Introduction: Nutrition And Diseases

Malnutrition : a number of diseases, each with a specific cause related to

one or more nutrients (for example, protein, iodine or iron) and each
characterized by cellular imbalance between the supply of nutrients and
energy on the one hand, and the body's demand for them to ensure growth,
maintenance, and specific functions, on the other.
Malnutrition is having the inappropriate level of a micro- or macro- nutrient.
Under nutrition: protein energy malnutrition (PEM), micronutrients deficiency.
Over nutrition: overweight, obesity, and chronic disease caused by over
nutrition.
PEM Protein Energy Metabolism
It refers to a form of malnutrition where there is inadequate calorie or protein
intake.
Epidemiology It touches mainly adult lives and most often strikes early in
childhood.
PEM is most relevant in South Africa.
Long Questions
1.What are the three phases of severe PEM management?
Treatment of acute complications: Correction of dehydration, electrolyte
disturbances, acidosis, hypoglycemia, hypothermia, and treatment of
infections.
Start of cure: Refeeding, gradually working up the calories (from 100 to
150 kcal per kg) and protein (to about 1.5 g per kg). There may be anorexia,
and children often have to be hand fed. Potassium, magnesium, zinc, and a
multivitamin mixture are needed but iron should not be given for the first
week.
Nutritional rehabilitation: After about three weeks if all goes well the child
has lost edema and the skin is healed. The child is no longer ill and has a
good appetite but is still underweight for age. It takes many weeks of good
feeding for catch up growth to be complete.
2.What are the main differences between Kwashiorkor and
Marasmus?

3.What are the 4 measures to prevent PEM? Whats the meaning of

GOBI, which is actively promoted around the world to prevent PEM?
G Growth monitoring
O Oral rehydration
B Breast feeding
I Immunization
Growth monitoring The WHO has devised a simple growth chartthe
Road to Health card. The mother (not the clinic) should keep the card in a
cellophane envelope and bring the child (plus card) to the nearest clinic
regularly for weighing and advice.
Oral rehydration The UNICEF formula is saving many lives from
gastroenteritis, it contains: NaCl 3.5 g, NaHCO3 2.5 g, KCl 1.5 g, glucose 20 g
(or sucrose 40 g) and clean water to 1 L.
Breast feeding Is a matter of life and death in a poor community with no
facilities for hygiene. Additional food, prepared from locally available
products, is needed from four to six months of age.
Immunization should be done against measles, tetanus, pertussis,
diphtheria, polio, and tuberculosis, these infections predispose children to
and aggravate malnutrition.

Malnutrition Deficiencies
1.What are the four methods usually concerned for micronutrient
deficiencies prevention?
Four methods have brought vitamin and mineral deficiency under control in
developed countries:
Fortification
Supplementation
Education
Disease control

Fortification One way to meet the recommended daily intake of

micronutrients is to provide foods fortified with micronutrients. Adding
essential vitamins and minerals to foods that are regularly consumed by a
significant proportion of the population (such as flour, salt, sugar, oil and
margarine). The cost can be as low as a few cents per person per year.
Fortified foods, such as corn-soya blend, biscuits, vegetable oil enriched with
vitamin A, and iodized salt, are usually provided as part of food rations
during emergencies.
The aim is to avert micronutrient deficiencies or prevent them from getting
worse among the affected population. Such foods must be appropriately
fortified, taking into account the fact that other unfortified foods will meet a
share of micronutrient needs..
Supplementation Reaching out to vulnerable groups (particularly
children and women of childbearing age) with vitamin and mineral
supplements in the form of tablets, capsules and syrups.
Education and food based approaches Informing communities about
the kinds of foods that can increase the intake and absorption of vitamins
and minerals.
Disease control Controlling diseases like malaria, measles, diarrhea, and
parasitic infections can also help the body to absorb and retain essential
vitamins and minerals.
2.What are the four strategies for vitamin A deficiency in developing
countries?
Nutrition education
Vitamin A for mothers
Periodic dosing of young children
Fortification of staple foods with vitamin A
Nutrition education Nutrition education emphasizes garden cultivation and
regular consumption of locally grown plant sources of beta-carotene.
Absorption of beta-carotene is improved if there is oil or fat in the meal.
Vitamin A for mothers The vitamin may be given to pregnant women, but
it must not exceed 3300 IU (1 mg retinol) per day (or 23,300 IU once a week)
because more vitamin A can be teratogenic. After delivery large single oral
doses (200,000 IU) can be given to them in the first month.

Periodic dosing of young children This should be done in areas of high

incidence with capsules of 110 mg retinol palmitate or 66 mg retinol acetate
(200,000 IU) at six monthly intervals. Doses must be smaller in infancy.
Fortification of staple foods with vitamin A In industrialized countries
vitamin A is added to margarines to the level found in butter (2500 IU or
0.75mg retinol per 100 g). In Central America sugar is fortified. In China,
people can choose vegetable oil fortified with vitamin A.

3.What is USI? What are the indicators of USI impact?

USI The major preventative measure is for governments of countries at risk
to make iodization of salt mandatory (Universal Salt Iodization).
USI involves the iodization of all human and livestock salt, including salt used
in the food industry. Adequate iodization of all salt will deliver iodine in the
required quantities to the population on a continuous and self-sustaining
basis.
Indicators of USI impact
Urinary iodine Median urinary iodine concentrations of 100 g/l and
above define a population which has no iodine deficiency.
Thyroid size The traditional method for determining thyroid size is
inspection and palpation. Ultrasonography provides a more precise and
objective method.
Blood constituents Two blood constituents, TSH and thyroglobulin can
also serve as surveillance indicators.

Nutrition through the life cycle

1.What are the advantages of breastfeeding over formula feeding?
Advantages of breastfeeding
Nutritional superiority: Human milk is tailored to meet infant nutrient
needs for the first 4 to 6 months of life.
Protection from infections and allergies
Mother-infant bonding
Physiologic benefits for mother: Breastfeeding helps quicken the return
of the uterus to prepregnancy size, reduce bleeding, and lose the weight
gained during pregnancy.
Convenience and cost: Breast milk is always ready, clean, at the right

temperature, and available on demand. The cost is much less than infant
formula.
2.List the main differences between colostrum and mature breast
milk.
Colostrum: The thick, yellowish fluid, produced during the first two or three
days after delivery by the breasts.
Colostrum is higher in protein, sodium, potassium, and chloride and lower in
carbohydrate and fat than mature milk;
Colostrum contains antibodies, immune cells, and bifidus factors, which
encourage the growth of bifidus bacteria (good bacteria in colon).
Mature milk: Breast milk produced 2 weeks after infant birth.
3.Describe when and how to give the infant solid food
When: Infants begin to need complementary ( or solid) foods at around 4~6
months of age.
Why:
Nutrition needs: The declining nutrient stores, particularly iron, and
continued growth; Physical readiness: Infants gradually develop the ability to
chew, swallow, and digest the wide variety of foods.
Control allergic reactions: Introducing solid foods too early might increase
the risk of food allergy.
How Copy table from ppt

4.Why do energy needs usually decline with advancing age?

Energy need
The energy needs of older adults are lower than those of younger adults
because of:
lower basal metabolic rate (loss of muscle mass and lean tissue)
less physically active lifestyle.
The total daily energy expenditure decreases approximately 7~10 kcal each
year after 20 years.
Macronutrients need
Because the energy needs are lower, consuming a diet high in nutrientdense foods is recommended.
Protein: RDA for older adults are 65~75 grams, make sure high quality
protein from meat and beans.
Fat: Total fat intake remains within 30% of total daily energy intake, avoiding
too much saturated fatty acids and cholesterol.
Carbohydrates: 55%~65% of total energy should come from carbohydrates,
with plenty of dietary fibers.

5.Which vitamins and minerals need special consideration for the

elderly? Explain why.
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Food nutrition value and balanced diet

1.What is INQ?
Index of Nutrition QualityINQ
INQ is an odds ratio i.e. the density of nutrient (quantity of certain nutrient in
food vs. its RNI) vs. the density of energy (quantity of energy in food vs. its
RNI).
INQ implies that what degree the nutrients satisfy the human body demand
while food supplies energy.
2.What are the advantages of a balanced diet for human health?
(Find answer)

3.List the main food groups of the food pyramid.

Grains
Vegetables
Fruits
Oils
Milk
Meat

Nutrition And Obesity

1.What is BMI? For Asian population, what are the cut-off for
overweight and obesity?

2.What factors contribute to obesity?

Genetics Polygenic (genetic susceptibility): Genes related to appetite
control, energy regulation, and obesity development.
Example: ob gene codes for the peptide leptin expressing in adipose tissue,
which helps the brain to control eating.
Drug-induced obesity Glucocorticoids
Antidiabetic drugs: Insulin, Sulphonylureas, Thiazolidinediones
Antipsychotic drugs
Antiepileptic drugs
Miscellaneous: Antihistamines, Cyproheptadine, Cyclophosphamide, 5Fluorouracil

Endocrine induced obesity Hypothyroidism: due to a fall in basal

metabolic rate
Cushing syndrome
Polycystic ovarian syndrome (PCOS): Insulin resistance is common
Hypothalamic disease
Pituitary disorders: growth hormone deficiency
Environment (life style induced obesity) The environment includes all
of the circumstances that we encounter daily that push us toward fatness or
thinness:

Overeating
Physical inactivity Sedentary life and vehicles
3.How to calculate a persons daily energy intake?
Easy method to estimate usual daily intake
For male adults:
Energy intake=24hr1 kcal/kg/hrbody weight (kg)PAL
For female adults:
Energy intake=24hr0.9 kcal/kg/hrbody weight (kg)PAL
* PAL: physical activity level
Example (Question)
Indra, 22 years old, male college student (supposing his PAL is 1.55), height:
165 cm, weight 72 kg. Whats his BMI? To maintain his weight, how much
energy should he intake?
Indras BMI=72/1.652=26.4, between 24~28, he is overweight.
Energy intake=24hr1kcal/kg/hr72 kg1.55=2678 kcal, he will consume
almost 2700 kcal to maintain his weight. If he planed to lose some weight, he
needs a 300~500 kcal reduction per day.
4.Describe the possible health consequences of overweight and
obesity.
People who are overweight and obese more commonly suffer and die from
serious diseases, such as hypertension, diabetes, and heart disease.
Obesity and diabetes
Obesity accounts for 80%~85% of the overall risk of developing type 2
diabetes.
Central (and especially visceral) obesity is specifically associated with type 2
diabetes.
Obesity predisposes to type 2 diabetes by causing both insulin resistance
and -cell dysfunction.
Obesity and CVD
Obesity is an independent risk factor for cardiovascular diseases, including
hypertension, coronary-heart disease (CHD), cardiac failure, arrhythmias and
cardiovascular death.
Visceral obesity may increase cardiovascular risk by generating high FFA
levels, which induce insulin resistance, stimulate very low density lipoprotein

(VLDL) production by the liver, and promote triglyceride deposition in the

myocardium.

Obesity and liver disease

Obesity is a major risk factor for non-alcoholic fatty liver disease (NAFLD).
Hepatocyte damage and inflammation are initiated by high FFA levels,
release of cytokines.
Obesity and cancer
Obesity contributes to the risk for several malignancies, including cancers of
the endometrium (30% of total risk), colon, oesophagus and breast, and
lymphoma.
Suggested mechanisms include dietary factors and physical inactivity
(colorectal cancer), gastro-esophageal reflux (esophageal cancer) and
cirrhosis complicating fatty liver disease (hepatocellular carcinoma).
Obesity and other diseases
Obesity increases the risk of osteoarthritis of the knees, hips and hands.
Lung volumes are decreased due to mechanical restriction.
Polycystic ovarian syndrome (PCOS): characterized by failure of ovulation,
causing multiple ovarian cysts and infertility.
Gallbladder diseases: Being overweight is associated with an increase in
gallstones.
Psychosocial problems.
5.Describe reasonable dietary strategies for achieving and
maintaining a healthy body weight.
Healthy eating
Emphasize nutritional adequacy: Nutritional adequacy is difficult to achieve
on fewer than 1200 kcal a day, a multivitamin supplement can help people
following low-energy diets to achieve nutrient adequacy.
Eat small portions: The amount should leave a person feeling satisfiedbut
not stuffed.
Lower energy density: Chose more foods containing water, rich in fiber, low
in fat help to lower energy density.
6.What are FITT of exercises standing for?
FITT principle
F (Frequency): How often per week.
I (Intensity): How hard one exercises.

T (Type): Choice of activity.

T (Time): Duration of session.

Nutrition And Cardiovascular Diseases

1.What is DASH diet?
DASH Dietary approach to stop hypertension
The blood pressure reductions seen in the DASH trial (in 1990s) are most
likely a synergistic effect of increasing potassium, magnesium, calcium, and
fiber while reducing sodium and saturated fat.
What does DASH diet look like?
Rich in vegetables and fruits
Low-fat dairy products
Reduced saturated fats and total fats
2.What is TLC diet for AS treatment and prevention?
TLC diet guide
Total dietary fat: maintenance of dietary fat intake within 20%35% (less
than 30% recommended for Chinese) of total caloric intake is recommended.
Current guidelines emphasize reducing amounts of saturated and trans fatty
acids rather than a strict adherence to a reduced-fat diet.
Saturated: no more than 7% of total kcal should be from saturated fat
sources.
Trans fatty acids: mostly found in partially-hydrogenated oil, can raise LDL
and possibly decrease HDL levels.
Monounsaturated fatty acids: MUFAs intake (such as in olive oil) appears to
lower LDL while having no affect on HDL levels.
Polyunsaturated fatty acids: When substituted for saturated fatty acids,
PUFAs have been linked to a reduction of LDL and are associated with
decreased CVDs risk.
n-3 PUFA: also called omega-3 fatty acid, is essential fatty acid. EPA is a 20carbon fatty acid that is a precursor of the important eicosanoids, may help
decrease the CVDs risk.
Cholesterol: The U.S NCEP currently recommends an intake of less than 200
mg/day (less than 300mg/day for Chinese).
Fiber: Soluble fiber may reduce LDL and total serum cholesterol levels.
Phytosterols: Plants do not contain cholesterol but they do have similar sterol
components which can assist in lowering serum cholesterol and LDL levels.
Folate: Folic acid and Vit B12 are required for the conversion of Hcy to

methionine, therefore preventing hyperhomocysteinemia, which is a CVDs

risk factor.

Nutrition And Diabetes

1.How is diabetes diagnosed?
Criteria for diagnosis of diabetes:
Symptoms of diabetes plus casual plasma glucose concentration 11.1
mmol/L OR
Fasting plasma glucose 7.0 mmol/ OR
2-hour post-prandial glucose 11.1mmol/L during an oral glucose tolerance
test (OGTT)
Criteria for IGR (impaired glucose regulation)
IFG: Impaired fasting glucose, fasting plasma glucose is >6.1mmol/L and
<7.0mmol/L.
IGT: Impaired glucose tolerance, 2-hour post-prandial glucose >7.8mmol/L
and <11.1mmol/L during an oral glucose tolerance test.
2.What are the goals of medical and nutrition therapy for people
with diabetes?
a. Attain and maintain optimal metabolic outcomes, including Glucose level
in normal range, or as close to normal range as possible, to prevent or
reduce risk of complications
Lipid or lipoprotein profile that reduces risk for macrovascular disease
Blood pressure levels that reduce risk for vascular disease.
b. Prevent and treat chronic complications. Modify nutrient intake and
lifestyle as appropriate for prevention and treatment of obesity, dyslipidemia,
cardiovascular disease, hypertension, and nephropathy.
c. Enhance health through food choices and physical activity.
d. Address individual nutritional needs with regard to personal and cultural
preferences and lifestyles while respecting the individuals wishes and
willingness to change.
3.Describe the meal-planning strategies that are used to control
carbohydrate intake.
The carbohydrate found in foods is the major macronutrient influencing postprandial glucose variations.

It influences pre-meal insulin requirements. The total amount of daily

carbohydrate intake, not its source, is the focus of this meal planning
approach.
Food carbohydrate sources are starches, fruits, milk/yogurt, and sweets.
Method: Carbohydrates can be counted in one of the following two ways:
The amount of food containing 15 g carbohydrate counts as one
carbohydrate choice.
Total grams of carbohydrate in a meal or snack can be counted by use of
food label information or other sources of nutrient analysis information.

4.Meal planning for DM patients using exchange list.

a. Assess current food intake and eating pattern using diet history or food
records.
b. Categorize usual food intake into exchange amounts based on portions
and foods consumed at each meal and snack. Calculate total grams of
carbohydrate, protein, and fat and translate into energy.
c. Determine appropriate energy prescription. Generally 250~500 kcal per
day can be subtracted/added for a 0.5~1 pound per week weight loss/gain.
d. Translate energy prescription into exchanges, staying as close to current
pattern of intake as possible. Calculate grams of carbohydrate, protein, and
fat from exchanges and determine percentages of energy contributed by
each macronutrient
e. Adjust exchanges as needed to reach goal percentages for each
macronutrient.
f. Compare usual intake to energy prescription and mutually determine how
to distribute exchange groups among meals and snack.

Nutrition And GI Tract Diseases

1.Identify three major goals for nutrition interventions to assist in
the control of symptoms associated with PUD (Peptic Ulcer
Diseases).
a. Restricting foods that may increase acid secretion or cause direct irritation
to gastric mucosa: black and red pepper, coffee, alcohol.

b. Avoiding foods individually intolerance: milk and cream consumption

increases both gastrin and pepsin secretion.
c. pH of a food prior to its consumption has little effect after it is consumed.
Restricting acidic juices or other foods is not consistently warranted.
d. Eat smaller, more frequent meals
2.What are pre- and pro-biotics? How do they affect the health of
the GI tract?
Prebiotics are a source of food for probiotics to grow, multiply and survive in
the gut.
Prebiotics are fibres which cannot be absorbed or broken down by the body
and therefore serve as a great food source for probiotics to increase in
numbers. Prebiotics by nature do not stimulate the growth of bad bacteria or
other pathogens; the official definition of prebiotics is: "non-digestible food
ingredients that beneficially affect the host by selectively stimulating the
growth and/or activity of one or a limited number of bacteria in the colon,
which can improve host health." Probiotics are live bacteria and yeasts that
are good for your health, especially your digestive system. Probiotics are
often called "good" or "helpful" bacteria because they help keep your gut
healthy.
3.Describe the types of diarrhea and compare their possible
etiologies. Describe the dietary measures that are commonly
recommended for diarrhea.
Classified by durations:
Acute diarrhea: short-term, less than 2 weeks
Chronic diarrhea: lasting longer than 4 weeks.
Classified by the mechanisms:
Osmotic diarrhea: increased osmotically active particles (e.g. fructose,
sorbitol) in the intestine.
Secretary diarrhea: excessive fluid and electrolyte secretion into the
intestines (e.g. infectious agents-induced secretions).
Measures:
a. Restoration fluid, electrolyte and acid-base balance through intravenous
therapy or use of ORS.
b. Decrease motility: avoiding high-sugar beverage, foods high in simple
sugar (lactose, fructose, or sucrose), sugar acohols (sorbitol, xylitol,
mannitol), caffeine, alcoholic beverages, gas-producing foods.
c. Thicken the stool: adding soluble fibers (banana flakes, apple or other

pectin sources) and resistant starch.

d. Use of probiotics and prebiotics: foods or supplements support growth of
healthy colonic flora.

Nutrition And Cancer

1.Describe the process of tumor formation. Discuss the dietary
factors that may increase or decrease the risk of cancer.
Growth and development of tumors
Neoplasm: new growth; an abnormal mass of tissue, the growth of which
exceeds and is uncoordinated with that of normal tissue.
Metastasis: spread of cancer from the primary site to nearby or distant areas
through the blood or lymph.
Dietary components associated with cancer:
Excesses of certain substances such as:
Fat: the end products of metabolism have been found to be carcinogenic.
Alcohol: has been connected with liver, colorectal, and breast cancers.
Pickled and Smoked Foods: related to cancers of the esophagus and
stomach.
Cooking methods Frying or charcoal-broiling meats at very high
temperatures creates carcinogenic chemicals, such as polycyclic aromatic
hydrocarbon (PAH), heterocyclic amines (HCAs).
Protective dietary components:
Vitamin C: has been shown to protect against cancer of stomach,
esophagus, and oral cavity.
Vitamin E and selenium: both antioxidants that protect cells against
breakdown.
Fiber: Insoluble fiber is connected to decreased risk of colon cancer.
Phytochemicals: these are certain non-nutrients found in fruits and
vegetables, such as flavonoids, isothiocyanates, curcumin, allicin, etc.
2.What is cancer cachexia? What factors promote its development?
Profound destructive process characterized by skeletal muscle wasting and
harmful abnormalities in fat, carbohydrate, and protein metabolism in spite
of adequate energy and nutrient intake.
Metabolic alterations, involuntary weight loss, tissue wasting (particularly
lean body mass and adipose tissue), inability to perform daily activities.
Pathophysiology is not completely understood.

Cytokine activation:
TNF-alpha
IL-1 and IL-6
IFN-alpha, beta and gamma
3.Describe the abnormalities in nutrients metabolism of cancer
patients
Abnormalities in nutrients metabolism
Cancer patients experience changes in carbohydrate, lipid, and protein
metabolism that can contribute to fluid imbalance, acid-base imbalance, and
changes in the concentration of electrolytes, vitamins, and minerals.
Carbohydrate metabolism:
Increased gluconeogenesis from amino acids and lactate.
Insulin resistance, decreased glucose tolerance.
Increased Cori cycle activity (increased lactate production from glycolysis).
Lipid metabolism:
Increased lipolysis, decreased lipogenesis.
May see increased lipid metabolism and decreased activity of lipoprotein
lipase.
Elevated triglycerides
Protein Metabolism:
Muscle wasting is caused by increased protein breakdown and decreased
protein synthesis.
Nitrogen depletion/abnormal plasma AA levels.
Increased whole-body protein turnover, increased liver and tumor protein
synthesis.

Nutrition And Renal Diseases

1.What is the cause of edema in nephrotic syndrome patients?
Should you recommend a high level of dietary protein for them?
Edema: The most common consequences of NS. Edema can be caused by:
Hypoalbuminemia: Albumin is lost significantly through urine.
Hypoalbuminemia contributes to a fluid shift from blood to the interstitial
spaces.
Sodium and water retention: Kidneys reabsorb sodium in greater amounts
than usual, causing sodium and water retention within the body.

Protein and Energy

High-protein diets are not advised, which may exacerbate urinary protein
loss and result in further damage to the kidneys.
Moderate protein intakes: 0.8-1.0 g/kg.bw
High quality protein: 50% of the diet protein should be from milk products,
lean meat, fish, poultry, eggs, and soy products.
Adequate energy intake: 35kcal/kg.bw sustains body weight and spares
protein.

Nutrition And HIV/AIDS

What is AIDS-related wasting syndrome? Explain the common reasons for
AWS
Also called AIDS-related wasting syndrome (AWS). Significant weight loss
(10% weight loss within a 6-month peroid) occurs during opportunistic
infection or other events. AWS has many causes including:
Anorexia and inadequate food intake
Malabsorption and chronic diarrhea
Diet-drug interactions
Hormonal deficiencies (testosterone or thyroid)
Inflammatory cytokines
2.Explain why an HIV infection often results in anorexia and reduced
food intake.

3.Discuss the features of medical nutrition therapy for HIV-infected

and AIDS patients.
Nutrition therapy

Nutrition assessment and counseling should begin as soon as a patient is

diagnosed with HIV infection.
Dietary evaluation

Anthropometric assessment
Biochemical assessment
Medical history
Nutrition diagnosis Common problems include:
Increased energy expenditure
Inadequate oral food/water intake
Increased nutrients needs
Impaired nutrients utilization
Malnutrition
Altered GI function
Swallowing difficulty
Underweight
Altered laboratory value
Food-drug interactions
Physical inactivity
Intake of unsafe food
Nutrition intervention: Goals for the nutrition care plan may include:
Restoration of adequate nutritional status
Prevention of adverse events related to therapies
Management of co-conditions (diabetes, liver disease, renal dysfunction).

Why are people with HIV infections highly susceptible to foodborne illness?
Describe some measures that can be taken to prevent foodborne illness.

Nutrition Support EN And PN

1.Characterize standard formulas, elemental formulas, specialized
formulas, and modular formulas.
Standard formulas polymeric formulas
Provided to individuals who can digest and absorb nutrients without difficulty

Contains intact proteins extracted from milk or soybeans or a combination of

protein isolates (proteins isolated from foods);The carbohydrate sources
include modified starches, glucose polymers (such as maltodextrin), and
sugars..
Elemental formulas monomeric formulas
Prescribed for patients who have compromised digestive or absorptive
functions.
Contains proteins and carbohydrates that have been partially or fully broken
down to fragments that require little digestion. Often low in fat, and may
contain medium-chain triglycerides (MCT) to ease digestion and absorption.
Specialized formulas disease-specific formulas
Designed to meet the specific nutrient needs of patients with particular
illnesses (such as liver, kidney, and lung diseases and glucose intolerance).
Modular formulas
Created from individual macronutrient preparations called modules
Prepared for patients who require specific nutrient combinations to treat their
illnesses.
2.Discuss complications associated with tube feedings.
GI complications
Diarrhea: caused by malabsorption, medications, bacterial overgrowth,
malnutrition, or hypertonic formulas.
Constipation: due to dehydration, motility impairments, obstructions, and
low-fiber intakes.
Others: abdominal discomfort, nausea, and vomiting.
Aspiration pneumonia
Aspiration: drawing in by suction or breathing; a common complication of
enteral feedings in which foreign material enters the lungs, often from GI
secretions or the reflux of stomach contents.
Aspiration pneumonia: a lung disease resulting from the abnormal entry of
foreign material.
Mechanical complications
Clogged feeding tubes
Feeding tubes dislodged after placement
Feeding tube as a physical irritant
Dry mouth from increased mouth breathing and reduced salivary secretions.

Metabolic complications
Fluid imbalances: dehydration or overhydration
Electrolyte imbalances
Glucose intolerance
Discuss the potential complications associated with parenteral nutrition.
Hyperglycemia
Reasons: glucose intolerant, or undergoing severe metabolic stress.
Prevention: providing insulin along with feedings or by restricting the amount
of dextrose in a solution.
Hypoglycemia
Reasons: feedings are interrupted or discontinued or if excessive insulin is
given.
Prevention:
Feedings may be tapered off over several hours before discontinuation.
Infusing a 10% dextrose solution at the same time that the parenteral
feedings are interrupted or stopped.
Hypertriglyceridemia
Reasons: critically ill patients, severe infection, liver disease, kidney failure,
hyperglycemia, and use of immunosuppressant or corticosteroid
medications.
Prevention: If blood triglyceride levels exceed 500 mg/dL, lipid infusions
should be reduced or stopped.
Reefeding syndrome
Definition: a condition that develops when a severely malnourished person is
aggressively fed; characterized by electrolyte and fluid imbalances and
hyperglycemia.
Reasons: dextrose infusions raise insulin levels, that quickly remove P, K and
Mg from the blood.
Prevention: start parenteral feedings slowly and carefully monitor electrolyte
and glucose levels.
Other abnormalities
Fatty liver: the reason of PN-induced fatty liver is unclear
Gallbladder disease: PN continues for more than four weeks, thickened bile
builds up and may eventually lead to gallstone formation
Metabolic bone disease: Long-term PN has been associated with lower bone
density and bone mineralization.