A Custom Education

for Multiple Nutrition-Related Diseases

Addie Abohosh, Dietetic Intern

Learning Outcomes
Understand diets for multiple disease states
How to combine diets for multiple disease states into
one intervention
How to listen and learn from your patient in order to
best meet their needs
 45 Year Old Caucasian Male
PMH: Diagnosis:

Chronic pancreatitis Presenting Dx: Abdominal

Occasional gastroparesis pain & N/V
T2DM Official Dx: Acute on
chronic pancreatitis
Hypertension
Chronic neuropathy
Familial hx of elevated TG

& colon cancer
 45 Year Old Caucasian Male
Social History: Anthropometrics:

90 pounds weight loss in 115.8 kg, 187.96 cm

past 2 years BMI = 32.78
Lives with wife and IBW = 86.4 kg
daughter
Smoke marijuana
4x/month

Denies alcohol intake
Type 2 Diabetes1
Description of disease

T2DM comes from insulin

secretion abnormalities and
resistance of insulin.
Treatment: medication to
control blood sugar, insulin
if needed, lifestyle changes
Type 2 Diabetes1
Description of disease Typical Symptoms

T2DM comes from insulin Elevated BMI

secretion abnormalities and Elevated glucose
resistance of insulin. Altered lipid profile
Treatment: medication to Ketoacidosis
control blood sugar, insulin Poor wound healing
if needed, lifestyle changes Neuropathy
Chronic Pancreatitis1
Description of disease

Irreversible inflammation of
the pancreas that can lead to
fibrosis
Disease progression: can
progress to fibrosis and
calcification of the pancreas.
Survival rate is 45% when
diagnosed after age 20.
Chronic Pancreatitis1
Description of disease Typical Symptoms

Irreversible inflammation of Loss of endocrine and

the pancreas that can lead to exocrine function
fibrosis Weight loss/malnutrition
Disease progression: can
Malabsorption
progress to fibrosis and
calcification of the pancreas. Abdominal pain
Survival rate is 45% when Diabetes
diagnosed after age 20.
Gastroparesis1
Description of disease

Delayed emptying of the

stomach without a known
blockage
Treatment: improve gastric
emptying and N/V
Gastroparesis1
Description of disease Typical Symptoms

Delayed emptying of the Nausea

stomach without a known
blockage
Treatment: improve gastric
emptying and N/V
Vomiting
Early satiety
Upper abdominal pain
Malnutrition if prolonged
Unpredictable glycemic
control
 MNT for 3 Disease States1,2

Type 2 Diabetic Exchange system and Carbohydrate counting

Diabetes Increase fiber, whole grains, fruits & vegetables. Lower calorie intake for weight loss

Pancreatitis Frequent small meals, pancreatic enzymes taken with each meal.
Low-fiber diet, promote weight gain

Gastroparesis
Frequent small meals.
Low fat and low fiber diet
Comparison to typical disease profile1,2
Multiple diseases with conflicting treatments
Weight loss vs. weight management
Increased vs. decreased calorie intake

High fiber vs. low fiber intake

Patients Hospital Stay
Previous admit 9/14/2016 - uncontrollable
vomiting
Dx: pancreatitis with dramatic lipase increase
Re-admit 9/21/2016 - N/V, abdominal pain
Upon visiting patient for Carb-Controlled Diet
Education, custom education material drafted
 Patient Labs & Meds
Lab Value
Glucose POC 180-250
Potassium 3.2
Total Serum Protein 6.3
Cholesterol 222 mg/dL
Triglycerides 560 mg/dL
BUN 7
Lipase 73

Hospital Medication: Sliding-scale insulin (NovoLOG)

PES Statement3
Inadequate oral food and beverage intake related to
nausea and vomiting as evidenced by consumption
of meal percent less than 50% and patient symptom
report.
Nutrition Prescription
Calculated needs:
2,110 kcal from MSJ (will not need an activity factor due to BMI >30, will add a
small range for patient ease)
2,110-2,300 kcal (18-20 kcal/kg/day)
140 g protein (1.2 g/kg/day)

2,110-2,300 mL fluid (18-20 mL/kg/day)

 Intervention - Custom Education
Foods T2DM Pancreatitis Gastroparesis
Recommended Not Recommended Not Recommended Not
Recommended Recommended Recommended

Dairy Low-fat dairy High-fat dairy Low-fat dairy High fat dairy Fat-free dairy Cream cheese, sour
cream, cheese

Meat & Lean cuts, eggs, Fried meat, high- Lean cuts, egg High-fat meat Lean cuts, egg Tough meat, fried
beans, lentils fat meat whites whites, smooth nut meat, nuts, beans
alternatives butter & lentils

Vegetables ALL none Low-fiber veggies, High-fiber veggies Canned or well- Raw veggies,
canned veggies cooked veggies cooked greens,
high-fiber veggies

Fruit ALL Fruit juice Low-fiber fruit Berries, high-fiber Canned fruit, fruit Raw fruit, dried
fruit juice fruit

Grains Whole-wheat Refined grains, White flour Whole-wheat White flour Whole-wheat
products, oatmeal, grains in excess products, oatmeal, products, brown products, oatmeal, products, brown
brown rice, quinoa, crackers, white rice rice, popcorn, etc. crackers, white rice rice, popcorn, etc.
etc. all portion
controlled
 Intervention - Custom Education
Foods T2DM Pancreatitis Gastroparesis
Recommended Not Recommended Not Recommended Not
Recommended Recommended Recommended

Dairy Low-fat dairy High-fat dairy Low-fat dairy High fat dairy Fat-free dairy Cream cheese, sour
cream, cheese

Meat & Lean cuts, eggs, Fried meat, high- Lean cuts, egg High-fat meat Lean cuts, egg Tough meat, fried
beans, lentils fat meat whites whites, smooth nut meat, nuts, beans
alternatives butter & lentils

Vegetables ALL none Low-fiber veggies, High-fiber veggies Canned or well- Raw veggies,
canned veggies cooked veggies cooked greens,
high-fiber veggies

Fruit ALL Fruit juice Low-fiber fruit Berries, high-fiber Canned fruit, fruit Raw fruit, dried
fruit juice fruit

Grains Whole-wheat Refined grains, White flour Whole-wheat White flour Whole-wheat
products, oatmeal, grains in excess products, oatmeal, products, brown products, oatmeal, products, brown
brown rice, quinoa, crackers, white rice rice, popcorn, etc. crackers, white rice rice, popcorn, etc.
etc. all portion
controlled
Monitoring and Evaluation
Food and Beverage intake: goal to meet >75% of
energy needs and tolerate food and beverage by mouth.
Anthropometrics: goal for gradual wt loss
Digestive system: goal for BM every 1-3 days and to
control N/V
Electrolyte and renal profile: electrolytes to be WNL
Endocrine profile: goal glucose <150mg/dL
References
1. Nelms M, Sucher KP, Lacey K. Nutrition Therapy and Pathophysiology. 3rd ed.
Boston, MA: Cengage Learning; 2016: 369-373, 461-463, 480-510.
2. DM: Executive Summary of Recommendations. Evidence Analysis Library.
http://www.andeal.org/topic.cfm?menu=5305&cat=5596. Published 2015.
Accessed May 10, 2017.
3. Nutrition Care Process Introduction. Nutrition Terminology Reference Manual.
https://ncpt.webauthor.com/pubs/idnt-en/. Published 2015. Accessed May 10,
2017.
QUESTIONS?