Note

Exam

180 minutes

120 multiple choice questions-120 points-4 short answer question-60 points

multiple choice-lecture 7a-12c inclusiveshort answer-whole Nutrition 2105 course

Note

World Health Organisation indicated on 5 March 2014 that keeping one’s simple sugar (mono and disaccharides) consumption to less than 5 % of daily calories (ie less than about 6 teaspoons of sugar) has added health benefits compared to keeping one’s simple sugar (mono and disaccharides) consumption than 10 % of calories.

This refers to all simple sugars whether they are added (pop, cakes) or naturally (e.g. honey, fruit) occurring.

Canadian government seeking input on changing food labels. Please provide your input:

http://www.hc-sc.gc.ca/ahc-asc/minist/messages/_2014/2014_01_28-eng.php

Note

CNS

Diet technician and dietitian positions

anita.binder@compass-canada.com

Lecture 9a 10 March 2014 Disorders of the Upper GI tract

Mouth Chewing

Impaired due to:-sedation and pain

 Solution

-mechanical soft diet, food selection or pureed foods

-what is the difference between these three solutions?

Mouth Impaired Chewing continued

Solution-pureed foods -can be boring

-bore factor may be overcome by commercially available thickeners

-thickeners allow one to shape foods so that look like the original food but are much easier to chew

Mouth Impaired Chewing continued

Solution -pureed foods

-make more appealing by:varietycolourserve foods at right temperatureseasonings and spicessupplement with nutritious liquids

likemilk, instant breakfasts, or

liquid formulas

Mouth ulcers-caused by?

Solutions 

-moist soft textured foods and eliminate spicy, salty and acid

foods

-example of each of these food types

Inflammation of throat and lips-solutions- nutritional approaches-see mouth

ulcers Reduced flow of saliva: solutions

-moisten foods with sauces and gravies-problem with this?

 -avoid salty foods and snacks (examples) that dry mouth

 -give sugarless candy

Dysphagia -difficulty swallowing

-due to aging, neurological disorders, developmental disabilities and strokes

 -muscles cannot not push food back to back of throat or push foods down the esophagus into stomach

Achalasia

-cardiac sphincter does not open up-it fails to relax

-food backs up until sphincter opens or there is regurgitation

Indications of dysphagia

-pain on swallowing, weight loss, feeling food is sticking in mouth

  -tendency to hold food in mouth rather than swallowing

-choking or coughing during meals

-frequent throat clearing, drooling or change in voice quality

Dysphagia Dietary interventions -mono-texture meals  -mildly spiced and moderately sweet foods served at room temperature

-avoid sticky foods and foods that break into small pieces when eaten

-avoid true liquids – thickened liquids are better (eg milkshakes and puddings) as they slide downmore easily

 

Dysphagia

Solutions

-posture- sit up, feet flat on floor, head tilted slightly forward to avoid choking

  -tube feedings –intestinal tubes may be better

than stomach tubes to avoid aspiration 

Esophageal reflux-solutions -eat small meals and drink liquids one hour

before or after a meal

-limit foods that weaken cardiac sphincter (fat,alcohol,caffeine)

-lose weight

-avoid cigarettes

-during reflux avoid acidic foods like citric acid juices, tomatoes, spices, very hot or very cold foods

Nausea and vomiting

Nausea-solutions

-avoid foods and aromas that make one nauseous-do not overeat-drink cold or carbonated liquids upon first sensation of nausea-eat carbohydrate-rich, low fat foods before getting

out of bed in morning-if cyclical , one is avoid food at critical times-ginger or peppermint teas provide relief for some

people-relax after eating

Vomiting-solutions

-if vomiting resolves, consume clear fluids to replace water and electrolytes

-otherwise use intravenous (iv) feedings 

Gastritis-solutions

Except as tolerated avoid: -alcohol and caffeine-decaffeinated coffee-pepper and spicy foods

-fatty and greasy foods-any other offending agent

give B12 as required (injection or prescription

nasal spray) as clinically indicated 

Ulcers-solutions

Post-onset-eat slowly, chew well

-avoid overeating and any foods than irritate the ulcer

e.g. -alcohol and caffeine -chocolate -pepper and spicy foods

Class activity

Design a diet for the pathology/problem of your choice than meets the dietaryprinciples of adequacy, variety, moderation,nutrient density, energy control, and balance

Lecture 9b 10 March 2014

 Disorders of the Lower GI tract

Constipation-solutions 

At least 25 grams of fibreLots of fluidsEating prunesDrinking prune juice

Foods containing fibre suitable to assist in the relief of constipation

1 slice whole wheat bread1 oz of ready to eat cereal (100 % bran cereals contain 10 grams of fibre)1   cup raw bean sprouts½ cup cooked broccoli , brussel sprouts, carrots, cauliflower½ cup chopped raw carrots1 medium apple, banana, kiwi, orange, pear½ cup apple sauce, blackberries, blueberries, strawberriesfruit juices contain very little fibre

Foods containing fibre suitable to assist in the relief of constipation

 ½ cup baked beans, blackbeans, blackeyed peas, kidney beans, navy beans (about 8 grams of fibre)

½ cooked garbanzo beans, lentils, lima beans, split peas (about 5 grams of fibre)

Foods containing fibre suitable to assist in the relief of constipation

most whole grain products contain about 1-2 grams of fibre per serving

most vegetables contain 2 grams-3 grams of fibre per serving

fresh, dried and frozen fruits contain about 2 grams per serving

many legumes contain about 8 grams of fibre per serving 

Relief of constipation via fibre consumption

fibre adds volume and weight to the stool which normalises the transit of undigested materials through the intestine and minimises the pressure within the colon

Gas

Everybody responds differently to different foods

Eliminate foods, one by one, to discover offending foods

Diarrhoea-solutions

-replace lost fluids and electrolytes

-consume diluted fruit juices, sports drinks and caffeine free-carbonated beverages for mild cases -use oral rehydration formulas- (salts, sugar and water)-mild to moderate cases

-severe cases combined with vomiting require intravenous solutions

-if eating aggravates the situation then withhold food and diarrhoea should resolve in a day or two-patient should drink only clear fluids in this case

Irritable bowel syndrome

Common motility disorder characterised by abdominal pain associated with diarrhoea, constipation i.e. alternating episodes of diarrhoea and constipation or both diarrhoea and constipation occurring at the same time Cause unclear but stress and anxiety have been suggested Solutions-Avoid eating too much, too fast or swallowing without chewing enough

Irritable bowel syndrome-solutions continued

Keep track of fluid and food intake and stool consistency associated with that fluid and food intake  Also keep track of other gastrointestinal tract symptoms at particular times people may benefit from reduced fat and liberal fibre and fluid intake

However fibre intake has to be watched-why?

Inflammatory bowel diseases

Crohn’s disease and ulcerative colitis are two of the most prevalent

In children , Crohn’s gives protein energy malnutrition (PEM), vitamin and mineral deficiencies nutritional interventions -food during day and tube feedings at night -or tube feedings day and night in severe cases

All Crohn’s patients regardless of age should reduce lactose intake and avoid high fibre foods 

 

Inflammatory bowel diseases-solutions

For ulcerative colitis no dietary interventions seem to lessen symptoms For all inflammatory bowel syndromes- fluid and electrolytes may have to be replaced by iv

 

Lactose intolerance-covered in first term

Malabsorption syndromes

Steatorrhea-malabsorption of fat and energy, essential fatty acids, fat soluble vitamins and some minerals

-also get binding of calcium to fatty acids

-this means that binding of calcium to oxalate in gut is lost-how does this relate to the last lecture?

Malabsorption syndromes-solutions

-treatment- high kcal and high protein diets are given-why?

-enzyme supplements given to aid digestion (pancreatic enzymes given)-medium chain fatty acids are given-

easier to digest-frequent small meals- why?-fat soluble vitamins given in water

soluble form-restrict oxalate in diet-why?

PancreatitisAcute-solutions

-fluids and electrolytes given iv

-suctioning of gastric secretions to help relieve pain and distension

-oral intake allowed after abdominal discomfort subsides and serum amylase returns to normal levels

-oral feeding starts off with liquid progressing to fat restricted diet to normal diet as tolerated

  

Chronic Pancreatitis

Absorption of fat can be permanently impaired

solution to this?

Cystic fibrosis-solutions

High kcal diet and high protein diet up to tolerance limits for protein and energy

 As pancreas is damaged fat absorption is reduced but do not limit fats

 Enzyme replacements for fat digestion

 Multivitamin and fat soluble vitamins

supplements are routinely given

Cystic fibrosis –solutions continued

Liberal use of table salt to make up for losses in sweating

Oral diets in day and tube feedings at night for some people Breast milk, standard infant formulas and hydrolysed infant formulas work for infants provided that enzyme supplements are given

Bacterial overgrowth in stomach 

Signs include chronic diarrhea, gas, malnutrition and weakness

 Fat restricted diets to bring down bacterial growth

 Oral mineral and vitamin supplements except B12 which cannot be absorbed

as the result of this overgrowth (injections of B12 or prescription B12

nasal sprays required)

Coeliac disease

Avoid gluten (wheat, rye and barley are out-even trace amounts)

 Lactose intolerance may be permanent

Intestinal surgeries-solutions IV fluids to restore fluid and electrolyte imbalances after surgery then tube feedings and finally regular oral meals (low fibre, soft diets to prevent irritation and obstruction)

-low fibre, soft diets means avoiding dried fruits, raw apples and corn, stringy foods (celery, spinach for example), seeds, mushroom and nuts

Intestinal surgeries-nutritional interventions

B12 supplementation (injection or nasal

spray) if necessary 

If diarrhea then give foods that thicken stool -apple sauce, bananas, cheese, creamy peanut butter and starchy foods such as white bread and potatoes

-avoid apple, grape and prune juice, highly seasoned foods, foods that cause gas and avoid alcohol and caffeine

Diverticulitis-solutions

Prevent by avoiding low fibre diets and constipation

-strain of pushing hard stools creates pockets in intestine

  Liquid diets until symptoms subside

Class activity

Design a diet for the pathology/problem of your choice than meets the dietaryprinciples of adequacy, variety, moderation,nutrient density, energy control, and balance