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Week 14

Week 14 . Introduction to Medical Nutrition Therapy. Chapter 6: An Introduction to Medical Nutrition Therapy. Medical Nutrition Therapy Nutritional assessment and treatment of a condition, illness, or injury that places a person at risk Involves two components Assessment

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Week 14

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  1. Week 14 Introduction to Medical Nutrition Therapy

  2. Chapter 6: An Introduction to Medical Nutrition Therapy • Medical Nutrition Therapy • Nutritional assessment and treatment of a condition, illness, or injury that places a person at risk • Involves two components • Assessment • Of nutritional status • Treatment • May include therapeutic diets, counseling, and/or the use of nutritional support

  3. Introduction to Medical Nutrition Therapy: Therapeutic Diets • Therapeutic Diet • A regular diet that has been adjusted to meet client special needs. Diets may be adjusted to include: • Number of Calories • Amount of Nutrients and/or Specific Nutrients • Amount of Fluids • Elimination of Certain Foods • Promote good oral intake with foods • Accommodate difficulties in chewing or swallowing • Treatment of problems in the digestive system

  4. Introduction to Medical Nutrition Therapy: Cardiac Conditions • Cardiovascular Disease (CVD) is a general term that refers to diseases of the heart and blood vessels • Number one cause of death in the U.S. • One in five Americans die of heart disease, one in four has one or more of these forms: • Coronary Artery disease (CAD) • Stroke (CVA) • High Blood Pressure (HTN) • Rheumatic Heart Disease

  5. Introduction to Medical Nutrition Therapy: Cardiovascular Disease • CHD: Coronary Heart Disease • The result of atherosclerosis, hardening of the arteries due to plague buildup • CAD: Coronary Artery Disease • Occurs when the clogged (atherosclerotic deposits) arteries block blood flow to the heart • Heart Attack • Caused by the blockage of blood to the heart muscle. If part of the heart muscle is denied oxygen, it becomes damaged of dies. • Myocardial Infarction (MI) • Heart muscle damage – damaged piece no longer contracts causing the heart works less efficiently

  6. Introduction to Medical Nutrition Therapy: Coronary Artery Disease • Hyperlipidemia (HPLD) - High Blood Cholesterol • Low Density Lipoproteins (LDL) • “Bad Cholesterol” • Carries most of the cholesterol in the blood • Cholesterol and fat from LDL’ s are the main source of buildup and blockage in the arteries • High Density Lipoproteins (HDL) • “Good Cholesterol” • Carries cholesterol away from the organs and takes it to the liver for destruction

  7. Introduction to Medical Nutrition Therapy: Coronary Artery Disease • Risk Factors • High LDL • Low LDL • Male, 45 yrs. • Female, 45yrs. • Heredity • Obesity, >120% IBW • Diabetes • Hypertension • Smoking • Physical Inactivity

  8. Introduction to Medical Nutrition Therapy: Coronary Artery Disease • Dietary Interventions • Reduce saturated fats and total fat • Reduce cholesterol • Increase starch and fiber

  9. Introduction to Medical Nutrition Therapy: Stroke • Stroke: Caused by blockages or rupture in the arteries that supply blood to the brain. • Thrombus • Caused by clot/blockage that forms on the inner lining of a brain or neck artery that is already clogged with atherosclerotic plague • Embolus • Caused by a wandering clot that has broken off from plague in the artery wall • Hemorrhage • Occurs when a spot in the brain weakened by disease ruptures an leaks blood • Cerebral Hemorrhage • A rupture inside the brain • Aneurysm • Occurs when a section of the artery balloons out and bursts • High incidence with high blood pressure

  10. Introduction to Medical Nutrition Therapy: Hypertension • High Blood Pressure • The pressure that the blood travels through the arteries affect the risk of having a stroke • BP expressed as a fraction • Numerator ~ Systolic • The pressure of the blood within the arteries while the heart is pumping • Denominator ~ Diastolic • The pressure in the arteries when the heart is resting between beats • Hypertension • A heart has to pump harder due to high blood pressure • Many medications affect the nutritional status of the person. • Diuretics – increased urine output • Beta blockers – reduce the heart rate

  11. Introduction to Medical Nutrition Therapy: Hypertension • Treatment • Attain a reasonable weight • Reduce Sodium • 1gm Na = 1,000mg • Maintain adequate potassium, calcium and magnesium • Limit alcohol • DASH dietary approach to stop HTN

  12. Introduction to Medical Nutrition Therapy: Congestive Heart Failure • CHF: Congestive Heart Failure • A condition in which the heart becomes weak, beats faster, and enlarges causing the body to retain fluid • Dietary Treatment • 2 gm Sodium Diet

  13. Introduction to Medical Nutrition Therapy: COPD • COPD: Chronic Obstructive Pulmonary Disease • A group of diseases that includes chronic bronchitis, emphysema, and asthmatic bronchitis. • 90% of cases is caused by smoking and a leading cause of disability and death in the U.S. • Can cause malnutrition as it is hard to eat and breathe. • Dietary Treatment • High fat diet to reduce carbon dioxide production. • 50% of calories from fat • Reduces the load on the lungs • Adequate intake of Vitamins A & C for immune function

  14. Introduction to Medical Nutrition Therapy: Diabetes • DM: Diabetes • One of the world’s oldest diseases • First described in 1500 BC • A Greek (200 AD) word meaning, “To pass through” • Mellitus is “honey-like” in Latin • History • 1869: Paul Langerhans recognizes the clusters of cells in the pancreas • 1889: German researchers link the pancreas with DM • 1921: Canadians Banting and Best tested insulin from animals on humans with success

  15. Introduction to Medical Nutrition Therapy: Diabetes • Diabetes Mellitus • A disease in which the body either doesn’t make or use insulin properly which in turn affects the way that glucose (sugar) is used for energy in the body. • More than a “touch of sugar” and no such thing as “borderline” • “Sticky blood that clogs up the cardiac system” • 20% chance of a CVA within the 7 years of diagnosis

  16. Introduction to Medical Nutrition Therapy: Diabetes • The Silent Killer: DM Fast Facts • DM is a chronic disease that has no cure • In 2003: 7th leading cause of death in the U.S. • Has risen 9% every year for the past 10 years • More than 6% of the U.S population has DM (~17million people) • 5.8 million people don’t know they have it • Some people go for 7 or more years before being diagnosed • Ohio ranks highest in U.S. for DM deaths

  17. Introduction to Medical Nutrition Therapy: Diabetes • Increases in diabetes linked to aging Americans, obesity, and lack of exercise. • Affects: • 1 in 3 Caucasians • 2 in 5 African Americans • 1 in 2 Hispanics • Obesity • BMI over 30 is a risk factor for : • Heart disease • HTN • Hyperlipidemia • DM • Disability

  18. Introduction to Medical Nutrition Therapy: Diabetes • Obesity (cont) • Waist Circumference • Men • > 37 slight increased risk • >35 substantial increased risk • Women • > 31 inches- slight increased risk • > 35 substantial increased risk

  19. Introduction to Medical Nutrition Therapy: Diabetes • Diabetes Symptoms • Frequent urination • Excessive thirst • Dry skin • Slow healing wounds • Blurry eyesight • Always hungry • Feeling tired and weak • Weight loss • Skin infections • Numbness or tingling feet • Acanthosis Nigricans: a dark skin coloring and texture change on the back of neck, underarms, inside thighs, and hand & feet knuckles. • Sometimes called “velvet neck”, especially with insulin resistance. • Associated with insulin resistance and the free circulation of insulin

  20. Introduction to Medical Nutrition Therapy: Diabetes • Hyperglycemia (High Blood Sugar) • Causes: • Too much food • Too little insulin/oral agent • Illness • Onset: • Gradual • Symptoms: • Extreme thirst • Frequent urination • Dry skin • Fever • Abdominal pain • Difficulty breathing

  21. Introduction to Medical Nutrition Therapy: Diabetes • Hyperglycemia • Symptoms (cont) • Hunger • Blurred vision • Itching • Drowsiness • Headache • Nausea • Treatment • Call Your Doctor • Go to bed • Lie flat, keeping warm • Drink hot liquids

  22. Introduction to Medical Nutrition Therapy: Diabetes • Hypoglycemia (Low Blood Sugar) • Causes: • Too little food • Too much insulin/oral agent • Too much exercise • Onset: • Sudden • Symptoms: • Shaking • Fast heartbeat • Sweating • Tingling • Dizziness • Staggering

  23. Introduction to Medical Nutrition Therapy: Diabetes • Hypoglycemia • Symptoms (cont) • Hunger • Blurred vision • Itching • Drowsiness • Headache • Nausea • Treatment: • Drink orange juice or sugar • Eat a protein snack when symptoms disappear

  24. Introduction to Medical Nutrition Therapy: Diabetes • Types of Diabetes • Type 1 • No insulin, must be given by injection • Ketone prone • Autoimmune disease • Type 2 • Receptor sites are reduced • Insulin can’t “hook up” to site • Loosing weight improves insulin resistance • Metabolic Syndrome • Excess fat around the waistline, along with low HDL, high triglycerides, high FBS • Gestational • Abnormal glucose tolerance (GTT) during pregnancy • Usually occurs the 2nd half of pregnancy • GTT usually administered between the 24th and 28th week of pregnancy

  25. Introduction to Medical Nutrition Therapy: Diabetes • Type I DM • Formerly called IDDM • The insulin producing beta cells of the pancreas have been destroyed by the body’s own immune system. • 90% of beta cells are destroyed • Occurs in infants and up to 45 years of age • Linked to genetics, viruses and cow’s milk • A protein on certain parts of the pancreas looks like milk protein-this stimulates and autoimmune attack on beta cells.

  26. Introduction to Medical Nutrition Therapy: Diabetes • Type I (cont) • When cells aren’t able to get to the glucose they need from the bloodstream, they turn to the body’s stored fat and protein for energy, thus producing ketones • Unfortunately when the cells use fat for energy, they also need insulin. If insulin isn’t present, ketones build up in the body. KETONES ARE TOXIC

  27. Introduction to Medical Nutrition Therapy: Diabetes • Type II • Formerly known as NIDDM or Maturity Onset Diabetes • 90-95% of diabetics fall into this category • Some require insulin, but most do not • Strikes adults over the age of 30 • Obesity is a risk factor, especially combined with inactivity • A genetic tendency that can be avoided with weight control and exercise.

  28. Introduction to Medical Nutrition Therapy: Diabetes • Type II Risk Factors • >45 years of age • Parent or sibling with DM • History of gestational diabetes or a >9lb baby • African-American, Hispanic American, Native American and Asian American • Hypertension • High Triglyceride and low HDL levels • Limited activity or exercise on a daily basis

  29. Introduction to Medical Nutrition Therapy: Diabetes Management • Factors to maintain near normal blood glucose levels: • Insulin or oral glucose lowering medications • Food • Exercise

  30. Introduction to Medical Nutrition Therapy: Diabetes Management • Diabetes by the Numbers • Blood Glucose of 70-110mg, no greater than 140mg • Glycosolated Hemoglobin (HbA1C) – Blood sugar attached to the red blood cells. • Average blood glucose level over the past three months • Normal: <7%

  31. Introduction to Medical Nutrition Therapy: Diabetes Management • Insulin • A hormone that allows blood sugar to cross into the cell. • Without insulin, the body cells so not use blood sugar and the plasma blood sugar (glucose) is elevated. • Functions of Insulin • Allows glucose into the cells • Allows glucose into the liver • Prevents fat breakdown • Stores excess calories as fat.

  32. Introduction to Medical Nutrition Therapy: Diabetes Management • Types of Insulin • Rapid Acting Insulin (Humalog/Novolog) • Begins working in 15 to 20 minutes • Finishes in 3-5 hours • Short Acting Insulin (Regular) • Begins working in 30 minutes • Finishes in 5-8 hours • Intermediate Acting Insulin (NPH/Lente) • Begins working in 1-3 hours • Finishes in 16-24 hours

  33. Introduction to Medical Nutrition Therapy: Diabetes Management • Types of Insulin (cont) • Long Acting Insulin (Ultralente) • Finishes in 24-28 hours • Very Long Acting Insulin (Lantus) • Begins working in 4-6 hours • Begins working in 1 hour • Finishes working in 24 hours

  34. Introduction to Medical Nutrition Therapy: Diabetes Management • Oral Hypoglycemic Agents • Drugs taken by mouth to lower blood glucose levels in individuals with Type II diabetes. • Some stimulate the body to produce it’s own insulin. • Type of Oral Agents: • Metformin (glucophage) • Glipizide (glucotrol) • Prandin • Precose • Starlix

  35. Introduction to Medical Nutrition Therapy: Diabetes Management • MNT Goals • Maintain as near normal blood glucose levels as possible. • Achieve optimal blood lipid levels • Provide enough calories to maintain or attain a reasonable weight • Prevent and treat short-term and long-term complications of diabetes • Improve overall heath through proper nutrition

  36. Introduction to Medical Nutrition Therapy: Diabetes Management • MNT: Caloric Breakdown • 50-60% total calories from CHO • 10% from sugars • 90% from high starch foods • More nutrient dense • 30% total calories from Fat • 10% from saturated fat • 15-20% total calories from Proteins

  37. Introduction to Medical Nutrition Therapy: Diabetes Management • Food: myPyramid • Provides an excellent resource for meal planning • Individuals with DM should: • Eat meals and snacks at regular times everyday • Eat about the same amount of food each day • Try not to skip meals or snacks • Check blood sugar about 1½ -2 hours after eating (180mg is a good upper limit for a blood sugar level)

  38. Introduction to Medical Nutrition Therapy: Diabetes Management • Food: Exchange System • Classifies foods into groups according to how much protein, fat, and CHO they contain. • Specific serving sizes to meet protein, fat, CHO and caloric requirements of exchange group. • Contains seven exchange lists: • Starch • Fruit • Milk • Other CHO • Vegetables • Meat/meat substitutes • Fat

  39. Introduction to Medical Nutrition Therapy: Diabetes Management • Food: CHO Counting • The total amount of CHO is more important than where it comes from • The key is keeping the total CHO content of the meal the same • Adds flexibility to food choices • Count the foods that have CHO in them • Convenience foods easier to include • “Nutrition Fact Label” is helpful in CHO counting

  40. Introduction to Medical Nutrition Therapy: Diabetes Management • Other names for Sugars Found on Food Labels • Cane (sugar cane) • Corn or maple syrup • Corn sweetener • Dextrose or dextrin • Disaccharide • Erythritol • Fructose (fruit sugar) • High Fructose corn syrup

  41. Introduction to Medical Nutrition Therapy: Diabetes Management • Other names for Sugars Found on Food Labels (cont) • Honey • Hydrogenated starch hydrolysate (HSH) • Invert sugar • Isomalt • Lactose (milk sugar) • Maltose (malt sugar) • Maltodextrin • Mannitol • Molasses • Natural sweeteners • Sorbitol • Xylitol

  42. Introduction to Medical Nutrition Therapy: Diabetes Management • Exercise • Physician needs to approve exercise program • Exercise increases glucose release from the liver, thus increasing hyperglycemia • Regular exercise results in greater sensitivity of the body to insulin and increases glucose tolerance • Decreases cardiovascular risk factors and promotes weight loss • Snack of 10-15gms CHO before moderate exercise

  43. Introduction to Medical Nutrition Therapy: Diabetes Management • Monitoring • Routine blood sugars • Blood lipid levels, including total cholesterol, LDL, HDL, and triglycerides • Glycosylated Hemoglobin (HgA1C) • Body weight

  44. Introduction to Medical Nutrition Therapy: Diabetes Management • New and Ongoing Research • Better insulin • Insulin pump • Built in bra or waistband • Inhaled insulin • Insulin Patches • Non-evasive shot • Transplant • New oral agents • Computer sugar monitoring

  45. Introduction to Medical Nutrition Therapy: Obesity “Strength is the capacity to break a chocolate bar into 4 pieces with your bare hands, and then just eat one of the pieces” Judith Viorst

  46. Introduction to Medical Nutrition Therapy: Obesity • Overweight • An excess of body weight that includes all tissues such as fat, bone and muscle • Obesity • Refers specifically to an excess of body fat • Methods of Measuring Degree of Obesity • Height-Weight Tables • Body Mass Index

  47. Introduction to Medical Nutrition Therapy: Obesity • Benefits of MNT for Overweight and Obesity • Lowers blood pressure • Reduces abnormally high levels of blood glucose • Brings blood levels of cholesterol and triglycerides down to a more desirable level • Decreases sleep apnea (irregular breathing during sleep) • Decreases risk of osteoarthritis • Decreases depression • Improves appearance and self esteem

  48. Introduction to Medical Nutrition Therapy: Obesity • Treatment of Overweight and Obesity • “Live it” not “diet” • Cut 500 calories per day for a weight loss of one pound per week • Calories should not be over restricted • No foods should be forbidden • Do not skip meals • Portion control • Variety, balance, and moderation • Do not weigh everyday

  49. Introduction to Medical Nutrition Therapy: Obesity • Part of the treatment for Obesity will include: • Exercise • Behavior Modification • Attitude Modification • Social Support • Drugs and Surgery • Maintenance Support

  50. Introduction to Medical Nutrition Therapy: Obesity • Menu Planning for Weight Loss and Maintenance • Eat a variety of foods that are low in calories and high in nutrients • Eat less fat and fewer high fat foods • Eat smaller portions and limit second helpings of foods high in fat and calories • Eat more vegetables and fruits without added fats and sugars • Eat less sugar and fewer sweets • Drink less or no alcohol

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