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MEDICAL NUTRITION INNEUROBEHAVIORAL
Neurologic DisorderPsychiatric
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Medical Nutrition in
Neurologic Disorder
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Medical Nutrition in Neurologic
Disorder The nutritional management in patient
neuologic disease is complex.
Severe neurologic impairement compromisethe mecanism and cognitive abilities neededfor adequat nourishment;
Dysphagia
Ability to obtain, prepare, and present food to themouth.
All of neurologic patients are at risk for malnutrition.
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Medical Nutrition in Neurologic
DisorderFirst step:
Recognition sign and symptoms
Implementation of appropriate care plan tomeet nutritional requirement.
Counseling for the patient and familymembers on dietary choice.
Second: Regular evaluation of the patient’s nutrition
status inrelation to the disease management.
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Nutritional Assessment
Detail of diet history
History of weight loss or gain, weight loss 10
% or more indicated malnutrition. History of chewing, swalowing and rate of
ingestion
Anemias should be note, because synthesis of neurotransmiter dopamine and serotoninneeded iron.
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Problem with Access to Food
Chronic neurologic disease, a decline infunction may hinder the ability for self-care.
Fullfiling nutritional need and malnutritionare concern.
Access of food satisfying basic needs maydepend on involvement of family, friends, orprofessionals.
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Problem with Access to Food
In acute neurologic situations: trauma,
stroke,
or Guillain-Barre syndrome, Proccess of eating can be interrupted
abruptly
Patient may need enteral nutrition supportfor a period of time, until overall functionimprove and eating can be resume.
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Meal Preparation
Dificulty with meal preparation:
Confusion
Dementia Impair vision
Poor ambolation
Prepackaged and single servings can beencouraged.
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Feeding Issues:
Presentation of Food to the mouth
Hemiparesis: Risk of aspiration
Sit as upright (90 degree angle) as posible
If patient must be in bed during meal time,piloows can be used to bank and support theparetic side.
Hemianopsia: A patient may eat only half content of meal.
The patient must learn to recognise, compesatedby turning the head.
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Eating: The Oral Process
Dysphagia
Sawalowing; Oral phase
Pharengeal phase Esophagal phase
Liquids Liquid can be tickened with nonfat dry milk powder, corn
starch, modular carbohydrate supplement, or commercial
(contain cornstarch) Textures
Food consitency soft Small frequent meal
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Nutrition Support
Benefit to acute and chronic neurologicdisorder
In acute disease it may be required initialyuntil a degree of function regain.
In chronic disease it may be required in thelate stages to meet changing metabolicdemands.
Well managed nutrition support help toprevent pneumonia and sepsis.
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Nutrition Support
Enteral tube feeding (enteral) may be necessaryif the risk of aspiration from oral intake is high orif patients cannot eat enought to meet theirnutritional need.
In later case nocturnal tube feeding can bridgethe gap between oral intake and actualnutritional requirenment.
In most instances the GI tarct function is intack.Exception occurs after SCI, ileus is common for 7-10 day after insult, this condition parenteralnutrition may be neccessary.
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Nutrition Support
Nasogastric tube can be delivered as a short term
option. Percutaneus endoscopic gastrostomy (PEG) or
gastrostomy-jejenoustomy (PEG/J) tube is preferredfor long term nutritional management.
In acutely ill, well nourished indivdualwho is unableto oral alimentation for 7 days, nutrition support inused to prevent decline in nutrition, until oralnourishement can be resumed.
Conversely in the chronical ill, ussually need a
prolong nutrition support. In advance stage of disease, nutrition support should
enhance the quality of life of patient, health careteam plays an important role in alleviating patientand family conrcern.
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Neurologic Diseases Arising From
Nutritional Deficiancy or Excesses
Beri-beri (def. B1) and pellagra (def. Niacin)
Pernicious Anemia (def B12)
Wernicke-Korsakoff Syndrome (WKS) (def.Thiamin).
Stroke (excessed of macronutrient)
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Stroke
Nutrition Management:
Maintain adequate nutrition
Assess and manage dysphagia Vitamin and mineral supplementation as
needed.
Enteral nutrition support may be necessary.
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Neurologic Disease With
Nonnutritional Etiologies
Adrenomyeloleukodystrophy (ALD).
Azheimer’s disease
Amyotrophic Lateral Scleroris (ALS)
Epilepsy Guillain-Barre Syndrome (GBS)
Migraine Headache
Myastenia Gravis
Multiple sclerosis Parkinson’s Disease Neuro and spine trauma.
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Mental Illness:
Axis I
Axis II
Medical Nutrisi Therapy for
Psychiatric Condition
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Nutritional Aspect of Brain and
Nervous System Structure and
Function
Omega-3 Fatty Acid: Α-Linolenic Acid (ALA) (18:3 n-3)
Ecosapentanoic acid (EPA) (20:5 n-3)
Docosahexanoic acid (DHA) (22:6 n-3)
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Food sourches of ALA Broccoli, cooced
Brussel sprouts
Cabbage
Canola oil
Flaxseed, ground
Flaxseed oil
Kale
Parsley
Pumkin seed
Soybean oil
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Food sourches of ALA
Broccoli, coocedBrussel sproutsCabbage
Canola oilFlaxseed, groundFlaxseed oilKaleParsley
Pumkin seedSoybean oilSpinach
Spring greenWalnutsWalnuts oil
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Adequate DHA and EPA
Strategy to achieving and sustaining a healthybrain and nervous system:
During pergnancy and lactation
During infancy
During adulhood
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Sourches of DHA and EPA
Menhaden: include surface part and bone of fish.
Microencapsulated fish oil powder DHA and EPA produce ed by other livestock.
Marine algae
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An Integrative Approach
Nutrition – Basic principles
Nutritional Supplements
Omega-3 Fatty Acids Zinc
Magnesium
Multivitamins Creative Behavioral Approaches
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Nutrition recomendations
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Goal 1 : Consumtion of DHA
and EPA:
Need daily to sustain brain and nervoussystem
Daily recommended minimal 220 mg each of both DHA and EPA
All sea food is beneficial regard to n-3 content
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Goal 2 : Maintenance of a Diet with a
Low Total Daily omega-6 to Omega-3
Ratio
War of saturated fat, increase intake of omega-6 (n-6) fatty acids.
A high n-6:n-3 ratio (>10) appears to promoteimplamation and oxidation. (American dietthis ratio 17:1)
A beneficial n-6:n-3 ratio close to 2:1.
In very low fat diet (vegetarian) can have highn-6:n-3 ratios.
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Goal 3: Avoidance of Restriction
Diets that Encourage Rapid Weight
Loss
Restriction energy intake cannot specify withtype of fat.
Restriction diet create n-3 fatty acid acid arebeing liberated and oxidized.
Supplementation n-3 ALA during weight loss
not preserve n-3 store in tissues.
Restrictive eating creating DHA deficiencyhas been shown to affect brain function.
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Goal 4: Increased Antioxidant
Intake
The two major goals to maintenance of healthy fattyacid levels are :
increase the level through dietary choices (n-3 fatty acid)and
To prevent their oxidation through dietary food choices(antrioxidant).
Although DHA is an antioxidant, antioxidant in otherfood importance in preserving these fat as well.
A diet rich in fruit and vegetable is an importantstrategy, contain vitamin, mineral and antioxidant.
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Antioxidant Activity in the Brain
and Nervous System
Α-lipoic acid
Anthocyanins
Curcumin
EPAGingko biloba
Gluthatione
Grapeseed
Green tea
Manganese
Manitol
Miso
Quercetin
Resveratrol
Selenium
Thiamin
Vitamin A
Vitamin B12
Vitamin C
Vitamin E
Zinc
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