Transcript 2105Lecture 11abc powerpoint

Exam
please check registrar’s final version of the
exam schedule
180 minutes
120 multiple choice questions-120 points
-4 short answer question-60 points
multiple choice-lecture 7a-12c inclusive
short answer-whole term
Note
Nutrition 2106-Fall 2014- Principles of
Nutrition in Metabolism
Nutrition 2101-Nutritional AssessmentTheory-Fall 2014
Nutrition 2107- Introduction to Sports
Nutrition-Winter 2015
Nutrition care plan/essay
Due on time please-if problems please ensure I
know in advance
Lecture 11a 24 MARCH 2014
Arthritis and Dermatitis
Osteoarthritis (OA)
-involves swelling of the joints
-overweight – causes wear of cartilaginous
surfaces
-such wear results in loss of chondroitin
sulphate and glucosamine which are
carbohydrate polymers
Rheumatoid arthritis (RA)
-autoimmune attack that in part involves loss of
chondroitin sulphate and glucosamine
Nutrition approaches to Arthritis
-appropriate nutrition and exercise may
prevent weight gain thus avoiding that cause of
osteoarthritis
Nutrition approaches to Arthritis
nutraceuticals
-chondroitin sulphate
-glucosamine
-both of these nutraceuticals are
meant to replace lost
chondroitin sulphate and
glucosamine
-both readily available over the
counter (OTC) and are useless
Nutrition approaches to Arthritis
Nutraceuticals
-fish oils reduce arachidonic derived proinflammatory eicosanoids while producing antiinflammatory eicosanoids in RA but not OA
-evening primrose oil, blackcurrant oil, and borage
oil reduce arachidonic derived pro-inflammatory
eicosanoids while producing anti-inflammatory
eicosanoids in RA but not OA
-review pathways involved for nutraceutical oils
Class activity-what is the best nutritional approach
to arthritis? Why?
Dermatitis
Atopic (eczema)
-skin inflammation that is due to an
immune response
-can be due to a food allergy
-solution -avoid food allergen
Dermatitis-nutraceutical
-fish oils reduce arachidonic derived proinflammatory eicosanoids while producing antiinflammatory eicosanoids
-evening primrose oil and borage oil reduce
arachidonic derived pro-inflammatory eicosanoids
while producing anti-inflammatory eicosanoids
-as with RA many of these trials include subjects
that are on anti-inflammatory prescribed drugswhat is the impact of this?
Dermatitis
Sebborheic (scaly)
-can be due to biotin deficiency
solution: avoid biotin deficiency
- can be due to riboflavin deficiency
solution: avoid riboflavin deficiency
Scaling eczema-like dermatitis
-can be due to linoleic or a-linolenic acid
deficiency
-this may be a problem with long term
TPN
Nutritional remedy for dermatitis (types above) in
general
-topical application of retinoids (similar in
structure to vitamin A)
-reduces dermatitis
-avoid linoleic or a-linolenic acid deficiency
Dermatitis herpetiformis
-causes skin lesions
pruritic-itching
vesicular-vesicles
papular-solid elevation of the skin
- all of these lesions are consistent with
coeliac disease and are relieved by a
gluten-free diet
Lecture 11b
24 MARCH 2014
Colitis, Migraine and Respiratory
Colitis
Inflammation of the colon
Diarrhea is an issue since the inflamed colon is
incapable of its normal water management
function- i.e. removing water from the faeces
Complete bowel rest helps
Ulcerative colitis
Treatment
Complete resection (removal) of colon
No nutritional implications but may be
diarrhea initially
This diarrhea is transient and apparently selfcorrecting
Evening primrose oil may have some limited
success for this type of colitis in terms of
stool consistency but this contradicts
self-correcting diarrhea
Diversion colitis
Surgical diversion process by which the distal colon
is left intact but without the stool stream
This results in abdominal cramping with mucoid or
bloody diarrhea
Infusion of salt solution containing short chain
fatty acids(scfa) (2-4 carbon fatty acids) into rectal
remnant is a remedial measure but complete
reanastomosis is the only complete cure
Migraine
Dural blood vessels become dilated and the
pulsatile blood flow through these vessels distends
and irritates the highly pain sensitive dura mater
-this would explain the throbbing nature
of migraine headaches
-inflammatory component to migraine
headache has been proposed
Nutritional management of migraine
Riboflavin administration
Metabolites of riboflavin participate in overcoming
the mitochondrial defect that that plays a role in
migraine pathogenesis
Avoiding foods-Certain foods in certain persons
trigger migraines -however this is highly individual
with one food or group of foods affecting a
particular person but not another
Nutritional management of migraine
However dietary restriction of a food or food
groups may upset the principles of adequacy,
moderation, variety, nutrient density, energy
control, and balance
Migraine
Foods contributing to migraine:
Citrus foods
Tea(flavonoids)
Coffee
Pork
Chocolate
Milk
Nuts
Vegetables
Cola
Migraine
-food components affecting vascular tone and
causing migraine (highly individual):
tyramine, phenylalanine, phenolic flavonoids,
alcohol, food additives (sodium nitrate,
monosodium glutamate), aspartame, caffeine
Migraine
-foods thought to trigger migraines subsequent to
hypoglycemia are:
chocolate, cheese, citrus fruits, bananas, nuts,
cured meats, dairy products cereals, beans, hot
dogs, pizza, food additives coffee, tea, cola drinks,
alcoholic drinks such as red wine, beer or whiskey
distilled in copper stills
Migraine
-solution to all this is trial and error elimination
of foods including meticulous record keeping
Respiratory
Acute respiratory failure
Need sufficient energy and protein to support lung
function and prevent infections without overtaxing
the compromised respiratory system
Fluid and sodium restrictions may be necessary to
ease pulmonary edema
Respiratory
Acute respiratory failure
Overfeeding causes increased carbon dioxide which
results in additional respiratory requirementtherefore reduce kcal to an appropriate
level(energy to support lung function and prevent
infections without overtaxing the compromised
respiratory system)
Respiratory
Aspiration pneumonia
Potentially lethal lung infection
Nasogastric feeding or gastrostomy or
jejunostomy which allows the lower
esophageal sphincter to remain closed
-all this helps to reduce aspiration risk
Respiratory
Chronic obstructive pulmonary disease (COPD)
Emphysema and chronic bronchitis are the
two most common examples of chronic
obstructive diseases
COPD patients frequently experience:
-weight loss, protein energy malnutrition
(PEM) and infections due to anorexia
-poor food intake and high energy
expenditure both due to laboured
respirations
Respiratory
Chronic obstructive pulmonary disease addressed
by:
Weight loss (caloric restriction combined with
appropriate exercise levels)
Malnourishment- gradual re-feeding as
tolerated
-easy to eat foods in small meals to improve
food tolerance- enteral feeding may help
-need fewer kcal from carbohydrate due to
carbon dioxide issue
Avoid overfeeding –carbon dioxide load issue
Respiratory
Cystic fibrosis
Laboured breathing- increased kcal and protein
and do not restrict fat
Enzyme replacements for pancreatic
impairment
Multivitamin including fat soluble vitamins
Table salt to overcome electrolyte losses due
to sweating
Additional fluids to liquefy thick secretions
and prevent dehydration
Maintain appropriate height to weight ratio
Lecture 11c
24 MARCH 2014
Ulcers, Pruritis
Ulcers
Generally refers to peptic ulcer-an erosion of top
layer of cells from the lining of the esophagus
stomach or small intestine
Ulcers may also develop in the mouth, upper
esophagus and large intestine
Ulcers and Nutrition
Patient should:
-relax during meals, eating slowly, chewing
thoroughly,
-avoid overeating, alcohol, caffeine and caffeine
containing beverages, decaffeinated tea and coffee,
and except as tolerated pepper-containing and
spicy foods
Evening primrose has been proposed to help but
this proposal is subject to problems such as small
subject numbers and poorly controlled studies
Pruritis
-this is itch
-can result from liver and kidney disease,
cancers, parasites, aging and dry skin, and
contact dermatitis
Pruritis and Nutrition
-nutritionally address each of diseases
generating the pruritis, address life cycle issues
(aging and dry skin frequently go together) or
address aging or dry skin separately as appropriate
-contact dermatitis can be dealt with as per
earlier mention of dermatitis
-Evening primrose oil has had controversial
success in this regard (i.e. pruritis)