chapter 023
TRANSCRIPT
Williams' Basic Nutrition & Diet Therapy
Chapter 23
Nutrition Support in Cancer and HIV/AIDS
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14th Edition
Lesson 23.1: Nutrition Support in Cancer
Environmental agents, genetic factors, and weaknesses in the body’s immune system can contribute to the development of cancer.
The strength of the body’s immune system relates to its overall nutritional status.
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Process of Cancer Development (p. 471)
The nature of cancer Multiple forms: highly variable nature Second leading cause of death in United States Cancer designates a malignant tumor neoplasm
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The Cancer Cell (p. 472)
Orderly process of cell division is disrupted by mutation
Cancer is normal cell growth that has gone wrong
Tumors identified by: Primary site of origin Stage of tumor size and metastasis Grade: level of aggressiveness
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Causes of Cancer Cell Development (p. 473)
Dietary factors Role is complex Micronutrient imbalance linked to DNA damage
and cancer
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The Body’s Defense System(p. 473)
Two types of lymphocytes (defensive immune system cells) T cells B cells
T cells activate phagocytes Phagocytes destroy invaders and antigens B cells produce antibodies, which kill antigens
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The Body’s Defense System (cont’d) (p. 473)
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Relation of Nutrition to Immunity and Healing (p. 473)
Immunity Balanced nutrition maintains immune system Malnutrition reduces capacity of immune system
via atrophy of organs and tissues involve in immunity
Nutrition vital in combatting sustained attacks of diseases (e.g., cancer)
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Relation of Nutrition to Immunity and Healing (cont’d) (p. 473)
Healing Strong tissue is fundamental to immune system Tissue building and healing requires optimal
nutrition Vigorous MNT speeds recovery after surgery for
cancer
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Nutrition Complications of Cancer Treatment (p. 474)
Three major forms of therapy used to treat cancer Surgery Radiation Chemotherapy
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Surgery (p. 474)
All surgery requires nutrition support for the healing process
General condition of cancer patients often is weakened by the disease process
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Radiation (p. 474)
Involves high-energy radiographs targeted on the cancer site
Often kills surrounding healthy cells as well as cancerous cells
Nutrition problems driven by site and intensity of radiation treatment
Sense of taste may be affected, prompting efforts to enhance food appearance and aroma
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Radiation (p. 474)
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Chemotherapy (p. 474)
Highly toxic drugs administered via the bloodstream to kill cancer cells
Normal, healthy cells also affected Bone marrow Gastrointestinal Hair loss
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Drug-Nutrient Interactions(p. 475)
Use of monoamine oxidase inhibitors (pretreatment antidepressant drugs) requires tyramine-restricted diet
Antineoplastic drugs have drug-nutrient interactions Some patients use herbs to prevent or treat cancer,
can have food-drug interactions
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Medical Nutrition Therapy in the Patient with Cancer (p. 475)
General systemic effects of cancer Anorexia, loss of appetite Increased metabolism Negative nitrogen balance
Specific effects related to cancer Depending on location and nature of tumor
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Case Study
Mrs. Bowen has been undergoing chemotherapy for cancer. She is 55 years old. She complains of nausea and that food tastes “funny.” She has lost 5 pounds from her normal weight of 130 lbs. (64 inches tall).
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Case Study (cont’d)
Give a rationale as to why Mrs. Bowen is currently feeling nauseated and why she feels that food tastes funny.
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Basic Objectives of Nutrition Plan (p. 477)
Nutrition screening and assessment Primary responsibility of clinical dietitian Other members of health care team may take part
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Basic Objectives of Nutrition Plan (cont’d) (p. 477)
Nutrition intervention Prevent weight loss Maintain lean body mass Prevent unintentional weight gain Identify and manage treatment-related side effects
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Prevention of Catabolism(p. 477)
MNT to meet increased metabolic demands of disease process
Medications used to: Increase appetite Reduce nausea Prevent protein degradation Increase caloric intake
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Relief of Symptoms (p. 477)
Stress management Pain management Relaxation techniques Psychological support Physical activities
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Nutrition Monitoring and Evaluation (p. 478)
Dietitian develops customized MNT plan for patient Plan is evaluated regularly with patient and family Plan adjusted as needed
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Medical Nutrition Therapy(p. 478)
Energy: cancer places great metabolic demands Protein: essential amino acids and nitrogen for
rebuilding Vitamins and minerals: at least to DRI standards Fluid: to replace losses, remove waste products,
meet drug needs
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Case Study (cont’d)
What nutritional recommendations may assist Mrs. Bowen?
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Nutrition Management (p. 479)
Enteral: oral diet with supplementation Preferred route Adjust to maximize palatability Maximize energy and nutrient density
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Enteral: Oral Diet with Supplementation (p. 479)
Loss of appetite Major issue with cancer Can lead to cachexia Requires vigorous program of eating that does not
depend on appetite
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Enteral: Oral Diet with Supplementation (cont’d) (p. 482) Oral complications
Ensure basic mouth care Frequent small snacks rather than traditional
meals Strong seasonings, high-protein drinks
GI problems Avoid hot, sweet, fatty, spicy foods as needed Small, frequent feedings of soft to liquid foods Antinausea drugs
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Pain and Discomfort (p. 482)
Pain and discomfort Severe pain controlled and comfortable position Pain medication as needed Preventive therapy to avoid constipation
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Enteral: Tube Feeding (p. 483)
When gastrointestinal tract can be used but patient is unable to eat Indications include inadequate oral intake, oral
route contraindicated, comatose Some patients can be fed overnight, allowing them
to be free from tube during day
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Parenteral Feeding (p. 483)
When gastrointestinal tract cannot be used Peripheral vein feeding (for brief period) Central vein feeding (for extended period)
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Case Study (cont’d)
If Mrs. Bowen continues to lose weight, what might be necessary?
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Cancer Prevention (p. 483)
American Cancer Society, World Cancer Research Fund, American Institute for Cancer Prevention Be as lean as possible within normal range Adopt a physically active lifestyle Consume a healthy diet Limit alcohol consumption Do not rely on supplements
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Cancer Prevention (cont’d)(p. 484)
U.S. Food and Drug Administration claims approved for labels Low total fat may reduce risk of some cancers Fiber-containing grain products, fruits and vegetables may
reduce risk of some types of cancer Fruits and vegetables may reduce risk of some types of
cancer Ongoing cancer research: foods that may increase or
reduce risk of: Breast cancer Gastric cancer Colorectal cancer Prostate cancer
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Lesson 23.2: Nutrition Support in HIV/AIDS
Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS.
The progressive effects of the human immunodeficiency virus (HIV), through its three stages of white T-cell destruction, have many nutrition implications and often require aggressive medical nutrition therapy.
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Process of AIDS Development (p. 485)
Evolution of human immunodeficiency virus First case identified in 1959 By late 1970s and early 1980s had spread to
Europe and United States Underlying infectious agent identified in 1983
Parasitic nature Viruses contain only shreds of genetic material They invade a host cell and use it to make copies
of itself
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Transmission and Stages of Disease Progression (p. 487)
Modes of transmission Three distinct stages
Primary infection and extended latent period of HIV incubation
HIV-related diseases AIDS
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Case Study
John is a 32-year-old male diagnosed with HIV, category B. He complains of fatigue, mouth sores, and diarrhea. He has lost 10 pounds from his usual ideal body weight.
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Case Study (cont’d)
Describe Category B HIV. Does John exhibit signs and symptoms common to
Category B?
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CD4+ T-Lymphocyte Conditions (p. 487)
Terminal stage of HIV infection: AIDS Rapidly declining T-lymphocyte counts Kaposi’s sarcoma Protozoan parasites Cytomegalovirus
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Medical Management of Patient with HIV/AIDS (p. 489)
Delay progression of the infection and improve the immune system
Prevent opportunistic illnesses Recognize the infection early
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Drug Therapy (p. 489)
Effective drug therapy is difficult because of highly evolved nature of virus
Several drugs approved by FDA Highly active antiretroviral therapy is current primary
drug regimen
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Vaccine Development (p. 492)
Vaccine would train body’s immune system to identify and destroy HIV virus
Vaccine undergoing trials in Thailand considered somewhat effective
CDC and NIH working with other worldwide agencies to coordinate development of effective vaccine
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Medical Nutrition Therapy(p. 493)
Assessment Anthropometry Biochemical tests Clinical observations Diet observations Environmental, behavioral, and psychological
assessment Financial assessment
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Medical Nutrition Therapy (cont’d) (p. 493)
Intervention No specific nutrient recommendations for patient
with HIV Reduce or eliminate malnutrition Correct nutrition problems identified in assessment
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Wasting Effects of HIV Infection on Nutritional Status (p. 493)
Severe malnutrition, weight loss Decreased appetite, insufficient energy intake in
addition to elevated resting energy expenditure Major weight loss, eventual cachexia
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Causes of Body Wasting (p. 494)
Inadequate food intake Malabsorption of nutrients Disordered metabolism Lean tissue wasting
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Lipodystrophy (p. 494)
Gaining of fat in neck and abdomen Concurrent loss of fat in face, buttocks, arms, legs Treatment with antiretroviral therapy may be
causative factor Other risk factors
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Nutrition Counseling, Education, and Supportive Care (p. 495)
Should focus on: Appropriate, adequate food intake Food behaviors Symptoms that may affect food intake Benefits and risks of supplemental nutrients Nutritional strategies for symptom management
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Counseling Principles (p. 495)
Motivation for dietary changes Rationale for nutrition support Provider-patient agreement on plan Development of manageable steps for change
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Personal Food Management Skills (p. 495)
Identify community programs (e.g., Meals on Wheels) Provide psychosocial support
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Case Study (cont’d)
Make nutrition recommendations for John.
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