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NHHC chapter 23 ppt
- 1. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Nutrition, Cancer, and HIV Infection Chapter 23
- 2. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 3. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 4. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 5. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 6. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 7. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 8. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 9. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 10. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 11. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 12. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 13. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 14. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 15. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 16. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 17. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 18. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 19. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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)
- 20. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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.
- 21. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 22. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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)
- 23. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 24. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 25. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 26. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 27. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 28. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 29. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • Lipodystrophy – Abnormalities in body fat and fat metabolism • Causes of weight loss and wasting – Anorexia and inadequate food intake, altered metabolism, malabsorption, etc.
- 30. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • Factors contributing to poor food intake – Emotional distress, pain, and fatigue – Oral infections – Respiratory disorders – Cancer – Medications
- 31. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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.
- 32. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 33. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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)
- 34. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 35. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 36. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 37. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 38. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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?
- 39. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
- 40. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 HIV Infection (cont’d.) • 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
Editor's Notes
- #7 Figure 23-1 Cancer Development
- #8 Figure 23-1 Cancer Development (cont’d.)
- #18 Table 23-4 Nutrition-Related Side Effects of Cancer Surgeries
- #19 Table 23-4 Nutrition-Related Side Effects of Cancer Surgeries (cont’d.)
- #27 Table 23-7 The HIV and AIDS Epidemic at a Glance, 2010
- #28 Table 23-8 Risk Factors for HIV Infection