Nutrition

From IKE
Jump to: navigation, search
  • To summarize some nutritional principles in regard to pregnancy
  • To list common supplements given to pregnant women, and sometimes prior to
  • To identify human breast milk as a completely adequate source of protein, energy and micronutrients for the initial 4-6 months of life
  • To be aware of several CFPC 10-step programs relating to pediatric care
  • To identify that iron supplementation is required once a baby starts to eat cow's milk
  • To identify linoleic acid as an important essential fatty acid to a baby s initial growth
  • To identify the elderly as a population at risk for malnutrition in our society
  • To identify the importance of simple questioning to identify elderly patients at risk to becoming malnourished
  • To summarize some reasons why the elderly are at risk to nutritional problems
  • To appreciate that most dietary guidelines for the general population are applicable to the elderly
  • To define enteral and parenteral feeding and describe principles in each approach ===

Pediatric

Prenatal

  • A low birth weight (LBW) infant is less than 2,500g (5.5 lbs)
  • nearly 40 times as likely to die in the first year of life as a normal baby
  • Achieving an IBW before pregnancy is important for obese women who may be at risk of developing gestational diabetes and hypertension
  • Pregnant women's food choices should be towards foods of high nutritional quality and away from calorie-rich foods
  • Women who are pregnant or contemplating pregnancy should be counselled not to smoke or consume recreational drugs including alcohol
  • Pregnant women should give special attention to ensuring adequate consumption of energy, protein, iron, calcium, vitamin D, folate and essential fatty acids
  • Supplementation may be necessary to achieve recommended daily intakes

Neonatal

  • Human breast milk is a completely adequate source of protein, energy and micronutrients for the initial 4-6 months of life
  • Exclusive breastfeeding is encouraged for the first four months of life
  • The current initiation rate in Canada is about 73%
  • The "Baby Friendly Hospital Initiative" is an effort by the WHO to encourage breastfeeding worldwide
  • The College of Family Physicians of Canada has developed several "10-Step Programs" to promote various aspects pediatric health, including breastfeeding [1]
  • Iron supplementation is required once a baby starts to eat cow's milk
  • Iron absorbabilty from human milk is 50% and only 1% from cow's milk
  • Infants fed cow's milk only are at extreme risk of developing iron deficiency
  • Iron should be given after 4-6 months as iron-fortified cereal or formula
  • Linoleic acid is an important essential fatty acid to a baby's initial growth
  • Linoleic acid should provide 3% of the baby's total energy calories (human milk is 5% and formula is usually 10%)

Geriatric

  • To identify the elderly as a population at risk for malnutrition in our society
  • In the Third World, children most suffer the effects of malnutrition
  • In the First World, the elderly are most at risk
  • Old people who are disease-free and socially integrated should be at no greater nutritional risk than anyone else
  • Malnutrition in the elderly is one of several interacting features including diminished mental function, decreased physical ability, social withdrawal and weight loss
  • To identify the importance of simple questioning to identify elderly patients at risk to becoming malnourished
  • Recognizing that older adults are at risk is the first step in helping them make changes.
  • Elderly risk can be assessed by the number of positive responses to the following statements:
    1. I have an illness that makes me eat different kinds / amounts of food
    2. I eat fewer than two meals a day
    3. I eat few vegetable and fruits and use few dairy products
    4. I have three or more alcoholic drinks per day
    5. I have tooth or mouth problems that make eating difficult
    6. I don't always have money to buy the food I need
    7. I eat alone most of the time
    8. I take 3 or more prescribed or over-the-counter medications per day
    9. Without wanting to, I have lost or gained 10 lbs (4.5kg) in the last 6 months
    10. I am not always physically able to shop, cook, and/or feed myself.
  • To summarize some reasons why the elderly are at risk to nutritional problems
  • Older adults run the risk for malnutrition for many different reasons. Examples include:
    1. poor appetite
    2. lack of money
    3. disease
    4. dental
  • To appreciate that most dietary guidelines for the general population are applicable to the elderly
  • Most dietary guidelines for younger adults hold true for elderly people without disease:
    1. even though energy intake will be smaller, eat a variety of nutritional foods to ensure a good mix of nutrients
    2. guard against obesity which can strain osteoarthritic joints as well as ageing heart and lungs
    3. implement regular enjoyable daily physical exercise into the elderly lifestyle
    4. reduce saturated fat levels, although it is controversial how much survival advantage can be gained in very old people
    5. encourage eating plenty of bread and cereals, vegetable and fruit, which will add to dietary fibre and decrease risk of constipation
    6. Limit alcohol consumption as it is less easily metabolized by smaller livers and the consequences of falls and accidents are more serious
    7. cut down on salt to decrease hypertension and risk of stroke.


  • To define enteral and parenteral feeding and describe principles in each approach

Enteral Feeding

  • The first option to be used in patients whose small intestinal function is maintained
  • Enteral feeding of a liquid diet can be administered via a nasogastric, nasoduodenal or nasojejunal tube depending on the patient's GI problem, or feeding tubes can be placed in the stomach or in the intestine surgically or using endoscopy
  • Enteral feeding is much less expensive than parenteral nutrition, has fewer complications, and is monitored more easily

Parenteral Feeding

  • When patients have a bowel obstruction, intractable vomiting or diarrhea, severe bleeding of the upper GI tract or are at a high risk for respiratory aspiration, the enteral route must be by-passed for feeding purposes
  • Total Parenteral Nutrition (TPN) describes the treatment via a peripheral or central vein of a purified diet which meets all of the nutrient requirements of the patient
  • Long-term TPN is challenging, as the entire diet must be prepared and maintained aseptically along with the venous delivery line and site. TPN solutions typically contain all essential amino acids, dextrose, lipids containing essential fatty acids, vitamins, minerals and trace elements. [2]

Resources