plan meals, snacks, and grocery shopping. Eat Wisely Wait 10 minutes before eating when you feel the urge; hunger pangs may go away if you delay eating. Never skip meals. Eat before you’re starving and stop when satisfied, not stuffed. Eat only in one designated place, avoid activities such as reading and watching television while eating.  Eat the low-calorie foods first. Drink water with meals. Use a small plate to give the appearance of eating a full plate of food. Chew food thoroughly and eat slowly. Leave some food on your plate to help you feel in control of food rather than feeling that food controls you. Eat before attending a social function that features food; while there, select low-calorie foods to eat. Eat satisfying foods and do not restrict particular foods. Shop Smart Never shop while hungry. Shop only from a list Buy food only in the quantity you need. Don’t buy foods you find tempting. buy fruits and vegetables for low-calorie snacking. Change Your Lifestyle Keep busy with hobbies or projects that are incompatible with eating to take your mind off eating. Brush your teeth immediately after eating. Cut of extra fat and sugar. Keep food and activity records. Keep hunger records. Exercise. Get more sleep , fatigue triggers eating. Weigh yourself regularly. Promoting Dietary Adherence Through Regular visits to nutritionist , family and friends Support. Physical Activity Reduce the health risks of obesity Preserve or increase lean body mass,‫ﻛﺗﻠﺔ ﺍﻟﻌﺿﻼﺕ‬ Lowers blood pressure Lowers triglycerides, increases HDL cholesterol in blood improves glucose tolerance Improves cardiorespiratory fitness. At least 30-50 minutes of moderate to vigorous physical activity (MVPA) 5 to 7 days per week : for weight loss and to maintain weight loss  Aerobic activity (e.g., walking, cycling, swimming) is most recommended for weight loss and maintenance.  Strength training improves insulin sensitivity and increases muscle mass and strength. B. Pharmacotherapy Given with lifestyle changes (diet, behavior modification, and physical activity), 3 major groups of drugs : Medications that alter appetite. Medications that impair dietary absorption. Medications that increase energy expenditure. Liraglutide approved GLP1 agonist Pancreatitis, gall stones, renal impairment C. Bariatric Surgery most effective treatment for severe obesity. and usually maintained over time. High remission rates of many obesity-related complications Work Through (1) restricting the stomach’s capacity, (2) creating malabsorption of nutrients and calories, or (3) combining both. Types Adjustable Gastric Banding considered to be more flexible, less invasive, and safe , but its less effective. Risks include band slippage or erosion into the stomach and reflux esophagitis.‫ﺍﺭﺗﺠﺎﻉ ﻓﻲ ﺍﻟﻤﺮﺉ‬ Roux-en-Y Gastric Bypass Reduces storage capacity of the stomach to approximately 5% of normal and ingested food bypassing Approximately 95% of the stomach. more effective at producing weight loss than gastric banding. Weight loss occurs from malabsorption and dumping syndrome Advantages Long-lasting (15 years or more) maintenance of weight loss is good. And Resolution of complications. Postoperative complications sepsis, anastomotic leaks, internal hernias, GI bleeding, ulcers in the bypass segments, stomal stenosis. The most common micronutrient deficiencies after RYGB include iron, folate, vitamin B12, and vitamin D. Lifelong use of micronutrient supplements is required Stomach stapling removes 60% to 85% of the stomach longitudinally, reduces stomach capacity Malabsorption and dumping syndrome do not occur because the pylorus is preserved. Nutrition Therapy with Bariatric surgery Presurgical Phase. A diets last for 2 weeks , can shorten surgery time and may prevent surgical complications Also improve long-term weight loss results. It consist of low-carbohydrate protein shakes and low-calorie beverages VLCD very low CHO diet ( 1200 –1600 kcal /day)with or without pharmacology Simple changes may be recommended, such as eating more fruits and vegetables, eliminating sweetened beverages, or avoiding fried foods Postsurgical Phase. A clear liquid meal within 24 hours after surgery. A Protein shakes may be added within 48 hours. Start dairy products 3-7 days after surgery. pureed and minced animal proteins 2-3 weeks after surgery. At 4 weeks mashed legumes cooked carrots , lastly raw vegetables.  General rules Avoid fluids for at least 30 minutes before and after eating Eat Small, frequent meals. chew food thoroughly At least one to two multivitamins daily with additional supplements of iron, calcium with vitamin D, and vitamin B12. more than five servings of fruits and vegetables per day At least 1.5 L of fluid daily to maintain hydration. Weight Maintenance After weight Loss To avoid Weight regain Eat a low-calorie food. Eat 4 to 5 times per day.. Eat breakfast every day, which may help control hunger later in the day. Be physically active. approximately 1 hour per day. Monitor body weight at least once a week. watch fewer than 10 hours of TV a week.