patho - nutrition, ch. 11
Terms
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- The condition of the body related to the avialability and use of nutrients.
- Nutritional Status
- Amount of heat needed to raise the temperature of 1g of water 1ËšC.
- calorie (gram calorie)
- Amount of heat needed to raise 1kg of water 1ËšC.
- Kilocalorie (large calorie)
- The oxidation of proteins and carbohydrates yields how many calories?
- 4 kcal/g
- The oxidation of fats yields how many calories?
- 9 kcal/g
- The organized process through which nutrients are broken down, transformed or otherwise converted into cellular energy.
- metabolism
- Cells located everywhere in the body; responsible for uptake, synthesis, storage and mobilization of lipids. Stores 90% of body energy.
- Adipocytes
- These cells are fully differentiated (immature cells may divide postnatally), have a long life span, and vary in number among individuals.
- Adipocytes
- The lipid content of fat cells; contain no water; 3 molecules of fatty acid estericied to a glycerol molecule.
- Trigycerides
- Fat cells synthesize these cells from dietary fats and carbohydrates.
- trigylcerides
- This macromolecule is ingested in the diet, transported from the GI tract--> through the portal vein --> and to the liver before it gains access to the circulatory system.
- Glucose
-
1. converted to fatty acids and stored in fat cells as trigylcerides
2. stored in the liver and skeletal muscles as glycogen - Ways that excess glucose is stored.
- The breakdown of glycogen. Controlled by glucagon from the liver and epinephrine in muscle tissue.
- Glycogenolysis
- glucose absorbed from gut --> transported in portal circulation to --> liver (stored as glycogen/synthesized through gluconeogenesis) --> released into blood --> goes to 1.CNS(consumed), 2.skeletal muscle (consumed or stored as glycogen), 3.a
- Regulation of blood glucose by the liver
- Synthesis of glucose by the liver from amino acids, lactate, and glycerol. This glucose is either stored in the liver as glycogen or released into circulation.
- Glucogenesis (gluconeogenesis)
- What are the hormones that stimulate gluconeogenesis?
-
glucagon
glucocorticoids from adrenal cortex
thyroid hormone - Phase of metabolic storage and synthesis of cell consituents. It requires energy.
- Anabolism
- Breakdown of complex molecules into substances that can be used in the production of energy.
- Catabolism
- Why do humans require energy metabolism?
- Because humans cannot store energy in the form of heat. Metabolism allows cellular energy to be stored, then used by the body, and replenished.
- triglycerides with a complete lack of water
- anhydrous triglycerides
- Why do people lose weight quicker in the beginning of a fast/diet?
- Hydrous glycogen is burned first during rapid weight loss and a body loses water, which weighs alot. After a while the body converts to fat metabolism and slower weight loss since these molecules do not contain water ( makes them lighter).
- When lipases break triglycerides into 3 fatty acids and a glycerol.
- Fat catabolism
- These cause acidosis when present in large amounts.
- Ketones (ketoacidosis)
- Essential for the formation of all body structures - genes, enzymes, contractile structures in muscle, matrix of bone, hemoglobin, antibody function, fluid and electrolyte balance, nutrient transport.
- Proteins
- The building blocks of proteins.
- Amino Acids
- What happens to amino acids in excess of need for protein synthesis?
- They are converted to fatty acids, ketones, or glucose and are stored or used as metabolic fuel.
- Can fatty acids be converted to glucose?
- No - the body must break down amino acids to generate glucose if enough is not supplied by food intake.
- Breakdown of proteins to amino acids occurs primarily where?
- Liver
- What are the 4 categories of energy expenditure in the human body?
-
1.basal metabolic rate (resting energy equivalent)
2.diet-induced thermogenesis
3.exercise-induced thermogenesis
4.thermogenesis in response to changes in environmental conditions -
Chemical reactions occuring when body is at rest; necessary for maintaining normal body temp., cardiovascular and respiratory function, muscle tone, and other essential activities of tissues and cells in the resting body.
50-70% of energy requiremen - Basal Metabolic Rate (BMR) or Resting Energy Equivalent
-
The energy used by the body for the digestion, absorption, and assimilation of food after its ingestion.
Accounts for 10% of total calories expended. - Diet-induced thermogenesis
- Amount of energy expended for physical activity. Determined by type of activity performed, duration, and person's weight and physical fitness.
- Energy-induced thermogenesis
- This factor of exercise is a more significant aid to weight loss and maintenanc of weight loss.
-
Duration not intensity.
Institute of Medicine recommends:
60 min of exercise/5X per week - When are energy requirements greater?
- during growth periods: at birth, adolescence, pregnancy & breast feeding.
-
This disease is caused by lack of protein. "disease suffered by displaced child"
Edema, desquamating skin, enlarged abdomen, discolored hair, anorexia, apathy, skin lesions, enlarged liver, low CO, tachycardia. - Kwashiorkor
-
Composed primarily of triglycerides
can be: saturated (raises blood cholesterol), unsaturated & polyunsaturated (lowers blood cholesterol).
They provide energy, function as carriers for fat-soluble vitamins, precursors of prostaglandins, an - Fats
- Lack of linoleic acid can cause this.
- Dermatitis
- Composed of simple sugars, complex carbohydrates, and undigested carbohydrate.
- Carbohydrates
- Lack of this results in loss of tissue proteins and the development of ketosis.
- Carbohydrates
- Group of organic compounds that act as catalysts; part of the enzyme systems required for the release of energy from protein, carbs, and fat. Also necessary for formation of RBCs, hormones, genetic materials, and the nervous system. 2 types - fat soluble
- Vitamins
- Compounds involved in acid-base balance and the maintenance of osmotic pressure. They are components of vitamins, hormones and enzymes. 2 kinds - macrominerals (present in large amounts) & trace minerals (small amounts).
- Minerals
- Undigestible portion of food. Increase stool bulk, binds with cholesterol and prevents absorption, lowers blood glucose.
- Fiber
- These measurements provide a means for assessing body composition, especially fat stores and skeletal muscle mass. Measure ht, wt, body circumference, and thickness of skinfolds.
- Anthropometric measurements
-
A measurement of excess body fat.
weight in kg / (height in meters)squared - Body Mass Index (BMI)
-
A BMI of 30+
-coincides with lower incomes, minorities, less education
-increased risk factor for disease - obese
-
A BMI of 25 - 30
55% of the US population and increasing
risk factor for many diseases including obesity - overweight
- BMI under 18.5
- underweight
-
BMI of 18.5 - 25
lowest statistical health risk - normal
- What causes obesity?
- Consuming more calories than can be burned.
-
genotype
physiology
metabolism
environmental - Factors contributing to obesity
-
Determined by distribution of fat.
circumference of waist/circumference of hips
women:>0.8 men:>1.0
associated with aging, alcohol consumption, sedentary lifestyle, and increased weight
risk factor for: ischemic heart disease, s -
Upper Body Obesity
aka central, abdominal, male -
Peripheral, gluteal-femoral, female
not associated with CV disease
varicose veins, mobility issues - Lower Body Obesity
- This is the second leading cause of preventable death.
- Obesity as a disease.
-
children
adolescents
25-50 years
menopause
1st year after weight loss
(genetic factor is moderate) - Targets for prevention of Obesity
-
dietary therapy
increase physical activity
behavior therapy - lifestyle modifications for Tx of obesity
-
weight
risk factors
motivation
previous history weight management
time & abilities - Assessment for Obesity
-
1. prevent additional weight gain
2. reduction in current weight
3. maintain the weight loss long-term - Goals for Tx of obesity
- to decrease apetite
- focus of pharmacotherapy for Tx of obesity
-
This does NOT necessarily effect:
metabolic chemistry
central obesity
CV risk factors
future amounts of weight loss - Weight Cycling
-
Primary: lack of nutrition intake
Secondary: to disease that affects nutrition utilization - Malnutrition or Starvation
-
protein calorie malnutrition; leads to loss of muscle and fat.
Emaciated, hair loss and dull, low HR, low BP, low temp., wasted appearance, stunted growth - Marasmus
- leads to decreased body size, edema, wasting of organ mass (advanced)
- Marasmus - Kwashiorkor
- lack of food intake
- starvation
- What is the order of sources for glucose?
-
1.Blood
2.Liver
3.Muscles -
trauma
sepsis
cancer
HIV-AIDs
IBD
protein loss due to body favoring catabolism over anabolism - Illnesses that trigger malnutrition and wasting
- Increase fluid, electrolytes, calories, proteins, vitamins, minerals, but slowly to avoid strain on CV, kidneys, etc.
- Tx for Malnutrition
- Willful modification of food intake (restrict and binge).
- Eating Disorders
-
weight preoccupation
excessive self-evaluation of weight/shape - psychological aspects of eating disorders
-
Lack of appetite with psychological basis.
- refuse to maintain a minimal weight for body
- intense fear of weight gain or fat
- disturbed perception of body size, shape, weight
- amenorrhea in female
mostly occurs in females
- Anoexia Nervosa
-
amenorrhea
loss of secondary sex characteristics
bone loss at 6 months
constipation
cold-intolerance
bradycardia
hypotension
decrease heart size
ECG changes
electrolyte imbalance
skin with fine hair - common symptoms of Anorexia Nervosa
-
Risk of death when body drops to 35-40% of normal body weight
Death caused by heart muscle degeneration and heart failure - Death from Anorexia Nervosa
-
at least 3 of the following:
eat rapidly
eat until uncomfortably full
eat large quantities when not hungry
eat alone due to embarassment
negative feelings are associated
NOT accompanied by purging or other compensatory behav - For diagnosis of Binge Eating
-
recurrent binge eating
compensatory behaviors after the binge
self-evaluation of body/shape/weight
women>men - Bulemia Nervosa
-
dental disorders
electrolytes
upper GI problems
aspiration pneumonia
weight fluctuations
emotional problems - complications of bulemia nervosa
- people are more accepting of Tx because they are upset by the behavior
- Bulemia Nervosa
- These are catecholamines and are major hormones secreted in sympathetic response to stressors.
- epinphrine and norepinephrine
- What secretes epinephrine?
- adrenal medulla
- What secretes norepinephrine?
- sympathetic nerve endings
- What is characteristic of the sympathetic nervous system response?
- increase in heart rate, airway diameter, blood glucose levels, and muscle tension
- What are 5 endocrine glands related to the stress reaction?
- pituitary, adrenal, thyroid, parathyroid, and pancreas
- What secretes corticotropin releasing hormone?
- hypothalamus
- What does corticotropin releasing hormone stimulate?
- anterior pituitary
- What does the anterior pituitary release when stimulated?
-
ACTH - adrenal corticotropic hormone
TSH - thyroid stimulating hormone
and others - What does the posterior pituitary release?
- ADH - antidiuretic hormone
- What does the pancreas secrete?
-
Alpha cells - glucagon
Beta cells - insulin - What does the adrenal medulla secrete?
- epinephrine, norepinephrine
- What does the adrenal cortex secrete?
-
aldosterone
cortisol