NHHC chapter 23 ppt

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition, Cancer,and HIV Infection

Chapter 23


Cancer

• Growth of malignant tissue• Second most common cause of death in

the United States• Different types of cancers vary based on:

– Characteristics, locations in the body, courses, and required treatments


Cancer (cont’d.)

Type of cancer Origination (tissues or cells)

Adenocarcinomas glandular tissues

Carcinomas epithelial tissues

Leukemias white blood cell precursors

Lymphomas lymphoid tissue

Melanomas pigmented skin cells

Myelomas plasma cells in the bone marrow

Sarcomas connective tissues


Cancer (cont’d.)

• Development of cancer: carcinogenesis– Often proceeds slowly

• Continues for several decades– Genetic mutations or altered expression of

genes regulating cell division in a single cell• Affected cells: unable to halt cell division; produce

daughter cells with the same genetic defects


Cancer (cont’d.)

• Development of cancer: carcinogenesis– Tumors: abnormal mass of cells

• Disrupts normal surrounding tissue function• Metastasize: spread to other body regions

– Various reasons for cancer development• Inherited genetic defects• Metabolic processes• Interactions between genes and environment• Carcinogens


Cancer (cont’d.)

• Environmental factors can increase cancer risk (Table 23-1)

• Nutrition can influence cancer risk (Table 23-2)– Obesity: risk factor for a number of different

cancers


Cancer (cont’d.)

• Nutrition and increased cancer risk– Alcohol: correlates strongly with cancers of

the head and neck, colon, rectum, and breast– Combining alcohol and tobacco: higher

incidence of head and neck cancers– Food preparation methods: produce

carcinogens• Frying or boiling: meat, poultry, and fish• Grilled meat and fish


Cancer (cont’d.)

• Nutrition and decreased cancer risk– Fruits and vegetables: some protection

benefits• Phytochemicals: antioxidant activity• Folate: plays roles in DNA synthesis and repair• Dietary fiber: may protect against colon and rectal

cancers


Cancer (cont’d.)

• Nutrition and decreased cancer risk (Table 23-3)– Achieve and maintain a lifelong healthy body

weight– Be physically active as part of everyday life– Choose a healthy diet that emphasizes plant

sources• Limit consumption of foods that may increase

cancer risk


Cancer (cont’d.)

• Nutrition and decreased cancer risk– Limit consumption of alcoholic beverages– Aim to meet nutritional needs through the diet– Avoid using tobacco in any form


Cancer (cont’d.)

• Consequences of cancer– Complications

• Tumor’s impingement on surrounding tissues– Cancer cachexia: severe malnutrition

• Anorexia, muscle wasting, weight loss, anemia, and fatigue

• What factors play a key role in the wasting associated with cancer?


Cancer (cont’d.)

• Consequences of cancer– Metabolic changes

• Increased protein turnover rate, but reduced muscle protein synthesis

• Muscle: used for glucose production• Elevated serum lipids


Cancer (cont’d.)

• Consequences of cancer– Anorexia and reduced food intake due to:

• Chronic nausea and early satiety• Fatigue• Pain• Mental stress• Gastrointestinal obstructions• Effects of cancer therapies


Cancer (cont’d.)

• Treatments for cancer– Early detection and intervention

• Highest likelihood of effective treatment– Surgery

• Remove tumors, determine the extent of cancer, and protect nearby tissues

– Chemotherapy• Drugs: inhibit tumor growth; shrink tumors before

surgery; prevent or eradicate metastasis


Cancer (cont’d.)

• Treatments for cancer– Radiation therapy

• Bombard cancer cells with X-rays, gamma rays, or various atomic particles

• What are the advantages of radiation therapy over surgery and chemotherapy?

• What are the nutrition-related side effects of chemotherapy and radiation therapy? (Table 23-5)


Cancer (cont’d.)

• Treatments for cancer– Hematopoietic stem cell transplantation

• Replaces blood-forming stem cells: destroyed by high-dose chemotherapy or radiation therapy

– Biological therapies• Immunotherapy: biological molecules that

stimulate immune responses against cancer cells– Medications to combat anorexia and wasting

• Stimulate appetite; control nausea, etc.


Cancer (cont’d.)

• Treatments for cancer– Alternative therapies

• Complementary and alternative medicine (CAM): e.g., multivitamin and herbal supplements

– Nutrition therapy for cancer• What are the goals of nutrition therapy for cancer

patients?


Cancer (cont’d.)

• Nutrition therapy for cancer– Protein and energy

• Ensure appropriate intakes of protein and energy• “How To” Increase kCalories and Protein in Meals

– Managing symptoms and complications• Dietary considerations for specific cancers (Table

23-6)


Cancer (cont’d.)

• Nutrition therapy for cancer– Managing symptoms and complications

• “How To” Help Patients Handle Food-Related Problems

• Responses to strategies vary: adjustments may be necessary

– Low-microbial diet• Includes only foods unlikely to be contaminated

with bacteria or other microbes


Cancer (cont’d.)

• Nutrition therapy for cancer– Enteral and parenteral nutrition support

• Patients with long-term or permanent GI impairment or experiencing complications interfering with food intake

• Enteral strongly preferred over parenteral nutrition: preserve GI function and avoid infection

• Case Study – Woman with Cancer


HIV Infection

• Acquired immune deficiency syndrome (AIDS)– Develops from human immunodeficiency virus

(HIV) infection• Prevention of HIV infection

– Spread by direct contact with contaminated body fluids

– At risk individuals should undergo testing


HIV Infection (cont’d.)

• Consequences of HIV infection– Destroys immune cells with protein called

CD4 on their surfaces: helper T cells• Infected cells produce additional copies of the virus

– Left untreated: increased susceptibility to opportunistic infections

– AIDS: advanced stages of HIV infection• What diseases and complications are included in

AIDS-defining illnesses?



• Lipodystrophy– Abnormalities in body fat and fat metabolism

• Causes of weight loss and wasting– Anorexia and inadequate food intake, altered

metabolism, malabsorption, etc.



• Factors contributing to poor food intake– Emotional distress, pain, and fatigue– Oral infections– Respiratory disorders– Cancer– Medications



• GI tract complications– Attributed to opportunistic infections,

medications, or the HIV infection itself– Advanced stages of HIV: AIDS enteropathy

• Neurological complications– Clinical features

• Mild to severe dementia, muscle weakness and gait disturbances, and pain, numbness, etc.



• Other complications– Anemia, skin disorders, eye disorders, kidney

diseases, and coronary heart disease• Treatments for HIV infection

– Help to slow its progression, reduce complications, and alleviate pain

– Standard drug treatment• Combination of at least three antiretroviral drugs



• Treatments for HIV infection (Table 23-9)– Antiretroviral drugs (Table 23-9)– In addition to antiviral drugs, why may adjunct

drug therapies be necessary?– Be aware of diet-drug interactions (listed in

text)



• Control of anorexia and wasting– Anabolic hormones, appetite stimulants, and

regular physical activity• Reverse unintentional weight loss and increase

muscle mass

• Control of lipodystrophy– Aerobic activity and resistance training

• May help to reduce abdominal fat



• Control of lipodystrophy– Medications: treat abnormal blood lipid levels

and insulin resistance• Alternative therapies

– Monitoring patients’ use of dietary supplements:

• Essential to reduce likelihood of adverse effects or diet-drug interactions



• Nutrition therapy for HIV infection– Initial assessment

• Evaluation of body weight and body composition– Follow-up measurements

• Determine need for adjusting dietary recommendations and drug therapies

– Weight management• Overweight or obese: moderate weight loss

recommended



• Nutrition therapy for HIV infection– Weight management

• Weight loss and wasting: high-kcalorie, high-protein diet may be beneficial

– Metabolic complications• Insulin resistance and elevated triglyceride and

LDL cholesterol levels



• Nutrition therapy for HIV infection– Metabolic complications

• Achieve or maintain a desirable weight, replace saturated fats with mono- and polyunsaturated fats, increase fiber, limit intakes of trans fats, etc.

– Vitamins and minerals• Supplements: usually recommended• Why is it important to maintain intakes that are

close to DRI recommendations?



• Nutrition therapy for HIV infection– Symptom management

• Difficulties affecting food consumption; electrolyte balance affected by vomiting and diarrhea

• “How To” Help Patients Handle Food-Related Problems

– Food safety• High susceptibility to foodborne illness• Water safety considerations



• Nutrition therapy for HIV infection– Enteral and parenteral nutrition support

• Aggressive nutrition support: needed in later stages of illness

• Parenteral nutrition: reserved for patients unable to tolerate enteral nutrition

• Careful measures: avoid bacterial contamination of nutrient formulas and feeding equipment

– Case Study – Man with HIV Infection

NHHC chapter 23 ppt

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Transcript of NHHC chapter 23 ppt