How to Eat Your Veggies to Lose Weight: Weight Loss Tips from Downsize Fitness Downsize Fitness
Downsize Fitness is an international chain of gyms which helps our members lose 50+ pounds. Our weight loss program consists of Fitness, Nutrition, and Weight Loss Coaching sessions at our 6 facilities in the US and Canada. To become about Downsize Fitness memberships, our Certified Weight Loss Coach program, or Franchise opportunities, visit www.downsizefranchise.com
Upravljanje talentima, Vedrana Simić, SAP Human Capital Management Info day, ...S&T GROUP
SAP Human Capital Management Info day, 24. marec 2011, Zagreb
SAP Human Capital Management Info day je omogočil vpogled v prvovrstne storitve in rešitve, s katerimi se zagotavlja dolgoročno učinkovito upravljanje in razvoj ključnih virov v podjetju – zaposlenih. Rešitev SAP HCM omogoča avtomatizirano administracijo poslovnih procesov, povezanih s človeškimi viri, standardizirane procese in delovne operacije s podporo regulativi v kar 48 državah.
Na SAP Human Capital Management Info day so SAP strokovnjaki ob podpori partnerjev iz družb KING-ICT, Siemens in S&T predstavili ključne prednosti vodilne svetovne rešitve SAP HCM:
· Popolno upravljanje s celotno dokumentacijo zaposlenih.
· Neposreden dostop do digitalnih podatkov vseh zaposlenih.
· Hitrejše in učinkovitejše delo služb za ravnanje s človeškimi viri.
Več informacij o dogodku lahko najdete na www.sap.hr.
Will cover Ultrasonic Definition, its properties in nature and its 2 methods of production i.e. Piezoelectric and magnetostriction methods with their definitions, principle and working of their respective generators. And lastly, applications of Ultrasonic waves.
- Glycosaminoglycans (GAGs) are long, negatively charged, unbranched heteropolysaccharide chains composed of repeating disaccharide units. The major GAGs include hyaluronic acid, chondroitin sulfate, keratin sulfate, dermatan sulfate, heparin, and heparan sulfate.
- GAGs are important structural components of connective tissues and play roles in cell signaling and adhesion. They bind large amounts of water and lubricate joints.
- Mucopolysaccharidoses are a group of inherited disorders caused by deficiencies of lysosomal enzymes that degrade GAGs, leading to their accumulation in tissues and symptoms like skeletal abnormalities and developmental delays.
This document discusses the history and uses of ultrasound in gynecology. It was first introduced in 1950 by Ian Donald from Glasgow, UK. Ultrasound is commonly used due to its safety, acceptance, and low cost. Higher frequencies provide better resolution but lower tissue penetration. Ultrasound is used for infertility issues, diagnosing ovulation and ectopic pregnancy, IVF procedures, and evaluating ovarian and uterine masses, cancers, and other gynecological diseases and abnormalities. Transabdominal and transvaginal ultrasound are the main types used. The document provides details on performing transvaginal ultrasounds and evaluating various reproductive organs and structures.
The document discusses low back pain, its prevalence, causes, types of pain, and natural treatment approaches. It notes that low back pain is very common, costly, and can be caused by strains, sprains, herniated discs, and more. Treatment approaches discussed include trigger point therapy, spinal traction, exercise, posture correction, and chiropractic care, which studies have shown to be effective and safe alternatives to medication and surgery.
How to Eat Your Veggies to Lose Weight: Weight Loss Tips from Downsize Fitness Downsize Fitness
Downsize Fitness is an international chain of gyms which helps our members lose 50+ pounds. Our weight loss program consists of Fitness, Nutrition, and Weight Loss Coaching sessions at our 6 facilities in the US and Canada. To become about Downsize Fitness memberships, our Certified Weight Loss Coach program, or Franchise opportunities, visit www.downsizefranchise.com
Upravljanje talentima, Vedrana Simić, SAP Human Capital Management Info day, ...S&T GROUP
SAP Human Capital Management Info day, 24. marec 2011, Zagreb
SAP Human Capital Management Info day je omogočil vpogled v prvovrstne storitve in rešitve, s katerimi se zagotavlja dolgoročno učinkovito upravljanje in razvoj ključnih virov v podjetju – zaposlenih. Rešitev SAP HCM omogoča avtomatizirano administracijo poslovnih procesov, povezanih s človeškimi viri, standardizirane procese in delovne operacije s podporo regulativi v kar 48 državah.
Na SAP Human Capital Management Info day so SAP strokovnjaki ob podpori partnerjev iz družb KING-ICT, Siemens in S&T predstavili ključne prednosti vodilne svetovne rešitve SAP HCM:
· Popolno upravljanje s celotno dokumentacijo zaposlenih.
· Neposreden dostop do digitalnih podatkov vseh zaposlenih.
· Hitrejše in učinkovitejše delo služb za ravnanje s človeškimi viri.
Več informacij o dogodku lahko najdete na www.sap.hr.
Will cover Ultrasonic Definition, its properties in nature and its 2 methods of production i.e. Piezoelectric and magnetostriction methods with their definitions, principle and working of their respective generators. And lastly, applications of Ultrasonic waves.
- Glycosaminoglycans (GAGs) are long, negatively charged, unbranched heteropolysaccharide chains composed of repeating disaccharide units. The major GAGs include hyaluronic acid, chondroitin sulfate, keratin sulfate, dermatan sulfate, heparin, and heparan sulfate.
- GAGs are important structural components of connective tissues and play roles in cell signaling and adhesion. They bind large amounts of water and lubricate joints.
- Mucopolysaccharidoses are a group of inherited disorders caused by deficiencies of lysosomal enzymes that degrade GAGs, leading to their accumulation in tissues and symptoms like skeletal abnormalities and developmental delays.
This document discusses the history and uses of ultrasound in gynecology. It was first introduced in 1950 by Ian Donald from Glasgow, UK. Ultrasound is commonly used due to its safety, acceptance, and low cost. Higher frequencies provide better resolution but lower tissue penetration. Ultrasound is used for infertility issues, diagnosing ovulation and ectopic pregnancy, IVF procedures, and evaluating ovarian and uterine masses, cancers, and other gynecological diseases and abnormalities. Transabdominal and transvaginal ultrasound are the main types used. The document provides details on performing transvaginal ultrasounds and evaluating various reproductive organs and structures.
The document discusses low back pain, its prevalence, causes, types of pain, and natural treatment approaches. It notes that low back pain is very common, costly, and can be caused by strains, sprains, herniated discs, and more. Treatment approaches discussed include trigger point therapy, spinal traction, exercise, posture correction, and chiropractic care, which studies have shown to be effective and safe alternatives to medication and surgery.
The document lists the top 10 massage techniques. They are: 1) Swedish massage, 2) Deep tissue massage, 3) Sports massage, 4) Indian head massage, 5) Reflexology, 6) Hot stone massage, 7) Shiatsu massage, 8) Neuromuscular massage, 9) Pregnancy massage, and 10) Aromatherapy massage. Each technique is described in one to three sentences explaining its movements and therapeutic benefits such as relaxing muscles, improving circulation, and reducing stress and tension.
This document discusses spine mobilization and manipulation techniques. It defines mobilization and manipulation as skilled passive movements applied to joints and soft tissues. Manipulation involves high velocity, low amplitude movements while mobilization can involve oscillations of varying amplitudes. The effects of manipulation include mechanical, neurophysiological, and psychological impacts. Mechanical effects involve restoring tissue extensibility and range of motion. Neurophysiological effects occur through stimulation of mechanoreceptors and descending pain pathways in the central nervous system. Psychological effects involve reducing pain and anxiety through reassurance. Clinical decision making involves considering factors like joint mobility, pain response, and targeted treatment effects when selecting techniques.
This document provides an introduction and overview of spas, massage, and related regulations in the Philippines. It is a handbook intended for spa/salon operators, clients, and massage enthusiasts. The document defines different types of spas and discusses common types of massage practiced in the Philippines. It also outlines key government regulations from agencies like the Department of Health and Technical Education and Skills Development Authority that oversee the spa and massage industry.
The document provides an introduction to human anatomy, including anatomical position and directional terminology. It describes the major body cavities including the dorsal body cavity containing the brain and spinal cord, and the ventral body cavity containing the thoracic cavity with lungs and heart, and the abdominopelvic cavity containing organs like the liver, stomach and kidneys. It also discusses the four primary tissue types - epithelial, connective, muscle and nervous tissue - and their basic structures and functions.
This document provides information on various types of massages, including their techniques, benefits, and contraindications. It discusses Eastern techniques like anma, ayurvedic, and shiatsu massages as well as Western techniques like lymphatic drainage, classical, quick, and reflexology massages. Each type of massage has different techniques involving pressure, manipulation, and stretching to relax muscles, improve circulation, remove toxins, and promote overall health and wellness. Contraindications include illnesses, infections, cancer, and recent surgeries.
Anatomy and Physiology; Introduction to the human bodyJames H. Workman
A&P terminology introduced, a brief history of the study of anatomy, body systems, life processes, homeostasis, positive and negative feedback systems, directional terms and regions of the body terminology are introduced
The document provides an overview of anatomy and physiology, defining them as the study of structures and functions of the body respectively. It describes the levels of organization in the body from chemicals to cells to tissues to organs to systems. Key terms used in anatomy are also defined. The summary of the document is:
1. Anatomy is the study of structures and physiology is the study of functions in the body.
2. The body is organized from the basic unit of cells to tissues to organs to systems.
3. Anatomy uses terms like anterior, posterior, medial and lateral to describe positions in the body.
This document provides an introduction to anatomy and physiology. It defines anatomy as the study of body parts and their relationships, while physiology is the study of body functions. Anatomy can be examined on a microscopic or developmental level, while physiology analyzes systems and their functions. The document then outlines the structural hierarchy of the body from chemicals to organ systems. It describes several key organ systems and homeostasis, concluding with important anatomical terminology.
Stress is defined as a person's physical and emotional response to change. There are different types of stress including general stress, cumulative stress, acute traumatic stress, and post traumatic stress. Sources of stress can come from environmental factors, organizational factors, and personal factors. Common causes of stress include divorce, death of a loved one, financial setbacks, employment changes, and traffic. Stress can be positive or negative and classified as acute or chronic. Symptoms of stress affect behavior, physiology, and psychology. Stress management techniques include healthy living, exercise, social support, organization, anger management, flexibility, and pursuing hobbies.
Stress Management PowerPoint Presentation Content slides include topics such as: understanding the dynamics of stress, quickly and effectively managing stress, symptoms of stress, identifying sources of stress, negative and positive effects of stress, the five step system to tackle stress, 6 strategies to minimize burn-out, from distress to eustress, specific problems and associated treatments, 15 ways to make work less stressful, how to's and much more.
The document discusses stress, its causes and effects on the body. It defines stress as the body's response to any physical or emotional changes, which includes increased heart rate and blood flow to muscles. Stress can be positive in moderation but chronic stress from issues like family problems, health, or financial difficulties over long periods is very harmful. The signs of stress include physical, emotional, mental and behavioral changes. Ways to manage stress discussed include being organized, assertive communication, time management, social support, relaxation techniques, and cognitive behavioral therapy.
This document provides information on fascial spaces of the head and neck region. It begins by defining fascial spaces as clefts or compartments containing connective tissue. It then classifies the spaces based on mode of involvement and clinical significance. Several key fascial spaces are described in detail, including boundaries, contents, etiology, clinical features, and spread of infection. These include the buccal, sublingual, submandibular, pterygomandibular, masseteric, temporal, lateral pharyngeal, and retropharyngeal spaces. The objectives and microbiology of odontogenic infections are also summarized.
Good Health is Real Wealth at WorkplaceAnkur Tandon
Companies who are aggressively planning out to create a positive work atmosphere are advised to take examples from the major brands who always try to build their work environment employees-friendly.
Read more interesting content, at www.thecareermuse.co.in - We intend to inform and inspire recruiters, job seekers and anyone with an interest in the workplace and HR technology.
Hope you enjoyed reading the Infographic.
Feel free to share your feedback with us at @CareerBuilderIn
The 4 degrees of separation between pain and pleasureDeborah Davis
Do you feel any sort of foot pain whenever you go for a walk? There are a number of things you can do either to prevent or lessen the pain. For starters, you should regularly exercise your feet by doing some morning stretches. You can also use some orthotics or shoe inserts. To learn more about foot pain, check out these slides from Docpods.
11 Stats You Didn’t Know About Employee RecognitionOfficevibe
Recognizing employees is one of the most overlooked facets of managements that even great leaders sometimes forget about. Without a good employee recognition strategy, people will feel unappreciated and build up stress.
In fact, the number 1 reason why most Americans leave their jobs is that they don’t feel appreciated . The last thing you want is to have high employee turnover because of poor employee recognition.
Officevibe put together some incredible statistics about employee recognition.
Read more on Officevibe blog:
https://www.officevibe.com/blog/employee-recognition-infographic
Learn more about Officevibe, the simplest tool for a greater workplace:
https://www.officevibe.com/
Follow us on Facebook:
https://www.facebook.com/officevibe
The document lists the top 10 massage techniques. They are: 1) Swedish massage, 2) Deep tissue massage, 3) Sports massage, 4) Indian head massage, 5) Reflexology, 6) Hot stone massage, 7) Shiatsu massage, 8) Neuromuscular massage, 9) Pregnancy massage, and 10) Aromatherapy massage. Each technique is described in one to three sentences explaining its movements and therapeutic benefits such as relaxing muscles, improving circulation, and reducing stress and tension.
This document discusses spine mobilization and manipulation techniques. It defines mobilization and manipulation as skilled passive movements applied to joints and soft tissues. Manipulation involves high velocity, low amplitude movements while mobilization can involve oscillations of varying amplitudes. The effects of manipulation include mechanical, neurophysiological, and psychological impacts. Mechanical effects involve restoring tissue extensibility and range of motion. Neurophysiological effects occur through stimulation of mechanoreceptors and descending pain pathways in the central nervous system. Psychological effects involve reducing pain and anxiety through reassurance. Clinical decision making involves considering factors like joint mobility, pain response, and targeted treatment effects when selecting techniques.
This document provides an introduction and overview of spas, massage, and related regulations in the Philippines. It is a handbook intended for spa/salon operators, clients, and massage enthusiasts. The document defines different types of spas and discusses common types of massage practiced in the Philippines. It also outlines key government regulations from agencies like the Department of Health and Technical Education and Skills Development Authority that oversee the spa and massage industry.
The document provides an introduction to human anatomy, including anatomical position and directional terminology. It describes the major body cavities including the dorsal body cavity containing the brain and spinal cord, and the ventral body cavity containing the thoracic cavity with lungs and heart, and the abdominopelvic cavity containing organs like the liver, stomach and kidneys. It also discusses the four primary tissue types - epithelial, connective, muscle and nervous tissue - and their basic structures and functions.
This document provides information on various types of massages, including their techniques, benefits, and contraindications. It discusses Eastern techniques like anma, ayurvedic, and shiatsu massages as well as Western techniques like lymphatic drainage, classical, quick, and reflexology massages. Each type of massage has different techniques involving pressure, manipulation, and stretching to relax muscles, improve circulation, remove toxins, and promote overall health and wellness. Contraindications include illnesses, infections, cancer, and recent surgeries.
Anatomy and Physiology; Introduction to the human bodyJames H. Workman
A&P terminology introduced, a brief history of the study of anatomy, body systems, life processes, homeostasis, positive and negative feedback systems, directional terms and regions of the body terminology are introduced
The document provides an overview of anatomy and physiology, defining them as the study of structures and functions of the body respectively. It describes the levels of organization in the body from chemicals to cells to tissues to organs to systems. Key terms used in anatomy are also defined. The summary of the document is:
1. Anatomy is the study of structures and physiology is the study of functions in the body.
2. The body is organized from the basic unit of cells to tissues to organs to systems.
3. Anatomy uses terms like anterior, posterior, medial and lateral to describe positions in the body.
This document provides an introduction to anatomy and physiology. It defines anatomy as the study of body parts and their relationships, while physiology is the study of body functions. Anatomy can be examined on a microscopic or developmental level, while physiology analyzes systems and their functions. The document then outlines the structural hierarchy of the body from chemicals to organ systems. It describes several key organ systems and homeostasis, concluding with important anatomical terminology.
Stress is defined as a person's physical and emotional response to change. There are different types of stress including general stress, cumulative stress, acute traumatic stress, and post traumatic stress. Sources of stress can come from environmental factors, organizational factors, and personal factors. Common causes of stress include divorce, death of a loved one, financial setbacks, employment changes, and traffic. Stress can be positive or negative and classified as acute or chronic. Symptoms of stress affect behavior, physiology, and psychology. Stress management techniques include healthy living, exercise, social support, organization, anger management, flexibility, and pursuing hobbies.
Stress Management PowerPoint Presentation Content slides include topics such as: understanding the dynamics of stress, quickly and effectively managing stress, symptoms of stress, identifying sources of stress, negative and positive effects of stress, the five step system to tackle stress, 6 strategies to minimize burn-out, from distress to eustress, specific problems and associated treatments, 15 ways to make work less stressful, how to's and much more.
The document discusses stress, its causes and effects on the body. It defines stress as the body's response to any physical or emotional changes, which includes increased heart rate and blood flow to muscles. Stress can be positive in moderation but chronic stress from issues like family problems, health, or financial difficulties over long periods is very harmful. The signs of stress include physical, emotional, mental and behavioral changes. Ways to manage stress discussed include being organized, assertive communication, time management, social support, relaxation techniques, and cognitive behavioral therapy.
This document provides information on fascial spaces of the head and neck region. It begins by defining fascial spaces as clefts or compartments containing connective tissue. It then classifies the spaces based on mode of involvement and clinical significance. Several key fascial spaces are described in detail, including boundaries, contents, etiology, clinical features, and spread of infection. These include the buccal, sublingual, submandibular, pterygomandibular, masseteric, temporal, lateral pharyngeal, and retropharyngeal spaces. The objectives and microbiology of odontogenic infections are also summarized.
Good Health is Real Wealth at WorkplaceAnkur Tandon
Companies who are aggressively planning out to create a positive work atmosphere are advised to take examples from the major brands who always try to build their work environment employees-friendly.
Read more interesting content, at www.thecareermuse.co.in - We intend to inform and inspire recruiters, job seekers and anyone with an interest in the workplace and HR technology.
Hope you enjoyed reading the Infographic.
Feel free to share your feedback with us at @CareerBuilderIn
The 4 degrees of separation between pain and pleasureDeborah Davis
Do you feel any sort of foot pain whenever you go for a walk? There are a number of things you can do either to prevent or lessen the pain. For starters, you should regularly exercise your feet by doing some morning stretches. You can also use some orthotics or shoe inserts. To learn more about foot pain, check out these slides from Docpods.
11 Stats You Didn’t Know About Employee RecognitionOfficevibe
Recognizing employees is one of the most overlooked facets of managements that even great leaders sometimes forget about. Without a good employee recognition strategy, people will feel unappreciated and build up stress.
In fact, the number 1 reason why most Americans leave their jobs is that they don’t feel appreciated . The last thing you want is to have high employee turnover because of poor employee recognition.
Officevibe put together some incredible statistics about employee recognition.
Read more on Officevibe blog:
https://www.officevibe.com/blog/employee-recognition-infographic
Learn more about Officevibe, the simplest tool for a greater workplace:
https://www.officevibe.com/
Follow us on Facebook:
https://www.facebook.com/officevibe
CBD oil may have potential benefits for cancer treatment and prevention. Studies show CBD can reduce cancer cell growth, inhibit tumor development, and relieve symptoms like pain, nausea, and insomnia. However, research is still ongoing into how CBD specifically impacts different types of cancers and what doses may be effective. The endocannabinoid system plays a role in immunity and inflammation, both of which are involved in cancer development, suggesting CBD could lower cancer risk factors. More clinical trials are still needed to fully understand CBD's effects on various cancers.
The document discusses various types of fruits and vegetables that are beneficial for health and fighting cancer. It describes berries, yellow and orange fruits and vegetables, leafy greens, cruciferous vegetables, fresh herbs and spices, nuts and seeds, garlic, and broccoli as containing antioxidants and other compounds that may reduce cancer risk and promote immune system function. Steaming broccoli for 3-4 minutes is recommended to retain its cancer-fighting compounds, while broccoli sprouts are highlighted as containing higher levels of the beneficial compound sulforaphane than mature broccoli.
This document discusses nutrition for cancer prevention. It states that simple lifestyle changes like healthy eating can prevent 30-50% of all cancers. Unhealthy foods to avoid include molds, processed meats cooked at high temperatures, spoiled foods, and charred foods as they contain carcinogens like aflatoxins, heterocyclic amines, and polycyclic aromatic hydrocarbons. These dietary carcinogens are mutagenic and have been shown to damage DNA and cause cancer in laboratory experiments. Adopting a diet low in these carcinogens can help prevent many cancers.
Lycopene is a carotenoid responsible for the red color of tomatoes. Research shows lycopene may help prevent certain cancers, as eating 7+ servings of raw tomatoes weekly was linked to a 60% lower risk of stomach, colon, or rectal cancer compared to 2 or fewer servings. Lycopene has antioxidant properties and inhibits the growth of cancer cells in vitro. Studies in animals also suggest lycopene may prevent cancers of the mammary gland, liver, skin, lungs and colon. When combined with S-allylcysteine from garlic, lycopene reduced chemically induced gastric cancer in rodents.
This document summarizes Dr. Andrew Weil's anti-inflammatory diet. It recommends eating carotenoid-rich fruits and vegetables, whole grains, oils containing polyphenols like olive oil, fish and seafood, and herbs and spices. These foods contain antioxidants and nutrients that reduce inflammation. The diet avoids foods that promote inflammation, such as grains, sugar, processed oils, dairy, excess meat and cheese. Following this anti-inflammatory diet along with regular exercise can help reduce chronic inflammation and diseases linked to inflammation like arthritis, heart disease and cancer.
Osteoporosis is a condition where bone density decreases, making bones more brittle and prone to fractures. Proper nutrition and lifestyle can help prevent osteoporosis. Calcium intake is important for building strong bones, especially for women who lose bone mass quickly after menopause due to dropping estrogen levels. Other nutrients like vitamin D, magnesium, boron, and manganese also support bone health. A diet high in salt, protein, caffeine, or alcohol can negatively impact bones. Maintaining physical activity and the right calcium intake throughout life can help maximize bone density and reduce osteoporosis risk.
The document discusses the history and composition of capsicum sp. (paprika). It notes that Christopher Columbus was the first European to taste paprika, mistakenly thinking he had reached India. Paprika originated in South America and was cultivated by indigenous peoples as early as 5000 BCE before spreading to Europe, Africa, Asia, and the Middle East after Columbus brought it back. Turks introduced paprika to Serbia. The main active compounds in paprika that give it its pungency and color are capsaicinoids such as capsaicin. Higher levels of carotenoids contribute to the red color in ripe paprika. Several compounds in paprika and other spices like turmeric, ginger and garlic have shown antiviral effects
Oregano has a long history of usage dating back 50,000-70,000 years. It is commonly used as a flavoring herb, especially in Mediterranean cuisine. The main bioactive components of oregano essential oils are carvacrol and thymol. Studies have found that carvacrol has antiviral, anti-inflammatory, and immunomodulatory effects and may help treat COVID-19 by inhibiting the viral protease and reducing the cytokine response. Carvacrol shows promise as a potential natural treatment for COVID-19, though more research is still needed to fully evaluate its efficacy against SARS-CoV-2.
Peppermint is a hybrid of watermint and spearmint that is widely cultivated around the world. It has a long history of medicinal use dating back to ancient Egypt. Peppermint was first cultivated in England in the late 17th century and became popular for treating nausea, vomiting, and other ailments. Today, peppermint oil is extracted from the leaves and contains high concentrations of menthol and other compounds that provide its distinctive flavor and scent.
Curcuma longa, also known as turmeric, is a plant that is native to Indonesia and southern India. It has been used medicinally in those regions for over 5,000 years. Curcumin is the active compound in turmeric that has been shown to have antioxidant, anti-inflammatory, antiviral, and anticancer properties. Research suggests that curcumin's ability to inhibit inflammatory pathways and cytokines makes it a potential treatment for COVID-19 by reducing the severity of symptoms.
This document discusses coconut (Cocos nucifera) and coconut oil. It provides background on coconut, noting it is native to tropical regions near oceans. Coconut contains lauric acid and caprylic acid, which have anti-viral properties that can help fight infections. Coconut oil contains medium-chain triglycerides that also have anti-viral effects when broken down. Research suggests specific compounds in coconut oil like monolaurin can destroy the membrane of viruses like SARS-CoV-2 and may help treat COVID-19 patients.
4. Definition
• Osteoporoza se definiše kao progresivni
sistemski poremećaj koštanog sistema koji
karakteriše smanjenje mineralne gustine
koštanog tkiva, poremećena mikroarhitektura
istog, i sklonost prelomu.
• U novije vreme se definiše i ―kao poremećaj
koštanog sistema koji karakteriše smanjena
jačina kostiju koja predstavlja predispoziciju za
povećani rizik za prelom‖
5. Diagnosis of Osteoporosis
Using Central DXA
WHO-Definition
Normal
≥ - 1
Osteopenia
-1 do - 2,5
Osteoporosis
≤- 2,5
Severe osteoporosis
≤ - 2,5 sa frakturama
T score
6. Definicija
• OSTEOPOROZA je... stanje, bolest, koštane krhkosti koja je
posledica promena u mikro-arhitekturi i smanjenja gustine kosti.
• Patološki supstrat
• Od 65.godine god.
• U razvijenom svetu 50- godišnje ţene imaju 50%
šanse za prelom zbog osteoporoze
• ♀ 7 / ♂1
• family history
7. Incidenca/prevalenca
• svakih 30 sekundi u Evropi jedna osoba zadobije
frakturu zbog osteoporoze
• gotovo 1 od 5 ţena starijih od 50 godina ima frakturu
jednog ili više pršljenova.
Genetski faktori
Hormonski
Prehrambeni
Uslovi okoline
30% do 50% ţena starijih od 65 godina širom sveta će imati
OP
Oko ½ ţena od 50 i više godina će imati prelom zbog
osteoporoze u svom ţivotnom veku!!!!!
8. Incidenca/prevalenca
• Amerika :
verovatnoća za OP za ţene ♀ je 4x veća nego za muškarce♂
Engleska: 3 000 000 ljudi sa OP
1 od 2 ♀ i 1 od 5 ♂ posle 50-ete će zadobiti prelom usled
OP (250 000 preloma svake godine!!!!)
(ili svake 3 minute!!!)
½ preloma kičme
¼ preloma kuka
1/5 preloma podlaktice
9. u zemlji Srbiji
U Srbiji od osteoporoze boluju
svaka 3. ţena i
svaki 8. muškarac
stariji od 50godina
10. pravo vreme za početak prevencije te bolesti
detinjstvo.
Školska deca bi,
uz dovoljan unos
kalcijuma i vitamina D,
trebalo da veţbaju
svakog dana oko
sat vremena
11. etiologija Uloga kalcijuma
• kalcijum neophodan za
zdravlje kosti i da ima
pozitivan uticaj na gustinu
kosti i smanjenje preloma.
• dokazano da za vreme rasta i
razvoja kosti dakle u
detinjstvu,
odgovarajući unos kalcijuma
značajno povećava koštanu
masu, odnosno poboljšava
gustinu kosti i već time
preventivno utiče na mogući
kasniji razvoj osteoporoze.
• odgovarajući, dovoljan, unos
kalcijuma smanjuje gubitak
koštane mase u menopauzi
12. etiologija Demistificated MYSTERY!!!!!
Uzroci osteoporoze
• nedostatak veţbanja
• neadekvatna ishrana
• nedostatak istezanja
• nedostatak kalcijuma
• deficit vit. D
• nizak nivo estrogena u ţena
• nizak nivo testosterona u
muškaraca
13. etiologija Osteo-porosis = šupljikava kost
Zna se da je potrebna dovoljna količina kalcijuma da bi se postigla
najveća moguća koštana masa, a smatra se da su količine ispod
500 mg kalcijuma dnevno predisponirajuće za smanjenu
koštanu masu.
manjak vit. D,
manjak magnezijuma,
manjak bora, fluorida i vitamina K, B12 i B6,
mogu doprineti
nastanaku osteoporoze.
14. etiologija
• Muškarci!!!!
kod ţena bolest češća do
7 puta
i obično je povezana s
menopauzom, što odgovara
naglom padu ţenskih polnih
hormona, posebno estrogena.
Estrogen / progesteron
15. etiologija Uloga kalcijuma
• Kalcijum je kamen temeljac za jake kosti.
• Odrasli do 50 god trebaju 1000 mg dnevno.
• Posle 50.god. ţenama treba 1200 mg
dnevno a muškarcima preko 70-ete takođe
1200 mg
• Mleko, bez svake
sumnje!!!!!
čaša mleka od 250 ml, ima oko 300mg Ca
17. Faktori rizika-nepromenljivi
• hereditet na OP ili na prelom usled OP
• ţenski pol
• bela put
• sitna telesna građa
• kašnjenje puberteta ili ranija menopauza
• anorexia u nekom ţivotnom dobu
• stanje posle preloma vezanog za OP
• starost preko 60 god
• rheumatoid arthritis, hronična bolest jetre ili HBI
• hyperthyreosis ili poremećaj funkcije paraštitnih
ţlezda, upotreba hormona štitne ţlezde
• nizak nivo testosterona u muškaraca
• dugotrajna terapija kortikosteroidima
• ţene koje nisu rađale
• izlaganje jonizujućem zračenju
18. Faktori rizika- promenljivi
• nedovoljna fizička aktivnost
• nepravilna ishrana
• nedovoljan unos Ca
• malapsorpcioni sindromi
• pušenje
• prekomerni unos alkohola
• neadekvatan BMI
• često padanje
• dugotrajna imobilizacija
21. Symptoms
• Ne mora postojati ikakav simptom, sve do preloma ili ocigledne
promene stasa!!!!
• Čak i značajan gubitak koštane gustine može biti ASIMPTOMATSKI
• Bol u leđima –zbog promena na pršljenovima – može biti prvi znak
22. Symptoms
Iako OP nema izaţene simptome
komplikacije–
jako bolne,
ostavljaju trajne posledice,
Prelom kuka
Prelom podlaktice
Prelom pršljena
23. Symptoms
• Bez prevencije i tretmana,
osteoporoza moţe napredovati
bez bolova ili ikakvih simptoma
sve dok se ne dogodi prelom
• najčešće
• kuka,
• kičmenih pršljenova
• ili podlaktice
• OP Fx moţe nastati kao posledica
padova, dizanja manjeg tereta ili
savijanja. OP Fx mogu biti
simptomatske ili čak
asimptomatske!!!!
24. Praktično 1 od 5 pacijenata godinu dana nakon OP
Fx kuka nije medju ţivima
Osobe sa OP Fx imaju smanjen kvalitet ţivota
i samo 1/3 pacijenata se oporavi
25. • OP Fx pršljenskih tela definišu se kao smanjenje
prednjeg kranio-kaudalnog dijametra pršljena za
više od 20 % =najmanje 4mm = radiološka
definicija Fx
• Osobe sa vertebralnom OP Fx gube najmanje
2cm u visini.
• Najveća je prevalenca Fx
• od Th11 do L1 pršljena,
• a sledi Th8
26. simptomatology
• ZAŠTO ŢENE??
• ţene imaju manju koštanu masu
• nego odrasli muškarci,
• prema tome gubitak kalcijuma iz kosti
• češće dovodi do krhkosti kosti.
• testosteron duţe štiti muškarce jer počinje opadati iza 60-te godine,
a kod ţena je menopauza obično oko 50. godine.
• mlađe ţene koje se previše bave nekim fizičkim aktivnostima
(balet, moderan ples, ali i drugi oblici izvođačkih umjetnosti) +
anoreksične !!!
• ili zbog manjka estrogena.
• unose manje kalcijuma u ishrani nego muškarci
• češće imaju problema sa nepodnošenjem mleka zbog manjka
enzima laktaze
• češća upotrebe strogih redukcionih dijeta
27. Disease extent
• najugroţeniji su kičmeni pršljenovi i
butna kost
• do 2050. g., zbog savremenog načina
ţivota, broj obolelih biti 3x veći,
• Primarna
• Sekundarna
28. • Modeliranje & remodeliranje = 20% kosti se renovira svake
godine,
• Vaţno je Ca stalno ugrađivati u kosti!!!!
• Tokom rasta i razvoja činjenica je da najveću koštanu
masu imamo oko 30-te godine, a da od tada ona
postepeno opada, a nagli se pad očekuje kod ţena oko 50-te, a
kod muškaraca iza 65-te godine.
• Ţene u menopauzi gube do 20% koštane mase u prvih 5
godina
30. CLINICAL examine
• Laboratorija:
• - nivo Ca u krvi
• - nivo vit D
• Ro - da bi se OP detektovala na rentgenskom snimku
gubitak minerala u kosti mora da iznosi najmanje 30%.
Rentgenski snimci su ipak od koristi za procenu
osteoporotičnih vertebralnih Fx i deformiteta.
• DXA = absorpciometrija rentgenskih zraka dvostruke
energije - merenje BMD na femuru I kičmenom stubu
• ultrazvučna (QUS) merenja BMD na peti
• markeri koštanog metabolizma u krvi i urinu
31. Diagnosis
• Anamneza
• Klinicka slika
• Merenje koštane gustine (BMD - Bone Mineral Density)
DXA metodom,
• Testing: What Your T-Score Means
• Upoređuje koštanu gustinu -bone mineral density
(BMD) sa onom u 30-godišnjaka, kada je ona najveda
• T –score
• ˃-1.0 = normalan nalaz
• -1.0 do -2.5 osteopenia
• ˂-2.5 osteoporoza
32. Score
• Rezultati merenja BMD mogu da se izraze kao odstupanje (broj standardnih
devijacija) od srednje gustine kosti mladih zdravih osoba i to se zove (T-
skor) ili kao odstupanje od vrednosti koja odgovara istim godinama starosti
zdravih osoba i zove se (Z-skor).
• Rizik od OP Fx kuka raste više od 2,5 puta za svaku standardnu devijaciju
smanjenja BMD kuka.
• T-skor se koristi za dijagnostikovanje osteopenije (niska gustina kosti) i
osteoporoze.
• Z skor je vaţan u donošenju odluke o agresivnosti lečenja.
33. Diagnosis
• merenje koštane mineralne gustine (BMD - Bone Mineral Density) DXA metodom,
• Bazira se na niskoenergetskom X zračenju, prema preporukama WHO
• Merenje se vrši na lumbalnom delu kičme ili kuku.
• Pregled traje manje od 5 minuta, doza zračenja je minimalna (sto i više puta je
manje od doze koja se absorbuje standardnom radiografijom pluda).
34.
35. Diagnosis
• Postoji i ultrazvučna denzitometrija - brz i ekonomičan metod, bez
zračenja.
• Merenje se vrši na petnoj kosti.
• Ova metoda se može koristiti kao skrining metoda ali nije pouzdana i
precizna kao DXA metoda
36. Therapy
• bisfosfonati (Alendronat, Bonviva, Fosamax, Fosavance, Alefos, Bonap).
• Bisfosfonati povedavaju mineralizaciju kostiju, smanjuju razgradnju kostiju, što se
meri povedanjem mineralne koštane gustine.
• To su lekovi kod kojih je pravilna primena ključna za uspeh terapije (teško se
resorbuju).
• Uzimaju se uvek ujutru, naštinu, u uspravnom položaju, sa punom čašom vode.
Nakon uzimanja leka, bitno je, bar 30 minuta, ostati u uspravnom položaju (da bi
se izbegao refluksni ezofagitis), tj., možete šetati ili sedeti, ali ležanje ne dolazi u
obzir.
• Tek nakon sat vremena od uzimanja leka, možete popiti kafu, doručkovati i uzeti
ostale lekove.
• Bisfosfonati se međusobno razlikuju po režimu doziranja, neki se uzimaju jednom
mesečno, drugi jednom sedmično, a neki svakog dana.
• Poboljšanje rezultata može se očekivati tek posle godinu dana konstantne primene
leka.
37. Therapy
• Menopausal estrogen hormone therapy
• Selective estrogen receptor modulators (SERMs) are a class of drugs that
work like estrogen in some tissues. The SERMs are developed to reap the
benefits of estrogen while avoiding the potential side effects of estrogen.
Examples include tamoxifen and Raloxifene (Evista).
• Estrogen is available orally (Premarin, Estrace, Estratest, and others) or as
a skin patch (Estraderm, Vivelle, and others).
• Estrogen is also available in combination with progesterone as pills and
patches.
• Progesterone is routinely given along with estrogen to prevent uterine
cancer that might result from estrogen use alone.
• Women who have had a hysterectomy (surgical removal of the uterus)
may take estrogen alone
39. MNT
• primary goal is to restore and maintain
the nutrition status of the individual patient
• education is a
key
form
of
nutrition intervention
40. MNT - mleko i mlečni proizvodi
• Ca+ vit. D
• su mlečni proizvodi
prihvadeni kao standardi po
kojima se može proceniti
unos kalcijuma u ljudski
organizam .
41.
42. MNT
• 1 l svežeg mleka sadrži oko 1200 mg kalcijuma, a ima i
dovoljno vitamina D u sebi,
• ako mleko nije obrano.
43.
44. Milk & dairy
• Yogurt and kefir
• Proteini, Ca
• probiotici
• Punomasno!!!!
•
• lactobacilli
45. Milk & dairy
• slatko mleko – slabije se podnosi
• jogurt
• kiselo mleko
• mladi sir
• alteranative: sojino, bademovo, pirinčano mleko
• Ili lactose-free
46. • A 3 cm cube of hard cheese has as
much calcium as a cup of milk.
• A single 8-ounce cup of milk,
whether skim, low-fat, or whole,
has 300 milligrams of calcium.
• If you are intolerant to dairy
products or if you prefer to avoid
dairy, there are other alternatives
food sources that are high in
calcium. These include:
• calcium-fortified soy, almond and
rice beverages (check the nutrition
labels)
• calcium-fortified orange juice
(check the nutrition labels)
47. Proteini
• Počevši od ribe i ribljih konzervi koji u naročito u slučaju plave ribe
sadrže osim kalcijuma i značajne količine vitamina D .
• jaja
• Riba hladnih mora , losos, tuna, haringa
• 84 gr sardina = 1 šolja mleka
48. vegtables
• povrda bi za kalcijum
• bio najbolji kelj,
• brokoli i
• spanad,
• Greens
• You might be surprised to learn that calcium is
• plentiful in many vegetables.
• Go for dark leafy greens such as bok choy (seen above),
• Chinese cabbage, and kale. The traditional soul food
• favorites, collard and turnip greens, offer
• a lot of calcium, too.
• One cup of chopped, cooked turnip greens
• has about 200 milligrams of calcium.
49. Calcium Supplements
• Supplements are an easy way to boost
your calcium intake, but some reports
suggest you may not need them.
• If you're already getting enough calcium
from food, taking more in pill form won't
contribute to bone health. Experts say
there's little benefit in getting more than
2,000 milligrams of calcium per day,
and too much can lead to kidney stones.
For the best absorption, take no more
than 500 milligrams at one time.
Some calcium supplements, such as
calcium carbonate, are better
absorbed if taken with meals; however,
calcium citrate can be taken anytime.
50. • 300 mg Ca ima u :
• 1 šolja (250 ml) kravljeg ili kozjeg mleka (i
čokoladnog!)
• 1 šolja (250 ml) sojinog, bademovog,
pirinčanog mleka
• 1 šolja (250 ml) obogadenog soka od
pomorandže
• ¾ šolje yogurta (175 ml)
• 2 parčenceta kačkavalja
• Kockica kačkavalja (a3 cm cube)
• Losos , konzerviran sa kostima (107 g) ili
sardina ( 84 g).
60. • Soy Foods
• ½ šolje obogadenog tofua = 861 mg Ca
• Isoflavoni takođe utiču na jačanje kostiju
• tofu
• estrogen-like effect
• This may make soy useful in warding off bone
disease in postmenopausal women.
61. Dobri izvori kalcijuma su:
• mlečni proizvodi (mleko, sir), jogurt,
sardine, prokelj i brokoli, povrde sa
zelenim lišdem kao spanad, orasi,
lešnici, bademi, sezamovo seme,
morska hrana uključujudi školjke i
rakove.
62. • Salmon
• Salmon and other types of fatty
fish offer an array of bone-
boosting nutrients.
• They contain calcium as well as
vitamin D, which assists in
calcium absorption.
• They're also high in omega-3 fatty
acids.
• Fish oil supplements have been
shown to reduce bone loss in
elderly women and may prevent
osteoporosis.
64. • Nuts and Seeds
• Nuts and seeds can bolster bone
health in several ways. Walnuts
and flaxseeds are packed with
omega-3 fatty acids.
• Peanuts and almonds contain
potassium, which protects against
the loss of calcium in urine.
• Nuts also contain protein and
other nutrients that play a
supportive role in building strong
bones.
65. fruits
• Orašasto vode --orasi, lešnici i bademi, najbolje –
mleveno u šejkovima i smoothie-ima.
•
66. CALCIUM CONTENT OF SOME COMMON
FOODS
PORTION CALCIUM*
Food Product – 250 to 300+ mg Ca
Buttermilk 1 cup/250mL 300 mg
Fortified orange juice 1 cup/250mL 300 mg
Fortified rice or soy beverage 1 cup/250mL 300 mg**
Milk – whole, 2%, 1%, skim, chocolate 1 cup/250mL 300 mg***
Milk, evaporated 1/2 cup/125 mL 367 mg
Milk – powder, dry 1/3 cup/75 mL 270 mg
Yogurt – plain, 1-2% M.F. 3/4 cup/175 mL 332 mg
67. CALCIUM CONTENT OF SOME COMMON
FOODS
PORTION CALCIUM*
Food Product – 160 to 249 mg Ca
Almonds, dry roast 1/2 cup/125 mL 186 mg
Beans – white, canned 1 cup/250 mL 191 mg
Cheese – Blue, Brick, Cheddar, Edam,
Gouda, Gruyere, Swiss
1 ¼”/3 cm cube 245 mg
Cheese – Mozzarella 1 ¼”/3 cm cube 200 mg
Drinkable yogurt 4/5 cup/200 mL 191 mg
Frozen yogurt, vanilla 1 cup/250 mL 218 mg
Fruit-flavoured yogurt 3/4 cup/175 mL 200 mg
Ice cream cone, vanilla, soft serve 1 232 mg
68. CALCIUM CONTENT OF SOME COMMON
FOODS
PORTION CALCIUM*
Food Product – 125 to 159 mg Ca
Beans – baked, with pork, canned 1 cup/250 mL 129 mg
Beans – navy, soaked, drained, cooked 1 cup/250 mL 126 mg
Collard greens – cooked 1/2 cup/125 mL 133 mg
Cottage cheese, 1 or 2% 1 cup/250 mL 150 mg
Figs, dried 10 150 mg
Instant oatmeal, calcium added 1/2 cup/125 mL 127 mg
Tofu, regular – with calcium sulfate 3 oz/84 g 130 mg
69. CALCIUM CONTENT OF SOME COMMON
FOODS
PORTION CALCIUM*
Food Product – 75 to 124 mg Ca
Beans – baked, plain 1 cup/250 mL 86 mg
Bok choy, Pak-choi – cooked 1/2 cup/125 mL 84 mg
Bread, white 2 slices 106 mg
Chickpeas (garbanzo beans) 1 cup/250 mL 77 mg
Processed cheese slices, thin 1 115 mg
Okra – frozen, cooked 1/2 cup/125 mL 89 mg
70. • Sunshine
• OK, sunshine is not a
food....SOLAR NUTRITION. But
the body produces vitamin D in
response to sunlight. Without
vitamin D, our bodies cannot
properly absorb the calcium in
foods. Cloudy weather, a
northern latitude, and darker skin
can interfere. So some people
may choose a vitamin D
supplement. The recommended
dietary intake is 600 IU a day for
most adults, jumping to 800 IU
above age 70.
71. Kalcijum se ne moţe apsorbovati bez vitamina D.
• Vitamin D se stvara u
koži delovanjem sunca i
dovoljno je 2 do 3 puta
nedeljno biti izložen
suncu oko 15 minuta za
potrebe organizma.
• Osim toga taj važni
vitamin nalazimo u
jajima, jetri, masnoj
ribi, puteru ili u ved
gotovim preparatima.
72. Kalcijum se ne moze apsorbovati bez vitamina D.
• Osteoporosis Canada recommends
preporučuje suplementaciju vit. D for all
Canadian adults year round. Zdravi odrasli
od 19-50 godina. Kao i trudnice i dojilje,
trebaju 400 – 1,000 IU dnevno
• Oni preko 50 god ili mlađi ali sa faktorima
rizika (sa ved postojedeom osteoporozom,
višestrukim prelomima, ili stanjima koja
ometaju apsorpciju vitamina D ) trebalo bi da
unesu 800 – 2,000 IU dnevno.
• Ove doze su bezbedne.. Više od 2,000 IU
vitamina D dnevno treba unositit samo pod
medicinskim nadzorom!!!!!
73.
74. Vit K
• Zeleno lisnato povrde je
bogat izvor vitamina K, beta
karotina, vitamina C,
kalcijuma i magnezijuma.
Vitamin K je odgovoran za
formiranje osteokalcina,
proteina koji povedava
količinu kalcijuma koji je
uključen u mineralizaciju
kostiju. Izvori kalcijuma su
brokoli, mleko, orasi, lešnici,
bademi i semenke.
75. Magnezijum Mg
• Magnezijum u hrani: banane,
orasi, kikiriki, punozrne cerealije,
mekinje, koštano brašno, vedina
tamnozelenog lisnatog povrda,
mahunarke, mleko, tunjevina,
riba, vodni sok od jagode, šederni
sirup od melase, med
• Manjak magnezijuma narušava
aktivnost paratireoidne žlezde
(lučenje parathormona je
smanjeno), a koja sa svoje strane
može da dovede do manjka
kalcijuma u plazmi.
• Smanjen je odgovor delija na
parathormon zbog smanjene
aktivnosti adenilat ciklaze (kosti).
Klinički liči na
hipoparatireoidizam. Ovakvo
stanje se najčešde srede kod dece.
Hipokalcemija u ovom slučaju ne
reaguje na terapiju vitaminom D.
76. PROTEINI
• Salmon
• Salmon and other types of fatty
fish offer an array of bone-
boosting nutrients.
• They contain calciumas well
as vitamin D, which assists
in calcium absorption.
• They're also high in omega-
3 fatty acids.
• Fish oil supplements have been
shown to reduce bone loss in
elderly women and may prevent
osteoporosis.
1 gr/ kg TT
77. Fats&oils vit A,D,E,K
• maslinovo ulje i masna morska riba: tuna
skuša, sardine i losos.
• 2-3 sk maslinovog ulja
78. •
• Bor
• neophodan je za izgradnju kostiju i
njihovo održavanje u zdravom stanju,
• za homeostazu ćelijskih membrana
• kofaktor u fermentskim reakcijama
• KOŠTUNJAVO VOĆE
• bor drastično povišuje nivo estrogena u
krvi
• 3mg Bora dnevno
• 2 jabuke i 100 gr kikirikija
• Ta količina smanjuje gubitak kalcijuma za
čitavih 40 posto!
• Pored koštunjavog voća (badem,
lješnik) i kikirikija, bora ima i u
jabukama, kruškama, grožđu i
grožđicama, urmama, breskvama,
mahunarkama, naročito soji, ali i
medu, vinu, pivu i vinu od jabuka.
80. • Vežbanje sa opteredenjem
• Upotreba tegova
• Upotreba same težine tela –
• Antigravitacijsko delovanje
• mišida
• Žustro hodanje
• Ples
• Tenis
• Yoga
81. Excercise
• Vežbajte, ali pametno
• Vežbanje ima poseban značaj u sprečavanju i lečenju osteoporoze. Fizička
aktivnost povedava koštanu masu, poboljšava koordinaciju pokreta i
smanjuje učestalost preloma.
• Ne preterujte
– Pre nego što počnete da vežbate, konsultujte se sa svojim lekarom
– Počnite s lakšim vežbama
– Postepeno povedavajte intenzitet vežbi
– Da bi imalo efekta, vežbanje mora da bude deo svakodnevnih aktivnosti
– Izbegavajte vežbe koje zahtevaju značajno savijanje trupa
– Izbegavajte skakanje s visine i sportove koji zahtevaju nagle pokrete
82.
83. • Adults should engage in
at least 30 minutes of
moderate physical
activity on most
(preferably all) days of
the week. Children
should engage in at
least 60 minutes of
moderate physical
activity on most
(preferably all) days of
the week.
84. • Bone Density: Exercises for
Osteoporosis
“The components of mechanical load
that stimulate bone growth are the
load (intensity)
• and
• speed with which you lift the load,
direction of the forces,
• and the total number of repetitions of
lifting the load in a given workout(
typically 30-35 reps for a given
workout)”
85. • The best exercise to prevent osteoporosis is
weight-bearing exercise that works against
gravity.
• Weight-bearing exercises include
• walking, hiking, jogging, climbing
stairs, playing tennis, jumping rope,
and dancing.
• A second type of exercise is resistance
exercise.
• Resistance exercises include activities that
use muscle strength to build muscle mass,
and these also help to strengthen bone.
These activities include
• weight lifting, such as using free weights
and weight machines found at gyms and
health clubs.
• Exercise has additional benefits in older
people as well because exercising increases
muscle strength, coordination, and balance
and leads to better overall health
88. • Nutrition and Weight
• Nutritivni status i telesna masa takođe utiču na zdravlje koštanog
tkiva
• Na predispozicije ka padu
• Masno tkivo deluje amortizujuće! I protektivno
• Naročito bitno za starije tanušne osobe koje nemaju dovoljno
masnog tkiva i mišića u predelu kuka
• TELESNA MASA JE VAŢNA DETERMINANTA KOŠTANE
GUSTINE.
• SKELET TEŢIH OSOBA IMA BENEFIT OD SAME SVOJE
ULOGE NOSAČA
89. • Nutrition and Weight – conte
• Studije su pokazale da je telesna masa u pozitivnom odnosu sa
koštanom gustinom- bone mineral density, i da je gubitak telesne
teţine udruţen sa gubitkom koštanog tkiva
• (Povećan unos kalcijuma redukuje ovaj gubitak koštanog tkiva pri
gubljenju teţine )
• Gubitak TT u starijih udruţen je sa povećanim rizikom za prelom
• "extreme" weight loss (10% or more) beginning at age fifty,
increased the risk of hip fracture in older women and men.
Conversely, a weight gain of 10% or more decreased hip fracture
risk.
• Such studies suggest that maintaining weight in later life may
have a protective effect on bone
91. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 1: Salt Is Bad
for the Bone!
• baš so, a ne samo Na , dovodi do
gubitka Ca
• Najmanje 2 x više unosimo soli nego
što nam treba
• The 2005 Dietary Guidelines for
Americans advise limiting sodium to
2,300 milligrams a day – equal to a
teaspoon of salt = 1kk soli
• But most Americans get at least 4,000
milligrams a day.
• Za svakih 2,300 gr natrijuma koji
unesete oko 40 mg kalcijuma se
izgubi urinom
92. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 1: Salt Is Bad
for the Bone!
• Procesirana hrana = 75% natrijuma
koji unesemo
• Mesne prerađevine, šunka, prsa,
viršle
• Fast food, pizza, burgeri, tacosi
• prženi krompiridi
• Gotova jela
• Instant supe i čorbe
• Hleb, pecivo i pahuljice!!!!
93. • So je glavni krivac koji
izvlači kalcijum iz
organizma
• Što više soli jedemo, to
više kalcijuma
izlučujemo urinom.
• Ishrana sa malo soli
omogudava vedi unos
kalcijuma.
94. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 2: Some
Popular Drinks
• Soft drinks
• Gazirana pida
• Fosforna kiselina
• phosphoric acid, povedava
ekskreciju kalcijuma urinom
• Skoro sva!!!!!
• That combination spells trouble for
women at risk of osteoporosis.
95. MNT
• Dietary factors that
cause osteoporosis • Some concern has been expressed that
there may be too much phosphorous
in the North American diet, particularly
since phosphorous (in the form of
phosphoric acid) is a constituent of
cola beverages and because phosphate
is added to many processed foods.
• Phosphorous may increase the body's
need for calcium by interfering with
calcium absorption. There is no
scientific consensus that current levels
of phosphorous intake are, by
themselves, harmful. There is,
however, general agreement that
today's higher phosphorous intakes
would be entirely safe in individuals
with normal kidney function if calcium
intakes were at recommended levels.
96. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 3: The Cost of
Caffeine
• Kofein crpi kalcijum iz kostiju i čini ih
slabijim
• Gubi se 6 mg Ca za svakih 100 mg
unetog kofeina
• The good news is that limiting caffeine
intake to 300 milligrams a day while
getting adequate calcium probably
offsets any losses caffeine causes,
• Coffee is a major caffeine source.
• For example, a 16-ounce cup of coffee
can provide 320 milligrams.
• High-caffeine sodas can contain up to
80 milligrams per can or more.
97. MNT
• Dietary factors that
cause osteoporosis
• Količina kofeina u šolji kafe može
smanjiti apsorpciju kalcijuma za
nekoliko miligrama, i to se da lako
nadoknaditi dodavanjem kašike ili dve
mleka
• Najteži efekat koji pokazuje kofein nije
zbog njegove prirode, ved zbog toga što
se stavlja u mnogobrojne napitke koji
se piju namesto mleka!!!!
98. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 4: Is Protein
Problematic?
• Protein je neophodan
za izgradnju kostiju!!!
• 84 gr tune= 22 gr proteina
• 84 gr piletine, duretine ili svinjske
ruže oko 20 gr
• 84 gr lososa= 19 gr
• 250 gr običnog jogurta= 13 gr
• 250 ml obranog mleka= 8 gr
• 1 srednje jaje= 6 gr
99. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 4: Is Protein
Problematic?
• Kosti su 50% sastavljene od proteina.
• Za reparaciju koštano tkivo treba
aminokiseline!!!!
• Proteini su odmah iza kalcijuma i vit. D
po važnosti...
100. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 5: oxalati
• Oxalati
• Oxalati povedavaju zahteve za
kalcijumom jer se uplivišu u
apsorpciju kalcijuma u hrani
• Spanad - kalcijum iz spanada se
ne resorbuje jer je hemijski
vezan za prisutne oxalate!!!!
• Ali....smatra se da konzumiranje
spanada zajedno sa sirom ne sprečava
apsorpciju kalcijuma iz sira....
• hrana bogata oxalatima:
• spanad, rabarbara, slatki krompir
• kafa
Sirova namirnica
100gr
Sadržaj oksalata
(mg)
spanad 750
Repa 610
Peršun 100
praziluk 89
raštika 74
101. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 8: vlakna
• Vlakna
• Prekomerni unos
vlakana može da utiče
na apsorpciju kalcijuma
• Ali kako se ovo jako
retko dešava,
• ne predstavlja
problem!!!!
102. MNT
• Dietary factors that
cause osteoporosis
• Osteoporosis Diet
Danger 9: rafinisani
ugljeni hidrati
The excess consumption of carbohydrates raises
the blood level of glucose. In turn the abnormally
high blood glucose level stimulates the
hypothalamus to secrete growth hormone
releasing hormone (GHRH), which inhibits the
release of human growth hormone (hGH). A drop
in human growth hormone diminishes muscle
growth and slows bone growth. The net result is an
increase in body fat with poor muscle tone and
weak bones
NE POSTOJE ESENCIJALNI UGH
103. •
High-cortisol levels caused by excessive
carbohydrate consumption and high-insulin
levels cause the body to :
-extract high-tensile strength collagen protein
fibers from bones,
- remove the mineral matrix by
demineralization and
-weaken connective tissue at the joints.
108. • Prevention
• Telesna veţba povećava koštanu masu pre menopauze i usporava
gubitak kosti nakon menopauze.
• Kosti postaju jače uz veţbanje kao i mišići.
• Hodanje, lagano trčanje, veţbanje sa tegovima, tenis i aerobik
pomaţu kostima.
• Naravno da opterećenje, duţina trajanja veţbanja i učestalost
zavisi od zdravstvenog stanja osobe i mora se dogovoriti sa
nadleţnim lekarom ili trenerom.
• Yoga
• Tai chi chuan
109. • Prevention
• Gubitak kosti može se ubrzati ako osoba ishranom
unosi premalo kalcijuma.
• Kalcijum usporava gubitak kosti.
Ako je količina kalcijuma u krvotoku malena
telo ga uzima iz kostura.
110. • Prevention Ca
• Deca od 1 do 10 godina: 800 mg
• Mladi (11-24 godina): 1200-1500 mg
• Od 25 do 50 godina: 1000 mg ako su jajnici intaktni
• Od 25 do 50 godina: 1500 mg (bez jajnika, bez HNL)
• Preko 50 godina: 1500 mg bez HNL
• Preko 50 godina: 1000 mg uz HNL
• Sve žene starije od 65 godina: 1500 mg
• Trudnice i dojilje: 1200 mg
• Telo apsorbuje samo 350- 500 mg elementarnog
kalcijuma odjednom tako da je korisno dozu podeliti
barem u dve doze!!!!!!!!.
111. • Prevention vit D
• Dnevne potrebe za vitaminom D su oko 400-800 IU
• žene – Do 50 godina: 500 IU/dan
– Od 50 godina: 800 IU/dan
112. Sophia remedie for osteoporosis
• 50 gr sveţih lešnika
• 50 gr sveţih badema
• 50 gr sveţih oraha
• 50 gr sirovog susama
• 50 gr sirovog kikirikija
• 50 gr semena koprive
• 50gr semena lana
• samleti
• staviti u 1 kg MEDA
• kesica cimeta
• 7 sk kakaoa
113. Natural remedie for osteoporosis
• Med protiv osteoporoze:
• 5 sk mlevenog lanenog semena
• 3 sk susama
• 3 sk nepečenog suncokreta
• 3 sk pšeničnih klica
• 3 sk suvog grožđa
• 1 kliogram meda + KAKAO
• Sve sastojke pomešati i čuvati u staklenoj tegli sa dobrim poklopcem. Ovaj
med jedite ujutro na prazan stomak sa malo toplog čaja od žalfije i
rastavića. Med uzimajte isključivo plastičnom kašičicom. Možete ga koristii i
kao namaz na integralnom tostu. Izbegavajte kafu, alkohol i cigarete.
114. Remedie for osteoporosis
• Čaj protiv osteoporoze:
• Rastavić (Equisetum arvense) 200g
• Ţalfija (Salvia officinalis) 200g
• Lucerka (Medicago sativa) 200g
• Sve biljke pomešati pa 3 sk smeše preliti sa 0,5l ključale
vode, promešajte poklopite i ostavite 1/2 sata.
• Procedite i pijte u toku dana u malim gutljaima.
116. Juicing Diet for osteoporosis- one portion
• 1 carrot + 2 green apples + 1 cup broccoli/cauliflower + a bunch of cilantro
+ a slice of lemon
•
• 1 carrot + 2 green apples +½ cucumber + 3-4 leaves kale or a bunch of
spinach or 2 ribs celery + a slice of lemon
• 2 carrots + 2 green apples + 2 tomatoes
117. Juicing Diet for osteoporosis- one portion
• 2 green apples + 1 guava + 1 pear + 2 ribs of celery
•
• 2 green apples + 1 pear + ½ cucumber
• ½ medium-sized pineapple + 2 ribs celery + a bunch of cilantro
119. • Čokoladni frape sa keljom
•
• 1 velika banana
• nekoliko listova svježeg kelja
• 2 s k mlevenog badema
• 1 čaša borovnica
• 1 žlica kakaa u prahu
• 5 kockica leda
• 1 1/2 čaše mleka, kefira, jogurta
120. TEST: Da li ste skloni riziku od osteoporoze
– Da li je neko od vaših roditelja imao osteoporozu ili prelom kuka posle manjeg
udarca ili pada?
– Da li ste vi imali prelom kosti posle manjeg udarca ili pada?
– Da li uzimate glikokortikoide („prednizon―, „deksametazon―, „metilprednizolon―)
duţe od tri meseca?
– Da li ste se smanjili u visini više od tri centimetra?
– Da li često pijete veće količine alkohola?
– Da li pušite više od 20 cigareta dnevno?
– Da li imate prolive (zbog Kronove bolesti, ulceroznog kolitisa ili celijačne bolesti)?
– Da li ste izgubili menstrualni ciklus pre 45 godine?
– Da li su vam menstruacije izostale 12 ili više meseci, ali ne zbog menopauze ili
trudnoće?
Ukoliko su odgovori na sva pitanja „ne― a imate više od 50 godina, preporučuje se da
nastavite da čuvate zdravlje svojih kostiju.
Ako je odgovor na neko od ovih pitanja „da―, javite se svom lekaru i prođite ovaj test
zajedno. Vaš lekar će onda odlučiti da li treba da radite osteodenzitrometriju, tj.
merenje koštane gustine, kojom moţe da se utvrdi da li imate osteoporozu ili ne.
Ukoliko imate osteoporozu, vaš lekar će vam propisati terapiju. Danas postoje veoma
efikasni lekovi koji ne samo da zaustavljaju gubitak koštane mase već mogu da
dovedu i do njenog uvećanja.
125. Because happiness is a natural phenomenon — if somebody is
happy there is no skill in it, if somebody is happy it needs no
expertise to be happy.
Animals are happy, trees are happy, birds are happy. The whole
existence is happy, except man. Only man is so clever as to create
unhappiness — nobody else seems to be so skillful. So when you are
happy it is simple, it is innocent, it is nothing to brag about. But
when you are unhappy you are doing great things to yourself; you
are doing something really hard.
Osho, Zen: The Path of Paradox, Vol. 2, Talk #6
126. Tropski frape sa keljom
1 velika banana
1/4 avokada
150 g svežeg kelja
3/4 šolje ananasa
3/4 šolje manga
1 sk mlijeka kokosa (opcionalno)
1 sk agava sirupa
1 1/2 čaše vode
127. Kelj sa borovnicama i jagodama
1 velika banana
1 čaša borovnica
1/2 čaše jagoda
150 g kelja
1 1/2 čaše vode
135. Proteini
• Junece, telece i pilece meso moze da se kuva, dinsta ili pece,
samo ili sa povrcem.
• Jaja
• Morske ribe -3 x nedeljno
136. • Medications that cause bone loss: Several medications can contribute to
bone loss. For example, the long-term use of
• glucocorticoids (medications prescribed for a wide range of
diseases, including arthritis, asthma, Crohn’s disease, lupus, and other
diseases of the lungs, kidneys, and liver) can lead to a loss of bone density
and fracture.
• Bone loss also can result from long-term treatment with certain
antiseizure drugs,such as phenytoin (Dilantin) and
barbiturates; gonadotropin-releasing hormone
(GnRH) drugs used to treat endometriosis; excessive use of
aluminum-containing antacids; certain cancer
treatments; and excessive thyroid hormone.
• It is important to discuss the use of these drugs with your doctor and not
to stop or change your medication dose on your own.
146. Health is not something to be attained somewhere, it is not an
object.
Health is a totally different way of living. The way you are living
creates disease, the way you are living creates misery.