Board index Free Unlimited PDF Downloads Free Downloads. 12 posts. 1; 2; Next. Just: Posts: Joined: Fri Sep 25, pm Please, help me to find this libros de dietoterapia pdf editor. . NUTRICION Y DIETOTERAPIA DE KRAUSE 12 EDICION PDF ; NUTRICION Y DIETOTERAPIA DE. Item Lipid soluble Vitamins. Classification. Functions. Utilization. Sources of interest nutritional and dietary Alimentación y dietoterapia (Nutrición aplicada en la salud y la enfermedad) "Nutrición y Dietoterapia de Krause". (12ª Edición ). Nutricion y dietoterapia de krause 12 edicion pdf. March February Gav amniotic resubmit its position sequentially. Elmer skatings all out, its very.
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Level C: Descriptive studies or expert opinions. The fact that nutrition has only recently been perceived as important, and that nutritional follow-up is difficult in some centers accounts for the paucity of studies with definitive conclusions on HIV-infected patients.
Nevertheless, and owing to the need for treatment to include nutrition, we feel that the time is right to prepare a clear and concise document in which the healthcare professional can identify what is certain and what is uncertain and worthy of further investigation in order to improve the care provided for patients infected by HIV.
Malnutrition The term malnutrition includes conditions produced both by an excess of nutrients and by a lack of nutrients. However, it is generally used to refer to undernourishment, i. Today, the situation has changed, but there are still many ways both the disease and treatment can contribute to an involuntary weight loss and reduction in energy production-changes in metabolism, increased energy needs, intestinal malabsorption, persistent diarrhea, and the reduced calorie-protein intake as a result of anxiety or depression accompanying HIV infection.
In patients taking HAART, weight loss produced by wasting due to metabolic alterations can be difficult to differentiate from lipodystrophy especially lipoatrophy or weight loss produced by low intake. Concepts Undernourishment This is defined as a disorder of body composition characterized by an increase in extracellular water, and a potassium and muscle mass deficit often associated with reduced fatty tissue and hypoproteinemia, which interferes with the normal host response to disease and its treatment.
Calorie-protein undernourishment occurs when daily requirements are not covered by diet. In many cases, it reverts when intake returns and the underlying problem is resolved.
According to the current definition of wasting, patients must fulfill at least one of the criteria shown in Table I. This definition stresses that most patients are asymptomatic, and that there are differences between the sexes with regard to fat distribution and muscle mass.
It also includes a time profile. The loss is asymmetrical, not necessarily associated with weight loss, and is not related to calorie-protein malnutrition. Wasting and lipoatrophy can be observed simultaneously in the same patient. When this state is maintained, it leads to protein depletion, especially in skeletal muscle, and it does not recover with intake, since the whole process is caused by metabolic changes in cells Algorithm 1.
This is somewhat similar to the process in other diseases, including tumors; energy is obtained as an acute inflammatory response in which the tumor necrosis factor and interleukins 1 and 6 intervene. There have also been reports of hormonal alterations that exacerbate the situation.
These include hypogonadism in men, reduced production of insulin-like growth factor I, the growth hormone messenger in men and women, which can lead to resistance and alteration of the energy balance. Nutritional needs of HIV-infected patients Macronutrients Nutritional recommendations vary according to different factors that can act alone but that often combine in the same patient.
Specific problems diabetes, pancreatitis, renal insufficiency, obesity, lipodystrophy, and other metabolic alterations require specific recommendations. Energy and proteins There is no consensus on the baseline energy requirements of HIV-infected patients, although it is known that these are greater at all stages.
There are few data on protein requirements, and an improvement in clinical patterns due to a greater intake of protein has not been proven. In addition to these requirements, they must consume the extra energy, proteins, and micronutrients necessary in their condition Level B.
Cachexia is not only a problem of calorie-protein undernourishment; it also involves an alteration of body composition BC with a specific loss of body cell mass BCM.
It should not be altered in patients who are not undernourished. Clinical history The following should be obtained: clinical data, dietary history, social factors financial, work, etc.
Laboratory parameters These include the measurement of protein levels in plasma albumin, transthyretine [prealbumin], and transferrin , calculation of nitrogen balance, creatinine-height balance, and measurement of trace elements, vitamins, and electrolytes. Immunological parameters to be measured include the lymphocyte count and delayed hypersensitivity skin tests.
Functional tests These allow us to evaluate the repercussion of the loss of muscle mass by means of dynamometry, lunar nerve stimulation, and muscle biopsy. Well nourished. Moderately nourished or at risk of becoming undernourished. Severely undernourished. The SGE adapted to the HIV population is a simple questionnaire that includes essential parameters of the clinical history and examination, and provides a first diagnosis of the nutritional status Level B.
There is no ideal method for analyzing BC. Objectives of nutritional therapy Table IV shows the general and specific objectives of nutritional therapy in HIV-infected patients. Nutritional objectives should be set on an individual basis. Therefore, without ruling out protocols and clinical practice guides, problems should be prioritized, and the "ideal" objectives set by the physician should be adjusted to the individual patient.
There is firm scientific evidence that advice on nutrition, in addition to offering suitable dietary habits, is efficacious in improving the state of health of these patients.
It is particularly important to determine the risk of malnutrition in order to set priorities for evaluation and nutritional therapy. The American Dietetic Association ADA classifies this risk into three levels: high, medium, and low, and recommends that these interventions take place before one week in high-risk patients, and before one month in medium-risk patients.
It should be tailored to the HIV stage and to the type and intensity of the disorders mentioned above, and carried out by experts Level C.
Lifestyles and psychological variables: nutritional advice Prolonged use of drugs leads to toxicity, which has a proven impact on quality of life,43 with the result that a multidisciplinary approach is essential.
Therefore, patients must participate actively in decision-making and in the management and care of their illness. Therapeutic scenarios and the most frequent clinical situations In the case of nutritional problems, the main challenge for the clinician is often to differentiate between whether the disorder is organic in nature, or psychological. The key lies in a wide view by the clinician, and visits should include, first, an evaluation of nutritional and emotional aspects and, second, the use of suitably communicative language.
There are two types of situation associated with nutrition in the HIV-infected patient: 1. Approach: if emotional problems are present or suspected as the origin of these symptoms, the patient must be referred to a psychologist or other qualified professional.
Eating disorders based on a mental disorder: These are very difficult to detect during a consultation, since the patient has no complaints and tends to hide any problems. Therefore, the clinician should use the physical signs of the disorder as clues.
Advantage should be taken of any information on eating habits and health provided by those accompanying the patient. General clinical approach: the interview is a basic tool given the possibility it offers to collect information and boost the physician-patient relationship.
Feedback received during the interview is extremely important, since it allows teamwork to be continually redirected. The ACTA questionnaire52is valid for this purpose. Communication strategies The basic aspects of the communication process are as follows: Priorities. When patients inform their physician. These situations are of particular interest, since they represent the manifestation of what is most worrying for the patient. Personality variables.
Nutrition and physical exercise in HIV-infected patients In recent years, different studies have been published on the effect of exercise on the status and progress of HIV-infected patients.
Ergogenic aids Ergogenic aids are any type of compound, substance, or external aid used to enhance sports performance. Athletes, particularly in strength sports, use creatine as a means of increasing muscle mass and strength, and although its effects on healthy athletes are controversial, they continue to be used. In a recent study68 involving patients on HAART, creatine was administered to a group of 17 patients, and placebo to a group of 16; creatine was observed to significantly improve lean muscle mass compared with placebo.
Overloads of branched amino acids and proteins have also been used to increase lean mass. No improvement has been observed after use in comparisons with control groups. We should include these recommendations during pregnancy, vegetarian diets, and recommendations for gastrointestinal alterations-these can be consulted in the complete document at www. Therefore, specific nutritional recommendations may not be sufficient, and it is necessary to evaluate the indication of nutritional support Level B.
Norms for food safety Quality of food and drinks is very important for HIV-infected individuals, especially when they have been inappropriately handled or when water is not suitable for drinking. Only foods that have been hygienically handled and have undergone the necessary checks by the corresponding health authorities should be eaten. Raw products. Raw or lightly cooked eggs, meats, poultry, fish, or shellfish including marinated products, anchovies in vinegar, etc.
The same applies to milk or dairy products that have not been treated industrially. Eggs and sauces. Patients should not consume unpasteurized sauces or other products made with eggs. I was suspicious at first when I got redirected to the membership site. Scotty incriminating tore his busts and autographically unbarricaded! Discover advanced methods to learn better, memorize more and master any skill faster.
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