- Email: [email protected]
Risks and complications of malnutrition persist despite optimal nutritonal intake in a patient with pancreatic cancer
SUNDAY, OCTOBER 3
ORIGINAL CONTRIBUTIONS: LONG-TERM CARE TITLE: RISKS AND COMPLICATIONS OF MALNUTRITION PERSIST DESPITE OPTIMAL NUTRITONAL INTAKE IN A PATIENT WITH PANCREATIC CANCER
TITLE: DO OLDER ADULTS NEED CLOSER MONITORING OF DIETARY B VITAMINS INTAKE?
AUTHOR(S): K.D. Dougherty, MS, RD; Minnesota Masonic Home North Ridge Care Center, New Hope, Minnesota
AUTHOR(S): B.J. McCabe-Sellers, PhD, RD, LD; J.R. Sharkey, PhD, MPH, RD; USDA,ARS Lower Mississippi Delta Nutrition Intervention Research Initiative, Little Rock, AR and School of Rural Public Health, Texas A and M University System, College Station, TX
LEARNING OUTCOME: To increase the awareness among staff physicians that achieving optimal nutrition outcomes is not limited to the administration of estimated calories and protein.
LEARNING OUTCOME: To increase awareness of special needs of older adults for dietary monitoring.
TEXT: This case report illustrates that malnutrition may persist despite provision of ⬎160% estimated needs. A 78-year old male was admitted to our subacute unit following a Whipple procedure for pancreatic cancer. Admit weight⫽174 lbs. (UBW⫽190 - 200 lbs.). Admitted on amino acid-based tube feeding (TF) formula (via J-tube) providing 1870 kcals; 93 g protein. Food aversions limited oral intake to pleasure foods only. Weight decreased to 156 lbs and continued to decline despite increase to 3000 kcals; 150 g protein. Although calculated nutritional requirements were provided for several months, patient appeared malnourished. On assessment, labs confirmed depleted visceral proteins: albumin⫽2.7 g/dL (norm⫽3.5 5.0 g/dL); prealbumin⫽10.2 g/dL (norm⫽20 - 40 g/dL). TF formula switched to high-calorie, peptide-based, elemental diet to facilitate protein absorption and utilization (2,160 kcals; 97 g protein). Oral intake increased; pancreatic enzyme therapy initiated. Weight increased to 171 lbs., prealbumin increased to 14.1 g/dL. TF discontinued, pancreatic enzyme continued, based on physician assessment that oral intake was adequate. Albumin and prealbumin plummeted to 1.8 g/dL and 6.3 g/dL, respectively. Peptide-based TF reinitiated at 1,350 kcals; 60 g protein to augment oral intake. Albumin and prealbumin began to rise; weight remained stable. Shortly thereafter, patient was discharged home consuming the highcalorie, peptide-based formula with flavoring. For this patient, the desired nutritional outcomes were not achieved simply by meeting estimated caloric goals, but only when the nutritional regimen and formulation was uniquely suited to meet metabolic and physiologic needs.
TEXT: Nutrient requirements may not be readily met if dietary intake decreases, if nutrient losses increase, or if conditions increase needs. Nutrients such as water-soluble vitamins are especially prone to develop submarginal levels in a short time period in vulnerable populations. This study examined the nutrient intakes and drug usage of 279 older homebound women receiving 5 home-delivered meals/week. Dietary intake and a “brown bag” visual medication inspection were assessed in-home followed up by three telephone 24-hour dietary recalls. Over half of the subjects were taking ⱖ 6 medications. A comparison of nutrient intakes of those on diuretic therapy with those not receiving diuretics revealed significantly greater odd ratios for having inadequate intake of those receiving diuretic drugs for both thiamin and niacin. The percentage of subjects with low thiamin and niacin intakes paralleled those receiving greater than six medications as well as diuretic use. Low thiamin intake can quickly lead to loss of appetite and affect overall nutrient intake. Long term drug therapy such as diuretics increases losses of water-soluble vitamins. Suboptimal intake of water-soluble vitamins can lead to other conditions such as fatigue and anorexia that may be overlooked as simple disease symptoms. Whether low dietary intake is a consequence of drug side effects or reflects the disease for which diuretics are prescribed, the dietitian needs to be alert to the food-drug interactions occurring with these widely used drugs. Dietitians cannot assume that B vitamin intakes are adequate to meet the increased needs with long-term drug therapy. FUNDING DISCLOSURE: None
FUNDING DISCLOSURE:
TITLE: A COMPARISON OF LONG TERM CARE SNACK DELIVERY SYSTEMS AUTHOR(S): C. Koch, MS RD LD FADA CNSD; S.M. Lunnen, Dietetic Intern; and C.D. McKinney, MS, RD, LD; Johns Hopkins Bayview Medical Center of Baltimore, MD LEARNING OUTCOME: To identify an effective snack delivery system for a long term care facility. TEXT: Nourishments are an important part of a resident’s nutritional health. The purpose of this study was to compare two snack delivery systems, a non-select bagged snack vs. a new snack cart that contained a variety of foods for the residents’ selection. A pre-post survey conducted of 21 residents was used to assess levels of waste, perceived efficiency, and overall snack satisfaction before and after the implementation of the snack cart. Sampling was conducted by convenience. Waste results showed 29% of residents reported eating between half to the entire bagged snack as compared to 90% of residents who ate the same amount from the snack cart. Resident rated satisfaction with the timing and delivery of their snacks on a scale of 1-10, with 10 being extremely satisfied. Satisfaction with the timing and delivery of the bagged snack revealed a mean of 6.8, while mean ratings with the snack cart rose significantly to 8.5 (t ⫽ ⫺2.35, p ⫽ ⱕ.000). The aforementioned scale was also utilized to assess overall satisfaction with the snacks. Mean overall satisfaction with the bagged snack was 4.6, compared to 9.0 with the snack cart (t ⫽ ⫺5.23, pⱕ.000). While the snack cart did prove to be slightly more expensive, it significantly increased overall satisfaction, satisfaction with efficiency, and decreased the amount of food waste. After reviewing the surveys, it was evident that a snack cart offering a variety of snacks proved to be the best option for the patients as well as the facility. FUNDING DISCLOSURE: JHBMC Dietetic Internship
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-11
ORIGINAL CONTRIBUTIONS: LONG-TERM CARE TITLE: RISKS AND COMPLICATIONS OF MALNUTRITION PERSIST DESPITE OPTIMAL NUTRITONAL INTAKE IN A PATIENT WITH PANCREATIC CANCER
TITLE: DO OLDER ADULTS NEED CLOSER MONITORING OF DIETARY B VITAMINS INTAKE?
AUTHOR(S): K.D. Dougherty, MS, RD; Minnesota Masonic Home North Ridge Care Center, New Hope, Minnesota
AUTHOR(S): B.J. McCabe-Sellers, PhD, RD, LD; J.R. Sharkey, PhD, MPH, RD; USDA,ARS Lower Mississippi Delta Nutrition Intervention Research Initiative, Little Rock, AR and School of Rural Public Health, Texas A and M University System, College Station, TX
LEARNING OUTCOME: To increase the awareness among staff physicians that achieving optimal nutrition outcomes is not limited to the administration of estimated calories and protein.
LEARNING OUTCOME: To increase awareness of special needs of older adults for dietary monitoring.
TEXT: This case report illustrates that malnutrition may persist despite provision of ⬎160% estimated needs. A 78-year old male was admitted to our subacute unit following a Whipple procedure for pancreatic cancer. Admit weight⫽174 lbs. (UBW⫽190 - 200 lbs.). Admitted on amino acid-based tube feeding (TF) formula (via J-tube) providing 1870 kcals; 93 g protein. Food aversions limited oral intake to pleasure foods only. Weight decreased to 156 lbs and continued to decline despite increase to 3000 kcals; 150 g protein. Although calculated nutritional requirements were provided for several months, patient appeared malnourished. On assessment, labs confirmed depleted visceral proteins: albumin⫽2.7 g/dL (norm⫽3.5 5.0 g/dL); prealbumin⫽10.2 g/dL (norm⫽20 - 40 g/dL). TF formula switched to high-calorie, peptide-based, elemental diet to facilitate protein absorption and utilization (2,160 kcals; 97 g protein). Oral intake increased; pancreatic enzyme therapy initiated. Weight increased to 171 lbs., prealbumin increased to 14.1 g/dL. TF discontinued, pancreatic enzyme continued, based on physician assessment that oral intake was adequate. Albumin and prealbumin plummeted to 1.8 g/dL and 6.3 g/dL, respectively. Peptide-based TF reinitiated at 1,350 kcals; 60 g protein to augment oral intake. Albumin and prealbumin began to rise; weight remained stable. Shortly thereafter, patient was discharged home consuming the highcalorie, peptide-based formula with flavoring. For this patient, the desired nutritional outcomes were not achieved simply by meeting estimated caloric goals, but only when the nutritional regimen and formulation was uniquely suited to meet metabolic and physiologic needs.
TEXT: Nutrient requirements may not be readily met if dietary intake decreases, if nutrient losses increase, or if conditions increase needs. Nutrients such as water-soluble vitamins are especially prone to develop submarginal levels in a short time period in vulnerable populations. This study examined the nutrient intakes and drug usage of 279 older homebound women receiving 5 home-delivered meals/week. Dietary intake and a “brown bag” visual medication inspection were assessed in-home followed up by three telephone 24-hour dietary recalls. Over half of the subjects were taking ⱖ 6 medications. A comparison of nutrient intakes of those on diuretic therapy with those not receiving diuretics revealed significantly greater odd ratios for having inadequate intake of those receiving diuretic drugs for both thiamin and niacin. The percentage of subjects with low thiamin and niacin intakes paralleled those receiving greater than six medications as well as diuretic use. Low thiamin intake can quickly lead to loss of appetite and affect overall nutrient intake. Long term drug therapy such as diuretics increases losses of water-soluble vitamins. Suboptimal intake of water-soluble vitamins can lead to other conditions such as fatigue and anorexia that may be overlooked as simple disease symptoms. Whether low dietary intake is a consequence of drug side effects or reflects the disease for which diuretics are prescribed, the dietitian needs to be alert to the food-drug interactions occurring with these widely used drugs. Dietitians cannot assume that B vitamin intakes are adequate to meet the increased needs with long-term drug therapy. FUNDING DISCLOSURE: None
FUNDING DISCLOSURE:
TITLE: A COMPARISON OF LONG TERM CARE SNACK DELIVERY SYSTEMS AUTHOR(S): C. Koch, MS RD LD FADA CNSD; S.M. Lunnen, Dietetic Intern; and C.D. McKinney, MS, RD, LD; Johns Hopkins Bayview Medical Center of Baltimore, MD LEARNING OUTCOME: To identify an effective snack delivery system for a long term care facility. TEXT: Nourishments are an important part of a resident’s nutritional health. The purpose of this study was to compare two snack delivery systems, a non-select bagged snack vs. a new snack cart that contained a variety of foods for the residents’ selection. A pre-post survey conducted of 21 residents was used to assess levels of waste, perceived efficiency, and overall snack satisfaction before and after the implementation of the snack cart. Sampling was conducted by convenience. Waste results showed 29% of residents reported eating between half to the entire bagged snack as compared to 90% of residents who ate the same amount from the snack cart. Resident rated satisfaction with the timing and delivery of their snacks on a scale of 1-10, with 10 being extremely satisfied. Satisfaction with the timing and delivery of the bagged snack revealed a mean of 6.8, while mean ratings with the snack cart rose significantly to 8.5 (t ⫽ ⫺2.35, p ⫽ ⱕ.000). The aforementioned scale was also utilized to assess overall satisfaction with the snacks. Mean overall satisfaction with the bagged snack was 4.6, compared to 9.0 with the snack cart (t ⫽ ⫺5.23, pⱕ.000). While the snack cart did prove to be slightly more expensive, it significantly increased overall satisfaction, satisfaction with efficiency, and decreased the amount of food waste. After reviewing the surveys, it was evident that a snack cart offering a variety of snacks proved to be the best option for the patients as well as the facility. FUNDING DISCLOSURE: JHBMC Dietetic Internship
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-11