Question

1- Briefly describe why patients with Parkinson’s disease may need higher nutrient recommendations and be at an increased risk of malnutrition.

2- List three clinical manifestations of Alzheimer’s Disease. With each one you identify, describe how it may impact nutritional status.

3- What is the purpose of the neutropenic diet for cancer patients receiving immunotherapy? Include at least three tips to give patients who are on this diet.

4-  List at least four cancer types that can lead to cancer cachexia.

5- Explain how malnutrition in HIV patients can lead to further complications.

Answer 1

1) The possible factors responsible for the loss of weight in these patients could be low dietary intake due to dysphagia and/or anorexia, lowering of absorption caused by slow gastric emptying, the increase of energy consumption due to high muscular activity, like tremors. So patient with Parkinson's are at high risk of malnutrition.

2) Alzheimer's manifestation and its effect on nutritional status.

• Forgetfulness - patient has short term weak memory and usually forgets things like what he was doing sometime back. He forgets that he had food or not and that can result into forgetting to eat or what to eat and what not ot eat.
• Difficulty in thinking amd understanding - patient can't think by his own to what to eat and what not to eat and hence cannot maintain a healthy diet.
• Delusion - at late stage in Alzheimer's patient start experiencing delusion and starts having belief in things that are not happening. He has no logical thinking and cannot thinks for his own good. He cannot understand that what is good for him and what is not. He can get dehydrated, malnourished, and lethargic.

3)Neutropenic diets typically limit the intake of fresh fruits, fresh vegetables, raw or undercooked meats and fish, and soft cheese made from unpasteurized milk.

Immunotherapy used in cancer patients works on basis that to strengthen the immune system against the cancer cell. Neutropenic diet helps in immunotherapy by making immune system to focus more on cancer cell, as neutropenic diet is less on pathogen and that decrease the workload of immune system.

Tips -

Patient on neutropenic diet should strictly follow the diet and should be complaint.

Patient should not eat fresh fruits and vegetables as they have loads of pathogen.

Patient should follow strict aseptic condition with the diet to increase the efficiency of immunotherapy.

4) cancer cachexia is seen at advance stage of cancer are

stomach cancer

Pancreatic cancer

Oesophageal cancer

Colorectal cancer

5) factors responsible for malnutrition in an HIV-infected person is reduced appetite, which could be due to difficulty in ingesting food as a result of infections like oral thrush or oesophagitis caused by Candida, a common opportunistic infection in HIV-infected people and fever, side effects of medicines, or depression.

HIV causes damage to the intestinal cells by causing villus flattening and decreased D-xylose absorption. This leads to carbohydrate and fat malabsorption thereby affecting fat soluble vitamins like vitamins A and E, which are important for proper functioning of immune system. Whereas larger amounts of nutrients are required during fever and infections that accompany an HIV infection, they are utilised poorly by the body. This leads to loss of weight and lean muscle tissue, further causing damage to the immune system. Lack of iron in the diet and infections such as malaria and hookworm lead to anaemia. Anaemia causes lethargy, further reduces food intake and nutrient absorption, and also causes disruption of metabolism, chronic infections, muscle wasting.

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DR. PRADY