Nutritional interventions

Most CF patients have an increased caloric need due to increased energy expenditure through increased work of breathing and increased basal metabolism. Prevention of malnutrition requires early nutritional intervention. In patients with mild lung disease and well-controlled absorption, required caloric intake is approximately 100% to 120% of the recommended daily allowance (RDA) for age.15 As lung disease progresses, caloric requirements increase. 

CD occurs in approximately 4.56 per 100,000 pediatric patients, and UC occurs in about 2.14 cases per 100,000.43 A major issue in children with IBD is the risk of growth failure secondary to inadequate nutritional intake. Failure to thrive may be an initial presentation of IBD in this population. Aggressive nutritional interventions may be required to facilitate adequate caloric intake. Chronic corticosteroid therapy may also be associated with reductions in growth. 

In conclusion, it should be mentioned that there are numerous proposals for the application of various food products having antioxidant activity for the protection against various free radical-mediated pathologies. For example, it has been suggested that nutritional interventions such as increasing dietary intake of fruits and vegetables can decrease the age-related declines in brain functions probably via the suppression of oxidative stress [368],... 

First-line therapy includes nutritional and exercise interventions for all women, and caloric restrictions for obese women. If nutritional intervention fails to achieve fasting plasma glucose levels less than or equal to 105 mg/dL, 1-hour post-prandial plasma glucose concentrations less than or equal to 155 mg/dL, or 2-hour postprandial levels less than or equal to 130 mg/dL, then therapy with recombinant human insulin should be instituted glyburide may be considered after 11 weeks of gestation. 

Hamer, M., Wolvers, D., and Albers, R., Using stress models to evaluate immuno-modulat-ing effects of nutritional intervention in healthy individuals, J. Amer. Coll. Nut., 23, 637, 2004. 

Malnutrition, and its ultimate form cachexia, are encountered every day in cancer and haematology wards. Malnutrition results from the parasitic metabolism of the tumour at the expense of the host, from the impact of the tumour on the metabolism of the host... The major consequence is an increased risk of complications and death during the course of chemotherapy, radiation therapy and major surgery. It is thus important to offer nutritional support, in order to stop or reverse the process of malnutrition. Nutritional intervention should be founded on the abundant literature devoted to cancer cachexia, including the pathophysiology of the disease. .. 

Murphy, R., Mourtzakis, M., Chu, Q., Baracos, V., Reiman, T., and Mazurak, V. (2011). Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy. Cancer 117,1775-1782. 

Fat metabolism during exercise a review. Part IE effects of nutritional interventions. Int. J. Sports Med. 19, 371-379. 

Although a short-term modification of blood plasma TAC after ingestion of antioxidant-rich food apparently can be demonstrated, the effect of long-term nutritional intervention seems more doubtful. In one study, administration of 300 mg/day of o -tocopherol increased blood serum TAC by 25% after 7 days and by 32% after 14 days (V2). Administration of standardized Gingko biloba extract (300 mg/(kg day) for 5 days increased TAC of rat blood plasma. Complex-ation of the extract with phosphatidylcholine augmented this effect (C17). Subjects who consumed water spinach twice or more a week had higher mean TAC of blood plasma (W14). 

Li JY Taylor PR, Li B, et al. Nutrition intervention trial in Linxian, China multiple vitamin/mineral supplementation, cancer incidence, and disease specific mortality among adults with esophageal displasia. J Natl Cancer Inst 1993 85 1492-1498. 

In this volume, we have focused on how xenobiotics are metabolized in higher animals and how this metabolism is mediated by the nutritional status of the target animal. Emphasis has been placed on the toxic, mutagenic, carcinogenic and potentially mutagenic or carcinogenic compounds. The topic is a natural follow-up and expansion of Xenobiotics in Foods and Feeds (ACS Symposium Series No. 234, Finley and Schwass, Eds.) in which sources of xenobiotics were identified and discussed at length. The authors in this volume discuss how and why these xenobiotics are toxic and how nutritional intervention can mediate some of the toxicities. 

Von Berg, A., Koletzko, S., Grubl, A., et al. (2003). The effect of hydrolyzed cow s milk formula for allergy prevention in the first year of life The German Infant Nutritional Intervention Study, a randomized double-blind trial.. Allergy Clin. Immunol. Ill, 533-534. 

N11, Tl). DHEAS also reportedly has an antiobesity effect (N8). More recently, Lane and associates (L3) reported that, as with humans, male and female rhesus monkeys exhibit a steady, age-related decrease in serum DHEAS concentration. They also noted that the proportional age-related loss of DHEAS in rhesus monkeys is more than twice the decline rate observed in humans. More importantly, they found that caloric restriction slows the postmaturational decline in serum DHEAS levels, thereby providing the first evidence that nutritional intervention has the potential to alter certain aspects of postmaturation aging in a long-lived species. 

Bll. Blot, W. J., Li, J. Y., Taylor, P. R., Guo, W., Dawsey, S., et al., Nutrition intervention trials in Linxian, China. Supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J. Natl. Cancer Inst. 85, 1483-1492 (1993). 

Fewer than 20 years ago high-dose zinc supplementation was reported to reduce significantly the risk of vision loss in a short-term study that lacked a control arm. Since then, nutritional interventions have become popular with researchers as well as the general public. Unfortmiately, subsequent trials have felled to substantiate this initial result. 

An over iew of the di ease diabetes mellitus will be used to supply motivation prior to starling our journey through the pathways of energy production. Diabetes mellitus is a major health concern on a global basis. This disease takes two forms, i-e-, insulin-dependent diabetes mellitus (IDDM) and nan-insulin-dependent diabetes mellitus (NIDDM). Nutritional intervention is used in the treatment of diabetes, as revealed later in this chapter and in the Obesity chapter. IDDM is easily treated by injections of insulin, while NIDDM is more difficult to tneat. NIDDM is treated with insulin and by weight reduction in obese patients. Use of soluble fiber in the diet may be used in the treatment of both types of diabetes. 

The treatment of gastrointestinal involvement ultimately is aimed at correcting the nutritional deficit present in many patients. In addition to pancreatic enzyme replacement and other drug therapy described below, nutritional supplementation is employed frequently. Nutritional interventions range from behavioral modification to nocturnal feedings via gastrostomies. ... 

While most drug therapy has yet to show benefit in patients with ARF, certain nutritional interventions may be useful. Pre-existing nutrition status has been shown to be a strong predictor of outcomes in patients with ARF. The use of enteral nutrition in patients with ARF in ICUs has been associated with an improvement in outcomes. Parenteral nutrition did not show the same benefit and some have questioned whether parenteral nutrition should ever be used in this population. ... 

Koretz RL. Does nutritional intervention in protein-energy malnutrition improve morbidity or mortality J Renal Nutr 1999 9 119-121. 

A comprehensive nutrition assessment should include a nutrition-focused medical and dietary history, a physical examination including anthropometric measmements and laboratory measurements, and provides a basis for determining the patient s nutrition requirements and the optimal type and timing of nutrition intervention. 

Initially, nutrition requirements are determined on the basis of assumptions made about the patient s clinical condition and the nutrition needs associated with repletion or growth, if needed. Once a nutrition intervention has been initiated, periodic reassessment of nutrition status is critical to determine the accuracy of the initial estimate of nutrition requirements. Also, nutrition requirements are dynamic in the setting of acute or critical illness—as the patient s clinical status changes, so will protein and energy requirements, further emphasizing the need for continued reassessment. 

American Academy of Family Physicians, American Dietetic Association, and National Council on the Aging, Inc. Nutrition Interventions Manual for Professionals Caring for Older Americans. Washington, Nutrition Screening Initiative, 1992. http //www.aafp.org/nsi/. Accessed June 4, 2004. 

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