NFMNT Chapter 5 Overview of Body Systems and Medical Nutrition Therapy Interventions

1. Nutrition Fundamentals and Medical
Nutrition Therapy
Overview of Body Systems and Medical
Nutrition Therapy Interventions
Corresponds with
LEARNING PLAN 5
Copyright 2016 Association of Nutrition and Foodservice
Professionals

2. Objectives
 Identify basic medical nutrition terminology, as related to
the gastrointestinal tract, the hepatic and renal systems,
and other conditions of the body (Alzheimer’s disease
and developmental disabilities)
 Define the basic concepts of medical nutritional therapy,
as related to the gastrointestinal tract, the hepatic and
renal systems, and other conditions of the body
(Alzheimer’s disease and developmental disabilities)
 Relate basic concepts to nutritional deficiency and
excess
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

3. Objectives
 Relate basic concepts of medical nutritional therapy, as
related to the gastrointestinal tract, the hepatic and renal
systems, and other conditions of the body (Alzheimer’s
disease and developmental disabilities)
 Compare basic concepts to current diet manual or other
accepted resources
 Explain utilization of medical nutritional therapy in long-
term care and acute care settings
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

4. Medical Nutrition Therapy
 Nutritional assessment and treatment of a condition,
illness, or injury that places an individual at risk
» Two parts:
- Assessment of the client’s nutritional status
- Treatment/intervention
 Generally focuses on individuals at risk for nutritional
problems
» Begins with nutritional screening – identifying those clients
who are at risk
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

5. Medical Nutrition Therapy
 Important for prevention and treatment of many diseases
» Diseases resulting from nutrition deficiency
- Less common now than 50+ years ago
» Diseases resulting from nutrition excess
- By far the most common cause of many chronic diseases
 Each approach to Medical Nutrition Therapy is
individualized and dependent upon many factors to
determine appropriate treatment and intervention
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

6. MNT and Modified Consistency
Diets
 Dentition – development of teeth in the gums of a human,
their arrangement, and the function of those teeth in the
process of digestion
 Dental caries
» Major health issue caused by eating sugary and starchy
foods
» To prevent, brush teeth frequently and floss daily
 Edentulous – having no teeth or toothless
» Can cause issues with eating properly and clients may
require a modified consistency diet
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

7. Modified Consistency Diets
 Puree
 Mechanical Soft
» should be individualized to client
 Dysphagia Diets National Dysphagia Diet (NDD)
 Determination is made by a Speech Language Pathologist
(SLP)
 Level 1, 2, 3, or 4
 Defined fluid consistency, nectar, honey or pudding (spoon
thick)
 customized dysphagia diet recommendation contains two
specifications: one for food texture, and a second one for
liquids
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

8. Modified Consistency Diets
 Mechanically altered diets have a required change in
texture, not taste
 Make every effort to ensure the highest quality of taste
and appearance for these modified consistency foods
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

9. Brain Break
 How would you modify the menu with baked ham for a
client without most of their teeth?
» Ham could be chopped and/or served with a sauce
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

10. Brain Break
 If the client has been diagnosed with Level 3 Dysphagia,
would the menu item need to be changed?
» No. Level 3 requires easy to cut whole meats that could be
chopped and served with a sauce
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

11. Nausea and Vomiting
 Goal is to replace lost fluids and restore electrolyte
balance
» BRAT diet (Bananas, Rice, Applesauce, Toast)
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

12. Gastroesophageal Reflux Disease
(GERD)
 Medical term for acid indigestion or heartburn where
stomach acid comes up into the esophagus
 Medical nutritional therapy goals
» Limit spicy foods, tomatoes, citrus fruits and juice
» Limit alcohol, caffeinated drinks, mint, chocolate
» Eat smaller amounts of food
» Reduce fat intake
 Lifestyle modification goals
 Medicines such as antacids
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

13. Gastrointestinal Diseases
 Gastritis and Peptic Ulcer Disease (PUD)
» Small frequent meals, avoid foods causing dyspepsia,
exclude alcohol, coffee, and pepper
» Use of antibiotics to treat Helicobacter pylori (H. pylori)
 Gastroparesis (stomach paralysis)
» Small frequent meals, limit fiber and high fat foods, consume
foods in liquid form
- Medications may be prescribed for these issues
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

14. Brain Break
 A new client comes in with a
diagnosis of GERD. What
foods may need to be
avoided for this client?
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5
» Grapefruit and orange juice
» Caffeinated coffee or tea
» Chocolate desserts
» Foods with tomatoes

15. Gastrointestinal Diseases
 Inflammatory Bowel Disease (IBD) – ulceration of the mucosa
lining in both large and small intestine
» Crohn’s disease
» Ulcerative colitis
 Diverticular Disease
» Diverticulosis – presence of pouches (diverticula) in the intestine
» Diverticulitis – inflammation of diverticula
 Diarrhea
» Oral rehydration therapy
 Constipation
» Adequate fiber and fluid, medicine, exercise
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

16. Gastrointestinal Diseases
 Irritable bowel syndrome (IBS)
» Affects about 20% of adults
» May benefit from:
- Smaller meals
- Gluten-free foods
- Decaffeinated foods
- Minimal alcohol, milk products, chocolate
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

17. Brain Break
 Why is it more common for older adults to have problems
with constipation?
» Because the gastrointestinal system slows down with aging
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

18. Gastrointestinal Progression Diets
 Clear Liquid
» Short term use – no more than three days
» Provide fluids, electrolytes and energy with minimal GI
stimulation
 Full Liquid
» Foods that are liquid at room temperature or become liquid at
room temperature
» Supplementation required if used for more than 2 weeks
 Soft
» Soft consistency, mildly spiced, moderately low fiber
» Individualized for each client
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

19. Liver Diseases and Digestion
 Fatty Liver
» Triglycerides build up in liver
» Occurs due to excessive alcohol, infection, disease, poor protein intake,
certain drugs. Symptoms can be reversed
 Hepatitis
» Inflammation of the liver
» Occurs due to alcohol, viruses, drugs, toxins
» Malnutrition results
» Diet: High calorie, high protein diet, fat soluble vitamins
 Cirrhosis
» Advanced liver disease – unable to be reversed
» Ascites, jaundice
» Edema – abnormal water retention
» Hepatic Failure
» Diet: low protein, hepatic feeding formula
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

20. Brain Break
 For a client with chronic
kidney disease, what dietary
measures should be taken to
limit sodium intake?
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5
» Use low-sodium foods, lemon
juice, salt-free seasoning
mixes; limit high-potassium
foods such as dairy foods,
oranges, apricots, bananas,
kiwi, potatoes, tomatoes,
cooked spinach, legumes

21. Gallbladder Disease
 Cholelithiasis – gallstones
 Cholecystitis – inflammation of the gallbladder
 Treatment is typically a reduced fat, or low fat diet
» 40 g. of fat per day
 If gallbladder is removed, patient can progress to a
regular diet
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

22.  Pancreatitis
» Inflammation of the pancreas in which pancreatic
enzymes are blocked from emptying, causing some of
these strong enzymes to digest the pancreas itself
- causes fat malabsorption and steatorrhea (fatty
stools)
» Gallstones are the most common causes of
pancreatitis
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

23. Brain Break
 A client who has had their
gallbladder removed should
be on what type of diet?
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5
» A regular diet, as tolerated

24. Renal Disease
 Relating to the kidneys
 Renal failure
 Chronic renal failure (CRF) – not reversible
» Resulting in dialysis
» Hemodialysis
» Peritoneal dialysis
» Referred to as End-stage renal disease (ESRD)
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

25. Renal Diet
 National Kidney Foundation has established Dietary Guidelines for
Adults
 Complex medical nutrition therapy
» Protein, sodium, potassium, phosphorus, and fluids regulated
depending on a variety of individual factors
 Actual nutrient restrictions vary based on many factors, such
as:
» Degree of kidney failure
» Age of the client
» Mode of treatment and/or dialysis
» Need to maintain or achieve an ideal or desired weight
» Other medical conditions: diabetes, high blood pressure,
hyperlipidemia, or malnutrition
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

26. Alzheimer’s Disease
 Dementia – impaired mental functioning
 Individualized and creative nutritional approaches
 Early stage, intermediate state, late stage
 MNT
» Serve larger meals at breakfast because of “sundowning” effect
» Provide nutrient dense meals and snacks
 Carefully consider
» Environment
» Nutritional needs
» Other compounding medical factors
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

27. Finger Food Diet
 Logical way to provide nutrition to those with limitations in
handling utensils
 Bite size pieces
 Appropriate texture, not too slippery, gooey or crumbly
 No thick gravies or sauces on foods
 Can be nutritionally adequate with careful attention to
menu planning by the Certified Dietary Manager
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

28. Pressure Ulcers
 May result from immobilization
 Previously known as a ‘bedsore’
 Stages I, II, III, IV from least to most severe in that order
 Nutrition intervention is vital in prevention and treatment
with each stage
» Increased calories
» Increased protein
» Increased fluid
» Vitamin/mineral supplements
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

29. Developmentally Disabled and
Handicapped Clients
 Developmental disability refers to a severe, chronic disability
» May be mental or physical impairment
» Results in limitations
- Self care
- Language
- Mobility
- Self direction/independent living
- Self sufficiency
Nutrition Concerns
» Feeding problems, drug-nutrient interaction, obesity, constipation,
dehydration
 MNT is more effective with interdisciplinary team (IDT) approach
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5

30. Brain Break
 What should be added to the
following breakfast menu for
a person with Stage 4
pressure ulcers?
» Toast
» Omelet
» Bacon
» Fruit Cup
» Coffee
Nutrition Fundamentals and Medical Nutrition Therapy • Overview of Body Systems and MNT Interventions • Learning Plan 5
» Add peanut butter to the toast,
cheese to the omelet to increase
both calories and protein; change
the fruit cup to fruit juice and add
milk to increase fluids and additional
protein and calories.