BASICS IN CLINICAL NUTRITION

NEW - 3rd EDITION!

CONTENTS

1.
BASIC CONCEPTS IN NUTRITION
1
1.1. Energy and protein balance 1
1.2. Body composition and its measurement 6
1.3. Diagnosis of malnutrition - Screening and Assessment 11
1.4. Influence of malnutrition on physiological function 18
1.5. Overnutrition - functional and clinical consequences 20
1.6. Epidemiology of malnutrition 31
1.7. Nutritional requirements for health at rest and on exercise 37
1.7.1. Adult subjects 37
1.7.1.1. Macronutrients 37
1.7.1.2. Micronutrients 43
1.7.2. Nutritional needs of children and adolescents 45
2.
NUTRITIONAL PHYSIOLOGY AND BIOCHEMISTRY
57
2.1. Appetite and its control 57
2.2. Energy metabolism 61
2.3. Carbohydrate metabolism 66
2.4. Lipid metabolism 72
2.5. Protein and amino acid metabolism 78
2.6. Water and electrolytes in health and disease 82
2.7. Physiological function and deficiency states of trace elements 94
2.8. Physiological function and deficiency states of vitamins 99
2.9. Simple and stress starvation 107
2.10. Injury and sepsis 114
2.10.1. The neuroendocrine response 114
2.10.2. Main cytokines and their effect during injury and sepsis 118
2.10.3. Metabolic response to injury and sepsis 124
2.11. Metabolic response to hypoxia 129
3.
ORGANIZATION AND LEGAL ASPECTS
135
3.1. Organization of nutritional care 135
3.2. Ethical and legal aspects 139
4.
SUBSTRATES USED IN PARENTERAL AND ENTERAL NUTRITION
149
4.1. Energy 149
4.2. Carbohydrates 151
4.3. Lipids 153
4.4. Proteins and amino acids 157
4.5. Water and electrolytes during nutritional support 165
4.6. Trace elements and vitamins in parenteral and enteral nutrition 169
4.6.1. Trace elements in parenteral and enteral nutrition 172
4.6.2. Vitamins in enteral and parenteral nutrition 174
4.7. Fibre and short chain fatty acids 176
4.8. Immunonutrition 179
4.8.1. Nutrients which influence immunity - effect and mechanism of action 179
4.8.2. Nutrients which influence immunity - clinical and experimental data 185
4.9. Role of antioxidants in nutritional support 191
4.10. Special substrates for parenteral nutrition 196
5.
ENTERAL NUTRITION
201
5.1. Indications and contraindications for enteral nutrition 201
5.2. Methods of delivering enteral nutrition 204
5.2.1. Sip feeds 204
5.2.2. Transnasal access 204
5.2.3. Endoscopic access (PEG and PEJ) 207
5.2.4. Surgical access - gastrostomy, needle catheter jejunostomy 211
5.3. Administration of enteral tube feeds 214
5.4. Equipment for delivering enteral nutrition 215
5.5. Diets for enteral nutrition 217
5.5.1. Home made diets 217
5.6. Commercially prepared formulas 221
5.6.1. Polymeric formulas 221
5.6.2. Oligomeric and monomeric formulas 224
5.6.3. Special formulas (disease specific) 225
5.6.4. Modular diets 226
5.7. Complications of enteral nutrition 228
6.
PARENTERAL NUTRITION
233
6.1. Ways of delivering parenteral nutrition 233
6.1.1. Peripheral parenteral nutrition (PPN) 233
6.1.2. Central parenteral nutrition 237
6.1.3. Complications associated with central catheter insertion and care 246
6.2. Systems for parenteral nutrition 252
6.2.1. Different systems for parenteral nutrition (AIO vs MB) 252
6.2.2. Composition of nutritional admixtures and formulas for parenteral nutrition 255
6.3. Parenteral nutrition admixtures 260
6.3.1. How to prepare parenteral nutrition (PN) admixtures 260
6.3.2. Stability of parenteral nutrition admixtures 264
6.4. Drugs and nutritional admixtures 269
6.5. Metabolic complications of parenteral nutrition 275
7.
MONITORING OF NUTRITIONAL SUPPORT
281
7.1. Clinical monitoring 281
7.2. Some laboratory measurement of response to nutrition clinical studies 283
7.3. Refeeding syndrome 288
8.
NUTRITIONAL SUPPORT IN DIFFERENT CLINICAL SITUATIONS
293
8.1. Nutritional support in severe malnutrition 293
8.2. Perioperative nutrition 296
8.3. Nutritional support in critically ill and septic patients 302
8.4. Nutritional support in trauma 308
8.5. Nutritional support in inflammatory bowel disease 314
8.6. Nutritional support in liver disease 321
8.7. Nutritional support in renal disease 325
8.8. Nutritional support in acute and chronic pancreatitis 333
8.9. Nutrition support in gastrointestinal fistulas 342
8.10. Nutritional support in extensive gut resections (short bowel) 345
8.11. Nutritional support in the diabetic patient 357
8.12. Nutrition in the elderly 363
8.13. Nutritional support in burn patients 384
8.14. Nutritional support in cancer 392
8.15. Wasting syndrome - effect of anticachectic agents 403
8.16. Radiation enteropathy 405
8.17. Nutritional support in AIDS 408
8.18. Nutrition in cardiac and pulmonary diseases 414
8.19. Nutrition therapy for neurological disorders 416
8.20. Nutritional support during pregnancy 422
8.21. Nutritional support in neonatology 425
8.22. Nutritional support in children and adolescents 440
8.23. Home artificial nutrition 462
Back