ORAL NUTRITION: What You Need To Know

ORAL NUTRITION SUPPORT

Oral nutrition support is usually the cheapest, safest and most physiological method of providing additional nutrition. At its simplest, the importance of eating to prevent problems and to aid recovery should be explained to patients with encouragement to eat all meals provided. Staff should also try to ensure that meals are not missed through investigations or procedures unless absolutely necessary. Needing to be nil by mouth for a gastroscopy is acceptable, but missing lunch because the patient was off the ward for a chest X-ray is not.

If spontaneous intake is felt to be inadequate, encouragement and help should be offered and records of daily food, nutritious drinks and other fluid intake should be commenced. If the problem then persists, dietetic advice should be sought. Some patients may benefit from special menus, snacks and increased choice, and dietitians are in an ideal position to explore these possibilities. Changing food consistency may also lead to improved intake in some patients with swallowing difficulties.

Soft diets may help in oesophageal structuring whereas thickened liquids may help patients with neurological dysphagia. Great care must be taken, however, to ensure that dysphagic patients who are allowed to continue with oral intake do not aspirate. Assessment by a speech and language therapist (SALT), with or without radiological assessment of swallowing, may be required.

Food fortification, using either high-energy foodstuffs (e.g. butter or cream) or commercially available energy and/or protein supplements, is commonly recommended to try to improve nutritional intake. We believe, however, that the use of this type of nutritional supplementation should be viewed with caution. Malnourished individuals are usually depleted in micronutrients, electrolytes and minerals as well as energy and protein, and food fortification may fail to address all of their needs.

This could also put them at risk of a re-feeding problem through shortage of a critical nutrient (see Chapter 9). We therefore recommend that oral supplementation beyond that provided from normal food should be with commercially produced, nutritionally complete protein, energy and micronutrient preparations, e.g. sip-feed drinks. Even then, some caution is needed. Although such commercial ‘complete’ supplements do contain sufficient quantities of vitamins and minerals to meet daily requirements, they only do so if patients are consuming enough of the supplement to meet their entire energy and protein needs. This is often not the case and patients are only using the supplement as additional intake above that from food. They may, therefore, still need additional multivitamin and trace element supplementation to ensure balanced and truly complete nutrient intake.

It is important that any oral nutritional supplements including, for example, sip-feed drinks and micronutrients, are prescribed on drug charts. This will not only ensure that they are actually given by nursing staff but also indicate clearly to both patients and staff that nutritional care is an integral part of medical treatment.

ETHICAL FACTS ABOUT NUTRITION SUPPORT

ETHICAL ISSUES IN NUTRITION SUPPORT

Artificial nutrition support is fraught with ethical and legal difficulties and all prescribers of IVN should be familiar with these. In general, providing adequate and appropriate fluid and nutrients is a basic duty to sick patients and while a patient can swallow and expresses a desire or willingness to drink or eat, fluid and nutrients should be given unless there is a medical contraindication. If the patient cannot safely consume or absorb adequate amounts orally, administration of nutrients and/or fluid via a tube or vein must be considered. Legally, however, this becomes a ‘medical treatment’ and hence can be withheld or withdrawn if providing or continuing such support is not in the patient’s best interests.

If, for example, an illness is regarded as being in the terminal phase and the plan is to provide only compassionate and palliative care, ethical considerations indicate that a tube/vein supply of nutrients or fluid need only be given to relieve symptoms and should not necessarily be used to prolong survival. In cases where benefits are in doubt, a planned time limited trial of artificial feeding may be useful.

Whenever nutrition support is used, patients should give their consent and a competent patient’s refusal is binding. If a patient lacks the competence to make a decision, the patient’s doctor should seek to ascertain whether the patient expressed previous views about the type of treatment that he or she would wish to receive if the present state of incompetence occurred. If no such views can be identified, any decisions on tube or vein provision of food and/or fluids should involve consultation with the family and all members of the health care team.

However, under current English law, relatives or a nominated proxy cannot make a decision on behalf of an adult patient and so cannot override the clinician’s decision. Special considerations apply in relation to children and application to the court should be made regarding the legality of withdrawing artificial hydration and nutrition from a patient in a persistent vegetative state.

Under specified circumstances, it can be legal to enforce nutritional treatment for an unwilling patient with a mental disorder. This includes anorexia nervosa, in which it is considered that severe malnourishment per se can render patients incompetent of making rational decisions regarding their care.

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THE TRUE FACTS ABOUT NUTRITION SUPPORT

NUTRITION SUPPORT: THE FACT

Nutrition Support is intravenous nutrition or orally modified formulas necessitated by inability to consume a general diet; administered to malnourished individuals who cannot consume food in its original form. The provision of enteral or parenteral nutrients to treat or prevent malnutrition.  Nutrition Support Therapy is part of Nutrition Therapy which is a component of medical treatment that can include oral, enteral, and parenteral nutrition to maintain or restore optimal nutrition status and health.

All people need food to live. Sometimes a person cannot eat any or enough food because of an illness.  The stomach or bowel may not be working quite right, or a person may have had surgery to remove part or all of these organs (gastrectomy). Under those conditions, nutrition must be supplied in a different way.

Nutrition can be provided either through a feeding tube (enteral nutrition) or, when the digestive tract cannot be used, through an intravenous tube called a catheter that is inserted directly into the veins (parenteral nutrition).  The amount, type, and route of nutrition are tailored specifically to each patient with the goal being to improve patient outcomes, minimize infections, and allow patients to live their lives as normally as possible.

Nutrition support professionals work in a variety of settings including hospitals, home care agencies, long-term care facilities, research facilities, and academia.  They include dietitians, pharmacists, nurses, and physicians and may work either independently or as part of a nutrition support service or team. They are specialists in providing and managing enteral and parenteral nutrition in diverse patient populations from pediatrics to geriatrics.

Parenteral Nutrition  

Parenteral nutrition is one of the ways people receive nutrition when they cannot eat or use their gut via tube feeding.  It is a special liquid mixture given into the blood through an intravenous tube into a vein. The mixture contains all the protein, carbohydrate (sugars), fats, vitamins, minerals, and other nutrients needed.  It was once called "total parenteral nutrition," "TPN," or "hyperalimentation."  

Enteral Nutrition 

Enteral nutrition is another way people can receive the nutrition they need.  Also called "tube feeding," enteral nutrition is a mixture of all the needed nutrients.  It is thicker than parenteral nutrition and sometimes it looks like a milk shake.  It is given through a tube into the stomach or small intestine.  

IDEAL WEIGHT FOR MEN AND WOMEN

IDEAL WEIGHT

Before now, have you ever thought of being over weight? do you think your current body size is ideal for you age and gender? Is it not giving you problem?

Not to worry, here at NutrientsLounge we care for the safety and healthy living of our people. Hence we present a table showing several ideal weights for several age range and gender. But before we proceed, what is ideal weight?

An ideal weight is a weight that is believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development.

Expected weight of a healthy normal individual based on age, sex, and height. Thus, a malnourished person would weigh less than their ideal body weight.

Now, you can see for yourself.

The key benefits of metrics in nutrition

HOW TO THINK METRIC LIKE OTHER SCIENTISTS

Nutrition Scientists use metric units of measure. They measure food energy in kilocalories, people’s height in centimeters, people’s weight in kilograms, and the weights of foods and nutrients in grams, milligrams, or micrograms.


For ease in using these measures, it helps to remember that the prefixes imply 1000. For example, a kilogram is 1000 grams, a milli gram is 1/1000 of a gram, and a microgram is 1/1000 of a milligram.

Most food labels and many recipes provide “dual measures,” listing both Volume: Liters (L) 1 L  5  1000  milliliters  (mL) 0.95 L  5  1 quart 1 mL  5  0.03 fluid ounces 240 mL  5  1 cup household measures, such as cups, quarts, and teaspoons, and metric measures, such as  milliliters,  liters,  and  grams.

This  practice gives people an opportunity to gradually learn to  “think  metric.” A person might begin to “think metric” by simply observing the measure—by noticing the amount of soda in a 2-liter bottle, for example.

Through such experiences, a person can become familiar with a measure without having to do any conversions..

The international unit for measuring food energy is the joule—the amount of energy expended when 1 kilogram is moved 1 meter by a force of 1 newton. The joule is thus a A liter of liquid is approximately one US quart. (Four liters are only about 5 percent more than a gallon.)


Weight:  grams (g) 1 g  5  1000  milligrams  (mg) 1 g  5  0.04 ounce (oz) 1 oz  5  28.35 g (or 30 g) 100 g  5  3½ oz 1 kilogram (kg)  5  1000  g 1 kg  5  2.2 pounds (lb) 454 g  5  1 lb © 2016 Cengage Learning measure of work energy, whereas the kcalorie is a measure of heat energy. While many scientists and journals report their findings in kilojoules (kJ), many others, particularly those in the United States, use kcalories (kcal).

To convert energy measures from kcalories to  kilojoules, multiply by 4.2; to convert  kilojoules to kcalories, multiply by 0.24.

For example, a 50-kcalorie cookie provides 210 kilojoules: 50 kcal  3  4.2  5  210  kJ One cup of liquid is about 240 milliliters; a half-cup of liquid is about 120 milliliters. A kilogram is slightly more than 2 lb; conversely, a pound is about ½ kg. A half-cup of vegetables weighs about 100 grams; one pea weighs about ½ gram.

REFERENCE

1. Thomas Harm & Tom Peterson/ Quest Photographic Inc. Stephen Barnes/Farming/Alamy A 5-pound bag of potatoes weighs about 2 kilograms, and a 176-pound person weighs 80 kilograms.

2. Tarasyuk Igor/Shutterstock.com Convert your body weight from pounds to kilograms and your height from inches to centimeters.

THE CONCEPT OF NUTRITION

THE CONCEPT OF NUTRITION

Nutrition has always played a significant role in your life. Every day, several times a day, you select foods that influence your body’s health.


Each day’s food choices may benefit or harm health only a little, but over time, the consequences of these choices become major.

That being the case, paying close attention to good eating habits now supports health benefits later. Conversely, carelessness about food choices can contribute to chronic diseases.  Of course, some people will become ill or die young no matter what choices they make, and others will live long lives despite making poor choices.

For most of us, however, the food choices we make will benefit or impair our health in proportion to the wisdom of those choices.

Although most people realize food habits affect health, they often choose foods for other reasons. After all, foods bring pleasures, traditions, and associations as well as nourishment. The challenge, then, is to combine favorite foods and fun times with a nutritionally balanced diet.


Take a moment to review the definition and note that diet does not mean a restrictive food plan designed for weight loss. It simply refers to the foods and beverages a person consumes.  Whether it’s a vegetarian diet, a weight-loss diet, or any other kind of diet depends on the types of foods and beverages a person chooses.

People decide what to eat, when to eat, how much to eat, and even whether to eat in highly personal ways based on a complex interaction of genetic, behavioral, or social factors rather than on an awareness of nutrition’s importance to health.1

 A variety of food choices can support good health, and an understanding of human nutrition helps you make sensible selections more often.

Preferences As you might expect, the number one reason most people choose certain foods is taste—they like the flavor. Two widely shared preferences are for the sweetness of sugar and the savoriness of salt.2

High-fat foods also appear to be a universally common preference. Other preferences might be for the hot peppers common in Mexican cooking or the curry spices of Indian cuisine.

Research suggests that genetics may influence taste perceptions and therefore food likes and dislikes.3

Similarly, the hormones of pregnancy seem to influence food cravings and aversions. Habit People sometimes select foods out of habit. They eat cereal every morning, for example, simply because they have always eaten cereal for breakfast.

Eating a familiar food and not having to make any decisions can be comforting. Ethnic Heritage and regional Cuisines Among the strongest influences on food.


REFERENCES

1. E. R. Grimm and N. I. Steinle, Genetics of eating behavior: Established and emerging concepts,  Nutrition Reviews  69  (2011):  52–60.

2. A. Drewnowski and coauthors, Sweetness and food preference,  Journal   of Nutrition  142 (2012): 1142S–1148S; J. E. Hayes, B. S. Sullivan, and  V. B. Duffy, Explaining variability in sodium intake through oral sensory phenotype, salt sensation and liking,  Physiology and Behavior  100  (2010): 369–380.

3. J. E. Hayes and R. S. Keast, Two decades of supertasting: Where do we stand?  Physiology and Behavior  104  (2011):  1072–1074.

A TYPICAL STANDARD MEAL PLAN

A TYPICAL STANDARD MEAL PLAN

AGE GROUP: Old Children / Pre-School

AGE BRACKET: Two – five (2 – 5) years

ESSENTIAL NUTRITIONAL CONTENT: 
Macro Nutrients: 
Carbohydrate
Protein
Fats

Micro Nutrients:
Vitamins A
Vitamin B complex
Vitamin C
Iron
Zinc
Calcium
Phosphorus

COOK METHODS: Boiling, Stewing, Poaching, Shallow Frying, Baking etc.

Source: www.nutrientslounge.blogspot.com       I.G@jhaywhor007             Tel: 07061214127

NOTE: Kindly ensure that the foods are prepared in a manner that ensures that its nutrients are conserved and utilized. Never feed the children at odd hours, as this is inappropriate. Consult a dietician to conduct the necessary anthropometry study so as to give and appropriate measurement of the ingredients and to help quantify the child’s meal in terms of its serving sizes.

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GINGIVITIS AND ITS DIETARY INTERVENTION

GINGIVITIS
Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of the bacteria that accumulate on the teeth, called plaque. This type is called plaque induced gingivitis.


Gingivitis is a non-destructive type of periodontal disease. However, if left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.

TYPES OF GINGIVITIS
1. Dental plaque induced gingival disease: This can be caused by plaque, systemic factors, medications or malnutrition.

2. Non─ plaque induced gingival lesions: Can be caused by a specific bacterium, virus or fungus. It night also be caused by genetic factors, systemic conditions including allergic wounds, or reactions to foreign bodies (such as dentures).

CAUSES OF GINGIVITIS
• Accumulation of plaque and tartar between and around the teeth. The plaque triggers an immune response, which eventually lead to the destruction of gingival (gum) tissues and further complications, including loss of teeth.


• Dental plaque.

• Changes in hormones: Which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva might become more sensitive, raising the risk of inflammation.

• Drugs: E.g; dilatin (anti­convulsant).

• Smoking.

• Age: the risk of gingivitis increases with age.

• Family history: people whose parents had gingivitis have a higher risk of developing it too.

SIGNS AND SYMPTOMS OF GINGIVITIS
a. Gums are bright red or purple.
b. Gums are tender and sometimes painful to the touch.
c. Gums bleed easily when brushing teeth or flossing.
d. Halitosis (bad breath).
e. Inflammation (swollen gums).
f. Receding gums
g. Soft gums

Note: In mild cases of gingivitis, there may be no discomfort or noticeable symptoms.

TREATMENT/DIET INDICATION
If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Probiotics may help to decrease gingivitis and plaque, bacteria in fermented foods might suppress the growth of pathogens in the oral cavity.

Consuming fermented dairy products is associated with less periodental diseases.

1. Protein: for tooth structure, mucosal/corrective tissue development and immune function.

2. Calcium: tooth structure; may enhance enamel remineralization.

3. Phosphorous: tooth structure.
4. Zinc
5. Folate
6. Iron
7. Vitamin A
8. Vitamin C
9. Vitamin D
10. Omega 3 fatty acids (modulates the inflammatory response).

DIET PLAN
1. Whole foods diets with lots of lean protein and fresh vegetables
2. Avoid most processed foods, especially those high in simple sugars.
3. Oily fish/Fish oil and fluoride sources (e.g in tooth paste)

KEY POINTERS DURING THE SELECTION OF A PRE-OPERATIVE DIET

PRE-OPERATIVE DIET
Patients who have lost much weight prior to surgery benefit considerably by ingesting a high protein, high calorie diet for even a week or two prior to surgery.

The diet maybe of liquid, soft or regular consistency depending upon the nature of the pathologic condition.

Parenteral nutrition or semisynthetic fibre-free diets are sometimes used. In addition, the maintenance of metabolic equilibrium as in diabetes or other diseases must not be overlooked.

Foods which provide a maximum amount of nutrients in a minimum volume are essential.
Small feedings at frequent intervals are likely to be better accepted than large meals which cannot be fully consumed.

For additional protein, milk beverages may be fortified with non-fat dry milk or commercial protein supplements.

Fruit juices fortified with glucose or high carbohydrate food, increase carbohydrate intake and facilitate storage of glycogen.

Butter incorporated into foods and light cream mixed with equal amounts of milk are also useful for increasing the calorie intake. On should remember that the excessive use of sugars and fats may cause nausea.

Foods and fluids are generally allowed until midnight just preceding the day of operation, although a light breakfast maybe given when the operation is scheduled for afternoon and local anaesthesia is to be used.

It is essential that the stomach be empty prior to administering the anaesthesia so as to reduce the incidence of vomiting and subsequent danger of aspiration of vomitus.

When an operation is to be performed on the gastrointestinal tract, a diet very low in residue maybe given 2 to 3 days prior to operation.

In acute abdominal conditions such as appendicitis and cholecystitis, no food is allowed by mouth until nausea , vomiting pain and distension have passed in order to prevent the danger of peritonitis.

DIET IN SURGERY
Good nutrition prior to and following surgery ensures fewer post-operative complications, better wound healing, short convalescence and lower mortality. chronic diseases increase the nutritional requirements.

Malnutrition can lead to weight loss, poor wound healing, decreased intestinal motility, anaemia, oedema or dehydration and the presence of ulcers. The circulating blood volume and the concentration of the serum proteins, haemoglobin and electrolytes may be reduced.

Following surgery or injury the need for nutrients is greatly increased as a result of loss of blood, plasma, or pus from the wound surface, haemorrhagefrom the gastrointestinal or pulmonary tract, vomiting and fever. During immobilization, loss of some nutrients such as protein is accelerated.

A fairly simple operation often involves moderate deficiency in food intake for a few days following the operation /surgery. Some nutrients may be supplied by parenteral fluids, but the full needs of the body usually are not met by that means alone.

Adequate oral intake is often delayed for a considerable period following cardiac or gastrointestinal surgery. Metabolic losses are great and alternative methods of nutritional support needed.

The objectives in the dietary management of surgical conditions are:

1. To improve the pre-operative nutrition whenever the operation is not of an emergency nature.
2. To maintain correct nutrition after operation or injury as far as possible and
3. To avoid harm from injudicious choice of foods.

REQUIRED NUTRIENTS

(1) PROTEIN: A satisfactory state of protein nutrition ensures

a. Rapid wound healing
b. Increases resistance to infection
c. Exerts a protective action upon the liver against the toxic effects of anaesthesia and
d. Reduces the possibility of oedema at the site of the wound .

The presence of oedema is a hindrance to wound healing and in operations on the gastrointestinal tract, may reduce motility thus leading to distension.

When protein is depleted in post-operative condition complications are increased. Protein catabolism is increased for several days immediately following surgery or injury , patients are characteristically in negative nitrogen balance even though the protein intake may be appreciable. The degree of negative balance can be reduced at higher intakes of protein and calories.

The level of protein to be used in pre-operative and post-operative diets depends on the previous state of nutrition, the nature of the operation and the extent of the post-operative losses. Intake of 1.0 to 1.5g per kilogram or about 100g of protein are necessary as a rule.
   
(2) ENERGY: Without sufficient caloric intake tissue proteins cannot be synthesized. Excess metabolism of body fat may lead to acidosis, whereas depletion of the liver glucose may increase the likelihood of damage to the liver with 2500 to 3000 kcal patients make progress.
Obesity delays healing. Whenever possible, it should be corrected. Rapid weight loss results in loss of lean body mass and should be avoided.

(3) MINERALS: Phosphorus and potassium are lost in proportion to the breakdown of body tissue. In addition derangements of sodium and chloride metabolism may occur subsequent to vomiting, diarrhoea, perspiration, drainage, anorexia and dieresis or renal failure.

Iron-deficiency anaemia occurs in association with mal-absorption or excessive blood loss. Diet alone is ineffective in correction of anaemia, but a liberal intake of protein and ascorbic acid, together with administration of iron salt is of value in convalescence. Transfusions are usually required to overcome severe reduction in haemoglobin level.

(4) FLUIDS: The fluid balance maybe upset prior to and following surgery owing to failure to ingest normal quantities of fluids and to increased losses from vomiting ,exudates , haemorrhage , diuresis and fever. A patient should not be operated in a state of dehydration since the subsequent dangers of acidosis are great. When dehydration exists prior to operation, parenteral fluids are administered, if the patient is unable to ingest sufficient liquid by mouth.

(5) VITAMINS: Ascorbic acid (vitamin C) is especially important for wound healing and should be provided in increased amounts prior to and following the surgery. Vitamin k is of concern to the surgeon since the failure to synthesize vitamin k in the small intestine, the inability to absorb it or the defect in conversion to prothrombin is likely to result in bleeding. Haemorrhage is especially likely to occur in patients who have diseases of the liver.