Archive for January 25th, 2011

CANCER TREATMENTS: DIET THERAPY

Tuesday, January 25th, 2011

Assessing the Patient’s Nutritional Status
1. Factors influencing the nutritional status
2. Dietary patterns and habits
3. Food changes, aversions
4. Taste changes
5. Weight changes
6. Metabolic abnormalities
7. Surgical intervention, chemotherapy, radiotherapy.
Patient interview, history, questionnaire
Selection of nutritional parameters
1. Weight change
(a) Recent (4-6 weeks)
(b) Long-term (More than 6 weeks)
2. Laboratory values
3. Body composition
(a) Fat/lean mass
(b) Height/weight, Body Mass Index
4. Cause of poor intake
(a) Anorexia
(b) Early satiety
(c) Pain
(d) Difficulty in swallowing
(e) Aversion to food taste
(f) Lack of strength
(g) Inability of position
(h) Difficulty in purchasing/preparing
(i) Fear/depression.
Formulating Appropriate Nutritional Support
Calories: Non ambulatory = 20-25 kcal/kg/IBW (ideal body weight)
Hypermetabolic = 30-35 kcal/kg/IBW or
Desirable weight in lb x 20 (M)
Desirable weight in lb x 18 (F)
Proteins: 1.5-2.5/kg/IBW or
Desirable weight in lb x 0.77
Fibre: Increase fibre.
Fats: Less than 30% of total calories, avoid saturated fats.
Vit. A: Increase (3-carotene for cancer of lung, skin and breast.
Vit. С: Vitamin С for protective action.
Vit. E: Folic acid, calcium to be increased.
Feeding Modalities
1.  Oral-regular
(a) Frequent
(b) Mechanically soft textured
(c) Blenderized
(d) Bland
(e) Lactose free
(f) High calorie density
2. Tube feeding (Enteral nutrition)
3. Parenteral nutrition
Enteral nutrition
Tube feeding has to be individualized depending upon the status of the patient.
1. Continuous tube feeding of 20-25 ml/hour of isotonic or hypertonic formula to be increased slowly.
2. Intermittent tube feeding of 120 ml/4 hours of isotonic or hypertonic formula to be increased slowly.
There are three kinds of formulae:
1. Polymeric formulae
2. Partially hydrolyzed formulae
3. Disease specific formulae.
Parenteral nutrition
1. It is an indication when tube feeding has failed or where gastrointestinal (GI) tract is not usable (obstruction, high output fistula).
2. The patient is malnourished.
3. The GI tract is unable to support nutritional needs due to its non-availability.
*3/356/5*

CANCER TREATMENTS: DIET THERAPY Assessing the Patient’s Nutritional Status      1. Factors influencing the nutritional status      2. Dietary patterns and habits      3. Food changes, aversions      4. Taste changes      5. Weight changes      6. Metabolic abnormalities      7. Surgical intervention, chemotherapy, radiotherapy.Patient interview, history, questionnaire Selection of nutritional parameters      1. Weight change      (a) Recent (4-6 weeks)      (b) Long-term (More than 6 weeks) 2. Laboratory values      3. Body composition (a) Fat/lean mass      (b) Height/weight, Body Mass Index      4. Cause of poor intake      (a) Anorexia      (b) Early satiety      (c) Pain      (d) Difficulty in swallowing (e) Aversion to food taste      (f) Lack of strength      (g) Inability of position      (h) Difficulty in purchasing/preparing      (i) Fear/depression.
Formulating Appropriate Nutritional SupportCalories: Non ambulatory = 20-25 kcal/kg/IBW (ideal body weight)      Hypermetabolic = 30-35 kcal/kg/IBW or      Desirable weight in lb x 20 (M)      Desirable weight in lb x 18 (F) Proteins: 1.5-2.5/kg/IBW or      Desirable weight in lb x 0.77 Fibre: Increase fibre.Fats: Less than 30% of total calories, avoid saturated fats.Vit. A: Increase (3-carotene for cancer of lung, skin and breast.Vit. С: Vitamin С for protective action. Vit. E: Folic acid, calcium to be increased.
Feeding Modalities1.  Oral-regular      (a) Frequent      (b) Mechanically soft textured      (c) Blenderized      (d) Bland      (e) Lactose free      (f) High calorie density
2. Tube feeding (Enteral nutrition)3. Parenteral nutrition
Enteral nutritionTube feeding has to be individualized depending upon the status of the patient.1. Continuous tube feeding of 20-25 ml/hour of isotonic or hypertonic formula to be increased slowly.2. Intermittent tube feeding of 120 ml/4 hours of isotonic or hypertonic formula to be increased slowly.There are three kinds of formulae:1. Polymeric formulae2. Partially hydrolyzed formulae3. Disease specific formulae.
Parenteral nutrition1. It is an indication when tube feeding has failed or where gastrointestinal (GI) tract is not usable (obstruction, high output fistula).2. The patient is malnourished.3. The GI tract is unable to support nutritional needs due to its non-availability.*3/356/5*

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