Mid-Term Assignment: Raaidah Wahab
Mid-Term Assignment: Raaidah Wahab
Mid-Term Assignment: Raaidah Wahab
Dietetics FT 5217
Raaidah Wahab
No. of References: 14
I declare that the attached work is entirely my own and that all sources have been acknowledged.
Raaidah Wahab: 19412-CMB
INTRODUCTION
Colorectal cancer (CRC) is now known to be the third most common type of cancer for women
and the fourth most common type of cancer in men globally1. Although CRC was primarily
observed in longstanding developed countries, it has now become prevalent in newly developed
countries as well due to dietary modifications, increased consumption of high calorie highly
processed foods, decreased physical activity and lifestyle-related factors (such as smoking)1,2.
Recent studies show the importance of proper nutrition and how it is essential for better recovery
and decreased mortality for people with cancer3. A study by Ravasco et al.3 showed that under
nutrition is a major source of morbidity and mortality in cancers of the colon and rectum. Novelli
et al.4 suggests that surgery is the main treatment for CRC and the only curative factor is
nutritional status which has a large impact on post-operative recovery.
Good nutrition can help to manage the side effects of treatment (e.g. fatigue, loss of appetite)
and speed up recovery, heal wounds and rebuild damaged tissues (this is important after surgery,
radiotherapy, chemotherapy or other treatment), improve your body’s immune system and ability
to fight infections and reduce the risk of recurrence4,5. A nutritional counseling protocol for
patients who require surgery (with or without chemotherapy and radiotherapy) was found to have
a positive effect in post-operative prognosis and risk of recurrence as well4,5.
CASE STUDY
In our case study, the 45-year-old male experienced a loss of weight of 10kg during a period of 2
months, following which he underwent a colectomy and is now under-going adjuvant
chemotherapy to prevent recurrence. He is also reporting symptoms of loss of appetite (LOA),
constipation and associated abdominal discomfort. His current weight is 50 kg (previous weight
was 75 kg) and height is 165 cm.
His daily diet provides an average of 342 g of carbohydrate, 110 g of protein and 25 g of fat.
His biochemistry is as follows: Albumin = 1.5 g/ dL (Decreased)
Protein = 4.5 g/dL (Decreased)
To calculate patient’s BMR, we use Harris Benedict Equation for BMR of men:
BMR = 66.5 + (13.7 × weight in kg ) + ( 5 × height in cm ) – ( 6.8 × age in years )
BMR = 66.5 + (13.7 × 50 ) + ( 5 × 165 ) – ( 6.8 × 45 )
BMR = 1270.5 kcal/day
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Then we calculate Total Daily Energy Expenditure (TEE) taking Injury/ Stress factor and
Activity factor into account:
Injury/ stress factor for major surgery considered – 1.4
Activity level factor considered – 1.2
TEE = BMR × 1.4 × 1.2
TEE = 2134.4 kcal/day
Based on the information above it is noted that the patient is underweight and has to increase his
total daily energy intake above the expenditure (TEE).
In accordance with WHO criteria8, the Asian criteria-based BMI was used as follows: <18.5 for
underweight, 18.5-23 for normal-weight, 23.0-27.5 for overweight, and >27.5 for obese.
Therefore, for this patient, an ideal weight would be 68 kg.
Given the information above, there is an energy deficit of: 2548.7 KJ - 2134.4 KJ = 414.3 KJ
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A healthy normal diet contains 60% carbohydrate, 25% fat and 15% protein. Based on this, we
are able calculate the daily intake require in grams10:
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It is vital to avoid food that might carry a risk of infection such as non-pasteurized soft cheeses,
under cooked meat, uncooked fish, raw eggs in uncooked items, etc. Studies 12 show that surgery
induced immuno-suppression can result in increasing susceptibility to infection.
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An increase in protein intake as also recommended by The American Cancer Society to help
heal tissues and fight infection and it is recommended to eat at least 1.1 g of protein/ kg of
body weight7.
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Proteins 110 143.6 Choose high protein lean meat like chicken and fish.
Some examples of other protein-rich foods include eggs,
meat, milk, yogurt, cheese, beans, nuts, and peanut butter.
Fat 25 73.7 Fats have more calories per gram than carbohydrates or
proteins. Therefore, it is important to add healthy fats to
the diet such as avocado, olive oil, coconut oil, nuts,
butter, full cream milk to the diet.
Fiber Unknown 25~35 g Healthy adults need at least 25~35 g per day. Its best to
start in small quantities and then gradually increase
according to tolerability and other symptoms (such as
constipation)
Whole grain- Whole grain cereals (oats), whole grain
basta/bread
Pulses- Lentils, chickpeas, red kidney beans
Vegetables- Cauliflower, peas, carrot, sweet potato,
spinach, green leafy vegetables
Fruit- Apples, prunes, raisins
*it is important to add a good balance of both soluble and
insoluble fiber.
Fluid Unknown 1800~2000 Stay hydrated to avoid cancer treatment-related
ml /day dehydration.
Avoid caffeinated beverages.
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Diet plan
Based on the information above, it is best that the management plan for the individual includes
components to help with gaining weight safely, dealing with hypoproteinemia, LOA and
constipation.
Gaining weight safely can be addressed over a span of 3 months with a target weight gain of 6
kg per month so that the individual reaches a healthy weight of 68 kg.
The issue of hypoproteinemia has to also be clinically assessed since it is a sign of inflammation.
The subsequent nutritional information has been gathered from the following sources:
Biodiversity for food and nutrition Sri Lanka: https://bfnsrilanka.org/nutrition-facts
Indian food composition table 2017: http://www.ifct2017.com/frame.php?page=home
Food labels
MyFitnessPal.com: https://www.myfitnesspal.com/
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+ + glass
coconut orange
sambol juice
(1 tbsp) (111.6 kcal-
(79 kcal- Carbs: 25.7g,
Carbs: 1.78g, Fat: 0.5g,
Fat: 7.55g, Protein: 1.74g)
Protein:
1.04g)
Mid- Papaya 1 full fat Dried fruits- Woodapple Papaya 1 cup Dried
morning juice yoghurt (dates, juice juice mulligatawny fruits-
(114 kcal- (Highland) prunes) (114 kcal- soup dates,
snack Carbs: 29.9g,
Fat: 0.05g,
(159 kcal-
+ 2 cream
Carbs: 29.9g,
Fat: 0.05g,
(180.5 kcal-
prunes)
Carbs: 13g, Carbs: 21g,
Protein: 0.3g) Protein: 0.3g)
Fat: 2g, + 1 tbsp crackers Fat: 26g,
Protein 3g) Protein: 12.g)
Cashew (74 kcal- +1 tbsp
+ 2 cream nuts/
Carbs: 4g,
Fat: -,
+2 Cashew
crackers + chopped peanuts Protein: -) cream nuts
(74 kcal-
Carbs: 4g,
dates/ prunes (82.95 kcal) crackers (82.95 kcal)
(74 kcal-
Fat: -,
Carbs: 4g,
Protein: -)
+ nuts if Fat: -,
Protein: -)
possible
(Cashew
nuts/
peanuts)
Dessert
Mixed fruit salad-Pineapple, Starfruit, Mango, Sweet melon, Papaya (250g) (87 kcal- Carbs: 20.4g, Fat: 0.5g,
Protein: 1.3g)
Dinner Grilled Coconut roti Whole Grilled fish 6 white Thosai Macaroni
(~175 kcal)
chicken (227 kcal-
Carbs: 39.9g,
wheat / flour +saambar stir fry
breast-no Fat: 6.3g, white rice + steamed string +coconut with egg
Protein: 5.1g)
skin noodles stir vegetables hoppers sambol
(137.3 kcal- (319 kcal-
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Carbs: 0g,
Fat: 3g,
+ fish curry fry with egg (carrot, + green Carbs: 46.9g,
Fat: 13g,
&
(132 kcal-
Protein: 25.7g)
Carbs: 1g,
& beans, gram Protein: 6.6g) vegetables
Fat: 10g, vegetables spinach, curry (137.3 kcal-
Carbs: 0g,
+ Protein: 10g)
potato) + +fish/chicken Fat: 3g,
steamed + chicken/ (225 kcal-
coconut curry Protein: 25.7g)
Fluid Hydration is extremely important with fluid intake of at least 1800~2000 ml /day
Other For dealing with constipation: it is also beneficial to take laxatives such as
remarks ‘Fybogel/ Ispaghula husk’: 1 sachet 2 times/day after meals. Or a stool
softener such as Dulcolax syrup 5ml tds.
Fruits such as Papaya, Wood apple and prunes have been chosen as they may
help relieve constipation. Papaya is known to be a good source of fiber.
Lentils, poultry, fish, eggs, dairy, nuts and seeds have been included because
they contain BCAA: as they will quickly metabolize in muscle providing
direct energy.
Coconut has also been included in most main meals in various forms (scraped,
coconut sambol, coconut milk) as it is high in fat content.
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References
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Colorectal Cancer Patients after Surgery Improves Outcome [published online ahead of print,
2020 Sep 15]. Nutr Cancer. 2020;1-9. doi:10.1080/01635581.2020.1819345
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diet, physical activity, and weight control in cancer survivors. CA Cancer J Clin.
2015;65(3):167-189. doi:10.3322/caac.21265
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8. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its
implications for policy and intervention strategies [published correction appears in Lancet. 2004
Mar 13;363(9412):902]. Lancet. 2004;363(9403):157-163. doi:10.1016/S0140-6736(03)15268-3
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Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.
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percentages
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Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors. Ann Surg Oncol.
2015;22(13):4317-4324. doi:10.1245/s10434-015-4731-9
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