Term
| Is insoluble fiber fermented by gut bacteria? |
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Definition
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Term
| What are the advantages of MCTs in enteral formulations? |
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Definition
- They are absorbed directly into portal circulation
- They do not require chylomicron formation for absorption
- They do not require pancreatic enzymes or bile salts for digestion and absorption
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Term
| What is the disadvantage of MCTs in enteral formulations? |
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Definition
| They do not provide essential fatty acids |
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Term
| What are structured lipids? |
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Definition
| Structured lipids are a re-esterification of LCTs and MCTs on the same glycerol backbone |
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Term
| How are structured lipids used in enteral formulations? |
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Definition
| Some enteral formulations contain structured lipids |
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Term
| What is the advantage of structured lipids? |
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Definition
| Structured lipids offer the benefits of MCTs while providing enough LCTs to meet essential fatty acid needs |
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Term
| What is the maximum peptide length that can be absorbed by the gut? |
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Definition
| Any peptide greater than 3 amino acids requires further hydrolyzation prior to absorption |
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Term
| How is osmolality determined, and what is the relevance to enteral products? |
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Definition
| Osmolality increased with increased free particles, ions, or molecules per kg water. Thus, hydrolyzed/elemental products have a higher osmolality than intact ones and concentrated formulas have higher osmolality than more dilute ones. |
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Term
| What is the risk of delivering hyperosmolar formulas containing sucrose into the small intestine? |
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Definition
| Dumping syndrome can occur |
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Term
| How does osmolality affect the tolerance of a formula? |
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Definition
| Other than sugar-related hyperosmolality (dumping syndrome), the osmolality of a formula has little to do with tolerance |
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Term
| How does secretion of saliva and gastric juices affect osmolality of tube-fed patients? |
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Definition
| The average gastric tube-fed patient will dilute the formula with 1 to 2 liters of saliva and gastric juices, decreasing osmolality |
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Term
| Do patients with muscle wasting diseases (cancer, HIV, sarcopenia) benefit from PO diet supplementation? |
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Definition
| Yes, although early intervention is imperative to gain benefit |
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Term
| How have percentage-of-calorie recommendations for carbohydrates changes in regards to T2DM? |
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Definition
| Recent updates in guidelines recommend active carbohydrate management in terms of glycemic control or weight loss rather than prescribing absolute carbohydrate amounts or percentages |
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Term
| What is the recommended intervention for T2DM patients who are overweight or obese and on enteral feeds? |
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Definition
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Term
| What are the practice guidelines for T2DM patients on EN? |
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Definition
- Minimize overfeeding
- Consider diabetic formula if glucose control becomes problematic despite insulin use. Diabetic formula not recommended unless glucose control is problematic.
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Term
| What are the EN recommendations for patients with malabsorption? |
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Definition
| Historically, patients with malabsorption were kept NPO. However, recent research indicates that it is important to enterally feed patients to maintain gut integrity and immunity |
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Term
| What is the recommendation for peptide-based formulas in patients with malabsorption or diarrhea? |
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Definition
| Evidence is mixed regarding efficacy, use of peptide-based formulas in not recommended in patients with malabsorption or diarrhea |
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Term
| What is the recommendation for BCAAs in hepatic failure patients? |
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Definition
- In critically ill patients with HE, there is no evidence to support use of high BCAA formulations to alter patient outcomes compared to provision of a standard formula
- Supplementation with oral BCAA may be useful for slowing progression of liver disease or failure in long-term outpatients
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Term
| What is the recommendation regarding immune-modulating formulas in patients? |
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Definition
| There is not enough evidence to support their use at this time |
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Term
| How do protein needs vary depending on the stage of kidney disease? |
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Definition
- Those with chronic kidney disease but not on dialysis need LESS protein because of organ dysfunction resulting in byproduct buildup
- Those on dialysis need MORE protein because dialysis is catabolic
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Term
| What is the evidence regarding HMB in muscle-wasting conditions? |
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Definition
| HMB promotes anabolism and inhibits protein degradation, promoting accretion of lean body mass. It has been shown to improve nitrogen balance in trauma patients and preserve lean body mass in patients with sarcopenia, cancer cachexia, and AIDS. (some of this evidence is now disputed) |
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Term
| How do PO supplements affect risk of developing pressure ulcers? |
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Definition
| Use of high-protein oral nutrition supplements decrease risk of developing pressure ulcers by 25% in high-risk populations |
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Term
| What are the disadvantages of closed enteral systems? |
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Definition
- Increased wastage in patients who frequently switch formulas
- Potential for IV misconnection errors
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