Case 17.6

The dietitian deemed that intentional weight gain will reduce malnutrition, as will additional calories/protein in the diet. Nutrition interventions were also devised to help build trust with reintroduction of the missing food groups to help add calories and protein. Shared decision making with the patient was utilized for optimal engagement. He was open to hearing strategies! He was not comfortable with adding gluten just yet though.

 The dietitian provided a strategy to add one food high in plant-based protein at each meal in ½ cup portions. He agreed to try quinoa and tofu. How will adding protein assist with optimizing nutritional status? 
 It will not help as he is already including sufficient protein as he eats eggs or lentils at each meal 
 Promote weight gain of 1-2 lb in a week 
 Reduce sarcopenia 
   

 Increasing intake of plant-based protein is indicated as he is a vegetarian, has only one source in the diet, and overall, has limited intake of protein. Due to a low intake of protein, sarcopenia may persist as well as risk for further weight loss. Tolerance of fiber in the setting of a flare will be dependent on particle size, portions, and type of fiber. Both raw and cooked forms of fiber in small particle size can be consumed as tolerated. As he has not had dairy for a while, low lactose and lactose free dairy can be explored to initiate intake. Tolerance to dairy is also dose dependent.

The dietitian provided a strategy to add a fruit or a vegetable to each meal in ½ cup portions to help add fiber. He agreed to try cantaloupe and spinach. How would you recommend that the patient try these foods to optimize tolerance?
Raw forms only
Cooked forms only
Small particle size (e.g. chopped, blended, minced, mashed) 
Large particle size (e.g.whole, cubed, coarse)
The dietitian provided a strategy to introduce one source of low lactose and lactose free dairy in small amounts once a day for now. The patient decided to start with hard cheeses. How would you recommend that the patient eat hard cheeses in his current diet to build trust?
A sprinkle of parmesan cheese over eggs 
A slice of colby cheese with white bread
Making a cheesy lentil stew
A sauce made from cheddar cheese that smothers the omelet

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