Nutritional problems in patients who have chronic disease.

Abstract

1. Uwe Blecker* 2. Devendra I. Mehta* 3. Rebecca Davis† 4. Melinda S. Sothern† 5. Robert M. Suskind† 1. 2. *Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, DE. 3. 4. †Department of Pediatrics, Louisiana State University Medical Center, New Orleans, LA After completing this article, readers should be able to: 1. Describe the nutritional problems of children who have malignacies. 2. Delineate the role of gastroesophageal reflux in a neurologically impaired child. 3. Describe the nutritional problems of children who have cystic fibrosis. 4. List the nutritional deficiencies that may occur with chronic renal disease and renal failure. 5. Explain the effects of a restricted diet for multiple food allergies. 6. Describe what nutritional deficiency may develop in children who have malabsorption. Nutritional problems in chronic disease are a significant cause of increased morbidity, mortality, and psychosocial consequences of growth failure. Several mechanisms may coexist that could lead to nutritional problems. Mere increased inflammatory burden can increase the caloric need and, thereby, the risk of protein-calorie malnutrition. The organs involved, such as the liver and small bowel, may be important in the digestive and absorptive processes, and their Winvolvement may lead to selective nutrient deficiencies. Anorexia of chronic disease may coexist and compound the situation. Although this discussion focuses on general principles in specific areas, attention to detail in individual cases is needed. Nutrition support can be achieved at several levels. Dietary counseling leading to better choices in caloric density can be augmented by using specific high-calorie commercial preparations to boost caloric intake. Occasionally, a multidisciplinary approach with a feeding team can help with issues relating to gastroesophageal reflux and delayed gastric emptying as well as oral skills and behavioral aversion, which can optimize intake. Nasogastric tube feeding and, for long-term use, gastrostomy tube feedings are the next step. These devices allow delivery of appropriately chosen milk-based formulas either in convenient bolus regimens or continuously, as needed. Continuous nocturnal feeding regimens are particularly popular because they allow oral intake when awake, yet increase the caloric intake. These generally are safe techniques that can be taught easily to …