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1. Welcome to Seminar on Optimal Nutrition Support to Cancer Patients Meera Kaur, PhD, RD. kaur@cc.umanitoba.ca. KILDONAN MEDICAL CENTRE. 2. Outline of the Session. Motivation for this Study Objectives The concept The food development Clinical outcome Materials and methods - PowerPoint PPT Presentation

Text of KILDONAN MEDICAL CENTRE

  • Welcome to Seminar onOptimal Nutrition Support to Cancer Patients

    Meera Kaur, PhD, RD.

    kaur@cc.umanitoba.ca

    *KILDONAN MEDICAL CENTRE

  • Outline of the SessionMotivation for this Study ObjectivesThe conceptThe food developmentClinical outcomeMaterials and methodsResults and discussionImplications for the healthcare professionalsSummary and conclusionReferencesAcknowledgement

    Meera Kaur, PhD, RD*KILDONAN MEDICAL CENTRE

  • Motivation for this research Approximately 50 % of hospitalized cancer patients are malnourished.

    Effective nutritional support to cancer patients is particularly challenging in developing countries due to the high cost of proprietary enteral formulae.

    Hence, the objectives of this study were .

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Objectives of the studyTo:develop natural ingredient-based, low- cost enteral food (LCEF) for cancer patients

    determine physicochemical and nutritional properties

    evaluate clinical outcome in cancer patients

    Meera Kaur, PhD, RD*KILDONAN MEDICAL CENTRE

  • The conceptImproving the bioavailability of nutrients in natural ingredients by suitable processing

    Modifying the texture of natural ingredients to suit enteral tube or oral feeding

    Enhancing with synbiotics and conditionally essential nutrients

    Meera Kaur, PhD, RD*KILDONAN MEDICAL CENTRE

  • The process for LCEF (patented)

    *Meera Kaur, PhD, RDMaltedCerealsMaltedMung BeanToasted Soy MixingCookingHomogenizingSpray dryingFortificationVegetable/fish oil Milk + LABPoppedAmaranthKILDONAN MEDICAL CENTRELCEF

  • Nutritional information

    FormPowder% of cal.Moisture (g%)2.1Protein (g%)2219-20Fat (g%)-4 g fish oil16 30-31Available Carbohydrate (g%)56 49-50 Energy (Kcal/100g)456Vitamins+minerals (g%)2.5Total dietary fiber (g%)5.0Soluble dietary fiber (g%)2.3Insoluble dietary fiber2.7Calcium (mg%)300Phosphorous (mg%)314LAB (cfu/g)5.4106BCAA (g/100g of protein) 13.31(2.9g/100g food)L-Glutamine (g%)4.0

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Clinical Outcome inCancer Patients*Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Materials and Methods*Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Patients characteristics...Characteristics Experimental Control (n=32) (n=31)Gender ratio (M/F)19/13 17/14Age (years)*51.87.4 53.77.7 BMI (kg/m2)*17.63.4 17.44.6 Usual wt (kg)*66.12.4 65.83.7Wt. loss at admission(%)* 7.13.6 7.31.8 Performance Status (Zubrod) 2.10.6 2.10.7

    *Values are meanSD

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Patients characteristicsType of Cancer:

    Treatment Received:

    Exclusion Criteria:Inoperable Carcinoma Esophagus (Stage III or IV with no prior treatment)

    Radiation and/or Chemotherapy

    Pediatric patients, pregnant and nursing mothersMeera Kaur, PhD, RDKILDONAN MEDICAL CENTRE11

  • Nutritional SupportFeeding mode:BolusTube feedingEnergy requirement:Herris-Benedict EquationProtein requirement:1.5-2.0g /Kg/day Initiation of feeding:Within 24 of admissionFeeding duration:Till Discharge (45-60 days)Additional nutrientsL-glutamine, Fish oil, in experimental diet:Lactic acid bacteria (LAB)Control diet:Isocaloric, Isonitrogenousproprietary enteral formula

    ,

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Outcome measuresToleranceCalorie intakeAnthropometric indices

    Biochemical indicesLiver function tests

    Infectious episodes

    Test for lactose intolerance

    Length of hospital stay*Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Results*Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

  • Energy Estimated and Intake

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

    Chart2

    12410190024001531

    22436194024321597

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    124101900

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    WeekE-ESTE-INTC-ESTC-INT

    12410190024001531

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    72500227525001893

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    Sheet2

    00000

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    Week

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    cal

    EstimatedIntake

    124101531

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    424501639

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    Estimated

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    Week

    Kcaal

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    EXPTCONT

    160.159.9

    259.759.6

    359.657.7

    459.657

    559.156.7

    65956

    758.856.9

    85856

    wt

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    EXPT

    CONT

  • Changes in body weight

    *Meera Kaur, PhD, RDKILDONAN MEDICAL CENTRE

    Chart4

    61.461

    60.759.6

    59.658

    59.457

    59.156.7

    5956.2

    58.856

    58.455.7

    EXPT

    CONT

    Week

    Weight (kg)

    Changes in Body Weight

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    61.461

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    EXPT

    CONT

    Week

    Weight (kg)

    Changes in body weight

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    6.7

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    Percent Loss of Body Wt.

    Chart1

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    Percent

    Percent loss of body weight

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    Expt.Cont

    46.7

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    Percent loss of body weight

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  • Anthropometrical indices of patients ParametersControl Experimental C Vs EIT I T p