Nutrition Therapy and Pathophysiology

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 Dedication

For our colleagues in

nutrition and dietetics

For our students: past,

present, and future

In memory of Irma and Robert Nahikian

Marcia Nahikian-Nelms

For my supportive and loving husband Peter,

and my son Alexander
Kathryn Sucher

For my husband Jim; your

encouragement and support
mean the world to me
Karen Lacey

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 Brief Table of Contents

Part 1 Part 4
The Role of Nutrition Therapy Nutrition Therapy
in Health Care 12 Diseases and Disorders of Energy
1 Role of the Dietitian in the Health Care Imbalance 250
System 2 13 Diseases of the Cardiovascular
System 292
Part 2 14 Diseases of the Upper Gastrointestinal
The Nutrition Care Process Tract 342
2 The Nutrition Care Process 17 15 Diseases of the Lower Gastrointestinal
Tract 379
3 Nutrition Assessment: Foundation
of the Nutrition Care Process 36 16 Diseases of the Liver, Gallbladder,
and Exocrine Pancreas 436
4 Nutrition Intervention and Nutrition
Monitoring and Evaluation 72 17 Diseases of the Endocrine System 469

5 Enteral and Parenteral Nutrition 18 Diseases of the Renal System 521

Support 88 19 Diseases of the Hematological
6 Documentation of the Nutrition Care System 562
Process 115 20 Diseases and Disorders of the
Neurological System 596
Part 3 21 Diseases of the Respiratory System 635
Introduction to 22 Metabolic Stress and the Critically Ill 665
Pathophysiology 23 Neoplastic Disease 686
7 Fluid and Electrolyte Balance 126
24 HIV and AIDS 711
8 Acid-Base Balance 145
25 Diseases of the Musculoskeletal
9 Cellular and Physiological Response System 733
to Injury: The Role of the Immune
26 Metabolic Disorders 759
System 157
10 Nutritional Genomics 192 Appendixes A-1
11 Pharmacology 217 Glossary G-1

Index I-1

iv

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 Table of Contents

Part 1 Purpose of Providing Nutrition Care 19

The Role of Nutrition Therapy The AND’s Standardized Nutrition Care
Process 19
in Health Care Standardized Nutrition Language 19
Use of the NCP to Improve Quality of Care 20
1 Critical Thinking 21
Big Picture of Nutrition Care: The Model 21
Role of the Dietitian in the Health Central Core 21
Care System 2 Two Outer Rings 22

Introduction 2 Supportive Systems: Screening and Referral System

and Outcomes Management System 22
The Registered Dietitian in Clinical Practice 2
Steps of the NCP 23
The Role of the Clinical Dietitian 2
Step 1: Nutrition Assessment 23
Scope of Practice 3
Obtain and Verify Appropriate Data 24
The Clinical Nutrition Team 3
Cluster and Organize Assessment Data 24
Other Health Professionals—Interdisciplinary Evaluate the Data Using Reliable Standards 25
Teams 5
Step 2: Nutrition Diagnosis 25
Health Care Services and Reimbursement PES Statements 26
for Medical Nutrition Therapy (MNT) 9 Criteria for Evaluating PES Statements 27
Developing Critical Thinking Skills and Relationship of Nutrition Diagnosis to the Other Steps
Professional Performance 10 of the NCP 28
Definition of Critical Thinking 10 Step 3: Nutrition Intervention 29
Components of Critical Thinking 11 Prioritize the Nutrition Diagnoses 29
Specific Knowledge Base 11 Write the Nutrition Prescription 29
Experience 11 Set Goals 29
Competencies 11 Select the Nutrition Intervention 30
Attitudes 12 Implement the Nutrition Intervention 30
Standards 13 Step 4: Nutrition Monitoring and Evaluation 30
Levels of Clinical Reasoning 13 Monitor Progress 31
Conclusion 14 Measure Outcomes 31
Evaluate Outcomes 32

Part 2 Documentation 32
Conclusion 32
The Nutrition Care Process
3
2
Nutrition Assessment: Foundation
The Nutrition Care Process 17
of the Nutrition Care Process 36
Improving Health and Nutritional Status
Introduction 36
through Nutrition Care 17
Health Status 17
Nutritional Status 36
Nutritional Status 17
v

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An Overview: Nutrition Assessment Nutrition Care Indicator: Bioelectrical Impedance
and Screening 37 Analysis (BIA) 54
Subjective and Objective Data 38 Nutrition Care Criteria: Interpretation and Evaluation
of BIA Measurements 55
Subjective Data Collection 38
Nutrition Care Indicator: Hydrostatic (Underwater)
Client History 39
Weighing 55
Information Regarding Education, Learning,
Nutrition Care Indicator: Dual Energy X-Ray Absorptiometry
and Motivation 41
(DXA) 56
Tools for Data Collection 41
Nutrition Care Indicator: Air Displacement
Food- and Nutrition-Related History 41 Plethysmography 56
Nutrition Care Indicator: Twenty-Four-Hour Recall 41 Biochemical Assessment and Medical Tests
Nutrition Care Indicator: Food Record/Food Diary 41 and Procedures 56
Nutrition Care Indicator: Food Frequency 43 Protein Assessment 57
Nutrition Care Indicator: Observation of Food Intake/“Calorie Somatic Protein Assessment 57
Count” 43 Visceral Protein Assessment 58
Evaluation and Interpretation of Dietary Immunocompetence Assessment 60
Analysis Information 44 Nutrition Care Indicator: Total Lymphocyte
Nutrition Care Criteria: Evaluation and Interpretation Count (TLC) 60
Using the U.S. Dietary Guidelines 47 Nutrition Care Indicators for Hematological Assessment 60
Nutrition Care Criteria: Evaluation and Interpretation Hemoglobin (Hgb) 60
Using the USDA Food Patterns 47
Hematocrit (Hct) 60
Nutrition Care Criteria: Evaluation and Interpretation
Mean Corpuscular Volume (MCV) 60
Using the Exchange Lists for Diabetes/Carbohydrate
Counting 47 Mean Corpuscular Hemoglobin (MCH) 60
Nutrition Care Criteria: Evaluation and Interpretation Mean Corpuscular Hemoglobin Concentration (MCHC) 60
Using Individual Nutrient Analysis 48 Ferritin 60
Computerized Dietary Analysis 48 Transferrin Saturation 60
Nutrition Care Criteria: Evaluation and Interpretation Protoporphyrin 60
Using Dietary Reference Intakes and Daily Values 48 Serum Folate 60
Anthropometric/Body Composition Serum B12 60
Measurements 49 Vitamin and Mineral Assessment 61
Anthropometrics 49 Other Labs with Clinical Significance 61
Nutrition Care Indicator: Height/Stature 49 Nutrition-Focused Physical Findings 61
Nutrition Care Indicator: Weight 50
Functional Assessment 61
Nutrition Care Criteria: Evaluation and Interpretation
of Height and Weight in Infants and Children 50 Nutrition Care Criteria: Energy and Protein
Growth Charts 50 Requirements 62
Body Mass Index 51 Measurement of Energy Requirements 64
Nutrition Care Criteria: Evaluation and Interpretation Estimation of Energy Requirements 64
of Height and Weight in Adults 51 Energy Requirements Based on DRI 65
Usual Body Weight 51 Activity Factor 65
Percent Usual Body Weight and Percent Weight Stress Factors 66
Change 52 Measurement of Protein Requirements 66
Reference Weights 52 Estimation of Protein Requirements 66
Body Mass Index (BMI) 52 RDA for Protein 66
Waist Circumference 52 Protein Requirements in Metabolic Stress, Trauma,
Body Composition 52 and Disease 66
Nutrition Care Indicator: Skinfold Measurements 53 Protein–Kilocalorie Ratio 66
Nutrition Care Criteria: Interpretation and Evaluation Interpretation of Assessment Data: Nutrition
of Skinfold Measurements 54 Diagnosis 67
Conclusion 67

vi Table of Contents

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 Nutrition Assessment and Intervention: Determination
4 of the Enteral Nutrition Prescription 98
Monitoring and Evaluation: Complications 100
Nutrition Intervention Tube-Related Complications 101
and Nutrition Monitoring Gastrointestinal Complications 101

and Evaluation 72 Aspiration 102

Dehydration 102
Introduction 72
Electrolyte Imbalances 102
Nutrition Prescriptions 73
Underfeeding or Overfeeding 102
Food and/or Nutrient Delivery (Oral Diets) 74 Hyperglycemia 102
Modification of Meals and Snacks 75 Refeeding Syndrome 103
Supplements 77
Parenteral Nutrition 103
Medical Food Supplements 77
Indications 103
Modified Beverages and Foods 77
Venous Access 104
Vitamin and Mineral Supplements 77
Short-Term Venous Access 104
Bioactive Substance Management 78
Long-Term Venous Access 104
Feeding Assistance and Feeding Environment 79
Solutions 105
Nutrition-Related Medication Management 79
Parenteral Nutrition Substrates 105
Nutrition Education 79 Protein 105
Nutrition Counseling 81 Carbohydrate 105
Counseling Skills 81 Lipid 106
Theoretical Basis/Approach for Nutrition Counseling 82 Electrolytes 106
Counseling Strategies 83 Vitamins and Minerals 106
Coordination of Nutrition Care 84 Medications 107
Nutrition Monitoring and Evaluation 85 Nutrition Assessment and Intervention: Determination
of the Parenteral Nutrition Prescription 107
Conclusion 85
Administration 110
Monitoring and Evaluation: Complications 110
5 Conclusion 111
Enteral and Parenteral Nutrition
Support 88 6
Introduction: Planning and Implementation Documentation of the Nutrition
of Nutrition Interventions with Enteral
and Parenteral Nutrition Support 88 Care Process 115
Enteral Nutrition 90 Introduction 115
Indications 90 Charting: Documentation of the Nutrition
Gastrointestinal Access 91 Care Process 115
Formulas 93 Standardized Language and Medical Abbreviations 116

Protein 94 Problem-Oriented Medical Records 117

Carbohydrate 94 Organization of Nutrition Documentation 117

Lipid 95 SOAP 117

Vitamins/Minerals 95 PES, or Problem, Etiology, Signs/Symptoms

Statements 118
Fluid and Nutrient Density 95
Assessment, Diagnosis, Intervention,
Regulation of Enteral Formula Manufacture 97 Monitoring/Evaluation (ADIME) 119
Cost 97 IER Notes 119
Feeding Initiation and Advancement 97 Focus Notes 119
Feeding Delivery Methods 97 PIE Notes 120
Equipment 97 Charting by Exception 120

Table of Contents   vii

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Keeping a Personal Medical Notebook 120 Disorders of Fluid Balance 133
Guidelines for All Charting 120 Alterations in Volume 134
Confidentiality 121 Hypovolemia 134
Beyond Charting: An Overview of Writing Hypervolemia 136
in the Profession 122 Alterations in Osmolality 137
The Functions, Contexts, Parts, and Processes Sodium Imbalances 137
of Writing 122 Hyponatremia 137
Rhetorical Norms 122 Hypernatremia 137
Levels of Discourse 122 Potassium Imbalances 138
Steps in the Writing Process 122 Hypokalemia 138
Reporting Your Own Research 123 Hyperkalemia 138
Conclusion: Your Ethos—Establishing Calcium Imbalances 139
Expertise 123 Hypocalcemia 139
Hypercalcemia 139
Phosphorus Imbalances 139
Part 3
Hypophosphatemia 140
Introduction to Pathophysiology Hyperphosphatemia 140
Magnesium Imbalances 140
7 Hypomagnesemia 140
Hypermagnesemia 140
Fluid and Electrolyte Balance 126 Conclusion 141
Introduction 126
Normal Anatomy and Physiology of Fluids 8
and Electrolytes 126
Total Body Water 126 Acid-Base Balance 145
Fluid Compartments 126 Introduction 145
Movement of Fluid between Blood and Interstitial Basic Concepts: Acids, Bases, and Buffers 145
Spaces 127 Acids 145
Movement between Extracellular Fluid and Intracellular Bases 146
Fluid 128
Buffers 146
Total Body Water Balance 128
pH 146
Fluid Intake 129
Terms Describing pH 147
Fluid Output 129
Regulation of Acid-Base Balance 147
Fluid Requirements 130
Chemical Buffering 147
Body Solutes 130
The Bicarbonate–Carbonic Acid Buffer System 147
Types of Solutes 130
Other Chemical Buffer Systems 148
Distribution of Electrolytes 130
Respiratory Regulatory Control 148
Movement of Solutes 131
Renal Regulatory Control 149
Electrolyte Requirements 131
Control of Hydrogen and Bicarbonate Ions 149
Physiological Regulation of Fluid Other Renal Regulatory Controls 150
and Electrolytes 131
Effect of Acid and Base Shifts on Electrolyte Balance 150
Thirst Mechanism 131
Assessment of Acid-Base Balance 150
Renal Function 132
Hormonal Influence: Renin-Angiotensin-Aldosterone
Acid-Base Disorders 151
System and Arginine Vasopressin 132 Respiratory Acidosis 151
Electrolyte Regulation 133 Etiology 151
Sodium 133 Pathophysiology 151
Potassium 133 Clinical Manifestations 151
Calcium and Phosphorus 133 Treatment 152

viii Table of Contents

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Respiratory Alkalosis 152 Communication between Immune Cells 168
Etiology 152 Complement 168
Pathophysiology 152 Cytokines 169
Clinical Manifestations 152 The Immune Response 169
Treatment 152 Innate and Adaptive Immunity 169
Metabolic Acidosis 152 Innate Immune Response 169
Etiology 152 Inflammation and Healing 169
Pathophysiology 153 Adaptive Immune Response 178
Clinical Manifestations 154 Autoimmunity 178
Treatment 154
Attacking Altered and Foreign Cells: Tumors
Metabolic Alkalosis 154
and Transplants 180
Etiology 154
Tumor Immunology 181
Pathophysiology 154
Transplantation Immunology 181
Clinical Manifestations 154
Transplant Rejection 181
Treatment 154
Matching 181
Mixed Acid-Base Disorders 154
Immunosuppression 181
Assessment of Acid-Base Disorders 154
Transplantation of Specific Organs and Tissues 182
Conclusion 155 Immunization 182
Passive Immunization 182
9 Active Immunization 182
Types of Vaccines 182
Cellular and Physiological Immunodeficiency 183
Response to Injury: The Role Malnutrition and Immunodeficiency 183
of the Immune System 157 Inherited Immunodeficiencies 184
Introduction 157 Acquired Immunodeficiencies 184

The Disease Process 157 Hypersensitivity (Allergy) 184

Overview of Hypersensitivity 184
Cellular Injury 161
Definition 184
Mechanisms of Cellular Injury 161
Epidemiology 184
Cellular Response to Injury 161
Etiology: Classifications of Allergic Reactions 184
Cellular Accumulations 161
Pathophysiology 184
Cellular Alterations in Size and Number 162
Medical Diagnosis and Treatment 185
Cellular Injury from Infection 162
Delayed Hypersensitivity 185
Cellular Death 164
Adverse Reactions to Food 185
Host Resistance to Infectious Cellular Injury 164
Definition 185
Preventing Transmission of Infection 165
Epidemiology 185
Foundations of the Immune System 165 Etiology 185
Organs of the Immune System 166
Pathophysiology 186
Cells of the Immune System 167
Medical Diagnosis 186
Monocytes and Macrophages 167
Nutrition Therapy for Food Allergy 187
Leukocytes 167
Nutrition Implications 187
Other Cells Derived from the Myeloid Stem
Nutrition Assessment 187
Cell 167
Nutrition Diagnosis 187
Lymphocytes 167
Nutrition Intervention 187
Major Histocompatibility Complex/Human Leukocyte
Antigens 168 Conclusion 189

Table of Contents   ix

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 10 11
Nutritional Genomics 192 Pharmacology 217
Introduction 192 Introduction to Pharmacology 217
Nutritional Genomics: Nutrigenetics, Role of Nutrition Therapy in Pharmacotherapy 218
Nutrigenomics, and Nutritional Drug Mechanisms 220
Epigenomics 192 Administration of Drugs 221
An Overview of the Structure and Function Pharmacokinetics 221
of Genetic Material 197 Absorption of Drugs 221
Deoxyribonucleic Acid (DNA) and Genome
Distribution of Drugs 222
Structure 197
Metabolism of Drugs 222
Translating the Message from DNA to Protein 197
Excretion of Drugs 222
The Genetic Code 197
Alterations in Drug Pharmacokinetics 222
Transcription and Translation 199
Altered GI Absorption 223
Genetic Variation 200
Altered Distribution 223
Inheritance 200
Altered Metabolism 223
Single-Nucleotide Polymorphisms 201
Altered Urinary Excretion 223
Other Polymorphisms 202
Epigenetic Regulation 202 How Foods and Drugs Interact 223
DNA Methylation 203 Effect of Nutrition on Drug Action 224

Histone Modification 204 Effect of Nutrition on Drug Dissolution 224

The Epigenotype 204 Effect of Nutrition on Drug Absorption 224

Developmental Origins of Adult Disease 204 Effect of Nutrition on Drug Metabolism 224

Genomics and Technology 205 Effect of Nutrition on Drug Excretion 224

Nutritional Complications Secondary to Pharmacotherapy 225
Nutritional Genomics in Disease 206
Drug Consequence: Effect on Nutrient Ingestion 225
Cancer 206
Drug Consequence: Effect on Nutrient Absorption 226
From Single-Gene Inherited Cancers to Gene–Nutrient
Interactions 206 Drug Consequence: Effect on Nutrient Metabolism 227
Variations in Xenobiotic Metabolism Influence Drug Consequence: Effect on Nutrient Excretion 227
Risk 206 At-Risk Populations 228
MTHFR and ADH Polymorphisms Interact with Dietary Folate Drug–Nutrient Interactions in the Elderly 230
and Alcohol 207 Drug–Nutrient Interactions in HIV and AIDS 236
Fruits and Vegetables 207 Drug–Nutrient Interactions in Nutrition Support 236
Obesity 208
Nutrition Therapy 237
Diabetes 209
Nutritional Implications 237
Cardiovascular Disease 210
Nutrition Assessment 237
Individual Variation in Response to Environmental
Influences 210 Conclusion 239
Dietary Modification Is Effective in Monogenic
­Disease 210
Part 4
Dietary Fats Interact with Various Genotypes to ­Influence
Outcomes 210 Nutrition Therapy
Nutritional Genomics and the Practice
of Dietetics 211 12
Individual Testing in the Marketplace 212
Evolving Knowledge and Practice Requirements Diseases and Disorders of Energy
for Dietitians 212
Conclusion 213
Imbalance 250
Introduction 250
Energy Balance 250
Energy Intake 250
x Table of Contents

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Energy Expenditure 250 Underweight in Infants and Children 278
Resting Energy Expenditure 251 Eating Disorders 279
Thermic Effect of Food 252 Diagnosis and Behavioral Manifestations 279
Physical Activity Energy Expenditure 252 Anorexia Nervosa 279
Estimating and Measuring Energy Requirements 253 Bulimia Nervosa 279
Equations 253 Binge Eating Disorder 280
Indirect Calorimetry 254 Common Features 280
Regulation of Energy Balance and Body Epidemiology of Eating Disorders 280
Weight 254 Etiology of Eating Disorders 282
Neurochemicals That Regulate Appetite and Food Intake 254 Complications of Eating Disorders 282
Metabolic Activity of the Adipocyte and Adipose Tissue 254 Mortality 282
Overweight and Obesity 255 Health Complications of Anorexia Nervosa 282
Assessment and Identification of Overweight and Obesity 255 Health Complications of Bulimia Nervosa 283
Body Composition 255 Health Complications of Binge Eating Disorders 284
Body Mass Index 256 Treatment of Eating Disorders 284
Body Fat Distribution 257 Medical Treatment 284
Waist Circumference 258 Behavioral/Psychotherapy Treatment 285
Waist-to-Hip Ratio and Waist-to-Height Ratio 259 Nutrition Therapy 285
Epidemiology 259 Conclusion 286
Socioeconomic Status: Race, Gender, and Education 259
Adverse Health Consequences of Overweight and Obesity 260
13
Psychosocial and Emotional Consequences 260
Physiological Consequences 260 Diseases of the Cardiovascular
Etiology of Obesity 261
System 292
Medical Disorders, Pharmacological Treatments,
and Smoking Cessation 261 Introduction 292
Genetic Effects on Body Weight 261 Anatomy and Physiology of the Cardiovascular
Obesogenic Factors 263 System 292
Disordered Eating Patterns 265 The Heart 292
Sleep Patterns 266 Electrical Activity of the Heart 294
Treatment of Overweight and Obesity 266 Cardiac Cycle 294
General Guidelines for Medical Management 266 Cardiac Function 294
Pharmacologic Treatment 266 Regulation of Blood Pressure 295
Surgery 267 Hypertension 296
Nutrition Therapy for Overweight and Epidemiology 296
Obesity 270 Pathophysiology 296
Nutrition Assessment 270 Treatment 297
Anthropometric Measurements 270 Nutrition Therapy for Hypertension 301
Client History and Biochemical Data 270 Nutrition Assessment 301
Food-/Nutrition-Related History 271 Nutrition Diagnosis 301
Nutrition Diagnosis 271 Nutrition Intervention 301
Nutrition Intervention 272 DASH—Dietary Approaches to Stop Hypertension 302
Weight-Loss Goals 272 Weight Loss 302
Dietary Interventions 273 Sodium 305
Physical Activity 275 Alcohol 305
Nutrition Counseling Strategies for Behavior Change 277 Potassium, Calcium, and Magnesium 305
Underweight 278 Physical Activity 306
Underweight in Older Adults 278 Smoking Cessation 306
Possible Nutrition Diagnoses 278

Table of Contents   xi

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Atherosclerosis 307 Etiology 325
Definition 307 Pathophysiology 325
Epidemiology 307 Clinical Manifestations, Medical Diagnosis, and Treatment 326
Pathophysiology 307 Heart Failure 326
Risk Factors 309 Definition 326
Family History 309 Epidemiology 326
Age and Sex 309 Etiology 326
Obesity 309 Pathophysiology 326
Dyslipidemia 309 Clinical Manifestations 326
Hypertension 310 Treatment 328
Physical Inactivity 310 Nutrition Therapy for Heart Failure 328
Diabetes Mellitus 311 Nutrition Assessment and Diagnosis 328
Impaired Fasting Glucose and Metabolic Syndrome 311 Nutrition Intervention 328
Cigarette Smoke 311 Sodium 328
Obstructive Sleep Apnea 311 Energy and Protein 328
Clinical Manifestations and Diagnosis 312 Fluid 331
Medical Treatment 315 Drug–Nutrient Interactions 331
Nutrition Therapy for Atherosclerosis 315 Medical Procedures for Cardiac Failure 331
Nutrition Assessment 316 CRT, Ventricular Restoration, and VAD 332
Nutrition Diagnosis 316 Heart Transplant 332
Nutrition Intervention 317 Selection Criteria and the Donor List 332
Weight Loss 317 Transplant Surgery 332
Physical Activity 317 Nutrition Therapy for Heart Transplant 332
Total Dietary Fat 317 Nutrition Assessment 332
Saturated Fat 317 Nutrition Diagnosis 333
Trans Fatty Acids 317 Nutrition Intervention, Monitoring, and Evaluation 333
Monounsaturated Fat 319 Nutrition Support Route 333
Ω-3 (Omega-3) Fatty Acids: Linolenic Acid 319 Energy 334
Other Polyunsaturated Fatty Acids 319 Carbohydrate 334
Cholesterol 319 Lipid 334
Fiber 319 Protein 334
Nuts 319 Fluid 334
Plant/Sterols (Phytosterols) 320 Micronutrients 334
Folate 322
Atrial Fibrillation 334
Nutrition Education and/or Nutrition Counseling 322
Epidemiology 334
Monitoring and Evaluation 322
Treatment 334
Ischemic Heart Disease 322 Nutritional Implications and Nutrition Intervention 334
Definition 322
Conclusion 334
Epidemiology 322
Pathophysiology 322
Clinical Manifestations 324 14
Medical Diagnosis 324
Treatment 325
Diseases of the Upper
Nutrition Therapy for Ischemic Heart Gastrointestinal Tract 342

Disease 325 Introduction 342

Nutrition Intervention 325 Normal Anatomy and Physiology of the Upper
Peripheral Arterial Disease 325 Gastrointestinal Tract 342
Definition 325 Motility, Secretion, Digestion, and Absorption 342
Epidemiology 325

xii Table of Contents

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Anatomy and Physiology of the Oral Cavity 344 Clinical Manifestations 359
Oral Cavity Motility 344 Diagnosis 359
Oral Cavity Secretions 344 Nutrition Therapy for Dysphagia 359
Physical Assessment of the Oral Cavity: An Important Nutritional Implications and Assessment 359
Component of Nutrition Assessment 345 Nutrition Diagnosis 361
Normal Anatomy and Physiology of the Esophagus 345 Nutrition Intervention 361
Normal Anatomy and Physiology of the Stomach 346 Monitoring and Evaluation 362
Gastric Motility 347 Hiatal Hernia 362
Gastric Secretions 347
Pathophysiology of the Stomach 363
Gastric Digestion 348
Indigestion 363
Gastric Absorption 348
Nausea and Vomiting 363
Pathophysiology of the Oral Cavity 348 Nutrition Therapy for Nausea and Vomiting 364
Dental Caries 348 Nutritional Implications 364
Individuals at Risk for Dental Disease 349 Nutrition Diagnosis 364
Prevention of Dental Disease 349 Nutrition Intervention 364
Inflammatory Conditions of the Oral Cavity 350 Gastritis 365
Conditions Resulting in Altered Salivary Gland Function 350 Definition 365
Surgical Procedures for the Oral Cavity 351 Etiology 365
Nutrition Assessment and Diagnosis 352 Pathophysiology 365
Nutrition Intervention 352 Peptic Ulcer Disease 365
Impaired Taste: Dysgeusia/Ageusia 352 Definition 365
Nutrition Therapy for Pathophysiology of the Oral Epidemiology 365
Cavity 353
Etiology 365
Nutritional Implications 353
Clinical Manifestations 366
Nutrition Diagnosis 353
Diagnosis 366
Nutrition Intervention 353
Treatment 366
Monitoring and Evaluation 354
Nutrition Therapy for Peptic Ulcer Disease 366
Pathophysiology of the Esophagus 355 Nutritional Implications and Assessment 366
Gastroesophageal Reflux Disease 355 Nutrition Diagnosis 366
Definition 355 Nutrition Intervention 366
Epidemiology 355 Monitoring and Evaluation 367
Pathophysiology 355 Gastric Surgery 367
Clinical Manifestations 355 Vagotomy 367
Medical Diagnosis 355 Gastroduodenostomy (Billroth I), Gastrojejunostomy
Treatment 355 (Billroth II), and Roux-en-Y Procedure 368
Nutrition Therapy for GERD 355 Nutrition Therapy for Gastric Surgery 368
Nutrition Diagnosis 356 Nutritional Implications 368
Nutrition Assessment 356 Nutrition Diagnosis 368
Nutrition Intervention 356 Dumping Syndrome 368
Monitoring and Evaluation 357 Nutrition Intervention 369
Barrett’s Esophagus—A Complication of GERD 357 Monitoring and Evaluation 369
Eosinophilic Esophagitis 357 Bariatric Surgery 369
Definition 357 Gastroparesis 369
Epidemiology 357 Definition 369
Etiology 357 Etiology 371
Diagnosis 359 Diagnosis 371
Clinical Manifestations 359 Clinical Manifestations 371
Treatment 359 Treatment 371
Dysphagia 359 Nutrition Therapy for Gastroparesis 372
Definition 359 Nutritional Implications 372

Table of Contents   xiii

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 Nutrition Diagnosis 372 Malabsorption 400
Nutrition Intervention 372 Definition 400
Stress Ulcers 372 Etiology 400
Zollinger-Ellison Syndrome 373 Pathophysiology 402
Conclusion 373 Treatment 403
Nutrition Therapy for Malabsorption 403

15 Nutrition Assessment 403

Nutrition Diagnosis 403
Diseases of the Lower Nutrition Intervention 403
Celiac Disease 405
Gastrointestinal Tract 379
Definition 405
Introduction 379
Epidemiology 405
Normal Anatomy and Physiology of the Lower Etiology 405
Gastrointestinal Tract 379 Pathophysiology 405
Small Intestine Anatomy 379
Clinical Manifestations 405
Small Intestine Motility 381
Medical Diagnosis 406
Small Intestine Secretions 382
Prognosis and Treatment 406
Small Intestine Digestion 383
Nutrition Therapy for Celiac Disease 406
Small Intestine Absorption 383
Nutrition Assessment 406
Large Intestine Anatomy 387
Nutrition Diagnosis 406
Large Intestine Motility 387
Nutrition Intervention 406
Large Intestine Secretions 387
Irritable Bowel Syndrome 413
Large Intestine Digestion and Absorption 388
Definition 413
Nutrition Assessment for Lower Epidemiology 413
Gastrointestinal Tract Conditions 389 Etiology 414
Pathophysiology of the Lower Gastrointestinal Pathophysiology 414
Tract 389 Clinical Manifestations 415
Diarrhea 390 Medical Treatment 415
Definition 390 Nutrition Therapy for Irritable Bowel Syndrome 415
Epidemiology 390 Nutrition Assessment 415
Etiology 390 Nutrition Diagnosis 415
Clinical Manifestations 392 Nutrition Intervention 415
Medical Diagnosis 392 Inflammatory Bowel Disease 418
Treatment 392 Definition 418
Nutrition Therapy for Diarrhea 392 Epidemiology 418
Nutrition Assessment 394 Etiology 418
Nutrition Diagnosis 394 Pathophysiology 418
Nutrition Interventions 394 Clinical Manifestations 419
Constipation 395 Treatment 420
Definition 395 Nutrition Therapy for Inflammatory Bowel Disease 420
Epidemiology 396 Nutrition Assessment 421
Etiology 396 Nutrition Diagnosis 421
Clinical Manifestations 396 Nutrition Intervention 421
Medical Diagnosis 396 Diverticulosis/Diverticulitis 423
Treatment 396 Definition 423
Nutrition Therapy for Constipation 396 Epidemiology 423
Nutrition Assessment 400 Etiology 423
Nutrition Diagnosis 400 Pathophysiology 423
Nutrition Interventions 400 Clinical Manifestations 423
Treatment 423
xiv Table of Contents

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Nutrition Therapy for Diverticulosis/Diverticulitis 423 Pathophysiology of the Liver 446
Nutrition Assessment 423 Hepatitis 446
Nutrition Diagnosis 423 Hepatitis A Virus 446
Nutrition Intervention 423 Serum Hepatitis or Hepatitis B Virus 446
Common Surgical Interventions for the Lower Hepatitis C Virus 447
GI Tract 424 Hepatitis D and E Virus 449
Ileostomy and Colostomy 424 Nutrition Therapy for Viral Hepatitis 449
Nutrition Therapy for Ileostomy and Colostomy 424 Nutritional Implications 449
Nutrition Intervention 425 Nutrition Assessment 449
Short Bowel Syndrome 426 Nutrition Diagnosis 449
Definition 426 Nutrition Intervention 449
Epidemiology 426 Monitoring and Evaluation 449
Etiology 426 Alcoholic Liver Disease 450
Pathophysiology 427 Fatty Liver 450
Treatment 427 Alcoholic Hepatitis 452
Nutrition Therapy for Short Bowel Syndrome 427 Nutrition Therapy for Individuals with Alcohol Dependency/
Nutrition Assessment 427 Alcoholic Hepatitis 453
Nutrition Diagnosis 427 Nutritional Implications 453
Nutrition Intervention 427 Nutrition Assessment 453
Bacterial Overgrowth 429 Nutrition Diagnosis 453
Definition 429 Nutrition Intervention 456
Pathophysiology 429 Monitoring and Evaluation 456
Clinical Manifestations 429 Cirrhosis 456
Treatment 429 Clinical Manifestations 457
Nutrition Therapy for Bacterial Overgrowth 430 Treatment 457
Conclusion 430 Nutrition Therapy for Cirrhosis 457
Nutritional Implications 457

16 Nutrition Assessment 458

Nutrition Diagnosis 458
Diseases of the Liver, Gallbladder, Nutrition Intervention 458

and Exocrine Pancreas 436 Monitoring and Evaluation 458

Liver Transplant 458
Introduction 436
Nutrition Therapy for Liver Transplant 459
Anatomy and Physiology of the Hepatobiliary Nutritional Implications 459
System 436
Nutrition Assessment 459
Anatomy of the Liver 436
Nutrition Diagnosis 459
Functions of the Liver 439
Nutrition Intervention 459
Bile Secretion 439
Monitoring and Evaluation 459
Enterohepatic Circulation of Bile 440
Pathophysiology of the Biliary System 459
Anatomy and Physiology of the Gallbladder 440
Cholelithiasis (Gallstones) 459
Anatomy and Physiology of the Pancreas 441
Biliary Obstruction 460
Pertinent Laboratory Values 441
Cholecystitis 460
Liver 441
Cholangitis 460
Pancreas 443
Nutrition Therapy for Cholelithiasis 460
Pathophysiology Common to the Hepatobiliary
Nutritional Implications 460
Tract 443
Nutrition Assessment 460
Jaundice 443
Nutrition Diagnosis 460
Portal Hypertension/Ascites 443
Nutrition Intervention 461
Encephalopathy 444
Monitoring and Evaluation 461

Table of Contents   xv

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Pathophysiology of the Exocrine Pancreas 461 Nutritional Implications 495
Pancreatitis 461 Nutrition Assessment 495
Acute Pancreatitis 461 Nutrition Diagnosis 495
Chronic Pancreatitis 461 Nutrition Intervention 495
Nutrition Therapy for Pancreatitis 462 Monitoring and Evaluation 503
Nutritional Implications 462 Physical Activity 504
Nutrition Assessment 462 Nutritional Implications 504
Nutrition Diagnosis 462 Nutrition Assessment 504
Nutrition Intervention 462 Nutrition Intervention 505
Monitoring and Evaluation 462 Acute Complications 505
Conclusion 463 Side Effects and Complications of Insulin Therapy 505
Dawn Phenomenon 505
Diabetic Ketoacidosis 505
17 Hyperglycemic Hyperosmolar Syndrome 505
Diseases of the Endocrine Short-Term Illness 507
Long-Term Complications of Hyperglycemia 507
System 469 Macrovascular Complications: Cardiovascular
Introduction 469 Disease 507
Normal Anatomy and Physiology of the Nephropathy 507
Endocrine System 472 Retinopathy 508
Classification of Hormones 472 Nervous System Diseases 508
Endocrine Function 473 Nutrition Therapy for Long-Term Complications
Pituitary Gland 473 of Hyperglycemia 508
Thyroid Gland 473 Gestational Diabetes Mellitus 508
Adrenal Glands 474 Definition 508
Endocrine Pancreas 474 Epidemiology 508
Endocrine Control of Energy Metabolism 474 Etiology 508
Insulin 476 Pathophysiology 508
Glucagon 477 Clinical Manifestations 509
Diagnosis 509
Pathophysiology of the Endocrine System 479
Medical Treatment 509
Diabetes Mellitus 480
Monitoring 509
Type 1 Diabetes Mellitus 481
Nutrition Therapy for Gestational Diabetes Mellitus 509
Epidemiology 481
Nutritional Implications 509
Etiology 481
Nutrition Diagnosis 509
Pathophysiology and Clinical Manifestations 481
Nutrition Intervention 509
Type 2 Diabetes Mellitus 482
Monitoring and Evaluation 510
Epidemiology 482
Etiology 483
Hypoglycemia 510
Definition 510
Pathophysiology 484
Etiology 510
Clinical Manifestations 484
Pathophysiology 510
Diagnosis of Diabetes Mellitus 486
Fasting Hypoglycemia 511
A1c (Glycosylated Hemoglobin) 487
Post-prandial (Reactive) Hypoglycemia 511
Oral Glucose Tolerance Test 487
Clinical Manifestations 511
Islet Cell Autoantibodies 487
Medical Treatment 511
C-Peptide 487
Nutrition Therapy for Reactive Hypoglycemia 511
Medical Treatment of Diabetes Mellitus 487
Nutritional Implications 511
Insulin 490
Nutrition Diagnosis 511
Medications for Type 2 Diabetes 492
Nutrition Intervention 511
Nutrition Therapy for Diabetes Mellitus 495

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Other Endocrine Disorders 511 Nutrition Intervention 532
Hypothyroidism 512 CKD Pre-dialysis 532
Definition 512 CKD Stage 5 538
Epidemiology 512 Nutrition Therapy for Comorbid Conditions and
Complications 547
Etiology 512
Medicare Coverage for Medical Nutrition Therapy 548
Pathophysiology 512
Nutritional Requirements after Kidney Transplant 549
Clinical Manifestations 512
Monitoring and Evaluation 552
Medical Treatment 513
Nutrition Therapy for Hypothyroidism 513 Acute Kidney Injury 552
Hyperthyroidism 513 Definition 552
Definition 513 Epidemiology 553
Epidemiology and Etiology 513 Etiology 553
Pathophysiology 513 Pathophysiology 553
Clinical Manifestations 513 Clinical Manifestations 553
Medical Treatment 513 Electrolytes 553
Nutrition Therapy for Hyperthyroidism 514 Blood Urea Nitrogen and Creatinine 553
Pituitary Disorders 514 Treatment 553
Pituitary Tumors 514 Nutrition Therapy for Acute Kidney
Hyperpituitarism 514 Injury 553
Acromegaly 514 Nutrition Intervention 553
Cushing’s Syndrome 515 Nephrolithiasis 554
Hypopituitarism 515 Definition 554
Diabetes Insipidus 515 Epidemiology 554
Adrenal Cortex Disorders 515 Pathophysiology 555
Excess Secretion of Glucocorticoids 516 Diagnosis and Treatment 555
Insufficient Secretion of Adrenal Cortex Steroids 516 Nutrition Therapy for Nephrolithiasis 555
Conclusion 516 Nutrition Assessment 555
Nutrition Diagnosis 555
18 Nutrition Intervention 555
Conclusion 557
Diseases of the Renal System 521
Introduction 521 19
The Kidneys 521
Anatomy 521 Diseases of the Hematological
Physiological Functions 523 System 562
Laboratory Evaluation of Kidney Function 524 Overview of the Hematological System 562
Pathophysiology Overview 525 Blood Composition 562
Chronic Kidney Disease 526 Anatomy and Physiology of the Hematological
Definition and Medical Diagnosis 526 System 564
Epidemiology 527 The Cells of the Hematological System 564
Etiology 527 The Development of the Hematological Cells 565
Treatment 527 Hemoglobin 566
Dialysis 528
Homeostatic Control of the Hematological
Renal Transplantation 530 System 567
Nutrition Therapy for Chronic Kidney Blood Clotting 567
Disease 531 Factors Affecting Hemostasis 568
Nutrition Assessment 531 Summary 568
Nutrition Diagnosis 532

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Nutritional Anemias 569 Aplastic Anemia 587
Microcytic Anemias: Iron-Deficiency and Functional Nutrition Therapy 587
Anemia 569 Clotting and Bleeding Disorders 587
Definition 569 Hemophilia 587
Epidemiology 570 Nutrition Therapy 587
Etiology 570 Hemorrhagic Disease of the Newborn 587
Associated Health Conditions 572 Nutrition Therapy 587
Clinical Manifestations 573
Conclusion 589
Treatment 576
Nutrition Therapy for Microcytic Anemias 576
Nutritional Implications 576
20
Nutrition Diagnosis 576
Diseases and Disorders of the
Nutrition Intervention 576
Monitoring and Evaluation 579 Neurological System 596
Megaloblastic Anemias 579 Introduction 596
Definition 579 Normal Anatomy and Physiology of the
Epidemiology 580 Nervous System 596
Etiology 580 Communication within the Nervous System 596
Pathophysiology 580 The Central Nervous System (CNS) 599
Clinical Manifestations 581 Epilepsy and Seizure Disorders 599
Treatment 581 Definition 599
Nutrition Therapy for Megaloblastic Anemias 581 Epidemiology 599
Nutritional Implications 581 Etiology 599
Nutrition Diagnosis 581 Pathophysiology 599
Nutrition Intervention 581 Clinical Manifestations 600
Monitoring and Evaluation 582 Medical Diagnosis 600
Hemochromatosis 582 Treatment 601
Definition 582 Antiepileptic Drugs 601
Epidemiology 582 Surgical Treatments 601
Etiology 582 Nutrition Therapy for Epilepsy and Seizure
Pathophysiology 583 Disorders 601
Clinical Manifestations 583 Nutritional Implications 604
Treatment 583 Nutrition Assessment 604
Nutrition Therapy 583 Nutrition Diagnosis 604
Nutritional Implications 583 Nutrition Intervention 604
Nutrition Diagnosis 584 Monitoring and Evaluation 605
Nutrition Intervention 584 Stroke and Aneurysm 606
Monitoring and Evaluation 584 Definition 606
Hemoglobinopathies: Non-Nutritional Epidemiology 606
Anemias 584 Etiology 606
Sickle Cell Anemia 584 Pathophysiology 607
Nutrition Therapy 584 Clinical Manifestations 608
Thalassemia 584 Medical Diagnosis 608
Nutrition Therapy 584 Treatment 608
Polycythemia 584 Nutrition Therapy for Stroke and Aneurysm 609
Nutrition Therapy 587 Nutritional Implications 609
Hemolytic Anemia 587 Nutrition Diagnosis 609
Nutrition Therapy 587 Nutrition Intervention 609
Anemia of Prematurity 587 Monitoring and Evaluation 611
Nutrition Therapy 587
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Progressive Neurological Disorders 611 Dementia 619
Parkinson’s Disease 611 Definition 619
Definition 611 Epidemiology 619
Epidemiology 611 Etiology 619
Etiology 611 Pathophysiology 619
Pathophysiology 611 Clinical Manifestations 619
Clinical Manifestations 611 Medical Diagnosis 619
Medical Diagnosis 611 Treatment 620
Treatment 611 Nutrition Therapy for Dementia 620
Nutrition Therapy for Parkinson’s Disease 613 Nutritional Implications 620
Nutritional Implications 613 Nutrition Diagnosis 621
Nutrition Diagnosis 614 Nutrition Intervention 621
Nutrition Intervention 614 Monitoring and Evaluation 622
Monitoring and Evaluation 614 Neurotrauma and Spinal Cord Injury 622
Amyotrophic Lateral Sclerosis 614 Traumatic Brain Injury 622
Definition 614 Definition 622
Epidemiology 615 Epidemiology 622
Etiology 615 Etiology 622
Pathophysiology 615 Pathophysiology 622
Clinical Manifestations 615 Clinical Manifestations 622
Medical Diagnosis 615 Medical Diagnosis 623
Treatment 615 Treatment 623
Guillain-Barré Syndrome 615 Nutrition Therapy for Traumatic Brain Injury 623
Definition 615 Nutritional Implications 623
Epidemiology 615 Nutrition Diagnosis 623
Etiology 615 Nutrition Intervention 623
Pathophysiology 615 Monitoring and Evaluation 624
Clinical Manifestations 615 Spinal Cord Injury 624
Medical Diagnosis 615 Definition 624
Treatment 616 Epidemiology 624
Myasthenia Gravis 616 Etiology 624
Definition 616 Pathophysiology 624
Epidemiology 616 Treatment 624
Etiology 616 Nutrition Therapy for Spinal Cord Injury 624
Pathophysiology 616 Nutritional Implications 624
Clinical Manifestations 616 Nutrition Diagnosis 625
Medical Diagnosis 616 Nutrition Intervention 625
Treatment 616 Monitoring and Evaluation 625
Multiple Sclerosis 616 Conclusion 625
Definition 616
Epidemiology 616
Etiology 616
21
Pathophysiology 617 Diseases of the Respiratory
Clinical Manifestations 617
Treatment 617
System 635
Nutrition Therapy for Multiple Sclerosis 617
Introduction 635
Nutritional Implications 617 Normal Anatomy and Physiology
Nutrition Diagnosis 617 of the Respiratory System 635
Nutrition Intervention 617 Measures of Pulmonary Function 637

Monitoring and Evaluation 619 Nutrition and Pulmonary Health 639

Table of Contents   xix

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Asthma 640 Biochemical Data and Medical Tests 651
Definition 640 Nutrition Diagnosis 652
Epidemiology 640 Nutrition Intervention 652
Etiology 640 Nutrition-Related Medication Management: Pancreatic
Enzyme Therapy 652
Pathophysiology 641
Clinical Manifestations 641 Energy and Macronutrients 652

Treatment 641 Vitamin and Mineral Supplements 653

Recommended Infant Feeding 653
Nutrition Therapy for Asthma 641
Pneumonia 654
Bronchopulmonary Dysplasia 642
Definition 654
Definition 642
Epidemiology 654
Etiology 642
Etiology 654
Treatment 642
Aspiration Pneumonia 655
Nutrition Therapy for Bronchopulmonary
Dysplasia 643 Patients with Tracheostomies 655
Nutrition Assessment and Diagnosis 643 Nutritional Implications 656
Nutrition Intervention 643 Respiratory Failure 656
Energy and Macronutrient Needs 643 Nutrition Therapy for Respiratory Failure 657
Vitamins and Minerals 643 Nutritional Implications 657
Feeding Practices 643 Nutrition Assessment and Intervention 657
Chronic Obstructive Pulmonary Disease 644 Nutrient Requirements 657
Definition 644 Enteral and Parenteral Nutrition 657
Epidemiology 644 Transplantation 657
Etiology 645 Definition and Epidemiology 657
Pathophysiology: Chronic Bronchitis 646 Pathophysiology 657
Clinical Manifestations: Chronic Bronchitis 646 Nutrition Therapy for Transplantation 658
Pathophysiology: Emphysema 646 Nutritional Implications 658
Clinical Manifestations: Emphysema 646 Nutrition Assessment 658
Treatment 646 Nutrient Requirements 658
Nutrition Therapy for Chronic Obstructive Nutrition Intervention 658
Pulmonary Disease 647 Upper Respiratory Infection 658
Nutrition Assessment and Diagnosis 647
Definition and Epidemiology 658
Anthropometric Measurements 647
Pathophysiology 658
Food-/Nutrition-Related History 648
Clinical Manifestations 658
Medication Use 649
Nutritional Implications 658
Physical Activity and Function 649
Conclusion 659
Nutrition Intervention 649
Energy and Nutrient Needs 649
Food and/or Nutrient Delivery 649 22
Coordination of Nutrition Care: Physical Exercise 650
Cystic Fibrosis 650
Metabolic Stress and the
Definition 650 Critically Ill 665
Epidemiology 650 Introduction 665
Etiology 650 Physiological Response to Starvation 665
Pathophysiology 650 Physiological Response to Stress 667
Medical Diagnosis 651 Definition 667
Nutrition Therapy for Cystic Fibrosis 651 Epidemiology 667
Nutritional Implications 651 Etiology 668
Nutrition Assessment 651 Clinical Manifestations 668
Anthropometric Measurements 651

xx Table of Contents

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Pathophysiology 668 Pathophysiology 690
Medical Diagnosis and Treatment 669 Medical Diagnosis 690
Nutrition Therapy for Metabolic Stress 670 Treatment 692
Nutrition Assessment 670 Surgery 693
Nutrition Diagnosis 672 Cancer Diagnoses Requiring Surgery 693
Nutrition Intervention 672 Cancers of the Head and Neck 693
Sepsis, Systemic Inflammatory Response Esophageal Cancer 693
Syndrome (SIRS), and Multiorgan Distress Gastric Cancer 693
Syndrome (MODS)/Multisystem Organ Failure Intestinal Cancers 694
(MSOF) 675 Pancreatic Cancer 694
Definition 675
Chemotherapy 694
Epidemiology 675
Radiation 694
Etiology 675
Biological and Targeted Therapy 696
Clinical Manifestations 675
Immunotherapy 696
Pathophysiology 675
Cytokines 696
Treatment 676
Hematopoietic Stem Cell Transplantation 696
Nutrition Therapy for Sepsis 677
Nutrition Therapy 698
Burns 677 Nutritional Implications 698
Definition 677
Nutrition Assessment 698
Epidemiology 677
Nutrition Diagnosis 698
Etiology 677
Nutrition Intervention 698
Clinical Manifestations 677
Interventions for Common Side Effects of Cancer
Pathophysiology 678 and Treatment 698
Treatment 679 Interventions during Chemotherapy and Radiation
Nutrition Therapy for Burns 679 Treatment 704
Nutrition Assessment 679 Interventions before and after Surgery 705
Nutrition Diagnosis 679 Interventions for Hematopoietic Cell Transplantation 706
Nutrition Intervention 679 Determining Nutrient Requirements 706
Monitoring and Evaluation 706
Surgery 680
Definition 680 Conclusion 706
Epidemiology 680
Etiology 680 24
Clinical Manifestations 680
Nutrition Therapy for Post-Surgery 681 HIV and AIDS 711

Nutrition Assessment 681 Introduction 711

Nutrition Diagnosis 681 Epidemiology 711
Nutrition Intervention 681 Pathophysiology 712
Conclusion 681 Clinical Manifestations 713
Medical Diagnosis 716
23 Treatment 717
Anti-HIV Therapies 717
Neoplastic Disease 686
Nutrition and HIV 718
Introduction 686 Opportunistic Disease 718
Definition 686 Wasting Syndrome 721
Epidemiology 686 Side Effects of ARV Medications 721
Etiology of Cancer 686 Lipodystrophy 721
Cancer Genetics 687 Supplements and Herbal Therapies 722
Cancer and Nutrition 690

Table of Contents   xxi

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