Case Study Report: Nutritional Management of Crohn’s Disease
description
Transcript of Case Study Report: Nutritional Management of Crohn’s Disease
![Page 1: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/1.jpg)
CASE STUDY REPORT: NUTRITIONAL MANAGEMENT OF CROHN’S DISEASE
Lindsey Warren, MSARAMARK Dietetic InternProvidence Medical CenterFebruary 13th, 2012
![Page 2: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/2.jpg)
Crohn’s Disease and Malnutrition
Hebuterne et al (2009)
Intake Deficien
cyMetabolic Disturban
ces
Protein-losing
EnteropathyChronic Blood loss
Malabsorption
Medication
Multi-factorial
![Page 3: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/3.jpg)
Vitamin and Mineral Supplements
Hebuterne et al (2009)
![Page 4: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/4.jpg)
Diet-Related Disease Systematic review (19 studies):
↑intake total fats, PUFAs, omega-6 fatty acids, and meat ↑development of CD.
↑Fiber and fruit intake ↓risk of CD.
↑Fiber: protective affect >22.1gm/day
↑Fruits: 73-80% decreased risk of CD
Hou et al (2011)
![Page 5: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/5.jpg)
Relapse Prevention with a Semi-Vegetarian Diet 2-yr Prospective Clinical Trial Remission Rate
Semi-Vegetarian Diet 100% 1-year, 92% 2-year Incidence of relapse at 2-years was
significantly lower in the SVD group (p=0.0003)
Omnivorous Diet 67% 1-year, 25% 2-year
Chiba et al (2010)
![Page 6: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/6.jpg)
Anti-Inflammatory Effect of Probiotic Yogurt
Single-blinded clinical trial Daily supplementation (125gm x 30
days) Increased immune response
↓TNF-α and IL-12-producing monocytes May play a major role in pathogenesis in
CD No significant changes with plain
yogurt supplementation .Baroja et al (2007)
![Page 7: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/7.jpg)
Research Limitations
More research is needed Lack of large, randomized, controlled
clinical trials Studied only small populations Open-label or single blinded Studied short-term effects only
![Page 8: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/8.jpg)
Nutrition Prescription for Exacerbations Prevent negative nitrogen balance Provide adequate fluid and
electrolyte replacements Diet progression
Clear liquids low-fat, low-fiber, high-protein, high-kilocalorie, diet in small frequent meals.
Add fiber as tolerated Short-term lactose intolerance
Nutrition Care Manual: Nutrition Therapy for Inflammatory Bowel Disease
![Page 9: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/9.jpg)
Nutrition Prescription for Remission Focus:
Weight management Replenishment of nutrient stores
Avoid high-oxalate foods Increase antioxidant intake Encourage probiotics and prebiotics
![Page 10: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/10.jpg)
Case Study Report
27-year-old morbidly obese male Recent job loss; no insurance + Bloody diarrhea and abdominal
pain x 2-3 months before hospitalization
Admission #1 : Crohn’s Disease diagnosis
#2: Pan colitis #3: Colectomy and
Ileostomy placement
![Page 11: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/11.jpg)
Anthropometric Measurements
Height Admission Weight
Ideal Body Weight
Adjusted body weight
BMI
6’ 1” 473lbs 184lbs 256lbs 63kg/m2
Estimation of Nutrient NeedsNutrient needs
19 to 22kcal/kg x 116kg = 2200 to 2552kcal/day
Protein needs
1.5 to 2.0 x 116kg = 174 to 232gm of Protein/day
![Page 12: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/12.jpg)
Diet Progression
Procalamine with lipids @ 75cc/hr
Custom TPN
Clear Liquid Diet
Soft, Bland Diet
Regular Diet
Provided:52g Pro/day941kcal/day
Provided: 150g of Pro/day2120 Kcals/day
Provided: 0g of Pro/day350 Kcals/day
Both Soft and Regular Provided: 80g of Pro/day2000 Kcals/day+ Beneprotein36g of Pro/day150kcal/day
![Page 13: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/13.jpg)
Pertinent MedicationsMedication PurposeZofran Anti-nauseaPrednisone Reduces swelling and redness Insulin Used to treat hyperglycemia secondary to
steroid treatmentRemicade Anti-inflammatoryProtonix Decreases stomach acid productionMesalamine Anti-inflammatoryPropofol Short-acting sedation for surgery and
intubationAlbumin To replete albumin Zosyn Fights infectionFlagyl Fights infectionMagnesium To treat hypomagnesemia
![Page 14: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/14.jpg)
Biochemical DataLaboratory Reference
Range
Case Study Patient’s Lab Values During Time
of Hospitalization
Contributors to Lab Abnormalities
Albumin 3.4 – 4.7 gm/dL 1.1↓,0.9↓, 1.4↓, 1.3↓, 1.4↓
Malnutrition, Malabsorption, Blood loss, Inflammation
PreAlbumin 18 – 36mg/dL 15↓, 27 Malnutrition, Malabsorption, Blood loss, Inflammation
Glucose 70 – 99mg/dL 120↑,136↑, 195↑,181↑, 218↑,197↑, 156↑,139↑,112↑
Steroid treatment, inflammation, infection,
Magnesium 1.5 – 2.5mg/dL 0.7↓, 2.0 Malnutrition and Malabsorption
Calcium 8.4 – 10.2mg/dL 8.1↓, 7.8 ↓, 8.0↓, 8.7 Malnutrition and Malabsorption
Creatinine 0.7 – 1.3mg/dL 0.6↓, 0.7, 0.6↓, 0.5↓, 0.4↓
Malnutrition, Decreased Muscle Mass, Renal insufficiency, Increased protein from Gastrointestinal bleeding.
![Page 15: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/15.jpg)
ARAMARK Nutrition Classification
Nutrition History – 3 Feeding Modality – 0 Unintentional Weight loss – 3 Weight Status – 4 Serum Albumin – 4 Diagnosis – 3 Total = 17 Severely Compromised
![Page 16: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/16.jpg)
Nutrition DiagnosesNutrition Diagnosis Terminology
Domain
Problem Related To
Etiology As Evidenc
e BySigns
Clinical NC-1.4
#1 Altered Gastro-intestinal Function
R/T Crohn’s Disease
A/E/B 6% Wt ↓ x 3 mo, abdominal pain, N/V, and bloody diarrhea
Oral Intake NI-2.1
#2 Inadequate Oral Intake
R/T N/VAbdominal pain
A/E/B Pt stated poor intake, Alb 0.9gm/dL, and 6% wt loss x 3 mo
Nutrient NI-5.1
#3 Increased Protein needs
R/T Total Colectomy, Ileostomy placement, and malabsorption
A/E/B Alb 1.4gm/dL and pt only receiving 57% of est. needs
![Page 17: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/17.jpg)
Recommended Interventions
Parenteral Nutrition •Initiating Procalamine with lipids @ 100ml/hr
Parenteral Nutrition •Initiating Custom TPN
Meals and Snacks •Advance to low-fiber, bland diet when
medically appropriate
Medical Food
Supplements
•Two Scoops of Beneprotein TID with meals
Nutrition Education-
Content•Nutrition education regarding nutrition relationship
to health/disease and diet modifications for Crohn’s Disease and Ileosotomy
![Page 18: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/18.jpg)
Nutrition Goals
Short-term TPN Tolerance Diet Advancement Adequate po intake Hyperglycemia management during
steroid treatment Long-term
Gradual weight loss to a healthy weight Understands disease impact on health
and nutrition modifications.
![Page 19: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/19.jpg)
Discussion Diet-related disease Probiotics may have anti-
inflammatory benefits Malnutrition
Primary concern for CD patients Independent of weight status
![Page 20: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/20.jpg)
Discussion Continued…
Case Study Patient Achieved remission with wt↓ (76lbs, 16%
of BW) Short-term goals at discharge
Symptoms had resolved Laboratory data had improved Extremity weakness was improving
Discharged to rehabilitation center
![Page 21: Case Study Report: Nutritional Management of Crohn’s Disease](https://reader031.fdocuments.us/reader031/viewer/2022020417/56815dff550346895dcc4175/html5/thumbnails/21.jpg)
References
1. Hebuterne X, Filippi J, Al-Jaouni R, Schneider S. Nutritional consequences and nutrition therapy in Crohn’s disease. Gastroenterologie Clinique et Biologique. 2009; 33: S235-S244.
2. Hou J, Abraham B, El-Serag. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. 2011; 106: 563-573.
3. Chiba M, Abe , Hidehiko T, Sugawara T, Tsuda S, Tozawa H, Fujiwara K, Imai H. Lifestyle-related disease in crohn's disease: relapse prevention by a semi-vegetarian diet. World Journal of Gastroenterology. 2010; 16: 2484-2495
4. Baroja M, Kirjavainen H, and Reid G. Anti-inflammatory effects of probiotic yogurt in inflammatory bowel disease patients. Clinical and experimental immunology. 2007; 149: 470-479.
5. Nutrition Therapy for Inflammatory Bowel Disease. American Dietetic Association. http://nutritioncaremanual.org/index.cfm Accessed online on December 26, 2011.