Medical Nutrition in Neurobehavioral2

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MEDICAL NUTRITION INNEUROBEHAVIORAL

Neurologic DisorderPsychiatric



Medical Nutrition in

Neurologic Disorder



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.



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.



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.



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.



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.



Meal Preparation

Dificulty with meal preparation:

Confusion

Dementia Impair vision

Poor ambolation

Prepackaged and single servings can beencouraged.



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.



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



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.



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.



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.



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)



Stroke

Nutrition Management:

Maintain adequate nutrition

Assess and manage dysphagia Vitamin and mineral supplementation as

needed.

Enteral nutrition support may be necessary.



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.



Mental Illness:

Axis I

Axis II

Medical Nutrisi Therapy for

Psychiatric Condition



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)



Food sourches of ALA Broccoli, cooced

Brussel sprouts

Cabbage

Canola oil

Flaxseed, ground

Flaxseed oil

Kale

Parsley

Pumkin seed

Soybean oil



Food sourches of ALA

Broccoli, coocedBrussel sproutsCabbage

Canola oilFlaxseed, groundFlaxseed oilKaleParsley

Pumkin seedSoybean oilSpinach

Spring greenWalnutsWalnuts oil



Adequate DHA and EPA

Strategy to achieving and sustaining a healthybrain and nervous system:

During pergnancy and lactation

During infancy

During adulhood



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



An Integrative Approach

Nutrition – Basic principles

Nutritional Supplements

Omega-3 Fatty Acids Zinc

Magnesium

Multivitamins Creative Behavioral Approaches



Nutrition recomendations



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



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.











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.



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.



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



Medical Nutrition in Neurobehavioral2

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