Gastrointestinal Cancer and Complementary Therapies
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
Patients who underwent surgical procedure for treatment historically have been instructed to follow low-fat diets, thus reducing intake and absorption of fat-soluble vitamins. This is no longer the recommendation with the introduction of pancreatic enzyme replacement during meal times to reduce symptoms of steatorrhea. Small, frequent meals are encouraged while avoiding foods and beverages high in sugar. Patients may also be initiated on pancreatic enzyme replacement when symptoms of malabsorption are present (see Table 11.3 for symptoms of malabsorption). In order to provide an additional source of calories, medium-chain triglycerides may be incorporated into the diet for patients with low body weight and weight loss. Supplementation of fat-soluble vitamins may be necessary as close monitoring of vitamin status is essential in the management of this patient population (Dominguez-Munoz, 2011).
Short Bowel Syndrome
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
In general, hypoallergenic formulas are well tolerated and absorbed better compared to regular formulas in SBS patients. Older children generally may not need elemental formulas as protein allergy is uncommon at this age. Fiber supplementation may be helpful in preventing high fluid losses in SBS patients with a remaining colon, as fiber can decrease stool volume and can be useful in infants with perianal skin breakdown. Medium-chain triglycerides can be supplemented because of better absorption compared to long-chain triglycerides due to bile acid or pancreatic insufficiency. Lactose restriction is usually not necessary in children with SBS; however, it should be restricted in the presence of intolerance. Higher oxalate-containing foods (beets, cocoa, spinach, and rhubarb) may need to be restricted to prevent kidney stone formation. Vitamin and trace element replacement may be considered based on the blood levels of these nutrients. PN should be gradually tapered as the enteral intake increases. Indications for continued PN include poor weight gain and fluid and electrolyte imbalances which cannot be replaced orally.
Regulation of Intestinal Mucosal Growth
Jean Morisset, Travis E. Solomon in Growth of the Gastrointestinal Tract: Gastrointestinal Hormones and Growth Factors, 2017
The effects of different dietary components on post resectional adaptation also have been studied. Long-chain triglycerides enhance intestinal adaptation more than the administration of equicaloric protein, carbohydrate, or medium chain triglycerides.48 Dietary fiber also plays a role in producing adaptation. Pectin supplementation of a liquid diet enhanced mitotic activity as well as mucosal weight, protein, and DNA content after resection.49 It was postulated that bacterial fermentation of pectin resulted in the production of short-chain fatty acids which stimulated mucosal growth. A subsequent study has shown that intravenous administration of short-chain fatty acids can produce a modest but significant increase in ileal mass after resection.50
The Impact of a Ketogenic Dietary Intervention on the Quality of Life of Stage II and III Cancer Patients: A Randomized Controlled Trial in the Caribbean
Published in Nutrition and Cancer, 2021
Eden Augustus, Isabella Granderson, Kern D. Rocke
The MKD intervention involved the administration of a seven (7) day cyclic altered KD offered over a 16-week period. The cyclic menu was developed to avoid repetition and lack of interest in the meals. Subjects in the treatment group who required assistance with their meal plan received assistance from members of their family or live-in helper. The MKD meals contained approximately 10% CHO, 15% Proteins, and 75% Fats. This amounted to 50 grams CHO, 75 grams protein, and 167 grams fats, providing 2,000 calories. The main source of fat used in the menus was medium chain triglycerides. STD subjects were instructed to consume their usual diet with minor alterations being made to ensure that their daily energy and nutrient requirements were met. Three-day food diaries (two weekdays and one weekend) from each subject were obtained at the weeks 6 and 12 to ensure subjects were adhering to their dietary regiment.
Monogenic forms of lipodystrophic syndromes: diagnosis, detection, and practical management considerations from clinical cases
Published in Current Medical Research and Opinion, 2019
Camille Vatier, Marie-Christine Vantyghem, Caroline Storey, Isabelle Jéru, Sophie Christin-Maitre, Bruno Fève, Olivier Lascols, Jacques Beltrand, Jean-Claude Carel, Corinne Vigouroux, Elise Bismuth
Although rarely described in the literature, failure to thrive and diarrhea were the main symptoms that enabled discovery of congenital generalized lipodystrophy in these two patients. Particular attention should be paid to patients presenting with these symptoms who also have hepatomegaly or metabolic disorders; lipodystrophy should be considered in the differential diagnosis. Administration of intravenous glucose confirmed the presence of insulin-resistant diabetes in both patients, as was also described in a previous case report30. However, insulin resistance declined strongly when the patients resumed feeding. Our observations also emphasize the importance of a controlled diet for managing BSCL. The eucaloric diet of our patient was enriched with medium-chain triglycerides, which may have contributed to resolving the metabolic derangements, as previously reported4,31,32. Additionally, adjusting the diet to reference daily intake is also of major importance to improve metabolic parameters in children with BSCL, as recently reported20.
Diagnostic challenges in metabolic myopathies
Published in Expert Review of Neurotherapeutics, 2020
Corrado Angelini, Roberta Marozzo, Valentina Pegoraro, Sabrina Sacconi
Most patients with primary carnitine deficiency are followed by a metabolic specialist as well as a dietician., it has been documented that the main treatment with carnitine supplementation corrects heart problems and muscle weakness [25,43] in several patients. In some cases, this treatment prevents the need for a cardiac transplant. The L – carnitine dose may vary from 100 to 600 mg/kg per day based on the calculated carnitine depletion from tissues. To adjust the dose, several plasma carnitine level measurements might be useful, Plasma carnitine levels should be monitored frequently to reduce the episodes of hypoglycemia. Side effects for L – carnitine supplementation are mild and consist of diarrhea, intestinal discomfort, or a fishy body odor. In some cases, a medium-chain triglyceride diet (MCT) may be added. Muscle carnitine clinical features affect mostly limb and neck muscles. The patients show normal ketogenesis on fasting. Diagnostic biochemical features are low muscle carnitine (below 15%) and absence of organic aciduria. There is in vitro stimulation by L-carnitine of labeled palmitate oxidation and oleate [24]. Muscle carnitine deficiency could be caused by an abnormal low – affinity carrier or by a low number of sarcolemmal carriers. It is differentiated from carnitine insufficiency in FAO disorders because of the absence of acylcarnitines elevation in plasma or urine.
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