Examining Special Nutritional Requirements in Disease States Proceedings of a Workshop (2018) / Chapter Skim
Currently Skimming:
3 Disease-Induced Loss of Function and Tissue Regeneration
3 Disease-Induced Loss of Function and Tissue Regeneration
Pages 39-62
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 39... ...
dysfunction and nutrient malabsorption in intestinal failure. The next speaker, Sarah Jane Schwarzenberg, Chief of Pediatric Gastroenterology, Hepatology, and Nutrition at the University of Minnesota Masonic Children's Hospital, also provided an overview of GI dysfunction and nutrient malabsorption, focusing on cystic fibrosis (CF)
|
From page 40... ...
Therefore, the mainstay of intestinal failure treatment, Duggan explained, is early and aggressive parenteral nutrition, with gradually increasing amounts of enteral nutrition as the bowel adapts after massive resection. Micronutrient supplementation is an important therapy as well.
|
From page 41... ...
. A retrospective review of children with intestinal failure at Boston Children's Hospital showed a high prevalence of various micronutrient deficiencies, even while the patient was receiving parenteral nutrition at least several days per week at a center that takes special care to maintain children on micronutrient supplementations as they are weaning from parenteral nutrition (Yang et al., 2011; see Figure 3-1)
|
From page 42... ...
Duggan, High prevalence of multiple micronutrient deficiencies in children with intestinal failure: A longitudinal study, pages 39–44, Copyright 2011, with permission from Elsevier. https://www.sciencedirect.
|
From page 43... ...
In the United States, care for about 85 percent of CF patients is provided through Cystic Fibrosis Foundation care centers, which also includes a patient registry with data on infections, nutrition, liver disease, pulmonary function, and other information. These data allow care centers to compare survival, body mass index (BMI)
|
From page 44... ...
Cystic Fibrosis Nutrition Interventions CF-specific nutritional interventions are driven by quality improvement projects and guidelines developed by the Cystic Fibrosis Foundation. It is well established that children who obtain newborn screening
|
From page 45... ...
SOURCES: As presented by Sarah Jane Schwarzenberg, April 2, 2018; Yen et al., 2013. Reprinted from Journal of Pediatrics, volume 162/issue 3, Yen, E
|
From page 46... ...
Clinicians must pay attention to a complex disordered matrix of digestion, absorption, and intestinal function, and that is really the challenge in this disease. NUTRITIONAL REQUIREMENTS FOR INFLAMMATORY BOWEL DISEASE3 IBD is a chronic inflammatory condition with symptoms including abdominal pain, diarrhea, and blood in the stool, and systemic manifestations such as fever, body rashes, linear growth delay, and poor weight gain.
|
From page 47... ...
have been identified, it is unclear whether these are actually risk and protective factors, or whether individuals at risk of developing IBD merely have different nutrient requirements. Nutrient Deficiencies Associated with Inflammatory Bowel Disease It is known that individuals with systemic inflammation and IBD have anorexia, so they have decreased global intake of macro- and micronutrients.
|
From page 48... ...
Lee also described a second study, the PLEASE study, in which children with active Crohn's disease were divided into three groups -- partial enteral nutrition, EEN, and a biological medication (Lee et al., 2015)
|
From page 49... ...
Complexities of Inflammatory Bowel Disease and Nutrients Lee then summarized the following complexities with IBD and nutrients: • Nutritional therapy is used differently for Crohn's and ulcerative colitis and the formula-based approach (i.e., EEN) is effective only for Crohn's disease.
|
From page 50... ...
, and histones, d and in synthesis of neural transmitters. Folate is transported across the BBB 4 This section summarizes information presented by Martha Field.
|
From page 51... ...
In fact, at the very high folic acid doses that are shown to be effective in addressing CFD, folic acid can be associated with some toxicity. Field noted that the relationship between impairments in whole body folate status and brain disease or, more specifically, depression, have been recognized by authoritative bodies, including the American Psychiatric Association, the Institute of Medicine, and the World Health Organization
|
From page 52... ...
• The disease states are responsive to intervention, but some indi viduals are responders and others are not. There does seem to be evidence of dose response.
|
From page 53... ...
Ikizler observed that in developed countries, PEW, sarcopenia, wasting syndrome, and malnutrition predispose patients to significant complications that are associated with PEW, such as infection, cardiovascular disease, and frailty, that in aggregate or individually put CKD patients at increased mortality risk. Evidence of Unique Nutritional Requirements in Chronic Kidney Disease A number of studies have established the need for more or less of the nutrients that are usually given to healthy individuals6 in various disease states, including CKD (see Table 3-1)
|
From page 54... ...
Nutrition Issues in Chronic Kidney Disease Ikizler continued by explaining that CKD has three nutrition issues of relevance: changes in requirements for protein intake, hemodialysisassociated catabolism, and the effect of inflammation and how it influences the metabolic profile of people with kidney disease. He reminded workshop participants that the hallmark of uremia (or uremic syndrome, that is, urea in the blood due to an excess of amino acid and protein metabolism into end-products in the blood that would be normally excreted in the urine)
|
From page 55... ...
The resulting diminished amino acid pool leads to increased catabolism and decreased protein synthesis, which results in robust net catabolism. Results from a study that examined protein turnover using stable isotopes show a significant drop in the protein synthesis and a significant increase in protein breakdown, resulting in an almost doubling of the net catabolic process (Ikizler et al., 2002)
|
From page 56... ...
suggest that benefits to the intermediate surrogate outcomes of nutritional state, such as serum a lbumin, pre-albumin, body weight, lean body mass, bone density, and physical function, occur with protein supplementation. A recently completed study examined the effects of nutritional supplementation using a dual glucose-amino acid clamp procedure on changes in muscle protein signaling (Gamboa et al., 2016)
|
From page 57... ...
Duggan also commented that some animal data suggest that bacterial overgrowth seems to relate to non-alcoholic fatty liver disease, acknowledging that valid methods to diagnose bacterial overgrowth in humans has been the main conundrum there. Kemper noted a number of common elements, including the importance of determining not only the right nutrient or supplement to give but considering the right form and delivery system, and the important effect that inflammation seems to have on special nutritional requirements.
|
From page 58... ...
Evidence on Nutritional Factors That Trigger or Help the Disease Process To a question related to whether any evidence exists that separates nutritional factors that trigger the disease versus those involved in treating or managing the disease, Lee responded that the evidence about risk and protective factors comes from large epidemiological studies that do not provide high-quality, detailed assessment of dietary data. The epidemiological studies cited in his presentation probably reflect both risk and protective factors and are probably pertinent for inception of disease and treatment.
|
From page 59... ...
Lee responded that this is a critically important issue, and work is under way to better understand pathophysiology and how dietary changes affect the microbiome and how that microbiome interacts with the healthy host versus the inflamed diseased host. Protein Dietary Reference Intakes and Chronic Kidney Disease A comment was made on how potential increases in protein Dietary Reference Intakes might affect prevention of CKD in a population with a high prevalence of overweight or obesity.7 This is an important dilemma, Ikizler replied, illustrating the balance between recommendations for the public when many people in that population have conditions, or risk factors for conditions, that would necessitate more tailored nutrition recommendations.
|
From page 60... ...
2017. Pediatric intestinal failure.
|
From page 61... ...
2012. Natural history of pediatric intestinal failure: Initial report from the Pediatric Intestinal Failure Consortium.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.