Clare is a 16-year-old girl with Crohn’s disease affecting her terminal ileum and colon. She opens her bowels 9 times a day. Her weight is 46 kg and her height 147 cm. Her plasma albumin is 29 g/L, her hemoglobin 11.2 g/L and has a C-reactive protein (CRP) of 78. Plasma micronutrient assessment shows very high (above the upper reference range threshold) levels of ferritin, normal levels of copper and suboptimal levels (below the lower reference range threshold) of selenium and zinc. She is Tanner Stage I in pubertal development and her bone age is 12 y. The pediatric gastroenterologist refers the patient to you to assess her nutritional status and commence remission induction therapy with exclusive enteral nutrition (EEN) for 8 weeks.
1) Assess the nutritional status of the patient? What if any additional information would you collect?
2) Discuss the main nutritional issues of the patient using an evidence-based approach (primary literature)
3) Comment on and calculate Clare’s energy/nutrient requirements using an evidence-based approach and justify your decisions with reference to the primary literature and published guidelines
4) Present and justify short (first 8 week on EEN) and long-term nutritional management strategy (following completion of EEN) using an evidence-based approach (primary evidence) and referring to national/international guidelines
5) What type of EEN formula and justify your decisions with reference to the primary literature. Include feeding plan for Clare.
6) Describe and analyze, using Windiets, three days of her diet during EEN and three days following completion of EEN.