Optimal Nutrition For Gastrointestinal Dysmotility

Optimal Nutrition forGastrointestinal DysmotilityJILL TALIAFERRO RD, LDN, CNSC

Disclosure:ThriveRx Home InfusionClinical Dietitian

Objectives Define gastrointestinal-(GI) dysmotility and its clinicalpresentation Name two treatment options for GI dysmotility Name the three essential macronutrients needed for propergrowth and promotion of energy Name three signs of dehydration.

What is GI Dysmotility?GastrointestinalDysmotilityAny abnormality withinthe GI tract that preventsfood/nourishment in asolid or liquid form frommoving in a downwardfashion-(antegrade) toand through the intestineswhere absorption occurs.

Presentation of GI reflux (GERD)ConstipationGastroparesisCyclicVomiting

Treatment Options for GI Dysmotility

A Spectrum of Support

Why is Nutrition so Important? Helps to promote normalgrowth and developmentby providing adequatemacronutrients (carbs, protein,& fat). These macronutrientsare required to meet a person’senergy needs. Helps to increase immunesystem functioning which isimportant to minimizeinfection risk. To prevent obesity andmalnutrition which canpromote progression of disease.

Energy Production via NutritionCalories come from carbohydrates, proteins, and fats. They areessential to meet daily energy needs. Calories in must equal orexceed calories used to provide energy and prevent weight loss.

Carbohydrates can be Good!Dietary carbohydrates arethe body’s main source ofenergy or fuel andtherefore should comprise40-60% of total calorierequirements each day.Two major types ofcarbohydrates:Complex Carbohydrates &Simple Carbohydrates

Carbohydrates: Complex and Simple Complex Carbohydrates are alsoknown as starches and fibers. Complex carbohydrates in theform of starches should beincluded in the diet and shouldmake up the bulk of your dailycalories. Complex carbohydrates in theform of fiber should be avoided. Simple carbohydrates are alsoknown as sugars. Simple carbohydrates (sugars)should be minimized.

Starches To Choose

Dietary Fiber Modifications Fiber is a complex carbohydrate withmany functions including controlling themovement of food through the GI tract. Choose foods that contain less than 1gram of dietary fiber per serving. Avoid high fiber foods: whole grain cereals,fruits, vegetables, nuts, seeds Choose low fiber foods: dairy products,meats, refined grains, skinless fruits, wellcooked vegetables

Avoiding Dietary Fiber

Other culprits.,Limiting fermentable foods, simple sugars, raw foods, fructose, yeast,and soy., The low FODMAPS Diet:(Fermentable Oligo-Di-Monosaccharides and Polyols)The FODMAPs in the diet are: Fructose (fruits, honey, high fructose corn syrup (HFCS), etc.) Lactose (dairy) Fructans (wheat, garlic, onion, inulin etc.) Galactans (legumes such as beans, lentils, soybeans, etc.) Polyols (sweeteners containing isomalt, mannitol, sorbitol, xylitol,stone fruits such as avocado, apricots, cherries, nectarines, peaches,plums, etc.)

Dietary ProteinProtein has several essentialfunctions: Energy production Growth and maintenance oftissue Formation of essentialhormones like insulin,estrogen, growth hormones Development of enzymes suchas lactase, lipase, sucrase Antibody production Regulation of body water andtransport of nutrients

High Quality Protein

Dietary Fat Fat is a very importantpart of the diet but not allfats are alike. Foods high in animal fatand saturated fat shouldbe limited.

Dietary Fat Essential fats or essential fattyacids (EFA’s) cannot be madeby the body. EFA’s are found inpolyunsaturated fats. Fat can be difficult to tolerateas it tends to move the slowestthroughout the gastrointestinaltract. A low-fat diet is recommendedin some cases of extremegastroparesis and intestinaldysmotility. The recommended intake forthose able to tolerate fat isabout 30% of total calories.

Essential vs. Non-Essential Fats

Diet Tips to Remember

Tube Feeds

Formulas for Dysmotility The best choice in formulafor someone withdysmotility is one withoutfiber. A patient’s underlyingdiagnosis may also dictateformula selection as certainmetabolic conditions and/ordisease relatedcomplications may requiremore or less of specificnutrients. Formulas are also selectedbased on nutritional contentspecific to patient needs.

Fluid Intake

Assessing Baseline Fluid Needs Adults 25-35ml per kg (of actual or adjusted body wt) Pediatrics (*) 1-10kg 100ml/kg11-20kg 1000mls 50 mls /kg for each kg 10 kg 20kg 1500mls 20 mls /kg for each kg 20 kgOther considerations; excess fluid losses, malabsorption, heatexposure, or changes in body temperature(*)Texas Children’s Hospital, Pediatric Nutritional Reference Guide 2005, 7 th Edition, pg 11

Signs of Dehydration

IV Hydration When oral and enteralfluid intake alone failsto meet fluidrequirements,intravenous-(IV)hydration may benecessary. Hydration can be givenas needed (PRN) ordaily. The amount ofhydration needed isdetermined by yourclinical team.

Short Term Access: Peripheral IV’s IV fluids for hydrationmay be given via aperipheral IV if thetherapy course isintermittent and/orshort-term. When HYD therapy isneeded on a regularbasis a more permanentline should beconsidered.

TPN Total ParenteralNutrition (TPN)becomes necessarywhen a person cannotmeet their nutritionalneeds orally orenterally. The solution containscarbohydrates (in theform of glucose),protein, fat, vitamins,and minerals.

TPN Also known as: intravenous nutrition, hyperal orHPN (Home Parenteral Nutrition) This may be the first choice of therapy in consumers withsome types of GI obstruction or severe malabsorption. TPN is a viable option when adequate nutrition can not betolerated by the bowel or when access for enteral tubeplacement is limited. Consumers often use a combination of TPN, enteral orhydration.

Long Term Access: Central Catheters

Long Term Access: Central Catheters

Home Nutrition Support StatisticsEnteralandPN1992)Therapy(from theOleyHomeFoundation,HomeStatistics 40,000 peoplereceive TPN theirhomes in the U.S.On Top of the WorldRick Davis: Me "taking adrink" in the Grand Canyonthrough my MIC-KEY andextension tube with a 2 ozsyringe. (From www.oley.org) 152,000 people receive enteralnutrition in their homes in the U.S.

In Summary , Optimal nutrition is vital because it promotes growthand development, increases immune systemfunctioning, and helps to prevent obesity andmalnutrition which can promote progression ofdisease. How nutrition is delivered varies depending on apatient’s ability to eat and consume enough calories bymouth, tolerance to oral or enteral feeds, his/her fluidrequirement needs, and associated complications fromparenteral nutrition therapy.

Thank you for your timeQuestions ?Contact Info;Jill Taliaferro RD, LND, CNSCjtaliaferro@thriverx.net

Carbohydrates: Complex and Simple Complex Carbohydrates are also known as starches and fibers. Complex carbohydrates in the form of starches should be included in the diet and should make up the bulk of your daily calories. Complex carbohydrates in the form of fiber should be avoided. Simple carbohydrates are also known as sugars.