Improving Nutritional Intake for Chronic Illness Patients: Tips and Solutions

How to Improve Nutritional Deficiencies in Chronic Disease Patients

Hello Doctor: My mother has been a chronic scleroderma patient for over ten years.
She is 150 cm tall, weighs 30 kg, and is 53 years old.
Due to gastrointestinal function deterioration, she has poor digestion, is prone to bloating, and has some difficulty swallowing.
Currently, she is being fed through a nasogastric tube with Ensure powder six times a day: the first four feedings are 60 grams each, and the last two are 50 grams each, totaling 1530 calories per day.
She also takes two Pei En multivitamins daily.
However, she still experiences reflux during feedings, which may mean she is not actually receiving the full 1530 calories.
My mother seems very weak, often wanting to sleep, and her speech appears to be labored, making her reluctant to talk.
What other methods can we use to meet her daily caloric needs without causing bloating? Are there other food options, such as porridge, that you would recommend? If porridge is not suitable due to bloating, are there any other health supplements or prescription multivitamins that she can take?

Ms. Chen, 20~29 year old female. Ask Date: 2012/05/27

Dr. Shi Guimei reply Nutrition

Dear Ms.
Chen,
Hello! If the daily feeding amount of Elicon has reached 1500 kcal, there is no need for additional supplementation of multivitamins.
Regarding the issue of reflux, the assessment should be based on the color, consistency, and volume of the refluxed material to determine the digestive status.
If the refluxed material is milky white, it indicates poor digestion, and it should be discarded rather than reinfused.
If the refluxed material is in a semi-digested chylous state and the volume is less than 200 cc, it indicates partial digestion; in this case, the refluxed material can be reinfused, and the next feeding can be delayed by one hour.
If there are two consecutive instances of reflux with volumes greater than 200 cc before feeding, the next meal should be temporarily suspended.
If the digestive material appears clear yellow, it indicates good digestion, and the next meal can proceed as planned.
Additionally, if the feeding rate can be reduced to 20 to 30 minutes per meal, it may improve the patient's digestive status.
When the patient's digestion is indeed poor, it is also important to assess whether the patient's bowel movements are normal.
If bowel movements are not normal, consideration can be given to switching to a fiber-containing Elicon formula.
The above suggestions are general guidelines.
It is best for tube-fed patients to regularly consult with a dietitian from the original hospital for reassessment, so that the dietitian can provide nutritional advice tailored to the individual patient's condition, which will be beneficial for the patient's nutritional improvement.
Wishing you peace and health!
Sincerely,
Dietitian Shih Kuei-Mei
Director of Nutrition Department, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2012/05/27

More Info

Improving nutritional intake for patients with chronic illnesses, such as scleroderma, can be quite challenging, especially when gastrointestinal function is compromised. Your mother’s situation, with her low weight and difficulty in digestion, requires a careful and tailored approach to ensure she receives adequate nutrition while minimizing discomfort.

Nutritional Strategies
1. Increase Caloric Intake: Since your mother is currently receiving around 1530 calories per day, it may be beneficial to increase this amount gradually. Aim for a target of around 1800-2000 calories per day, depending on her tolerance. This can be achieved by slightly increasing the volume of her current feedings or adding additional meals if her digestive capacity allows.

2. High-Protein, Low-Fiber Formulas: Consider using a high-protein, low-fiber enteral formula. These formulas are designed to provide more calories and protein in a smaller volume, which can help reduce the risk of gastrointestinal discomfort and bloating. Brands like Ensure or Boost have specific formulations that might be suitable.

3. Adjust Feeding Schedule: If she is experiencing reflux or regurgitation, it may help to adjust the feeding schedule. Spacing out feedings more or reducing the volume per feeding can allow her stomach more time to digest the food. Additionally, consider administering the feedings over a longer period (e.g., 30-60 minutes) to promote better digestion.

4. Monitor Feeding Position: Ensure that your mother is in an appropriate position during and after feeding. Keeping her upright for at least 30-60 minutes post-feeding can help reduce the likelihood of reflux.

5. Consider Nutritional Supplements: If she is struggling to meet her caloric needs through enteral feeding alone, consider incorporating oral nutritional supplements that are easier to digest. These can include protein shakes or smoothies made with low-fiber fruits and vegetables.

6. Hydration: Ensure she is adequately hydrated, as dehydration can exacerbate feelings of fatigue and weakness. If she is having difficulty with fluids, consider offering electrolyte solutions or broths that are easier to consume.

Addressing Gastrointestinal Issues
1. Evaluate Feeding Tolerance: Keep track of her tolerance to the current feeding regimen. If she continues to experience significant reflux, it may be necessary to consult with a gastroenterologist or a dietitian specializing in enteral nutrition to explore alternative feeding options or medications that can help manage reflux.

2. Prokinetic Agents: Discuss with her healthcare provider the possibility of using prokinetic medications that can help improve gastric emptying and reduce reflux symptoms. These medications can help facilitate better digestion and absorption of nutrients.

3. Digestive Enzymes: In some cases, digestive enzyme supplements may help improve nutrient absorption. Consult with a healthcare provider to see if this is a suitable option for her.

Monitoring and Support
1. Regular Follow-ups: Regular follow-ups with a registered dietitian or nutritionist who specializes in chronic illness can provide ongoing support and adjustments to her feeding plan based on her changing needs and tolerances.

2. Family Support: Encourage family members to be involved in her care, as emotional support can significantly impact her overall well-being. Engaging her in conversations, even if she is fatigued, can help maintain her mental health.

3. Consider Palliative Care: If her condition continues to decline, it may be worth exploring palliative care options that focus on improving quality of life and managing symptoms rather than solely focusing on aggressive nutritional interventions.

In conclusion, improving your mother’s nutritional intake will require a multifaceted approach that considers her specific needs and tolerances. Collaborating closely with healthcare providers, including dietitians and physicians, will be essential in creating an effective and compassionate care plan.

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