Nutritional Aspects and Clinical Management of Chronic Disorders and Diseases (Modern Nutrition)

353 Pages·2002·4.32 MB·English

by  Felix Bronner

NUTRITIONAL ASPECTS
and
CLINICAL MANAGEMENT
of
CHRONIC DISORDERS
and
DISEASES
CRC SERIES IN
MODERN NUTRITION
Edited by Ira Wolinsky and James F. Hickson, Jr.
Published Titles
Manganese in Health and Disease, Dorothy J. Klimis-Tavantzis
Nutrition and AIDS: Effects and Treatments, Ronald R. Watson
Nutrition Care for HIV-Positive Persons: A Manual for Individuals and Their Caregivers,
Saroj M. Bahl and James F. Hickson, Jr.
Calcium and Phosphorus in Health and Disease, John J.B. Anderson and
Sanford C. Garner
Edited by Ira Wolinsky
Published Titles
Practical Handbook of Nutrition in Clinical Practice, Donald F. Kirby
and Stanley J. Dudrick
Handbook of Dairy Foods and Nutrition, Gregory D. Miller, Judith K. Jarvis,
and Lois D. McBean
Advanced Nutrition: Macronutrients, Carolyn D. Berdanier
Childhood Nutrition, Fima Lifschitz
Nutrition and Health: Topics and Controversies, Felix Bronner
Nutrition and Cancer Prevention, Ronald R. Watson and Siraj I. Mufti
Nutritional Concerns of Women, Ira Wolinsky and Dorothy J. Klimis-Tavantzis
Nutrients and Gene Expression: Clinical Aspects, Carolyn D. Berdanier
Antioxidants and Disease Prevention, Harinda S. Garewal
Advanced Nutrition: Micronutrients, Carolyn D. Berdanier
Nutrition and Women’s Cancers, Barbara Pence and Dale M. Dunn
Nutrients and Foods in AIDS, Ronald R. Watson
Nutrition: Chemistry and Biology, Second Edition, Julian E. Spallholz,
L. Mallory Boylan, and Judy A. Driskell
Melatonin in the Promotion of Health, Ronald R. Watson
Nutritional and Environmental Influences on the Eye, Allen Taylor
Laboratory Tests for the Assessment of Nutritional Status, Second Edition,
H.E. Sauberlich
Advanced Human Nutrition, Robert E.C. Wildman and Denis M. Medeiros
Handbook of Dairy Foods and Nutrition, Second Edition, Gregory D. Miller,
Judith K. Jarvis, and Lois D. McBean
Nutrition in Space Flight and Weightlessness Models, Helen W. Lane
and Dale A. Schoeller
Eating Disorders in Women and Children: Prevention, Stress Management,
and Treatment, Jacalyn J. Robert-McComb
Childhood Obesity: Prevention and Treatment, Jana Pavrízková and Andrew Hills
Alcohol and Coffee Use in the Aging, Ronald R. Watson
Handbook of Nutrition in the Aged, Third Edition, Ronald R. Watson
Vegetables, Fruits, and Herbs in Health Promotion, Ronald R. Watson
Nutrition and AIDS, Second Edition, Ronald R. Watson
Advances in Isotope Methods for the Analysis of Trace Elements in Man,
Nicola Lowe and Malcolm Jackson
Nutritional Anemias, Usha Ramakrishnan
Handbook of Nutraceuticals and Functional Foods, Robert E. C. Wildman
The Mediterranean Diet: Constituents and Health Promotion, Antonia-Leda Matalas,
Antonis Zampelas, Vassilis Stavrinos, and Ira Wolinsky
Vegetarian Nutrition, Joan Sabaté
Nutrient–Gene Interactions in Health and Disease, Naïma Moustaïd-Moussa
and Carolyn D. Berdanier
Micronutrients and HIV Infection, Henrik Friis
Tryptophan: Biochemicals and Health Implications, Herschel Sidransky
Nutritional Aspects and Clinical Management of Chronic Disorders and Diseases,
Felix Bronner
Forthcoming Titles
Handbook of Nutraceuticals and Nutritional Supplements and Pharmaceuticals,
Robert E. C. Wildman
Insulin and Oligofructose: Functional Food Ingredients, Marcel B. Roberfroid
0945_ FM_fm* Page 4 Thursday, June 20, 2002 11:13 AM
NUTRITIONAL ASPECTS
and
CLINICAL MANAGEMENT
of
CHRONIC DISORDERS
and
DISEASES
Edited by
Felix Bronner
CRC PR ESS
Boca Raton London New York Washington, D.C.
0945_ FM_fm* Page 6 Thursday, June 20, 2002 11:13 AM
Library of Congress Cataloging-in-Publication Data
Nutritional aspects and clinical management of chronic disorders and diseases / edited by
Felix Bronner.
p. cm — (CRC series in modern nutrition)
Includes bibliographical references and index.
ISBN 0-8493-0945-X
1. Diet therapy. 2. Cookery for the sick. 3. Diet in disease. 4. Chronic
diseases—Nutritional aspects. I. Bronner, Felix. II. Modern nutrition (Boca Raton, Fla.)
[DNLM: 1. Chronic Disease—therapy. 2. Diet Therapy. 3. Nutrition. WT 500 N976 2002]
RM216 .N886 2002
616′.044—dc21 2002023353
CIP
This book contains information obtained from authentic and highly regarded sources. Reprinted material
is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable
efforts have been made to publish reliable data and information, but the authors and the publisher cannot
assume responsibility for the validity of all materials or for the consequences of their use.
Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, microfilming, and recording, or by any information storage or
retrieval system, without prior permission in writing from the publisher.
All rights reserved. Authorization to photocopy items for internal or personal use, or the personal or
internal use of specific clients, may be granted by CRC Press LLC, provided that $1.50 per page
photocopied is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923
USA. The fee code for users of the Transactional Reporting Service is ISBN 0-8493-0945-
X/03/$0.00+$1.50. The fee is subject to change without notice. For organizations that have been granted
a photocopy license by the CCC, a separate system of payment has been arranged.
The consent of CRC Press LLC does not extend to copying for general distribution, for promotion, for
creating new works, or for resale. Specific permission must be obtained in writing from CRC Press LLC
for such copying.
Direct all inquiries to CRC Press LLC, 2000 N.W. Corporate Blvd., Boca Raton, Florida 33431.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation, without intent to infringe.
Visit the CRC Press Web site at www.crcpress.com
© 2003 by CRC Press LLC
No claim to original U.S. Government works
International Standard Book Number 0-8493-0945-X
Library of Congress Card Number 2002023353
Printed in the United States of America 1 2 3 4 5 6 7 8 9 0
Printed on acid-free paper
0945_ FM_fm* Page 7 Thursday, June 20, 2002 11:13 AM
Preface
Nutritional counseling and management are becoming important in health care,
particularly in the management of a number of chronic conditions and diseases. The
publication of this book is timely, because it aims to help physicians and their staffs
identify conditions and diseases that can be treated effectively with nutritional
intervention, and provides specifics on appropriate counseling and management.
The first of the 13 chapters discusses nutritional support for children, with
emphasis on premature infants, cystic fibrosis, and bronchopulmonary dysplasia. As
in all subsequent chapters, the authors, Valentine, Griffin, and Abrams, emphasize
the need for good general nutrition to ensure that an individual attains full genetic
potential. Malnutrition may be the result of inadequate nutrient intake — a possibility
that even in wealthy societies cannot be neglected — or may be due to illness or a
condition that magnifies the need for one or several nutrients. Diagnosis and assess-
ment thus become the first and essential steps in an evaluation of nutritional status
that is then followed by counseling, intervention, and clinical management. Con-
vincing the patient, including young children, and caretakers of the rationale for the
proposed approach is essential. The authors here, as authors of other chapters, deal
with the question of enteral vs. parenteral and intravenous feeding, appropriately
emphasizing the importance of milk or modified milks for the nutrition of children.
In cystic fibrosis, the principal nutritional defect is fat malabsorption, and the use
of supplementary fats, pancreatic enzymes, and vitamin supplements is discussed.
An adequate energy supply, often accomplished by increasing the fat-to-carbohy-
drate ratio in the diet, is needed in bronchopulmonary dysplasia, and the authors
discuss monitoring the patient to ensure reasonable weight gain over the long term.
The next several chapters discuss nutritional support and therapy in major organ
systems. Kotchen and Kotchen, in their discussion of cardiovascular health (Chapter
2), enumerate the risk factors that contribute to coronary heart disease, the impact
of diet and caloric balance, the dietary guidelines that have evolved, and the strategies
that should be followed by patients and physicians to implement the guidelines. The
authors point out how general guidelines — avoiding high fat intake, limiting caloric
intake, generous consumption of fruits and vegetables — can be individualized for
a specific patient, taking into account the social and cultural environment that may,
on occasion, make acceptance of some recommendations difficult.
In Chapter 3, Navder and Lieber point out that even though in the popular view
most diseases are thought to have originated in something eaten, diet has little to
do with causing gastrointestinal disorders. Yet GI diseases and their treatment can
often have serious nutritional consequences. The chapter systematically reviews and
discusses disorders of the esophagus, stomach, small and large intestines, and liver,
as well as inherited diseases and diseases of the gall bladder and pancreas. Each
section includes treatment and nutritional management, with tables providing sum-
mary recommendations. In many situations, obesity is a complicating factor and
0945_ FM_fm* Page 8 Thursday, June 20, 2002 11:13 AM
weight reduction is recommended, sometimes facilitated by the need to avoid certain
foods or food constituents. An example is peptic ulcer disease, where strong gastric
stimulants should be avoided, even though antibiotics now constitute the principal
treatment, whereas for a long time previously, diet therapy played a major role.
Another example is Wilson’s Disease, where penicillamine treatment reduces the
body copper content and where copper-rich foods, e.g., beef liver, roasted cashew
nuts, and chocolate chips, should be avoided.
Diabetes mellitus is a condition that illustrates the complexity of medical and
nutritional management. Preuss and Bagchi, in Chapter 4, point out that glu-
cose–insulin perturbations, a category that includes but is broader than diabetes
mellitus, have increased in incidence, probably because of changes in lifestyle
brought about by industrialization, urbanization, and increased longevity. One con-
sequence of changes in lifestyle is the increase in obesity, which appears to exac-
erbate disturbances of insulin homeostasis. A primary goal of therapy is the return
to normal metabolism of the three major nutrient groups — carbohydrates, lipids,
and proteins — and the avoidance of later complications such as vascular disease
and insufficiency that may eventuate the need for amputation. To achieve that requires
intervention and the often substantial modification of social and cultural habits. This
represents a major challenge to the physician, as well to the patient, and the chapter
discusses these challenges as well as less classical approaches, such as the use of
botanical supplements.
Chapter 5 by Utermohlen discusses endocrine control of metabolism, with
emphasis on thyroid and glucocorticoid disease and, in Part 2, deals with diseases
of carbohydrate intolerance, specifically galactosemia and lactose intolerance. Sup-
pression of the excess hormone secretion in thyroiditis or Graves’ disease or thy-
roxine replacement in hypothyroidism needs to be accompanied by management of
the nutritional consequences of each condition, e.g., severe nutritional depletion of
persons with hypermetabolism due to thyrotoxicosis, or the difficulty of maintaining
a normal body weight for the hypothyroid patient. Special tables list the nutritional
problems posed by hyper- and hypocorticalism, with medical management discussed
in detail. Carbohydrate intolerance is defined and discussed, as is management,
including nutritional management and complications resulting from galactosemia
and lactose intolerance.
Nutritional support and management of musculoskeletal diseases are the topics
of Chapter 6 by Favus, Utset, and Lee. The first topic is osteoporosis, a condition
that has become a major public health problem as a result of the increase in longevity.
Still more acutely a problem of women, it is becoming a problem for men in their
seventh and eighth decades as well. Nutritional rickets in children is fortunately now
very rare in countries that supplement their milk supply with vitamin D. Still, vitamin
D deficiency and osteomalacia, as well as phosphate depletion, do occur, sometimes
slowly over years, but need recognition and treatment. The chapter also discusses
primary hyperparathyroidism, osteoarthritis, rheumatoid cachexia, scleroderma, and
gout. All have nutritional implications or complications that need to be part of the
overall treatment and management, often requiring substantial changes in lifestyle.
Renal failure, its nutrient metabolism, nutritional status, and requirements and
medical and nutritional management are the topics of Chapter 7 by Ikizler. Renal
0945_ FM_fm* Page 9 Thursday, June 20, 2002 11:13 AM
failure is a chronic, progressive disease that requires different approaches at its
several stages. For example, in early renal failure, phosphate control can usually be
achieved by moderate phosphorus restriction, but when the glomerular filtration is
below 20ml/min, it becomes necessary to stimulate calcitriol production and to
employ phosphate binders. In malnourished patients who require dialysis, intradia-
lytic parenteral nutrition may need to be considered. Clearly, nutritional management
of renal failure patients is an integral component of therapy. Readers of this chapter
will be helped by tables summarizing the various points made in the text.
The importance of vitamin A for proper night vision has been known for some
time, but the overall importance of nutritional strategies to reduce the risk of eye
diseases and their use to treat such diseases is perhaps less well known and is the
subject of Chapter 8 by Trevithick and Mitton. In addition to dealing with specific
eye diseases — cataracts, macular degeneration, retinopathy, retinitis pigmentosa,
glaucoma, and keratoconus — the authors describe the rod visual cycle and give a
lesson in genetics and oxidation stress. They also devote attention to the various
herbal nutritional supplements that have been proposed, some of which may be
harmful. Their reference list is particularly extensive for a field that may be unfamiliar.
Patients with cancer frequently suffer from protein-calorie malnutrition, with
weight loss the most common manifestation. Yet, as discussed by Mason and Choi,
in Chapter 9, evaluating this kind of malnutrition quantitatively is difficult, because
it depends entirely on the assessment tool employed. Still, physicians need to be
aware that malnutrition of a degree that worsens clinical outcome is common among
cancer patients. The chapter deals with the mechanisms of body weight loss in
cancer, the effects of the various major nutrients on cancer wasting, discusses the
efficacy of nutritional support, and provides specifics on how to accomplish this in
a variety of cancers, as well as in patients on chemotherapy or radiation therapy.
Targeted nutrient therapy, i.e., the administration of specific nutrients in more than
the usual quantities, e.g., omega-3 polyunsaturated fatty acids, or certain amino
acids, is critically discussed, as is the advisability of aggressive nutritional support,
either prophylactically or concurrent with treatment. Because many cancer patients
tend to seek and use “alternative” treatments, physicians and their staffs must try to
know this in order to better manage the patient’s treatment.
Smith and Souba deal in considerable detail with the nutritional aspects of trauma
and postsurgical care in Chapter 10. They analyze stress and the stress response in
relation to surgical stress, the determinants of the host response to stress, and the
role of cytokines as mediators of the stress response. Whereas most patients under-
going elective surgery are reasonably well nourished, there are specific endocrine
and neuroendocrine responses to surgery that have nutritional consequences and
need to be taken into account. In trauma patients, responses and consequences tend
to be more dramatic, and the increased metabolic demands following injury can
readily lead to malnutrition if adequate nutritional support is not provided. The
chapter lists how nutritional requirements of the trauma patient can be determined.
It also deals with sepsis, the choice of feeding routes — enteral or parenteral — and
how to maintain gut function in the perioperative period.
Immunocompromised patients present a special challenge because of the intri-
cate and complicated relationship between immunity and nutritional status. In