Clinical nutrition

Meltem Ugras MDPediatric Gastroenterology Hepatology & Nutrition

Why human being has food/eats?

For…..

…..

…..

What can be a marker for increased risk even in persons with normal weight?

What percentile are

people at risk for

being overweight?

At what percentage are you considered obese/overweight?

Growth charts

Calculate age

Subtract Today: dd.mm.yyyy

From Birthday: dd.mm.yyyy

-----------------------------------

= Age: dd.mm.yyyy

Example

Today : 02.01.2014

Date of birth: 18.02.2010

Age: ……………

What is skinfold thickness?

Caliper

How much should one person have minimally in a day

What is the minimum nutritional intake

Scientists and nutritionists continue

to evaluate the nutrients found in

the healthiest diets to try to

determine the minimum nutritional

needs of individual people

. Recommended Daily Allowances (RDAs)

are the product of these studies, and

illustrate in a basic way what people should

try to eat every day.

Dietary Reference Intakes (DRIs)

attempt to illustrate the amount of

nutrients that should be included in the

diet for the purpose of disease

prevention and treatment

A combination of these two

(DRI and RDA)

recommendations generally supplies a complete picture of the foods and

nutrients that will constitute a healthy diet.

Clinical nutrition also often references macronutrients and micronutrients.

Macronutrients constitute the majority of the diet, whereas micronutrients are a much smaller portion of the diet.

Macronutrients include carbohydrates,

proteins, and

fats, and are used for energy in the body as well as the maintenance of cells and tissues.

Micronutrients include vitamins and

minerals, and

they assist the body in breaking down macronutrients for energy by triggering chemical reactions

Most nutrients needed by the body must

work in conjunction with other nutrients

to achieve any effect;

this is why it is important to eat a healthy

diet,

and not to simply rely on nutritional

supplements,

as scientists have yet not discovered all

of the ways in which nutrients work

together.

In general, people who eat a healthy, , balanced diet, take a

multivitamin, and who do not have any underlying medical

conditions are able to meet their nutritional needs without any

extra help.

If anyone is concerned about their diet, however, a visit to a

clinical nutritionist can help get them back on the right track. The

nutritionist will assess their overall health and eating habits

through a series of questions regarding lifestyle, medical history,

and family history, as well as laboratory tests. The nutritionist will

then be able to develop a healthy eating plan customized just for

them, which often includes other recommendations for a healthy

lifestyle, such as exercise

• Clinical nutrition is the study of the relationship between food that is consumed and the health and well-being of the body.

• The field of clinical nutrition considers • the way the body uses the nutrients found in

foods and supplements, • the way the body processes the nutrients

and then stores them for later use or eliminates them.

• also considers other contributing factors to health, such as the environment, family history, and overall well-being when trying to determine an individual's nutrient needs.

Clinical nutrition was first developed in

the early 1900s, when scientists

discovered that some diseases, such as

beri-beri or scurvy, seemed to be caused

by specific diets that were fairly limited in

the amount of foods consumed.

By 1912, Casimir Funk, a Polish biochemist, had

discovered that eating brown rice seemed to

prevent beri-beri. He set out to discover what

substance was found in brown rice that would

cause this, and discovered Thiamine, which he

referred to as a "vitamine" because it contained

an amine group. This would later come to be

known as vitamin B1, and Funk correctly theorized

that other diseases could be prevented with

vitamins as well.

Clinical nutrion deals with;

1. The role of nutrition in the treatment of selected diseases, nutritional disorders and clinical conditions.

2. The process of nutritional care (nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation) through the integration of knowledge and skills acquired from previous courses (nutrition, behavioural sciences, biochemistry and physiology).

3. The principles of therapeutic diets and their application with consideration of socioeconomical, cultural and psychological factors.

4. The role of the clinical dietitian as a member of the health care team in the provision of nutritional care.

Organizma hastalık halinde, beslenme yetersizliğine ve düzensizliğine daha duyarlı hale gelmektedir. Bu durum mevcut hastalığa ilaveten, başka sağlık sorunlarının da ortaya çıkmasına neden olmakta ve/veya ortaya çıkışını hızlandırmaktadır

Malnutrition

• The most important feeding problem, among people • Hospitalized in any clinic(ped, orthop, surgery etc)• Not hospitalized but has an ongoing illness.•

• Internal medicine, particularly neurology, oncology, Gastro-hepatology patients have malnutrition about 20-80 %

Malnutrition among hospitailized patients is reported as;

General %50,

Pulmonary diseases %45,

Inflamatory bowel disease %80,

Malign tumors %85 .

• Patients in surgery clinics are maltritioned about %30-65

• Becuase they have canser, trauma, acute inflamation, obstruction or fistulae as primary illness

• But• Hospital malnutrition =iatrogenic malnutrition

should not be forgotten• Nutritional disturbance that happens during

hospitalization is called iatrogenic malnutrition . • It is reported to be10-50%

m

BMI=body mass index

Kg/mxm

Aim of nutritional support

Prevent the existing malnutrition

Prevent advanced losses

Minimize katabolic effects

Prevent katabolism

Lower mortality and ratios of complications

Sum up

Reach a better nutritional state and keep that state.

The important point is to lower the loss of proteins and replace the loss

Nutritional support

Can be maintained in two major ways

1: Enteral route: oral

2:Parenteral route: via vessels, veins

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