Advanced Medical Nutrition Therapy

Cover Page
Title Page
Copyright Page
Dedication Page
Contents
Foreword
Preface
Features of This Text
Acknowledgments
About the Authors
Contributors
Reviewers
Section 1 Fundamentals in Practice
Chapter 1 Nutrition Assessment
Overview of the Nutrition Care Process
The Purpose of Nutrition Assessment
Nutrition Screening
The Role of Nutrition Screening in NCPM
Screening in Acute Care
Nutrition Screening Tools
Final Comparison of Screening Tools for Acute Care
Nutrition Assessment
Anthropometric Measurements
Biochemical Data, Medical Tests, and Procedures
Client History
Nutrition-Focused Physical Findings
Food/Nutrition-Related History
Energy Balance
Chapter Summary
Key Terms
References
Chapter 2 Biochemical Assessment
Introduction
Specimen Types
Assay Types
Routine Medical Laboratory Tests
Fluid and Electrolytes
Acid–Base Physiology
Endocrine Function: Glucose and Glycosylated Hemoglobin
Protein Assessment
Enzymes
Lipid Profile
Hematology
Interpretation of Anemia
Chapter Summary
Key Terms
References
Chapter 3 Enteral Nutrition
Introduction
The Evolution of Enteral Nutrition
Determining the Route of Enteral Nutrition
Short-term Placement
Long-term Placement
Types of Enteral Tubes
Gastric Versus Small-Bowel Feeding
Gastric Feeding
Small-bowel Feeding
Formula Delivery Methods
Continuous
Intermittent
Bolus Feedings
Enteral Formula Compositions
Carbohydrates
Fats
Protein
Vitamins and Minerals
Fiber
Pre- and Probiotics
Disease-Specific Formulas
Renal Dysfunction
Pulmonary Dysfunction
Liver Dysfunction
Diabetes
Trauma/Wound Healing
Developing an EN Feeding Plan
Complication Monitoring
Aspiration
Nausea/Vomiting
Abdominal Distention
Gastroparesis (Delayed Gastric Emptying)
Constipation
Diarrhea
Early Enteral Nutrition
Immunonutrition
Gastrointestinal Tract as an Immune Organ
The Gut and Systemic Inflammatory Response System
Conditionally Essential Amino Acids
Chapter Summary
Key Terms
References
Chapter 4 Parenteral Nutrition Therapy
Introduction
Brief History of Parenteral Nutrition
Parenteral Nutrition Administration
Venous Access
Central Parenteral Nutrition
Peripheral Parenteral Nutrition
Indications and Contraindications
Parenteral Nutrition Formulation
Carbohydrate
Amino Acids
Lipids
Electrolytes
Multivitamins
Trace Elements
Other Additives
Initiation and Progression of Parenteral Nutrition
Safety Check of Macronutrient Infusion Rates
Electrolyte Requirements
Vitamin and Trace Element Requirements
Progression of PN
Transitional Feeding
Parenteral Nutrition Monitoring
Anthropometrics
Vital Signs
Biochemistry
Nutrition-Focused Physical Exam
Central Venous Access Complications and Their Management
Mechanical Complications
Metabolic Complications
Hyper- and Hypoglycemia
Electrolyte Abnormalities
Hyper- and Hypovolemia
Overfeeding
Essential Fatty Acid Deficiency
Hepatobiliary Complications
Home Parenteral Nutrition
Indications and Access
Prognosis of HPN
Chapter Summary
Key Terms
References
Chapter 5 Energy Expenditure and Body Composition in Metabolic Stress
Introduction
Characteristics of the Inflammatory Response
Ebb and Flow Phases
Alterations in Metabolism Associated with the Inflammatory Response
Energy Cost Associated with Altered Metabolism
Hormonal and Metabolic Response to Stress Versus Starvation
Glucose Metabolism and Stress Hyperglycemia
Protein Catabolic State
Fat Metabolism and Lipolysis
Determination of Energy Expenditure During Normal and Stressed Conditions
Total Energy Expenditure and Its Components
Estimating Total Energy Expenditure
Factorial Approach to Determining Energy Requirements Under Normal Conditions
Factorial Approach in Determining TEE in Hospitalized, Metabolically Stressed Patients
Measuring Energy Expenditure—Direct and Indirect Calorimetry
Use of Indirect Calorimetry to Prevent Over- and Underfeeding
Interpretation of Respiratory Quotient
Determination of Body Composition and Its Components During Metabolic Stress
Traditional Assessment of Nutritional Status
Models of Body Composition
Anthropometry
Two Compartment Model
Methods Relying on Measures of Total Body Water
The Effect of Catabolic Disease on Body Composition
Multi-Compartmental Models
Combined Isotope Dilution Studies
Dual Energy X-ray Absorptiometry
Imaging Techniques
Metabolic Support Aimed at Preserving Body Cell Mass
Chapter Summary
Key Terms
References
Section 2 Nutrition in Disease States
Chapter 6 Nutrition in Critical Illness: A Burn Injury Model
Introduction
Pathophysiology of the Catabolic Response Following Acute Burn Injury
Medical Treatment/Clinical Course
Medical Treatment/Clinical Course Specific to Burn Patients
Oxandrolone
Propranolol
Nutritional Management
Assessment
Treatment
Chapter Summary
Key Terms
References
Chapter 7 Nutrition in Wound Healing
Introduction
Pathophysiology of Wounds and Wound Healing
Inflammation
Proliferation
Remodeling
Chronic Wounds
Pathophysiology of the Chronic Wound
Chronic Venous Ulcers
Diabetic Ulcers
Pressure Ulcers
Alterations in Physiological State and Metabolism During Wound Healing
Medical Treatment of Wounds
Medical Nutrition Therapy for Wound Healing
Screening
Assessment
Nutritional Requirements
Diet and Nutrition Intervention
Monitoring
Chapter Summary
Key Terms
References
Chapter 8 Nutritional Management of Obesity
Introduction
Prevalence
Classification of Obesity: Is Obesity a Disease?
Causes and Contributions to the Obesity Epidemic
Genetic Factors
Environmental Factors
Social Factors
Biological Factors
Developmental Factors
Hormonal Factors
Orexigenic Hormones
Anorexigenic Hormones
Alterations in Body Composition in Obesity
Nutrition Assessment in Obesity
Anthropometric Assessment
Body Mass Index (BMI)
Waist Circumference
Waist-to-Hip Ratio
Weight History
Biochemical Assessment
Clinical Assessment
Medical and Psychosocial History
Nutrition-Focused Physical Exam
Dietary Assessment
Dietary History
Nutrition Patterns
Other Considerations
Physical Activity
Sleep Patterns
Readiness/Motivation
Support System
Cultural and Socioeconomic Factors
Other
Assessment of Energy Requirement
Pathophysiology Associated with Obesity
Weight-Related Comorbidities
Cardiovascular System
Metabolic/Endocrine System
Gastrointestinal System
Immune System
Musculoskeletal System
Respiratory System
Obesity Management
Comprehensive Lifestyle Intervention
Dietary
Behavior
Physical Activity
Pharmacotherapy
Bariatric Surgery
Comorbidity Outcomes
Micronutrient Concerns
Emerging Treatment Options
Chapter Summary
Key Terms
References
Chapter 9 Nutritional Management of Diabetes Mellitus
Introduction: Incidence and Scope
Pathophysiology of Diabetes
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Screening, Risk Factors, and Diagnosis of Diabetes
Diabetes Screening and Risk Factors
Diagnostic Criteria and Staging
Nutritional Requirements in Diabetes
Carbohydrate
Fiber
Sucrose and Other Nutritive Sweeteners
Protein
Fat
Nonnutritive Sweeteners
Alcohol
Micronutrients
Herbal and Dietary Supplements
Cinnamon
Medical Nutrition Therapy for Diabetes
Nutrition Assessment
Nutrition Intervention
Advanced Carbohydrate Counting or Matching Insulin to Carbohydrate Method
Exercise
Type 1 Diabetes
Type 2 Diabetes
Carbohydrate Adjustment
Glycemic Targets and Self-Monitoring of Blood Glucose
Acute and Chronic Complications of Diabetes
Acute Complications
Chronic Complications
Medical Treatment of Diabetes
Insulin
Surgical Treatment Options
Metabolic Surgery
Hospitalization and Illness for Patients with Diabetes
Noncritical Patients with Diabetes Admitted to the Hospital
Management of Patients with Diabetes Requiring Nutrition Support
Chapter Summary
Key Terms
References
Chapter 10 Nutrition in Cardiovascular Disease
Introduction
Cardiac Physiology in Health and Disease
CVD Clinical Course
Dyslipidemia
Nutritional Management in CVD
Nutrition Assessment in CVD
Medications in CVD
Energy Needs in CVD
Nutrition Intervention in CVD
Replacement of Saturated/Trans Fats with Other Fats or Carbohydrates
Omega-3 Fatty Acids
Fiber
Nuts
Plant Stanols and Sterols
Added Sugar
Physical Activity
Antioxidant Supplements
Alcohol
Smoking Cessation
Nutrition Monitoring/Evaluation in CVD
Hypertension Clinical Course
Nutritional Management in Hypertension
Nutrition Assessment in Hypertension
Medications in Hypertension
Energy Needs in Hypertension
Nutrition Intervention in Hypertension
DASH Diet and Sodium Reduction
Potassium Supplementation
Alcohol Intake
Physical Activity
Smoking Cessation
Nutrition Monitoring/Evaluation in Hypertension
Obesity and CVD Clinical Course
CVD Outcomes
Advanced Coronary Artery Disease Diagnosis and Surgical Treatment
Heart Failure Clinical Course
Nutritional Management in Heart Failure
Nutrition Assessment in Heart Failure
Medications in Heart Failure
Assessing for Obesity
Assessing for Cardiac Cachexia
Nutrition Intervention in Heart Failure
Sodium and Fluid Restrictions
Heart-healthy Eating
Blood Glucose Management
Dietary Supplements
Nutrition Intervention in the Case of Cardiac Cachexia
Nutrition Monitoring/Evaluation in Heart Failure
Nutrition Support in CVD
Chapter Summary
Key Terms
References
Chapter 11 Nutrition in Oral Health
Introduction
Background
Nutrition and Oral Health Interrelationships
Nutrition and Development of the Oral Cavity
Effect of Oral Health on Diet and Nutrition
Effect of Systemic Nutrition Deficiency or Excess on the Oral Cavity
Effects of Diet and Dietary Habits on Common Oral Diseases
Dental Caries
Periodontal Disease
Edentulism and Dentures
Oral Infections
Oral Health During the Life Cycle
Pregnancy
Infancy and Early Childhood
Adolescence
Adulthood
Geriatrics
Chapter Summary
Key Terms
References
Chapter 12 Nutritional Management of Gastrointestinal Maldigestion
Introduction
Functional Anatomy of the Digestive System
Overview of Digestion and Absorption
Pathophysiological Distinction: Maldigestion versus Malabsorption
Key Mechanisms of Digestion
Medical Nutrition Therapy for Disorders of Digestion
Gastric Surgery
Pancreatitis
Gastroesophageal Reflux Disease
Chapter Summary
Key Terms
References
Chapter 13 Nutrition Management of Gastrointestinal Malabsorption
Introduction
Key Mechanisms of Absorption
Absorption Sites
Medical Nutrition Therapy for Disorders of Absorption
Celiac Disease (CD)
Irritable Bowel Syndrome (IBS)
Non-Celiac Gluten Sensitivity
Inflammatory Bowel Disease (IBD)
Leaky Gut
Helicobacter pylori
Small Intestinal Bacterial Overgrowth (SIBO)
Bowel Surgery and Short Bowel Syndrome (SBS)
Chapter Summary
Key Terms
References
Chapter 14 Nutrition in Kidney Disease
Introduction
Renal Physiology in Health and Disease
Functions of the Kidney
Diseases of the Kidney
Acute Kidney Injury
Chronic Kidney Disease
End-Stage Renal Disease
Renal Replacement Therapy
Kinetic Modeling
Monitoring Nutritional Adequacy During Dialysis
Nutrition Support in Kidney Disease
Indications for Nutrition Support
Nephrotic Syndrome
Medical Nutrition Therapy for Nephrotic Syndrome
Chapter Summary
Key Terms
References
Chapter 15 Nutrition in Liver Disease
Introduction to the Liver
Liver Structure and Functions
Overview and Pathophysiology of Liver Disease
Malnutrition in Liver Disease
Acute Liver Disease
Acute Viral Hepatitis
Acute Drug-Induced Hepatitis
Acute Liver Failure
Nutrition Management
Chronic Liver Disease
Alcoholic Liver Disease
Nonalcoholic Fatty Liver Disease
Inherited Diseases
Alterations in Metabolism
Carbohydrate Metabolism
Protein Metabolism
Fat Metabolism
Nutrition Assessment
Body Composition
Functional Capacity
Nutrition Therapy for Cirrhosis
Energy Requirements
Protein Requirements
Vitamin D
Zinc
Oral Nutrition
Enteral Nutrition
Parenteral Nutrition
Summary
Key Terms
References
Chapter 16 Nutrition in Pulmonary Disease
Introduction
Pulmonary Physiology in Health and Disease
Asthma
Chronic Obstructive Pulmonary Disease
Body Composition
Nutrition Intervention
Acute Respiratory Distress Syndrome
Nutrition Support and Pulmonary Disease
Immunonutrition
Micronutrients
Antioxidants
Vitamins and Minerals
Quality of Life and Psychosocial Support
Chapter Summary
Key Terms
References
Chapter 17 Nutrition in Cystic Fibrosis
Introduction
Diagnosis
Clinical Manifestations of CF
CF and the Lungs
Relationship between Lung Function and Nutritional Status
Nutrition Assessment
Energy and Protein Needs
Anthropometrics
Biochemical Assessment
Diet Assessment
Pancreatic Insufficiency
Nutrition Management in Patients with Cystic Fibrosis
Macronutrients
Infants
Micronutrients
Sodium Chloride
Nutrition Support
Nutrition-related Complications of Cystic Fibrosis
Gastrointestinal Complications
CF-related Diabetes
CF-related Bone Disease
Summary
Key Terms
References
Chapter 18 Nutrition in Solid Organ Transplantation
Introduction
Background
Indications and Contraindications for Transplantation
Kidney Transplant Indications
Pancreas Transplant Indications
Liver Transplant Indications
Heart Transplant Indications
Lung Transplant Indications
Small-bowel Transplant Indications
Contraindications to Transplantation
Medical Treatment
Organ Donation and Matching
Complicating Factors
Nutritional Management
Pretransplant Phase
Acute Posttransplant Phase
Dietary Therapy
Chronic Posttransplant Phase
Chapter Summary
Key Terms
References
Chapter 19 Nutrition in Oncology and Hematopoietic Stem Cell Transplant
Background/Etiology
Epidemiology
Cancer Staging
Medical Treatment of Cancer
Radiation Therapy
Chemotherapy
Surgery
Biotherapy
Hormone Therapy
Nutrition Screening and Assessment in Cancer Patients
Nutrition Screening
Nutrition Assessment
Estimating Nutrition Needs in Cancer Patients
Cancer Cachexia and Metabolic Changes Associated with Cancer
Cancer Cachexia
Approaches to Management in Cancer Cachexia
Overview of Nutritional Support in the Cancer Patient
Nutritional Management of Specific Solid Tumors
Head and Neck Cancers
Esophageal Cancer
Gastric Cancer
Intestinal Cancers
Pancreatic Cancer
Lung Cancer
Nutritional Management of Hematological Cancers Undergoing Hematopoietic Stem Cell Transplant
Estimating Energy Needs
Nutritional Support During Acute Phase of HSCT
Graft Versus Host Disease
Glutamine and Nutrition Support
Low-Microbial Diets
Nutrition Support in the Advanced Cancer Patient
Complementary and Alternative Medicine, Integrative Medicine, and the Cancer Patient
Chapter Summary
Key Terms
References
Chapter 20 Nutrition in HIV/AIDS
Introduction
HIV Infection
Epidemiology
Medical Management
Antiretroviral Treatment
Food Insecurity
Primary Care
Pathophysiology and Alterations in Physical State
Energy and Protein Metabolism
Lipid Metabolism
Bone Loss
Gastrointestinal Function, Inflammation, and Micronutrient Deficiencies
Breastfeeding
Nutritional Management
Medical History and Antiretroviral Treatment Adherence
Nutritional Assessment
Nutritional Management of HIV Wasting
Nutritional Management of Unintentional Weight Loss
Nutritional Management of Lipodystrophy
Nutritional Management of Bone Loss
Micronutrient Supplementation
Chapter Summary
Key Terms
References
Section 3 Nutrition in the Lifecycle
Chapter 21 Nutrition in Pregnancy and Lactation
Introduction: Nutrition in Pregnancy
Maternal Health and Birth Outcome
Physiological Alterations Throughout Pregnancy
Nutrition Therapy Throughout Pregnancy
Nutrition Assessment During Pregnancy
Preconception/Prenatal Care
Gestational Weight Gain
Macronutrient Requirements
Physical Activity Recommendations
Dietary Restrictions During Pregnancy
Food Cravings and Aversions
Gastroenterologic Symptoms During Pregnancy
Nutrition Therapy in Unique Pregnancies
Nutritional Management of Preexisting Diseases in Pregnancy
Eating Disorders During Pregnancy
Diabetes (Nongestational)
HIV Infection
Pregnancy-Induced Diseases
Nutrition Support in Pregnancy
Enteral Nutrition
Parenteral Nutrition
Summary: Nutrition in Pregnancy
Introduction: Nutrition in Lactation
Physiology of Lactation
Human Milk Composition
Nutritional Composition of Breast Milk
Practice of Lactation
Breastfeeding Initiation and Techniques
Special Cases and Contraindications
The Lactating Mother: Nutritional Considerations
Nutrition Assessment of a Lactating Mother
Nutritional Requirements for Lactation
The Registered Dietitian’s Role in Breastfeeding Promotion
Promoting Breastfeeding as an RD
Current Trends and Breastfeeding Assistance Programs
Summary: Nutrition in Lactation
Key Terms
References
Chapter 22 Nutrition in Neonatology
Introduction
Background
Goals of Growth and Nutrition for Premature Infants 
Metabolism and Body Composition in Prematurity 
Energy Requirements 
Protein Requirements 
Carbohydrate Requirements 
Fat Requirements 
Fluid Requirements 
Electrolyte Requirements
Methods of Feeding
Parenteral Nutrition (PN)
Vascular Access 
Energy Requirements 
Enteral Nutrition 
Feeding Selection 
Breast Milk, Breastfeeding, and Donor Milk
Preterm and Transitional Formulas 
Preparing for Discharge 
Chapter Summary
Key Terms
References
Chapter 23 Nutrition in Pediatrics
Introduction
Growth and Development
Physical Growth and Its Characteristics
Body Composition During Growth
Nutrition Screening and Assessment
Anthropometric Measures
Evaluating Growth Using Standardized Growth Charts
Diet Interview and History
Nutrition-focused Physical Exam
Biochemical Data
Medical and Social History
Assessing Patterns of Growth and Etiology
Interpreting Changes in Weight-for-Age
Normal Pediatric Nutrition
Nutrient Requirements
Introduction of Food and Developmental Cues
Pediatric Malnutrition
Failure to Thrive
Calculating Energy Needs for Catch-Up Growth
Nutrition Support During Times of Illness or Chronic Disease
Enteral Nutrition
Parenteral Nutrition
Immunonutrition in Nutrition Support of Children
Glutamine
Arginine
Omega-3 Fatty Acids
Chapter Summary
Key Terms
References
Chapter 24 Nutritional Management of Childhood Obesity
Introduction
Prevalence
Defining Childhood Obesity
Childhood Obesity and Medical Comorbidities
Left Ventricular Hypertrophy, Hypertension, and Epicardial Fat
Metabolic Syndrome
Insulin Resistance and Type 2 Diabetes
Asthma
Sleep Apnea
Other Comorbidities: Orthopedic, Dental, and Nonalcoholic Fatty Liver
Psychological Effects of Childhood Obesity
Depression and Obesity Stigma
Peer Relationships
Family Relationships
Cognitive Impairment
Health-Related Quality of Life
Factors Associated with Childhood Obesity
Low Socioeconomic Status
Family Patterns
Genetic Factors
Assessment, Management, and Intervention
Nutrition Assessment of Childhood Obesity
Primary and Secondary Prevention: Approaches to Weight Loss
Behavioral Intervention
Dietary Intervention
Physical Activity
Intervention Approaches
Group Based
Motivational Interviewing
Positive Reinforcement
Stimulus Control
Goal Setting
Surgical Intervention
Indications for Surgical Intervention
Weight Loss Procedures
Nutritional Considerations
Postoperative Care
Chapter Summary
Key Terms
References
Chapter 25 Nutrition in Eating Disorders
Introduction
Background and Etiology
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Other Specified Feeding or Eating Disorder
Unspecified Feeding or Eating Disorder
Avoidant Restrictive Food Intake Disorder and Orthorexia
Prognosis
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Psychological Treatment
Pharmacotherapy
Nutrition Assessment
Anthropometric Assessment
Dietary Assessment
Biochemical Assessment
Medical Nutrition Therapy
Goals and Guidelines
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Counseling
Nutrition Education
Patient Monitoring and Evaluation
Chapter Summary
Key Terms
References
Chapter 26 Nutrition in Developmental Disabilities
Introduction
Prader Willi
Anthropometrics
Biochemical and Clinical
Assessment of Energy Needs
Long-term Monitoring and Evaluation
Spina Bifida
Anthropometrics
Biochemical and Clinical
Assessment of Energy Needs
Feeding Difficulties
Weight Challenges
Long-term Monitoring and Evaluation
Cerebral Palsy
Anthropometrics
Biochemical and Clinical
Assessment of Energy Needs
Feeding Difficulties
Weight Challenges
Long-term Monitoring and Evaluation
Down Syndrome
Anthropometrics
Biochemical and Clinical
Assessment of Needs
Long-term Monitoring/Evaluation
Autism Spectrum Disorders
Anthropometrics
Biochemical and Clinical
Feeding Difficulties
Assessment of Needs
Long-term Monitoring and Evaluation
Chapter Summary
Key Terms
References
Chapter 27 Nutrition in Geriatrics
Introduction
Background and Etiology
Changes in Body Composition in the Geriatric Population
Sarcopenia
Frailty
Pressure Injury
Sarcopenic Obesity
Malnutrition Risk in Geriatrics
Physiologic Factors
Overall Health Status
Psychological/Neurocognitive Status
Functional Status
Dysphagia
Social Factors
Nutrition Screening and Assessment in Geriatrics
Nutrient Needs
Energy Requirements
Protein Requirement
Recommendations for Fiber Intake
Fluid Requirements
Physiologic Alterations Effecting Micronutrient Metabolism
Vitamin B12
Vitamin D
Calcium
Nutrition Management
Nutrition Support
Chapter Summary
Key Terms
References
Glossary
Index