Diet Plan

Pancreas -
pancreatitis
NCM 105

Batallones, anna mary

Cecilia, Issaiah Nicolle
Claver, kristine caithe
Ebite, marjorie
Garcia, tricia
Pajar jr., jessie
Uribe, ciara
 2 NRS – 1

NUTRITIONAL MANAGEMENT
Nutritional treatment in chronic pancreatitis
Maldigestion of macronutrients is the major cause of progressive nutritional and
metabolic impairment in patients with CP. Nutritional interventions depend on the degree
of maldigestion and the nutritional status.
The main goals for nutritional interventions are to ensure sufficient macro- and
micronutrients intake, to decrease maldigestion, malabsorption and other risk factors in
order to prevent or treat malnutrition.
The treatment of exocrine deficiency begins with dietary recommendations and
pancreatic enzyme supplementation. About 80% of patients can be managed by a
combination of analgesics, dietary recommendations and pancreatic enzyme supplements,
while 10%-15% need oral nutritional supplements, 5% need enteral tube feeding and
around 1% require parenteral nutrition[.
Diet recommendations
Dietary recommendations begin with total abstinence from alcohol. In addition, an
adequate number of calories should be taken. Estimation of REE [or measurement in
patients with a low BMI (< 20 kg/m 2)] is essential in all patients to calculate the adequate
caloric intake because of risk of increased resting energy expenditure. Frequent small
meals (4-8 times a day) should be given. The carbohydrate intake might be limited when
an overt diabetes mellitus is present (described in more detail in other article).
A protein diet of 1.0-1.5 g/kg body weight/d is generally sufficient and well tolerated.
Usually, if 30%-40% of the calories are given as fat this is well tolerated, especially when
the foods are rich in vegetable fats.
If weight gain is insufficient and/or steatorrhea persists, medium chain triglycerides
(MCT) can be tried to increase fat absorption. MCT are absorbed directly across the
small bowel into the portal vein, even in the absence of lipase, co-lipase and bile salts.
However, MCTs have low energy density and unpalatable taste, and a maximum of about
50 g/d might be given. Higher doses may be ketogenic and are associated with side
effects such as cramps, nausea and diarrhea. Fat soluble vitamins (A, D, E and K),
vitamin B12 and other micronutrients should be supplemented if serum levels indicate
deficiencies.
In general, a low fiber diet is recommended, because fiber may absorb enzymes and delay
the absorption of nutrients. An adequate quantity of exogenous pancreatic enzymes is
necessary to correct protein and lipid maldigestion. In 10%-15% of patients oral
supplements can help to attenuate weight loss and delay the use of enteral tube feeding.
The best clinical follow-up parameters for monitoring therapeutic success of dietary
counseling are improvement of the patient’s general condition and weight gain.

Enteral nutrition
The cause of inadequate caloric intake in CP can be anatomical (due to pyloro-duodenal-
stenosis or cyst compression) or inflammatory with acute complications (new attack of
acute pancreatitis or development of fistulas). Patients suffering from serious insufficient
caloric intake may benefit by oral supplements or enteral nutrition. To test if enteral
nutrition is tolerated and increases nutritional status it is recommended to give the
nutrition via a naso-jejunal tube. However, for long-term therapy feeding (exceeding 2-3
wk) a percutaneous endoscopic gastrostomy with a jejunal tube extension is more
convenient. Continuous overnight delivery of the nutrients is suitable and entails more
easily the patient’s nutritional goal. From a theoretical point of view a semi-elemental
diet can be recommended, but there are no studies showing improvement in the
nutritional status compared to regular enteral nutritional formulas.
Owing to the fact that CP patients are frequently undernourished, nutritional support
before pancreatic surgery may be beneficial. Data from patients undergoing general
abdominal surgery have provided evidence that preoperative enteral or oral nutritional
support improves outcome compared to undernourished patients by reducing
postoperative morbidity and the length of hospital stay. Thus, it should be emphasized
that nutritional therapy should go alongside surgery, and that surgery for pain or any
obstruction in the GI-channel should be a primary indication.
The potential to modulate the activity of the immune system by interventions with
specific nutrients is termed immunonutrition. This concept is normally applied to any
situation where nutritional formulas are supplemented with specific nutrients such as
arginine, glutamine, omega-3 fatty acids, nucleotides and others.
Another recent study showed that enteral immunonutrition given post-operatively vs a
standard enteral nutrition showed a reduction of infectious complications, anastomotic
leak rate and LOS as well as an improved immunologic outcome.
It is therefore highly recommend that patients going to elective surgery for chronic
pancreatitis must undergo a week with preoperative immunonutrition. Early postoperative
enteral nutrition is feasible and may additionally improve outcome after surgery.
Parenteral nutrition
Parenteral nutrition is infrequently used in patients with chronic pancreatitis. Enteral
nutrition preserves immune function and mucosal architecture and decreases the
possibility for hyperglycemia while parenteral nutrition also increases the risk of catheter
infections and sepsis complications. Parenteral nutrition is therefore only indicated when
it is impossible to use enteral nutrition. This means if the patients do not reach their
requirements because gastric emptying is blocked, the patient needs gastric
decompression, it is impossible to introduce a tube into the jejunum, or a complicated
fistula is present. Parenteral nutrition is mainly performed over a short term period, e.g.,
in apparent severe malnutrition prior to pancreatic surgery if enteral feeding is incomplete
and may thus be used as a supplement to fulfill their requirements.

Nutritional Guidelines
Malabsorption of nutrients can occur from poor digestion of food (due to reduced
pancreatic enzyme activity), which will result in nutrients passing into the stools. This is
seen especially with fat and fat soluble vitamins (A, D, E) as digestion of fat is highly
dependent on pancreatic enzymes.
In some cases, diabetes can develop if the pancreas is not able to make enough insulin to
help control blood sugars, so blood sugars stay high.
• Follow a low fat diet, which for chronic pancreatitis is often restricted to 50 grams
of fat, but could also range between 30-50 grams of fat depending on tolerance.
• If you have diabetes, eat recommended serving sizes of low fat carbohydrates to
help control blood sugars (low fat/non fat dairy, fruits, vegetables, whole grains, beans,
lentils etc). Information on serving sizes is available.
• Take pancreatic enzymes as prescribed by your doctor to treat malabsorption.
Take the enzymes before each meal and snack. They will not work if taken at the end of
the meal.
Low Fat Diet Tips
• Eat 4-6 small meals throughout the day
• Spread out your fat intake throughout the day
• Use butter, margarine and cooking oils sparingly
• Bake, grill, roast and/or steam foods. Do not fry or stir fry foods.
• Include fruits, vegetables, whole grains, low fat/non fat dairy daily in your
diet
• Add protein to each meal and snack (lean beef, chicken without skin, fish,
low fat/non fat dairy, egg whites, beans, soy etc)
• Avoid all alcohol and foods made with alcohol
• Read food labels. Choose foods labeled "low fat", "non fat", "fat free" and
"light"

Foods
Food Groups Foods Recommended Foods to Limit
Meats, baked, broiled, grilled or steamed: lean fried, fatty or heavily marbled
cuts of meats/poultry(without skin)/fish; meats/poultry(withskin), organ meats
Poultry,
canned tuna in water, eggs, egg whites, (liver etc), duck, fried eggs, bacon,
Fish, Eggs canned tuna in oil, whole fat
low fat/non fat deli meat slices
processed meats: hot dogs, salami,
sausages, etc
Dairy low fat/non fat dairy: milk, cheese, creamy/cheesy sauces, cream, fried
cottage cheese, cultured yogurt, ice cheese, whole fat dairy, milkshakes,
cream, frozen yogurt, sour cream half and half
Meat, Dairy almond/rice milk and its products, coconut milk, nuts, nut butters,
Alternatives beans, lentils, soy products, tofu refried beans, fried tofu
Grains whole grains: bagels, breads, bran, fried grains, biscuits, croissants,
buns, hot/cold cereals, couscous, low fat french fries, fried potato or corn
crackers, noodles, pancakes, pastas, chips, granola, fried rice, sweet rolls,
light butter popcorn, English muffins, muffins
rice, corn or flour tortilla, waffles

Fruits fresh, frozen and canned fruits avocado, fried fruits

Vegetables fresh, frozen and cooked vegetables fried/stir fried vegetables

Desserts applesauce, angel food cake, gelatin, fried desserts, brownies, cake, candy,
fruit ice, popsicles, puddings, sherbet, coconut, cookies, custard, donuts,
sorbet, small amounts of chocolate pastries, pies

Beverages coffee, fruit and vegetable juices, hot beverages with cream, eggnog, sodas
chocolate, sport drinks, tea
Seasonings, spices/herbs (as tolerated), jam, lard, meat drippings, regular
Condiments butter/margarine/cooking oils (small mayonnaise, olives, seeds, regular
amounts), broth, honey, low fat/light salad dressings, shortening, tahini
salad dressings, maple syrup, low fat/fat paste
free mayonnaise, non-dairy creamer,
mustard, salt, sugar

MCT oil and Nutritional Supplements (use if you have or at risk of losing weight) MCT oil
• MCT (Medium Chain Triglyceride) is a type of fat that is absorbed directly into
the blood without the need for pancreatic enzymes to break it down
• It is found in coconut and palm kernel oils
• Mix MCT oil into your foods. Start with 1-3 TBSP of MCT oil total for the day

Nutritional Supplements
• Drink fat free high calorie and protein juice nutritional supplements such as
Ensure Clear or Resource Juice Breeze at least twice daily
• MCT rich nutritional supplements such as Peptamen or Vital are available too
Current issues
about
nutrition
NCM 105
Issaiah Nicolle L. Cecilia
2 NRS – 1
HIGH-FIBER DIET TIED TO LOWER HEART RISK IN DIABETES PATIENTS

BY STEVEN REINBERG, HealthDay Reporter

FRIDAY, Oct. 4, 2019 (HealthDay News)

A fiber-rich diet appears to help people with high blood pressure and type 2 diabetes in
multiple ways, lowering their blood pressure, cholesterol and blood sugar levels, a new
study suggests.

High blood pressure (hypertension) and diabetes raise the risk for heart disease, and diet
may help keep it at bay, researchers say.

"This study helps us determine three important things for this patient population," said
lead author Dr. Rohit Kapoor, medical director of Care Well Heart and Super Specialty
Hospital in Amritsar, India.

"Firstly, a high-fiber diet is important in cases of diabetes and hypertension to prevent

future cardiovascular disease," Kapoor said in a news release from the American College
of Cardiology.

"Secondly, medical nutrition therapy and regular counseling sessions also hold great
importance in treating and prevention of diabetes and hypertension," he added.

Thirdly, this type of diet in combination with medical treatment can improve lipid levels,
pulse wave velocity [a measure of arterial stiffness], waist-to-hip ratio and high blood
pressure, Kapoor said.

For the study, Kapoor's team tracked fiber consumption among 200 participants over six
months. Patients sent photos of their meals on WhatsApp and engaged in phone calls
three times a week during which they were asked to recall their diet.
The study found that those participants eating a high-fiber diet showed significant
improvement in several risk factors, including a 9% reduction in cholesterol, 23%
reduction in triglycerides, 15% reduction in systolic (top number) blood pressure and a
28% reduction in blood sugar.

Foods high in fiber include fruits and vegetables, beans, whole grains and nuts.

The study results were scheduled to be presented Thursday at an American College of

Cardiology meeting, in Dubai, United Arab Emirates. Data and conclusions presented at
meetings are usually considered preliminary until published in a peer-reviewed medical
journal.
 LACTATING
HYPOCALCEMIA
PATIENT
NCM 105
Issaiah Nicolle L. Cecilia
2 NRS – 1
62” Heavy 60-15-25 Hypocalcemia Patient
DBW
62 x 2.54 = 157.48
157.48 – 100 = 57.48
57.48 – 5.748 = 51.732 K / 52 K
DBW = 52 K

TCR = 52K x 45 Cal/Kg DBW

TCR = 2340 Cal + 500 Cal
= 2840 Cal/day or 2850 Kcal

Carbohydrates/day = 2850 Kcal x .60

= 1710/4 Kcal
= 427.5 or 430 grams/day
Protein/day = 2850 Kcal x .15
= 427.5/4 Kcal
= 106.875 or 105 grams/day
Fats/day = 2850 Kcal x .25
= 712.5/9 Kcal
= 79.17 or 80 grams/day

Rx2850: 430-105-80
 # of CHO CHON Fat Kcal
exchange
Vegetabl 3 15 6 - 84 -100
e
Fruit 4 60 - - 240 – 250
Milk 7 84 56 21 749 – 750
Sugar 9 135 - - 540 – 550
430 – 294 = 136/15 = 9.07 or 9
Rice 9 135 27 - 648 – 650
105 – 89 = 16/7 = 2.3 or 2
Meat 2 - 14 16 200
80 – 37 = 43/5 = 8.6 or 9
Fat 9 - - 45 405 - 400
Total 429 g 103 g 82 g 2900 kcal
Rx2850: 430-105-80
 Diet Computation
Diet Prescription
and
Meal Planning
NCM 105

Issaiah Nicolle L. Cecilia

2 NRS – 1
 5’ 5” Moderate 65-15-20
DBW
12 x 5 = 60 + 5 = 65
65 x 2.54 = 165.1
165.1– 100 = 65.1
65.1 – 6.51 = 58.59 K / 59 K
DBW = 59 K

TCR = 59K x 40 Cal/Kg DBW

TCR = 2360 Cal/day or 2350 Kcal/day

Carbohydrates/day = 2350 Kcal x .65

= 1527.5/4 Kcal
= 381.875 or 380 grams/day
Protein/day = 2350 Kcal x .15
= 352.5/4 Kcal
= 88.125 or 90 grams/day
Fats/day = 2350 Kcal x .20
= 470/9 Kcal
= 52.22 or 50 grams/day

Rx2350: 380-90-50
 # of CHO CHON Fat Kcal
exchange
Vegetabl 3 15 6 - 84 -100
e
Fruit 4 60 - - 240 – 250
Milk 3 36 24 4 456 – 450
Sugar 9 135 - - 540 – 550
380 – 246 = 134/15 = 8.9 or 9
Rice 9 135 27 - 648 – 650
90 – 57 = 33/7 = 4.7 or 5
Meat 5 - 35 15 275 – 300
50 – 39 = 11/5 = 2.2 or 2
Fat 2 - - 10 90 - 100
Total 381 92 49 2350 kcal
Rx2350: 380-90-50

DIET PLAN

Vegetable = 3 = (1) Breakfast = (1) Lunch = (1) Supper

Fruit = 4 = (1) Breakfast = (1/2) AM Snack = (1) Lunch = (1) Supper = (1/2) PM
Snack
Milk =3 = (1) Breakfast = (1) AM Snack = (1) PM Snack
Sugar = 9 = (2) Breakfast = (1 1/2) AM Snack = (2) Lunch = (2) Supper = (1 1/2)
PM Snack
Rice = 9 = (2) Breakfast = (1 1/2) AM Snack = (2) Lunch = (2) Supper = (1 1/2)
PM Snack
Meat = 5 = (1) Breakfast = (1) AM Snack = (1) Lunch = (1) Supper = (1) PM
Snack
Fat = 2 = (1/2) Breakfast = (1/2) Lunch = (1) Supper
DIET PLAN No. of
exchange
Ripe Banana 1
Tenderloin Steak 1
Grilled Broccoli 1
Steamed Rice 2
Whole Milk 1
Sucrose 2
Butter ½
Red Apple ½
Bread 1½
Ham 1
Low Fat Milk 1
Jelly 1½
Ripe Mango 1
Grilled Chicken Breast 1
Chopsuey 1
Steamed Rice 2
Panocha 2
Margarine ½
Orange ½
Slice of Bread 1½
Bacon 1
Low Fat Milk 1
Syrup 1½
Strawberry 1
Beef Stew 1
Steamed Okra 1
Steamed Rice 2
Plain Ice Cream 2
Vegetable Oil 1