malnutrition part 2 obesity

1. Over nutrition
or
Obesity
Dr Mona Aboserea
Zagazig university

2. Learning objectives:
• To define obesity,
• To determine the risk factors of obesity
• To assess obesity
• To identify its preventive & management
strategies.
• To know the Therapeutic diet
• To identify the relation between nutrition and
both cancer and infection
•

3. Over nutrition or Obesity:
Excess adipose tissue in different areas of
body. It is the increase in body weight > 20%,
(or the increase of body mass index BMI >
30%) over the standard.

4. Energy balance

5. Risk factors of obesity :
• Genetics
• Age
• Sex
Non-
modifiable
• Behavioral
• EnvironmentalModifiable

6. Risk factors of obesity :
A. Biological factors (non-modifiable):
1. Genetics :
• Show control on regional distribution of
body fat, onset of obesity, feeding centre, fat
gain and energy expenditure.

7. Brown adipose tissue:
• It is interscapular adipose tissue and
found along the aorta.
• Thin persons have more brown adipose
tissue, so that fat oxidized more than
stored.
• Excess calories dissipated as heat more
than stored as fat.

8. Leptin :
• It is a hormone secreted from adipocytes
with central control from hypothalamus.
• Its function is to suppress appetite,
deplete fat stores and increase energy
expenditure.
• In obesity there is a state of leptin
resistance at cell level with
hyperleptinaemia leading to some
complications as cardiovascular
disorders.

9. Ghrelin:
• Is a hormone produced in the
stomach.
• Its secretion stimulated by adrenaline
and nor-adrenaline which are
released in response to hypoglycemia
where it promotes the appetite.

10. Risk factors :
A. Biological factors (non-modifiable):
2. Age :
• Obesity may appear at any age but
obesity in childhood is predictive to
obesity later on adulthood.

11. Risk factors :
A. Biological factors (non-modifiable):
3. Sex :
• Both sexes are exposed.
• Pregnancy causes increase in mother weight by 4-
6 pounds over her pre-pregnancy weight.
• Menopause represents a risk period for extra
weight gain and redistribution of fat towards
visceral regions.

12. Risk factors :
B. Behavioral factors (modifiable factors):
1. Diet :
Obese people eat more than they need in
quality and quantity due to faulty eating
pattern and eating habits as:
• Taking much sweets, fats and snacks.
• Nibbling in between meals.
• Consuming soft drinks regularly.
• Evening overeating which stimulate
storage of fat.

13. Risk factors :
B. Behavioral factors (modifiable factors):
2. Physical inactivity :
• The highest incidence of overweight were
found in the groups of sedentary occupations
with least activity.
3. Psychological and emotional disorders :
• Subjects with anxiety, psychological stress and
depressive illness may seek emotional relieve
in eating which results in over weight.

14. Risk factors:
C. Environmental factors (modifiable factors):
They include:
• family lifestyle and feeding pattern,
• work problems and unemployment
• effect of advanced technology and foods
advertisements on feeding pattern.

15. Health hazards of obesity:
1- Increased risk of cardiovascular diseases.
2- Increased risk of diabetes, gout and
infertility.
3- Increased risk of cholycystitis, hernia.
4- Degenerative joint disease, osteoarthritis,
flat foot.

17. Cont. Health hazards of obesity
5- Psychological disturbance, self-
dissatisfaction.
6- Increased incidence of cancer breast.
7- Obstructive sleep apnea, impaired lung
function.
8- Skin diseases (fungal infection).
9- Surgical and obstetric risks more than
normal weights.

18. Assessment of obesity
1- Qualitative assessment: through examining the
distribution of adiposity.
-Pear shaped obesity (gynacoid
or female type): more fat in hips
and thighs.
-Apple shaped obesity (android
or male type) : more fat around
waist and abdomen.

19. 2- Quantitative assessment
a. Waist circumference: Should not
exceed 88 cm for females and 102 cm for
males. (for adults, on average)
b. Waist hip ratio: dividing waist circumference by hip
circumference should be less than one.
C. Skin fold thickness: Common measuring sites are mid
triceps, mid biceps, subscapular and superailiac. It can be
used also to assess weight gain and weight loss.

20. d. Relative Weight; (RW):
𝑩𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒕𝒉 (𝒌𝒈)
𝑫𝒆𝒔𝒊𝒓𝒂𝒃𝒍𝒆 𝒘𝒆𝒊𝒈𝒉𝒕 (𝒌𝒈)
x 100
Desirable weight is the ideal weight for
height, obtained from special tables.
e. Body mass index: (BMI) =
𝑩𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕 (𝒌𝒈)
𝑯𝒆𝒊𝒈𝒉𝒕 𝒊𝒏 𝒎𝒆𝒕𝒆𝒓 𝟐

21. Remember:
Indices of excess weight:
Index RW (%) BMI (kg/m2)
Normal 100 20-24
Overweight 110-119 25-29
Obesity
o Mild
o Moderate
o Severe
120-139
140-200
over 200
30-34
35-39
≥40
Thus the individual is considered obese when:
 RW is 120% or more.
 BMI is >27.5 kg / m2

22. F-Arm Fat Area (AFA):
it is a measure of total body fat (fat weight) and
calculated from mid-arm circumference and triceps
skin fold thickness by certain equation as :
AFA = arm area - arm muscle area.

23. G-Hydrostatic water weighing (densitometry):
• It is comparing of body weight on standard
scale with the weight underwater.
• By assuming that adipose tissue is less dense
than lean tissue (muscles and bones), so the
more adipose tissue in a body, the less its
underwater weight (the more it tends to float).
• It is an accurate method for estimating the total
body fat.

25. Management of obesity:
1. Diet control. 2. Activity.
3. Social welfare.
4. Medication.
5. Surgical therapy.
6. Regular health-appraisal and follow-up

26. ((‫يح‬ ‫ال‬ ‫هللا‬ ‫ان‬ ‫تسرفو‬ ‫ال‬ ‫و‬ ‫اشربو‬ ‫و‬ ‫كلو‬ ‫و‬‫ب‬
‫المسرفين‬)))
‫االية‬ ‫االعراف‬ ‫سورة‬31

29. Loosing weight =
- Health education for whole community
concerning healthy diet in quality and quantity.
Encourage physical activities for all ages.
decrease food intake + increase physical
activities
- Encourage consumption of fresh vegetables and
fruits.
- Treatment of psychological troubles.

30. Any question?
????????????

31. 1. Nutritional excess:
a) Increased caloric intake in obesity predisposes to
increased risk of cancer breast, uterus, oesophagus,
pancreas and kidney.
b) Animal origin saturated fatty acids act synergistically
with growth factors to stimulate tumor growth.
c) Excess salting is associated with cancer stomach and
oesophagus.

32. 2- Carcinogens formed in foods:
a) Microbial toxins as Aflatoxins, ochratoxin A are
produced by fungi in nuts after long storage. They
have liver carcinogenic activity.
b) Chemical toxins: pesticides, herbicides, nitrogenous
fertilizers. Veterinary drugs as anabolic hormones,
estrogens and testosterone.
c) Packing materials, using Poly Chlorinated
Biphenyl (PCB) in ink, paint or paper can pollute
packed foods.

33. d) Heavy metals: soldered canned, food,
lead pipe predispose to kidney cancer.
e) Chloroform in water
f) Cooking method as grilling over
direct flame produces polycyclic
aromatic hydrocarbons.

34. Food additives:
Colors: as azo and triarylmethane dyes, xanthenes,
ammonia caramel.
Flavors: alkenes benzenes, citrus oils. Sweeteners: as
saccharine predispose to cancer bladder.
Preservatives: as nitrates and nitrite predispose to
stomach tumor.
Solvents: dichloromethane used in decaffeination of
coffee.
 Alcohol: more than 2 drinks per day predispose to
cancer breast, oral cavity.

35. 3- Foods have protective role against
cancer:
a) Fibers have protective effect against
cancer colon.
b) Fruits and vegetables: low intake is associated
with cancer mouth, stomach and breast. They
are rich in antioxidant vitamins A,E, C.
c) Fatty acids: n-3 polyunsaturated fatty
acids (lenolenic acid) have protective effect
against breast & colon tumors.

36. d) Micronutrients as iodine, selenium
calcium and vitamins.
e) Coffee, tea and soft drinks that contain
caffeine may have useful effect in
decreasing cancer colon as they increase
serum cholesterol (cancer colon is
associated with low serum cholesterol).

37. 1-Proteins, pantothenic acid, pyridoxins are
needed for formation of antibodies and
immunoglobulins.
2- Vitamin A, C and B2 are responsible for
normal proliferation of phagocytes and epithelial
lining integrity of respiratory and urinary
systems.

38. DASH EATING PLAN FOR
HYPERTENSIVE PATIENTS
DASH:
• Dietary approach to stop hypertension

40. 1- Salt (Sodium chloride): Salt is the best
known of the dietary factors affecting blood
pressure.
2- Body weight: Obese people are likely to
have a higher blood pressure than lean
people are.

41. Components in the diet that may lower
blood pressure:
1. Potassium: acts as a sodium antagonist.
2. Calcium: Increased calcium in diet or
supplement might be useful in a small
number of hypertensive patients.

42. 3. Increasing intake of fruits and vegetables.
& whole grain cereals.
4. Polyunsaturated fatty acids: Long chain W-
3 fatty acids significantly decrease blood
pressure.
5. Magnesium: Magnesium can lower blood
pressure in patients on diuretics.
6-lower sodium intake < 2.3 mg /day.
7-limit lean meat intake. 8-fewer sweets & sugar

43. Disease Foods allowed Foods avoided
Marasmus debilitating,
wasting
High energy balanced diet. Increased-proteins Nothing
Obesity/ diabetes type
II, atherosclerosis
Low energy balanced diet. Vegetables, sugar free drinks,
fish are permissible. Use poly- unsaturated vegetable oil
Refined sugar, whole milk,
Canned & dried fruits. Ice
cream, cakes, fatty meat,
sausage, burgers
Chronic renal failure Reduced proteins, potassium and sodium
Table salt, preserved
and canned food
Hypoalbuminemia, TB,
cancer, burns
High protein diet, low sodium, high caloric foods
Table salt, preserved
and canned food
Hypertension, heart
failure
Low sodium, moderate energy.
Table salt, smoked fish,
baking powder in food
Coronary heart
disease
frequent small meals. Vegetables and fruits. Fat, alcohol, salt, coffee
Peptic ulcer Protein, iron, vit. B12 vit C, milk, milk products
Alcohol, caffeine,
pepper, additives, pickles
Liver diseases High protein, low salt, Frequent small meals Alcohol, fat, vit. A
Iron deficiency
anemia
Varied diet, animal proteins Vit. C, dried fruits, fruits that
give brown color if exposed to air as banana, apple,
green vegetables
Tea with meals, tannin

44. Recommended Diet for Reducing
The Risk of Coronary Heart Disease
1. Reduce total fat especially
saturated fat and less cholesterol.
2. Vitamin E supplementation.
3. Plenty of fruits, vegetables.

45. 4. Avoid unfiltered coffee intake
because it increases LDL.
5. Increase meal frequency 3-6 or
more with regular spaced meals.
6. Reduce weight.
7. Regular use of aspirin is promoted.

46. 8. Fish oil capsule 2-3 gram per day.
This provide omega 3 Fatty Acids to
reduce blood clotting and so reduce the
risk of heart attack.
9. HDL carries more lipid-soluble
antioxidants which provide protection
against coronary heart disease.

47. 10. A modest intake of fatty fish
(e.g. sardines, herring, mackerel, or
salmon).
11. W-6 polyunsaturated oils also
appear to have an inhibiting effect on
platelet function.

48. Antioxidants are chemical compounds that
can bind to free oxygen radicals or nitric
oxide preventing these radicals from
damaging healthy cells.

49. Source of antioxidants:
•Allium sulphur compounds:
Leeks, onions and garlic.
• Anthocyanins: eggplant, grapes and berries.
• Beta-carotene: pumpkin, mangoes, apricots,
carrots, spinach
• Catechins: red wine and tea.

50. Cont. Source of antioxidants
• Copper: seafood, lean meat, milk and nuts.
• Cryptoxanthins: red capsicum, pumpkin
and mangoes.
• FIavonoids: tea, green tea, citrus fruits, red
wine, onion and apples.
• Vitamin C: broccoli,
cauliflower and cabbage.

51. Cont. Source of antioxidants
• Vitamin E: 15 mg of fortified cereals,
vegetable oils, nuts, spinach and kale,
mangoes and wheat germ.
• Selenium: onions, garlic, mushrooms, wheat
germ and rice bran.
• Vitamin A: As beta-carotene: Eggs, liver,
yellow-orange or dark-green leafy vegetables
and fruits.

52. Is a practice of a diet that excludes meat,
fish and poultry, eggs, milk and honey,
(exclude any foods from animal source).

53. Causes for choosing vegetarian
1- Morality 2- Culture
3- Environment 4- Political
5- Disease 6-Religion
7- Ethics 8-Economy
9- Taste

54. Health benefits of vegetarian diets
A properly planned vegetarian diet is considered as
healthy diet
reduce cancer,
ischemic heart disease,
 control body weight,
prevent osteoporosis and high blood pressure.
Necessary proteins can be obtained from
different plant sources.

55. Hazards of vegetarian diet:
The only deficient nutrient is vitamin B12 as all
its sources are in animal proteins.

56. • Any questions???????

57. THANK YOU