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Nutrition Lecture Revised 3-1-13
Nutrition Lecture Revised 3-1-13
Balancing Calories ● Enjoy your food, but eat less. ● Avoid oversized portions.
Foods to Increase ● Make half your plate fruits and vegetables. ● Make at least
half your grains whole grains. ● Switch to fat-free or low-fat (1%) milk.
Foods to Reduce ● Compare sodium in foods like soup, bread, and frozen meals
― and choose the foods with lower numbers. ● Drink water instead of sugary
drinks.
Website: http://www.choosemyplate.gov/
Includes interactive tools including a personalized daily food plan
Plan, analyze and track diet and physical activity.
Macronutrients
Carbohydrates
Converted to glucose, body’s major source of energy
Simple vs. Complex dependent on chemical structure
Yields 3.4 kcal/gm
Recommended 45-65% total daily calories.
Fats
Major endogenous fuel source in healthy adults
Yields 9 kcal/gm
Aids body in absorbing vitamins, proper growth and development
Too little can lead to essential fatty acid (linoleic acid) deficiency and
increased risk of infections
Chose less saturated and trans fats
Recommended 20-30% of total caloric intake
Protein
Needed to maintain anabolic state (match catabolism)
Yields 4 kcal/gm
Complete versus incomplete
Build and maintain bones, muscles and skin
Must adjust in patients with renal and hepatic failure
Recommended 10-35% of total caloric intake.
Normal Nutrition
Requirements
HEALTHLY male/female
(weight maintenance)
• Caloric intake=25-30 kcal/kg/day
•Harris Benedict Equation for Basal Metabolic Rate (multiply by activity factor for REE):
•Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years )
Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in year )
Requirements
? SURGICAL PATIENT ?
Increased Risk of Malnutrition
Inadequate nutritional intake
Metabolic response (hypermetabolism from long term
inflammation or infectious conditions)
Nutrient losses without proper replenishment
Protein /energy store depletion
Diminished nutrient intake (pre/post operative)
Prevalence of GI obstruction, anorexia, malabsorption
Extraordinary stressors (surgical stress, hypovolemia, sepsis,
bacteremia, medications)
Wound healing
Anabolic state, higher demand for nutrients (amino acids,
zinc, vitamin A & C, arginine)
Nutrition Needs
HEALTHLY 70 kg MALE SURGERY PATIENT
www.medscape.com
Gastric vs. Small Bowel
Access
“If the stomach empties, use it.”
AAFP.org
Refeeding Syndrome
Defined as “the metabolic and physiologic
consequences of depletion, repletion, compartmental
shifts, and interrelationships of phosphorus, potassium,
and magnesium…”
Severe drop in serum electrolyte levels (K, PO4, Mg)
resulting from intracellular electrolyte movement when
energy is provided after a period of starvation (usually >
7-10 days)
Physiologic and metabolic sequelae may include:
EKG changes, hypotension, arrhythmia, cardiac arrest
Weakness, paralysis
Respiratory depression
Ketoacidosis / metabolic acidosis
Refeeding Syndrome
(continued)
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