medical nutrition therapy for diseases of the musculoskeletal.pptx

7/25/2019 Medical Nutrition Therapy for Diseases of the Musculoskeletal.pptx

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Medical Nutrition Therapy forDiseases of the Musculoskeletal and

Nervous System


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Introduction

This topic has combined two important bodilysystems: physical and mental

A review of the anatomy and physioloy of

muscles! bones! and nerves reveals how closelyrelated these structures are"

A decline in conitive functionin is one of the

stronest predictors of impendin mortality

#onitive decline can occur with marked variation

amon individuals and nutrition is one factor that

is believes to be influential


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$actors Affectin the %otential &ole of Diet

Accordin to 'enton ()*+*,

$irst! conitive or brain reserve is said to decrease the

incidence of dementia- i"e" it has been suested that

those with larer brains and better intellectual functionin

have a reater capacity to resist the effects of thebioloical chanes that define dementia

Second! shrinkae of the brain beins in youn adulthood!

suestin that any insidious influence of diet will takeplace from that time onward" The marked decline in the

weiht of the brain associated with advanced dementia

suest it will be easier to slow that decline than repairin

the brain


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Therefore! diet is influential throuhout theentire lifespan and that it affects

neurodevelepment! neurodecline! conitive

performance! and that nutritional ade.uacyplays a crucial part in limitin the

development of dementias


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THE MUSCULOSKELETAL SYSTEM

The musculoskeletal system includes the bones!muscles! and /oints"

The muscles are responsible for movement ofthe body and classified as cardiac (heart

muscle,! skeletal(striated muscle,! and smooth

(non0striated muscles of the astrointestinaltract! blood vessels! and other involuntary

muscles,


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The skeletal system forms the supportin

framework of the body" It consists of axial(skull!

vertebral column! ribs! and sternum, andAppendicular (e1tremities,

The tendons that aid in locomotion attach the

muscles to the skeleton

Disorders of the Musculoskeletal System

Musculoskeletal diseases are those that affectthe bones! /oints! and muscles- some also affect

the internal orans and skin


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&heumatic Diseases

Mostly affects the /oint tissues and causesymptoms of arthritis

The basic structures affected by these

diseases are the connective tissues #onnective tissues are found in every oran

so manifestations of the disease may vary

The diseases are often accompanied by pain!inflammation! and sometimes are disablin


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2arthritis warnin sins

%ersistent pain and stiffness on arisin %ain! tenderness! and swellin in one or more

/oints

&ecurrence of these symptoms especiallywhen they involve more than one /oint

&ecurrent or persistent pain and stiffness in

the neck! lower back! knees! and other /oints"


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3steoarthritis

Also known as degenerativeor hypertrophicarthritis! is the most common form of all /oint

disorders"

A type of arthritis caused by inflammation!breakdown! and eventual loss of cartilae in the

/oints- it can also be caused by ain! heredity!

and in/ury from trauma or disease

3ften observable in elderly and in obese

persons


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Nutrition Therapy

Diet has a little role in the treatment unless thepatient is obese! in which case a low calorie

diet is necessary in order to reduce the strain

on the weiht0bearin /oints or maintain weiht

$or non0obese! a diet ade.uate in protein!

vitamins! minerals! and fluids is sufficient"

In both cases! increased use of fish or fish oil

(not supplements, is recommended forreducin inflammation" Ade.uate intake of 4inc

and vitamin # and 5 are needed"


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6out

Disorder of purine metabolism characteri4ed byelevated uric acid levels in the blood" &esultin

in deposition of urate crystals in the body

It is also characteri4ed by severe pain in the/oints followin an e1ceptionally lare amount of

stress"

Sometimes! the affected /oints swell and

become red and tender" %eople with out have

the tendency to develop kidney stones


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The risk factors are obesity! hih alcohol intake!

hih serum levels of uric acids (which may be

hereditary,! use of some hypertension drus! andhih intake of purines"

Attacks often can be triered by:

Drinkin alcohol especially durin a bine3ver0eatin especially if on a hih purine diet

Minor in/ury to a /oint

Drinkin insufficient fluids

$luid depletion due to certain drus such as diuretics

Attemptin a 7crash diet8

$astin! e"" before surery


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Nutrition Therapy

If the patient is obese! a reduction in weiht isnecessary" $luids should be plentiful to

eliminate urates

A hih carbohydrate and low fat diet alsosupports proper elimination of urates"

9rate crystals are usually formed with hih

sodium load- therefore reduce the intake of salt!

and condiments (patis! toyo! baoon! etc",


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&heumatoid Arthritis (&A,

An autoimmune disease that causes chronic

inflammation of the /oints! tissues around the

/oints! and other orans in the body"

&eferred as a systematic illness and is

sometimes called rheumatoid disease because itcan affect multiple orans

ess common than osteoarthritis but it is more

severe and the cause is unknown" %atients are usually underweiht and occurs

much more in women than in men


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Inflammatory process

The inflammation (called synovitis, results inthe warmth! redness! swellin! and pain"

These are common symptoms of &A"

$irst! the cells of the synovium row and divideabnormally! makin the normally thin synovium

thick 0 resultin a /oint to swell and puff"

As &A proresses! these abnormal synovial

cells bein to invade and destroy the cartilae

and bone within the /oint"


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The surroundin muscles! liaments! andtendons that support and stabili4e the /oint

become weak and unable to work normally"

All of these effects lead to the pain and

deformities often seen in &A


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&A patients; nutritional status is affected throuh

several ways- the inflammation leads to increased

nutritional re.uirements because of the increase inmetabolism

6astritis is often present due to the side effect of

medication The cripplin nature of the disease may affect the

individual;s food intake

The side effects of medications should be

considered and weiht chanes monitored"

The oal of treatment in &A is to reduce /oint

inflammation and pain! ma1imi4e /oint function!

and prevent /oint destruction and deformity"


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The ma/or approach is to control symptoms and prevent

further disability throuh a combination of a proram of

medical! surical! rehabilitative! and dietary services"

The ob/ectives of manaement are the followin:#ontrol pain and inflammation in the /oints and other tissues

usin anti0inflammatory drus and nonsteroidal anti0inflammatory"

Maintenance of /oint function and prevention of deformities

throuh therapeutic e1ercises desined to preserve /oint

motion! muscular strenth! and endurance"&epair of /oints damae throuh surical intervention" This

involves replacin irreversibly damaed /oints! improvin

functional capacity! or preventin damae to normal /oints


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Nutrition Therapy

To date! there is no specific diet that curesarthritis"

#alories should be ade.uate to meet the needs

of the patient for daily activities If patient is obese! a weiht control diet is

desirable" %atient should be at the level of the

recommended dietary allowance"

If patient is in a poor nutritional status or who is

in the inflammatory stae! +"< to )k of protein a

day is advised


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The intake of fish oils has been proven to help

with the inflammation

&ecent reports suested that a Mediterranean

or veetarian diet and=or eatin Bingcherries

helped some cases of &A

ow levels of >itamin '? and >itamin # have

been seen in patients with &A!

and patients with &A usually have lower 4inc

levels than normal individuals


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@uvenile &heumatoid Arthritis (@&A, 3r Stills Diseaseis an autoimmune disorder that

usually occurs in children under +< years old

In addition to the symptoms of arthritis-

splenomealy! lymphadenopathy! leucocytosis!

pyre1ia! rash! and involvement of the cervical spineoccurs"

As the child matures! their condition meres into a

form similar to that of adults" Most children with @&A need medication and

physical therapy


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Nutrition Therapy

There are no data suestin specific food thatcauses or alleviate @&A

Nutritional care can be important in related

problems such as malnutrition! rowth

retardation! weiht loss! obesity! and nutrional

anemia"

Treatments can help to preserve a hih level of

physical and social functionin maintainin aood .uality of life"


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Systemic upus 5rythematosus (S5,

An autoimmune disease in which the immunecomple1es of DNA and anti0DNA produce a

vasculitis causin lesions in many parts of the

body! particularly the /oints! skin! kidney!spleen! pleura! pericardium! endocardium! and

nervous system"

In some cases! a viral infection may producethe immune chanes"


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The most common symptoms are e1treme

fatiue! fever! an acute miratory arthaliaresemblin rheumatic fever and cold! and

numb finers"

There may be skin ulceration because of

abnormal sensitivity to sunliht"

To date! there are five survivors of S5 in the

%hilippines"


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Nutrition Therapy

%otassium supplement is needed if increasedpotassium needs are not met throuh dietary

means"

ih calorie! hih protein soft diet is

recommended durin fever" Diet is further

altered when there is kidney damae"

Some evidences show that a diet low in

saturated fat and supplemented by fish oil maybe helpful"


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Duchenne Muscular Dystrophy (DMD,

DMD is the most common form of musculardystrophy causin muscle deterioration and an

eventual death in men usually before ae B*"

It is a hereditary disease" The ene responsiblefor the production of a key muscle protein

called dystrophin is defective"

The lack of which is associated with complete

muscle corrosion over the first two decades of

life"


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evels of creatine phoshokinase (#%C,! an en4yme

involved in the production of enery for muscle

contraction are markedly elevated in the blood"

Damae to muscle fibers in DMD has already beun

even before birth" owever! visible sins of

weakness are usually evident at )0B years old when

the child beins to stand and walk"

'y the ae of 0


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&espiratory failure is the ma/or life0threatenin

manifestation of the disease"

%atients with trouble in swallowin (dysphaia,

are at hih risk of compromised nutritional status"

3ther neuromuscular disorders can also cause

nutritional problems"

Eeiht ain is evident and nutritional problems in

patients with DMD"


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Nutrition Therapy

An accurate dianosis of the neuromuscular

disorder is essential in order to determine

how best to achieve ade.uate nutrition"

Dietary manaement depends on the natureand scope of the swallowin problem"


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3steopenia and 3steoporosis

Osteopenia0 condition of the bone mass density('MD, less than normal and has no symptoms" The

'MD is not low enouh to be identified as

osteoporosis" Osteoporosis0 multifactorial condition influenced

by a number of enetic! dietary! and lifestyle

factors"

0 proressive decrease in the density of bones!which makes them brittle


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3steoporosis 3ne in four women may develop osteoporosis

%rimarily related to the ain process (older women

are at hiher risk,

Type 1 OsteoporosisF occurs in women after


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#an proress without symptoms and it may not be

years until later fracture takes place"

Most common symptoms are bone fractures in the

spine! hip! or wrist"

3ne sin of vertebral fracture is heiht loss! which

may lead to Dowagers Hump(the disfiurationof the back that results in stooped posture,

Most fre.uent fracture is the hips" It can lead to

chronic pain! disability! and disfiurement" if notcontrolled! may lead to death


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&isk $actors for 3steoporosis

6ender (women are at reater risk, istory of fractures amon elderlyrelatives

5arly menopause (before < y=o, Abnormal absence of menstrual period

Surical menopause (removal ofovaries,

Anore1ia nervosa or 'ulimia

ow bone mass ow testosterone levels in men

$amily history of osteoporosis actose intolerance

%oor nutrition (low calcium and >it" D, #ertain medications (e"" ! e1cessiveamounts of thyroid medication,

ack of weiht0bearin e1ercise Illnesses that impair absorption ofcalcium

#iarette smokin

51cessive alcohol consumption


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In osteoporosis! the oals of manaement are:Stop or reverse bone loss

Increase or stabili4e bone mass! and

&educe fractures! pain! disability! and mortality"

5stroen! calcitonin! and biphosphonates are

medications usually prescribed" 'uildin the bones before the ae of B< can bebest defense aainst developin osteoporosis"


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Nutrition Therapy

Diet alone has not been proven to treatosteoporosis when it has already developed"

$or preventive purposes! a diet with a calcium of

+*** to +)** m durin the rowin years isadvised"

#alcium supplements are used as substitutes if

dairy products and other sources are nottolerated or ade.uately taken

$or elderly women! physical activity is beneficial"


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THE NERVOUS SYSTEM

The nervous system alon with the endocrine

system correlates our ad/ustments and

reactions to internal and e1ternal conditions

as main parts F cranial! central (brain and

spinal cord,! peripheral (peripheral nerves,! and

autonomic


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Malnutrition Induced Neuroloic Disorders

These disorders are usually seen because of

chronic alcoholism! weakenin disease that

affect the astrointestinal tract! starvation!

malnutrition caused by diet inorance! andconditions caused by stress"


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Nutritional Neuropathy

Most common form of nutritional disorder of theperipheral nervous system"

Treatment involves improvement on the overall diet

STA65S

5arly staes

Symmetric impairment of motor and sensory function

&educed or absent refle1 activity affectin the les ate staes

Motor impairment

#omplete paralysis may be elicited


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Vitamin B12 Neuropathy

Described as a proressive deeneration of posteriorand lateral columns of the spinal cord due to a

deficiency in >itamin '+)

%eripheral neuropathy! coldness! numbness! loss of

normal refle1es! weakness of e1tremities! and mental

deterioration are observed

Treatment is achieved by administration of diet used

for pernicious anemia but with increased doses of

cyanocobalamin


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Pyridoxine (Vitamin B6 deficiency Neuropathy

&esults from anti0tuberculosis dru (isonia4id, inadults and dietary deficiency in infants

It may lead to brain damae and mental retardation

in infants" In adults! mood chanes! e1cessive

somnolence! and even psychosis"

Eomen usin oral contraceptives may also

e1perience the same symptoms because it may also

lead to >it" '? deficiency Treatment is throuh intake of lare amounts of

pyrido1ine


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Vitamin ! deficiency

Symptoms are motor0sensory polyneuropathy!

trunkal and limb ata1ia! opthalmopleia! retinal

deeneration! and myopathy"

In severe cases! it may result in neuroa1onaldeeneration and destruction of muscle fibres

Treatment is follow >itamin 5 therapy


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Pellagra (Niacin "eficiency

In the early staes! the patient may be depressed!apathetic! fearful! and apprehensive"

Insomnia! di44iness! and headache are common"

As the disease proresses! psychosischaracteri4ed by confusion! disorientation! and

hallucinations may develop

ater! the patient may lapse into coma" are amounts of niacin about +*0)* m per day

in the presence of ade.uate tryptophan is needed"


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Eernicke0Corsakoff Syndrome

Deficiency of thiamin which causes cardiovascular!central! and peripheral nervous system disturbances"

&esults from inade.uate dietary intake or from

impaired absorption of >itamin '+

Symptoms may be vomitin! diplopia! and

nystamus" $ollowed by mental chanes! apathy!

emotional disturbances! loss of memory!

disorientation! and hallucination Death is common if untreated" If patient survives! the

cerebral corte1 may be damaed

This condition occurs primarily in alcoholics


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Anticonvulsant0Induced >itamin Insufficiency

Nutritional deficiencies may also arise as a result

of usin anticonvulsants usually used for sei4ure

and medications"


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DIETARY EXCESSES

Food Additives 0 artificial colorin! suar! flavor! preservativeare responsible for certain learnin and behavior problems

associated with attention deficit disorder with or without

hyperactivity

0 The red dye ($D# HB, and yellow dye (yellow No"


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0 Damaes the liver! which can interfere with >itamin D

metabolism

0 Alcohol can impair behavior! /udment! memory!

concentration! and coordination"

0 In prenant women! alcohol abuse can lead to $etal

Alcohol Syndrome (baby suffers from birth defects and

mental retardation,

0 Alcoholics often present symptoms of astritis! peptic

ulcer! acute alcoholic hepatitis leadin to cirrhosis and

bronchitis


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0 Alcohol is a dru that burns rapidly in the body" It

produces calories per ram

0 If alcohol is taken in e1cess of


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a!!eineF is a central nervous system stimulant

belonin to a roup called methyl1anthines

0 51cessive caffeine intake can lead to /itterness!aitation! and insomnia

0 Ehen individuals addicted to caffeine withdraw from

it! symptoms (headache! drowsiness! irritability! and

mild depression, bein within +G to ) hours"

0 ow doses (K


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0 %renant women are recommended to reduce

caffeine intake durin early prenancy

0 #affeine is not considered an important risk factorfor osteoporosis

"utrient #xcesses>itamin A F rise in intracranial pressure leadin to

drowsiness! irritability! headache! vomitin! and peelin of

the skin

>itamin D F usually seen in infants! manifestation of

hypercalcemia is evident" In addition! there;s mental

retardation! weakness! fatiue! lassitude! and headache"

>itamin '? F in lare doses! has been shown to cause

sensory neuropathy


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ead F is never a normal part of the body

0 It is widely distributed in our environment (air!

dust and soil! food! and waiter, and has manyuses

0 Small amounts of lead in the body have no bad

health effects0 ead to1icity may cause anemia! kidney damae!

decrease in bacterial and infection resistance! and

nervous system damae in children


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Nutrition Therapy

5vidence shows that diet deficient in calcium!4inc! iron! and copper and associated with

increased absorption of lead in the

astrointestinal tract $luid intake must be ade.uate

>itamin and mineral supplements are also

considered


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Developmental Disabilities with Neuroloical Disorders

&efer to sinificant physical! mental! or sensory

impairment often accompanied by associated

disabilities found in various combinations

Some of these conditions are cerebral palsy!

Down;s syndrome! and fetal alcohol syndrome


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#erebral %alsy (#%,

A type of brain damae resultin from birth in/ury!cerebral hemorrhae! prematurity

It is characteri4ed by two motor disability: atheosis

and spinal paralysis

#theosis $ movement is uncontrollable! the child

needs an increased intake of calories but because of

neuromuscular control may find difficulty in feedin

himself" Mixed Cerebral PalsyF condition when both

spasticity and atheosis may be present

%pastics $ limited activity prone to obesity


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Nutrition Therapy

Swallowin difficulty should be assessed by aspeech patholoist to determine the current stae of

dysphaia

Some may combin oral and tube feedin to supply

all the fluid! calorie! and nutrient re.uirementsaccordin to ae and ender

$or spastic patient! calorie intake must be controlled

to prevent too much weiht ain Maintenance of ood nutritional status and helpin

the child to lead a normal life

$iner foods are en/oyed by some individuals


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Down;s Syndrome (Monolism,

This condition is caused by trisomy of chromosome

)+! directly correlated with the ae of the mother

(above + yrs" old of conception,

#hildren sufferin from this are usually short andoverweiht! with sins of mental retardation that

varies from mild to sever

%atients are characteri4ed by rowth retardation!protrudin tonue! delayed development of oral

refle1es! poor swallowin! and chewin difficulties

medical nutrition therapy for diseases of the musculoskeletal.pptx

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