Basal metabolic ratethe energy needed to maintain lifesustaining

� Basal metabolic rate—the energy needed to maintain life-sustaining activities for a specific period of time at rest � Resting energy expenditure (REE) (aka resting metabolic rate)—the amount of energy that an individual needs to consume over a 24 -hour period for the body to maintain all of its internal working activities while at rest � In general, when energy requirements are completely met by kilocalorie intake in food, weight does not change. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Carbohydrates Complex and simple saccharides Main source of energy Proteins Amino acids Necessary for nitrogen balance Fats Saturated, polyunsaturated and monounsaturated Calorie-dense Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

(CONT’D) Water All cell function depends on a fluid environment. Vitamins Essential for metabolism Water-soluble or fat-soluble Minerals Catalysts for enzymatic reactions Macrominerals; trace elements Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Digestion Absorption Begins in the mouth and ends in the small and large intestines Intestine is the primary area of absorption. Metabolism and storage of nutrients Elimination Consist of anabolic and catabolic reactions Chyme is moved through peristalsis and is changed into feces. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

� Malnourished � Well-nourished � Obese � Physical presentation � Laboratory studies � Influences for nutritional status �Age �Culture �Socioeconomic status Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5

� Protein calorie malnutrition �Marasmus �Kwashiorkor �Marasmic-Kwashiorkor � Long-term nutritional disorders �Cancer �Kidney disease �Chronic neurologic disease � Patients who need total enteral nutrition (TEN) � Eating disorders �Anorexia �Bulimia nervosa Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6

� Enteral nutrition (EN) provides nutrients into the GI tract. It is physiological, safe, and economical nutritional support. �Nasogastric, jejunal, or gastric tubes �Surgical or endoscopic placement Nasointestinal Gastrostomy Jejunostomy PEG (percutaneous endoscopic gastrostomy) PEJ (percutaneous endoscopic jejunostomy) �Risk of aspiration Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

� Nutrients are provided intravenously. � Patients unable to digest or absorb enteral nutrition or are in highly stressed physiological states: � Sepsis � Head injury � Burns � Peripheral or central line � Initiating parenteral nutrition � Preventing complications Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.