1. Inflammatory bowel disease(IBD)-ulcerative colitis and Crohn’s
alterations in microbiome play a role in IBD
1)different oxidative pathways in the altered microbiome
2)more aggressive nutrient uptake by altered microbiome-this favours the altered microbiome
3) altered microbiome is more virulent

2. Exam
180 minutes
120 multiple choice questions-120 points
-4 short answer question-60 points
multiple choice-lecture 7a-12c inclusive
short answer-whole Nutr2105 course

3. Nutrition 2106-Fall 2013- Principles of Nutrition in Metabolism
Note
Nutrition 2106-Fall Principles of Nutrition in Metabolism
Nutrition 2101-Nutritional Assessment-Theory-Fall 2013
Nutrition Introduction to Sports Nutrition-Winter 2014

4. Lecture 10a
18 March 2013
Enteral and Parenteral Feeding

5. Enteral Feeding
-refers to use of intestine (uses oral or tube feeding to direct nutrients to intestine)
-called complete enteral feeding if formula is primary source of nutrients
-complete formulas can be used in smaller quantities to supplement table foods
-complete formulas required if patient is on tube feeding or oral liquid diet for more than a few days

6. Types of enteral formulations
-standardised
-hydrolysed
-modular
-characterised by type of protein in the formulation

7. Types of enteral formulations
Standardised
Appropriate for people who are able to digest and absorb
Contain complete proteins (complete refers to whole proteins or combination of protein isolates(purified proteins))
Blenderised formulas contain protein from pureed foods (e.g. blenderised meats)

8. Types of enteral formulations
Hydrolysed
Pre-digested protein- so only get small peptides or just free amino acids
Some have medium chain triglycerides or are very low in fat

9. Types of enteral formulation
Modular
Provide a single nutrient
Modules can be combined with other modules or with minerals and/or vitamins to address the specific needs of a patient

10. Candidates for tube feeding
Anybody who:
can not get food down orally or
has mental incapacitation
are malnourished or
have high nutrient requirements or
extensive intestinal resections or
is on a ventilator
gastrointestinal obstructions or fistulas
in short anyone who cannot access or utilise GI tract on their own

11. Distinguishing characteristics of enteral formulations
Nutrient density
1.0  kcal/ml- standard
1.2 – 2.0 kcal/ml for nutrient dense formulas nutrient dense formulations are given in smaller volumes to persons with fluid
balance issue- e.g. congestive heart patients

12. Distinguishing characteristics of enteral formulations
2) Fibre
if administered over short time - low to moderate fibre - otherwise gas and distension can be an issue
if long term administration -then higher amounts of fibre

13. Distinguishing characteristics of enteral formulations
3) Osmolality- measure of concentration of molecular and ionic particles in solution
-serum is 300 milliosmoles/kg of solution
-isotonic solution is 300 milliosmoles/kg
-hypertonic is greater than milliosmoles/kg of solution
-hypertonic can induce diarrhea in intestine- slow introduction of hypertonic solution for intestinal route is essential

14. Tube placement-1) transnasal or 2) direct catheter
Nasogastric-children and adults-larger nose than infants so nasogastric is used in children and adults
Orogastric-infants- smaller nose than adults and children so orogastric is used
Nasoduodenal-nose to duodenum
Nasojejunal placement-nose to jejunum

15. Tube placement
2) Catheter direct to stomach or jejunum
Enterostomies- surgical placement of catheter
-Gastrostomy- direct to stomach
-Jejunostomy-direct to jejunum

18. Safehandling of formulations
Open and closed systems
Open- exposed to air
Closed-not exposed to air
Keep your fingers out of the soup for open
systems

19. Initiating and progressing a tube feeding
Formula delivery techniques
Intermittent feeding
Best to stomach
No more than ml over minutes
Use- depends on tolerance
Bolus feeding included here ( ml) in 10 minutes

20. Initiating and progressing a tube feeding Formula delivery techniques
Continuous feeding
Delivered slowly over 8-24 hours
Good for people who have received nothing though GI tract for a long time, hypermetabolising persons and those receiving intestinal feedings
Formula volume and strength
institutionally based- standard operating procedures (sops)

21. Initiating and progressing a tube feeding Additional matters
Supplemental water
-standard formulas contain about ml of water/per formula
-most people need about 2 L of water per day
Gastric residual volume
-amount left over from previous feedings-significance of this?

22. 2 Youtubes- enteral feeding

23. Class activity
Design an enteral feeding for the pathology/problem of your choice that meets the dietary principles of adequacy, variety, moderation, nutrient density, energy control, and balance