Nutrition. Leah Gramlich and Des Leddin

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1 Nutrition Leah Gramlich and Des Leddin

2 Objectives 1) Know how to take a nutrition history 2) Be able to compare a patient s history to that recommended by the Canada Food Guide 3) Be able to apply this to a patient with IBS, and 4) Change your gastroenterology practice. Prerequisite reading: Canada s Food Guide.

3 AT 30 year old female Several year history Bloating Abdominal pain associated with looser, more frequent bowel movements and relieved by having a bowel movement; no bleeding

4 AT CBC, TTG, IgA, TSH normal Stool O&P negative Colonoscopy with intubation of ileum normal

5 AT: A Nutrition Perspective Take a history Do a nutrition physical exam Compare her diet to recommended Can you offer any advice on managing her symptoms?

6 AT: Nutrition History Goal: identify usual dietary intake identify whether GI symptoms are related to dietary intake (excess or deficiency)

7 AT: Nutrition Physical Examination Wt: Current, Usual, %Usual Ht BMI If concerned about Malnutrition: lean tissue stores, edema, fat stores, signs of micronutrient deficiency If concerned about Obesity: Waist circumference

8 Nutrition History: Dietary Intake by Diet Recall What do you eat for breakfast? Do you have an AM snack? What do you eat for lunch? Do you have an afternoon snack? What do you eat for supper? Do you have a night time snack? How often to you eat out? What beverages do you drink? Do weekends differ from weekdays? Preparation methods?

9 AT 30 year old female Several year history Bloating Abdominal pain associated with looser, more frequent bowel movements and relieved by having a bowel movement; no bleeding

10 AT: One Day Diet Recall B Cheerios (1c) with 2% milk; 1 cup coffee cream and sugar s granola bar L 1 cup tomato soup and crackers (4), yogurt cup (175 ml), raw veggies (1c),water s Coffee S hamburger helper, 1 cup white pasta, ½ cup peas, water s 1 bag chips, diet coke

11 AT Nutrition Physical Exam Current Weight=75kg, Usual Weight=69kg Ht=5 6 BMI=27 Recent weight gain is red flag

12 A healthy eating pattern for Canadians The interior pages provide guidance on quantity of food to eat and quality of food choices

13 Some Important Nutrients in the Food Groups

15 Comparing AT s reported intake to CFGHE F&V 4 servings Meat and alternatives 1 2 servings Milk and alternatives 2 servings Grains 6 servings Diet considerations: low in fiber, fruit and vegetables; lactose tolerance, FODMAPS, caffeine?eat out how often? What about weekends?

16 THREE DAY DIET RECALL INSTRUCTIONS METHODOLOGY detailed written instructions should also be provided. Participants are asked to record food names (including brand names), preparation methods, recipes, and portion sizes. For unweighed records, portion sizes are estimated using household measures (cups, spoons), food models, food photographs, or without aids. At the end of the recording period, a trained interviewer should review the record with the participant to clarify entries and check for forgotten foods. Weighed food records are the most appropriate method to use to assess actual nutrient intakes of individuals over defined periods of time. For accuracy, they should be completed for the duration of the time period, or at regular intervals throughout the period. INSTRUCTIONS Specific considerations: Record brand names whenever possible Record portion sizes in cups, tablespoons or teaspoons where applicable Estimate the size of meat, cheese and cakes in inches or centimetres Beverages: record the sugar or cream in tea or coffee; record alcoholic beverages; record whether fruit juice is sweetened or unsweetened, ensure water is recorded Bread: record the type (e.g. white, rye, etc.) and size of the slice, and record amount of butter or spread used Meat: specify the kind (ground beef, steak; lean, extra lean), cut and method of preparation (fried, roasted); if gravy is included, record the amount Vegetables: be specific as to the kind, amount and method of preparation, whether fresh/frozen/canned, and peeled or unpeeled Desserts: note specifics; e.g. cake (plain, iced), pie (kind, single or double crust), homemade or commercial, size of serving, toppings (e.g. whipped cream, ice cream) Combination foods (e.g. lasagna, spaghetti): provide detailed information on each ingredient and amounts if possible Spices and other noncaloric condiments need not be listed

17 Table 1. Food Sources of FODMAPs and Alternative Food Choices. 35. Barrett J S Nutr Clin Pract 2013;28:

18 e 1. Clinical management flowchart for IBS. FODMAPs, fermentable oligosaccharides, disaccha monosaccharides, and polyols; IBS, irritable bowel syndrome. Barrett J S Nutr Clin Pract 2013;28:

19 Dietary Intake: Food Diary Variety of templates Consider: Eat tracker (web based tool)

20 BMcD 43 year old male 10 year history of ileocecal Crohns On azathioprine and doing well apart from occasional cramps Physical normal

21 Participants: From a nutrition perspective Take a history Do a nutrition physical exam Compare his diet to recommended Can you offer any advice on managing his symptoms?

22 BMcD: Dietary Intake Breakfast: Fruit smoothie (2c yogurt, blackberries, banana, protein powder) s Lunch: peanut butter and jam sandwich, white bread, apple, water s Supper: (moxies) Cheese Quessidilla, fried potatoes, pint beer s

23 BMcD: Nutrition Physical Examination 6 CBW=160 lbs, UBW=160lbs, BMI=21.7 No signs of micronutrient deficiency

24 Comparing BMcD Dietary Intake to CFGHE F&V 4 servings Meat and Alternatives 4 servings Milk and alternatives 2 servings Grains 6 servings Diet low in fibre, low in milk,?eating out how often? Use of vitamin and mineral supplements?

25 McD Questions Can diet modify the activity of Crohn s? Does it have a role in bone health or cancer prevention? Should IBD patients take supplements?

Kidney Disease and Diabetes

Kidney Disease and Diabetes What is diabetes? Diabetes is a disease where your body cannot properly store and use food for energy. The energy that your body needs is called glucose (sugar). Glucose comes