chapter 023

Williams' Basic Nutrition & Diet Therapy

Chapter 23

Nutrition Support in Cancer and HIV/AIDS

Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1

14th Edition

Lesson 23.1: Nutrition Support in Cancer

Environmental agents, genetic factors, and weaknesses in the body’s immune system can contribute to the development of cancer.

The strength of the body’s immune system relates to its overall nutritional status.

2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Process of Cancer Development (p. 471)

The nature of cancer Multiple forms: highly variable nature Second leading cause of death in United States Cancer designates a malignant tumor neoplasm


The Cancer Cell (p. 472)

Orderly process of cell division is disrupted by mutation

Cancer is normal cell growth that has gone wrong

Tumors identified by: Primary site of origin Stage of tumor size and metastasis Grade: level of aggressiveness


Causes of Cancer Cell Development (p. 473)

Dietary factors Role is complex Micronutrient imbalance linked to DNA damage

and cancer


The Body’s Defense System(p. 473)

Two types of lymphocytes (defensive immune system cells) T cells B cells

T cells activate phagocytes Phagocytes destroy invaders and antigens B cells produce antibodies, which kill antigens


The Body’s Defense System (cont’d) (p. 473)


Relation of Nutrition to Immunity and Healing (p. 473)

Immunity Balanced nutrition maintains immune system Malnutrition reduces capacity of immune system

via atrophy of organs and tissues involve in immunity

Nutrition vital in combatting sustained attacks of diseases (e.g., cancer)


Relation of Nutrition to Immunity and Healing (cont’d) (p. 473)

Healing Strong tissue is fundamental to immune system Tissue building and healing requires optimal

nutrition Vigorous MNT speeds recovery after surgery for

cancer


Nutrition Complications of Cancer Treatment (p. 474)

Three major forms of therapy used to treat cancer Surgery Radiation Chemotherapy


Surgery (p. 474)

All surgery requires nutrition support for the healing process

General condition of cancer patients often is weakened by the disease process


Radiation (p. 474)

Involves high-energy radiographs targeted on the cancer site

Often kills surrounding healthy cells as well as cancerous cells

Nutrition problems driven by site and intensity of radiation treatment

Sense of taste may be affected, prompting efforts to enhance food appearance and aroma


Radiation (p. 474)


Chemotherapy (p. 474)

Highly toxic drugs administered via the bloodstream to kill cancer cells

Normal, healthy cells also affected Bone marrow Gastrointestinal Hair loss


Drug-Nutrient Interactions(p. 475)

Use of monoamine oxidase inhibitors (pretreatment antidepressant drugs) requires tyramine-restricted diet

Antineoplastic drugs have drug-nutrient interactions Some patients use herbs to prevent or treat cancer,

can have food-drug interactions


Medical Nutrition Therapy in the Patient with Cancer (p. 475)

General systemic effects of cancer Anorexia, loss of appetite Increased metabolism Negative nitrogen balance

Specific effects related to cancer Depending on location and nature of tumor


Case Study

Mrs. Bowen has been undergoing chemotherapy for cancer. She is 55 years old. She complains of nausea and that food tastes “funny.” She has lost 5 pounds from her normal weight of 130 lbs. (64 inches tall).


Case Study (cont’d)

Give a rationale as to why Mrs. Bowen is currently feeling nauseated and why she feels that food tastes funny.


Basic Objectives of Nutrition Plan (p. 477)

Nutrition screening and assessment Primary responsibility of clinical dietitian Other members of health care team may take part


Basic Objectives of Nutrition Plan (cont’d) (p. 477)

Nutrition intervention Prevent weight loss Maintain lean body mass Prevent unintentional weight gain Identify and manage treatment-related side effects


Prevention of Catabolism(p. 477)

MNT to meet increased metabolic demands of disease process

Medications used to: Increase appetite Reduce nausea Prevent protein degradation Increase caloric intake


Relief of Symptoms (p. 477)

Stress management Pain management Relaxation techniques Psychological support Physical activities


Nutrition Monitoring and Evaluation (p. 478)

Dietitian develops customized MNT plan for patient Plan is evaluated regularly with patient and family Plan adjusted as needed


Medical Nutrition Therapy(p. 478)

Energy: cancer places great metabolic demands Protein: essential amino acids and nitrogen for

rebuilding Vitamins and minerals: at least to DRI standards Fluid: to replace losses, remove waste products,

meet drug needs



What nutritional recommendations may assist Mrs. Bowen?


Nutrition Management (p. 479)

Enteral: oral diet with supplementation Preferred route Adjust to maximize palatability Maximize energy and nutrient density


Enteral: Oral Diet with Supplementation (p. 479)

Loss of appetite Major issue with cancer Can lead to cachexia Requires vigorous program of eating that does not

depend on appetite


Enteral: Oral Diet with Supplementation (cont’d) (p. 482) Oral complications

Ensure basic mouth care Frequent small snacks rather than traditional

meals Strong seasonings, high-protein drinks

GI problems Avoid hot, sweet, fatty, spicy foods as needed Small, frequent feedings of soft to liquid foods Antinausea drugs


Pain and Discomfort (p. 482)

Pain and discomfort Severe pain controlled and comfortable position Pain medication as needed Preventive therapy to avoid constipation


Enteral: Tube Feeding (p. 483)

When gastrointestinal tract can be used but patient is unable to eat Indications include inadequate oral intake, oral

route contraindicated, comatose Some patients can be fed overnight, allowing them

to be free from tube during day


Parenteral Feeding (p. 483)

When gastrointestinal tract cannot be used Peripheral vein feeding (for brief period) Central vein feeding (for extended period)



If Mrs. Bowen continues to lose weight, what might be necessary?


Cancer Prevention (p. 483)

American Cancer Society, World Cancer Research Fund, American Institute for Cancer Prevention Be as lean as possible within normal range Adopt a physically active lifestyle Consume a healthy diet Limit alcohol consumption Do not rely on supplements


Cancer Prevention (cont’d)(p. 484)

U.S. Food and Drug Administration claims approved for labels Low total fat may reduce risk of some cancers Fiber-containing grain products, fruits and vegetables may

reduce risk of some types of cancer Fruits and vegetables may reduce risk of some types of

cancer Ongoing cancer research: foods that may increase or

reduce risk of: Breast cancer Gastric cancer Colorectal cancer Prostate cancer


Lesson 23.2: Nutrition Support in HIV/AIDS

Nutrition problems affect the nature of the disease process and the medical treatment methods in patients with cancer or AIDS.

The progressive effects of the human immunodeficiency virus (HIV), through its three stages of white T-cell destruction, have many nutrition implications and often require aggressive medical nutrition therapy.


Process of AIDS Development (p. 485)

Evolution of human immunodeficiency virus First case identified in 1959 By late 1970s and early 1980s had spread to

Europe and United States Underlying infectious agent identified in 1983

Parasitic nature Viruses contain only shreds of genetic material They invade a host cell and use it to make copies

of itself


Transmission and Stages of Disease Progression (p. 487)

Modes of transmission Three distinct stages

Primary infection and extended latent period of HIV incubation

HIV-related diseases AIDS


Case Study

John is a 32-year-old male diagnosed with HIV, category B. He complains of fatigue, mouth sores, and diarrhea. He has lost 10 pounds from his usual ideal body weight.



Describe Category B HIV. Does John exhibit signs and symptoms common to

Category B?


CD4+ T-Lymphocyte Conditions (p. 487)

Terminal stage of HIV infection: AIDS Rapidly declining T-lymphocyte counts Kaposi’s sarcoma Protozoan parasites Cytomegalovirus


Medical Management of Patient with HIV/AIDS (p. 489)

Delay progression of the infection and improve the immune system

Prevent opportunistic illnesses Recognize the infection early


Drug Therapy (p. 489)

Effective drug therapy is difficult because of highly evolved nature of virus

Several drugs approved by FDA Highly active antiretroviral therapy is current primary

drug regimen


Vaccine Development (p. 492)

Vaccine would train body’s immune system to identify and destroy HIV virus

Vaccine undergoing trials in Thailand considered somewhat effective

CDC and NIH working with other worldwide agencies to coordinate development of effective vaccine


Medical Nutrition Therapy(p. 493)

Assessment Anthropometry Biochemical tests Clinical observations Diet observations Environmental, behavioral, and psychological

assessment Financial assessment


Medical Nutrition Therapy (cont’d) (p. 493)

Intervention No specific nutrient recommendations for patient

with HIV Reduce or eliminate malnutrition Correct nutrition problems identified in assessment


Wasting Effects of HIV Infection on Nutritional Status (p. 493)

Severe malnutrition, weight loss Decreased appetite, insufficient energy intake in

addition to elevated resting energy expenditure Major weight loss, eventual cachexia


Causes of Body Wasting (p. 494)

Inadequate food intake Malabsorption of nutrients Disordered metabolism Lean tissue wasting


Lipodystrophy (p. 494)

Gaining of fat in neck and abdomen Concurrent loss of fat in face, buttocks, arms, legs Treatment with antiretroviral therapy may be

causative factor Other risk factors


Nutrition Counseling, Education, and Supportive Care (p. 495)

Should focus on: Appropriate, adequate food intake Food behaviors Symptoms that may affect food intake Benefits and risks of supplemental nutrients Nutritional strategies for symptom management


Counseling Principles (p. 495)

Motivation for dietary changes Rationale for nutrition support Provider-patient agreement on plan Development of manageable steps for change


Personal Food Management Skills (p. 495)

Identify community programs (e.g., Meals on Wheels) Provide psychosocial support



Make nutrition recommendations for John.


chapter 023

Health & Medicine

imprint of elsevier

cancer site

development of cancer

mutation cancer

cancer cells normal

hivaids copyright

cancer cell development

process of cancer development