- Email: [email protected]
What are the calorie requirements for patients with cystic fibrosis?
NEW IN REVIEW osteoporosis, cardiovascular disease, and cancer. Key points are listed at the beginning of each chapter and a thorough list of references is provided at its end. The book also provides recommendations for research studies, a list of resources on the IGF system for both patients and health professionals, and numerous figures and tables that clarify complex processes and in-
teractions. Overall, IGF and Nutrition in Health and Disease is a comprehensive and authoritative review of nutrition and the IGF system in human health and disease that provides a clear understanding of the importance of the IGF system and nutritional state to human growth, metabolism, disease development, and therapy.
QUICK LOOKS Healthy Calendar Diabetic Cooking: A Full Year of Simple Menus and Easy Recipes By: Lara Rondinelli, RD; Jennifer Bucko; Alexandria, VA: American Diabetes Assocation; 2004; $19.95; paperback; 460 pp; ISBN: 1-58040-160-0
QUESTION OF THE MONTH
What Are the Calorie Requirements for Patients with Cystic Fibrosis?
T
he survival of patients with cystic fibrosis (CF) has increased because of improved and aggressive treatment of the disease and the increased awareness of the importance of nutrition management. The disease process can affect numerous systems in the body, including the pancreatic, gastrointestinal, hepatobiliary, respiratory, and reproductive systems. The complexity of the disease process makes medical nutrition therapy an essential component in the treatment of CF. The reason malnutrition is greater in this population is threefold. Energy needs are higher because of the increased workload of breathing, infection and fever; increased nutrient losses from malabsorption; and decreased food intake because of infection and illness. Factors such as deteriorating lung function, anorexia, vomiting, pancreatic insufficiency, and intestinal biliary complications combine with increased losses attributed to nutritional inadequacy leading to loss of lean body mass and depressed immune function (1). The impact of nutrition on CF has been well established. Inadequate nutrition seems to accelerate the progression of the disease and this in turn decreases the survival rate of the patient. The United States CF Foundation has recommended aggressive nutritional monitoring and nutrition intervention at all ages. Prevention and early intervention are key components to combat nutritional deficiencies (2). This article was written by Wendy Marcason, RD, of ADA’s Knowledge Center Team, Chicago, IL. Contact: [email protected] doi: 10.1016/j.jada.2005.02.040
660
April 2005 Volume 105 Number 4
Children and adults with CF generally need more calories than the general population. Calculations for daily energy requirements are affected by age, activity level, stage of lung disease, and fat absorption factor. To calculate the energy needs of a patient, one needs to calculate basal metabolic rate and then adjust for activity, lung function, and fat absorption factor using the method described by Olson and Schwenk (2). For example, in comparing two male patients, both 25 years of age and weighing 70 kg, the calorie needs would be the same until you factored in the activity, lung function, and fat absorption factor. For example, if one patient is confined to a bed, has severe lung disease, and severe fat malabsorption; and the other patient is very active, has normal lung function, and no fat malabsorption factor; the calorie needs would range from 3,620 kcal for the severely compromised patient to 2,975 kcal for the active male patient. Calculating the energy needs of each CF patient is the first step in providing adequate nutritional needs. Evaluating, monitoring, and recommending appropriate calories, protein, vitamins, and minerals to maximize the nutritional status of the patient is an ongoing process and needs to be addressed by the dietetics professional on a regular basis. References 1. Creveling S, Light M, Gardner P, Greene L. Cystic fibrosis, nutrition, and the health team. J Am Diet Assoc. 1997;97(suppl 2):S186-S194. 2. Olson DL, Schwenk WF. Nutrition for patients with cystic fibrosis. Nutr Clinl Pract. 2004;10:575-580.
teractions. Overall, IGF and Nutrition in Health and Disease is a comprehensive and authoritative review of nutrition and the IGF system in human health and disease that provides a clear understanding of the importance of the IGF system and nutritional state to human growth, metabolism, disease development, and therapy.
QUICK LOOKS Healthy Calendar Diabetic Cooking: A Full Year of Simple Menus and Easy Recipes By: Lara Rondinelli, RD; Jennifer Bucko; Alexandria, VA: American Diabetes Assocation; 2004; $19.95; paperback; 460 pp; ISBN: 1-58040-160-0
QUESTION OF THE MONTH
What Are the Calorie Requirements for Patients with Cystic Fibrosis?
T
he survival of patients with cystic fibrosis (CF) has increased because of improved and aggressive treatment of the disease and the increased awareness of the importance of nutrition management. The disease process can affect numerous systems in the body, including the pancreatic, gastrointestinal, hepatobiliary, respiratory, and reproductive systems. The complexity of the disease process makes medical nutrition therapy an essential component in the treatment of CF. The reason malnutrition is greater in this population is threefold. Energy needs are higher because of the increased workload of breathing, infection and fever; increased nutrient losses from malabsorption; and decreased food intake because of infection and illness. Factors such as deteriorating lung function, anorexia, vomiting, pancreatic insufficiency, and intestinal biliary complications combine with increased losses attributed to nutritional inadequacy leading to loss of lean body mass and depressed immune function (1). The impact of nutrition on CF has been well established. Inadequate nutrition seems to accelerate the progression of the disease and this in turn decreases the survival rate of the patient. The United States CF Foundation has recommended aggressive nutritional monitoring and nutrition intervention at all ages. Prevention and early intervention are key components to combat nutritional deficiencies (2). This article was written by Wendy Marcason, RD, of ADA’s Knowledge Center Team, Chicago, IL. Contact: [email protected] doi: 10.1016/j.jada.2005.02.040
660
April 2005 Volume 105 Number 4
Children and adults with CF generally need more calories than the general population. Calculations for daily energy requirements are affected by age, activity level, stage of lung disease, and fat absorption factor. To calculate the energy needs of a patient, one needs to calculate basal metabolic rate and then adjust for activity, lung function, and fat absorption factor using the method described by Olson and Schwenk (2). For example, in comparing two male patients, both 25 years of age and weighing 70 kg, the calorie needs would be the same until you factored in the activity, lung function, and fat absorption factor. For example, if one patient is confined to a bed, has severe lung disease, and severe fat malabsorption; and the other patient is very active, has normal lung function, and no fat malabsorption factor; the calorie needs would range from 3,620 kcal for the severely compromised patient to 2,975 kcal for the active male patient. Calculating the energy needs of each CF patient is the first step in providing adequate nutritional needs. Evaluating, monitoring, and recommending appropriate calories, protein, vitamins, and minerals to maximize the nutritional status of the patient is an ongoing process and needs to be addressed by the dietetics professional on a regular basis. References 1. Creveling S, Light M, Gardner P, Greene L. Cystic fibrosis, nutrition, and the health team. J Am Diet Assoc. 1997;97(suppl 2):S186-S194. 2. Olson DL, Schwenk WF. Nutrition for patients with cystic fibrosis. Nutr Clinl Pract. 2004;10:575-580.