Case Scenario 1:
Marcus is a 4-year-old boy with autism spectrum disorder who has communication impairments and social difficulties and exhibits repetitive behavior. His treatment includes medical nutrition therapy, speech-language therapy, occupational therapy, and physical therapy. Marcus does not eat a well-balanced eating pattern for several reasons: A feature of his compulsive behavior is that he only accepts a limited variety of foods, he is unable to eat when over stimulated at mealtime, and he has poor fine motor coordination that impairs his ability to feed himself. He is on a gluten-free/casein-free diet because these peptides are believed to cause a variety of effects in the neurotransmitter systems of the brain. Eliminating all foods containing gluten (foods containing wheat, barley, oats, and rye) and casein the major protein in milk and other dairy products and used as an additive in other foods such as soy products) is theorized to improve social and cognitive behaviors and speech in some children with autism. although there is a lack of scientific evidence of benefit.
His gluten-free/casein-free diet restricts many types of grain and milk products, and some children following this diet have developed amino acid deficiencies, which is essentially a form of protein malnutrition. Marcus has difficulty chewing meat, which further limits his intake of protein. What foods can provide protein within the context of his dietary restrictions? Which vitamins may he be under consuming given his restricted intake of grains, milk, and meats?
Will vitamin supplements compensate for the lack of variety in his intake?
He has a restricted diet and accepts only a limited variety of foods, so he may be under- or over consuming certain nutrients. His parents give him a multivitamin with minerals, plus additional supplements of vitamin D, vitamin C, and calcium. What questions would you ask about the supplements he 15 taking? Should Marcus's parents keep a food diary so that his total vitamin intake from food and supplements can be estimated?
One of his food obsessions is a fortified gluten-free cereal. It is fortified with 100% of the Daily Value (DV) for many vitamins- but those DVs are based on adult requirements, not recommendations for children. Marcus eats a few servings of this cereal daily, so he is getting much larger amounts of certain vitamins and minerals than is required. If the percentage of the DV is not valid due to his age, how can his vitamin intake from the cereal be determined?
Would you encourage Marcus's parents to find a non-fortified gluten-free cereal? Would you recommend they discontinue his vitamin and mineral supplements?
As with healthy adults, studies of children with autism taking supplements show that the children most likely to take supplements were less likely to need them. This may reflect heightened awareness of nutrition by some families in regard to both food and supplements. Is too much better than too little?
Case Scenario 2:
Myra is a healthy, active 83-year-old woman who is conscientious about healthy eating and exercise. She read about the many health benefits from using aloe to detox and decided to give them a try. Over a period of diligent use, she developed diarrhea but passed it off as part of the detox process. Her family took her to the emergency department when she exhibited what they thought were signs of a stroke: weakness, exhaustion, and delirium. What may be causing her symptoms?
She lost excessive amounts of fluid from diarrhea and is diagnosed with dehydration. Why didn't she feel thirsty as she became dehydrated?
The speed with which her food moved through the GI tract interfered with the absorption of fluid, electrolytes, and nutrients. She was given IV replacement fluid, an antidiarrheal medication, and oral fluids. What should Myra understand about the need for "detox" and its potential risks?
Her fluid and electrolyte status was the immediate priority. However, general malabsorption of nutrients also occurred due to the diarrheal effect of the aloe. What would you tell Myra about what she should eat and how much fluid she should consume? What strategies may help her drink enough fluid given that she doesn't experience thirst?
Which fluids should she be encouraged to use to satisfy her fluid recommendation? Would more than 8 glasses of fluid a day be excessive?
REFERENCE - Dudek, S.G. (2022). Nutrition essentials for nursing practice (9th ed.) Wolters Kluwer.
ISBN: 978-1-9751-6112-5 (e-book: 9781975161149)