This document provides an overview of mechanisms of nutritional-related diseases and clinical nutrition. It begins by outlining the objectives of understanding nutritional disease mechanisms, types of malnutrition, macronutrient and micronutrient metabolism, and nutrient interrelations. It then discusses etiologies of disease related to environment, host factors, and pathomechanisms. It also outlines common nutritional problems, competence levels for physicians, and topics for nutritional competence. The document discusses mechanisms and types of malnutrition as well as correlations between nutritional status and immune function. It provides details on pathogeneses of nutritional deficiencies and toxicities. Finally, it discusses medical nutrition therapy for various diseases.
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...MedicalWeb.gr
Κολοβέρου E, Παναγιωτάκος Δ.
Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ΣΚ τύπου 2: Υπεύθυνοι παθοφυσιολογικοί μηχανισμοί. Ελληνική Επιθεώρηση Αθηροσκλήρωσης 2014 5(3):200–206
This document discusses the position of the American Dietetic Association (ADA) on vegetarian diets. The ADA concludes that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits. Vegetarian diets have been shown to reduce the risk of heart disease, diabetes, obesity, and some cancers when planned properly. While vegetarian diets can meet nutritional needs, they require planning to ensure adequate intake of nutrients like protein, iron, zinc, vitamin B12, and omega-3 fatty acids. The ADA provides guidance on meeting nutritional needs at all stages of life with a vegetarian diet.
The document discusses obesity, diabetes, and the Mediterranean diet. It defines obesity using BMI and describes the increasing rates of obesity in the US. It explains that obesity develops from an energy imbalance where intake exceeds expenditure. The risks of diseases like diabetes and heart disease rise with increasing BMI. Diabetes is classified into types 1 and 2 and criteria for diagnosis are provided. The roles of insulin and glucagon in glucose homeostasis are outlined. Guidelines for the Mediterranean diet emphasize plant foods, olive oil, fish and limits on red meat and sweets.
I created and presented a PowerPoint to those attending the CHIP program at the Walla Walla General Hospital. It was about anti-inflammatory diets and was based on current scholarly research articles
This document discusses nutrition for various liver conditions. It recommends for hepatitis patients a high protein, moderate fat and carbohydrate diet along with plenty of fluids. For cirrhosis, it suggests a similar diet with moderate sodium and soft foods if needed, as well as vitamin and mineral supplements. The goals are to aid liver regeneration and recovery through optimal nutrition while avoiding further strain on liver function.
Evidence-based guidelines for the nutritional management of adult oncology pa...milfamln
Webinar Objectives
1. The participant will be able to discuss the validity of malnutrition screening and nutrition assessment tools and their utilization in clinical oncology settings
2. The participant will be able to better utilize the Nutrition Care Process to provide appropriate and high-quality nutrition care to oncology patients
3. The participant will be able to describe the evidencebased relationships between nutritional status and morbidity and mortality outcomes in oncology
This document discusses the relationship between nutrition and cancer. It notes that obesity rates have increased from 1990 to 2014 and lists several cancers that are associated with obesity. Potential reasons for the link include hormones, growth factors, and inflammation produced by excess fat tissue. The document outlines the three phases of nutrition for cancer prevention, treatment, and survivorship. It provides recommendations for cancer survivors, including maintaining a healthy weight through diet and exercise, limiting red meat and alcohol, and focusing on whole foods like vegetables and grains.
REGULAR YOGURT CONSUMPTION MAY HELP PREVENT CARDIOMETABOLIC DISEASES - Andre ...Yogurt in Nutrition #YINI
Growing evidence for the benefits of yogurt consumption in preventing type 2 diabetes and other cardiometabolic risk factors. The importance of dairy as part of a balanced and healthy diet is widely recognised by health authorities and scientific experts worldwide. Now, evidence is mounting that consuming yogurt in particular as part of a healthy diet helps to prevent type 2 diabetes and other cardiometabolic risk factors, with one of the most recent studies suggesting that people who regularly eat yogurt are almost 30% less likely to develop type 2 diabetes than those who do not (1). Speaking to public health officials at the III World Congress of Public Health Nutrition in Spain, Dr André Marette from the Heart and Lung Institute of Laval Hospital in Quebec, Canada, said it was time to recognize the all-round health benefits of yogurt and encourage more people to eat yogurt on a daily basis.
Κολοβέρου E, Παναγιωτάκος Δ. Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ...MedicalWeb.gr
Κολοβέρου E, Παναγιωτάκος Δ.
Η Μεσογειακή δίαιτα στην πρωτογενή πρόληψη του ΣΚ τύπου 2: Υπεύθυνοι παθοφυσιολογικοί μηχανισμοί. Ελληνική Επιθεώρηση Αθηροσκλήρωσης 2014 5(3):200–206
This document discusses the position of the American Dietetic Association (ADA) on vegetarian diets. The ADA concludes that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits. Vegetarian diets have been shown to reduce the risk of heart disease, diabetes, obesity, and some cancers when planned properly. While vegetarian diets can meet nutritional needs, they require planning to ensure adequate intake of nutrients like protein, iron, zinc, vitamin B12, and omega-3 fatty acids. The ADA provides guidance on meeting nutritional needs at all stages of life with a vegetarian diet.
The document discusses obesity, diabetes, and the Mediterranean diet. It defines obesity using BMI and describes the increasing rates of obesity in the US. It explains that obesity develops from an energy imbalance where intake exceeds expenditure. The risks of diseases like diabetes and heart disease rise with increasing BMI. Diabetes is classified into types 1 and 2 and criteria for diagnosis are provided. The roles of insulin and glucagon in glucose homeostasis are outlined. Guidelines for the Mediterranean diet emphasize plant foods, olive oil, fish and limits on red meat and sweets.
I created and presented a PowerPoint to those attending the CHIP program at the Walla Walla General Hospital. It was about anti-inflammatory diets and was based on current scholarly research articles
This document discusses nutrition for various liver conditions. It recommends for hepatitis patients a high protein, moderate fat and carbohydrate diet along with plenty of fluids. For cirrhosis, it suggests a similar diet with moderate sodium and soft foods if needed, as well as vitamin and mineral supplements. The goals are to aid liver regeneration and recovery through optimal nutrition while avoiding further strain on liver function.
Evidence-based guidelines for the nutritional management of adult oncology pa...milfamln
Webinar Objectives
1. The participant will be able to discuss the validity of malnutrition screening and nutrition assessment tools and their utilization in clinical oncology settings
2. The participant will be able to better utilize the Nutrition Care Process to provide appropriate and high-quality nutrition care to oncology patients
3. The participant will be able to describe the evidencebased relationships between nutritional status and morbidity and mortality outcomes in oncology
This document discusses the relationship between nutrition and cancer. It notes that obesity rates have increased from 1990 to 2014 and lists several cancers that are associated with obesity. Potential reasons for the link include hormones, growth factors, and inflammation produced by excess fat tissue. The document outlines the three phases of nutrition for cancer prevention, treatment, and survivorship. It provides recommendations for cancer survivors, including maintaining a healthy weight through diet and exercise, limiting red meat and alcohol, and focusing on whole foods like vegetables and grains.
REGULAR YOGURT CONSUMPTION MAY HELP PREVENT CARDIOMETABOLIC DISEASES - Andre ...Yogurt in Nutrition #YINI
Growing evidence for the benefits of yogurt consumption in preventing type 2 diabetes and other cardiometabolic risk factors. The importance of dairy as part of a balanced and healthy diet is widely recognised by health authorities and scientific experts worldwide. Now, evidence is mounting that consuming yogurt in particular as part of a healthy diet helps to prevent type 2 diabetes and other cardiometabolic risk factors, with one of the most recent studies suggesting that people who regularly eat yogurt are almost 30% less likely to develop type 2 diabetes than those who do not (1). Speaking to public health officials at the III World Congress of Public Health Nutrition in Spain, Dr André Marette from the Heart and Lung Institute of Laval Hospital in Quebec, Canada, said it was time to recognize the all-round health benefits of yogurt and encourage more people to eat yogurt on a daily basis.
This document discusses diabetes mellitus (DM), a metabolic disorder caused by factors that result in chronic hyperglycemia. It begins with background on DM and how it is an increasing health problem. DM is classified into type 1, caused by autoimmune destruction of insulin-producing beta cells, and type 2, caused by insulin resistance. Signs and symptoms of DM include frequent urination, excessive thirst, hunger, and weight loss. DM is diagnosed through blood tests measuring glucose levels when fasting and after consuming glucose. Treatment depends on the type, with type 1 requiring insulin injection and type 2 often controlled through diet, exercise and oral medication.
This document discusses nutrition support in cancer patients. It begins by reviewing cancer mortality statistics and trends in the US. It then describes common nutritional alterations in cancer patients, such as early satiety, dysphagia, nausea/vomiting, taste changes, and cachexia. The document outlines nutritional assessments for cancer patients, including screening tools, physical exams, laboratory tests, and quality of life assessments. It provides criteria for nutritional intervention and goals of therapy. The document discusses nutritional management strategies for issues like mucositis, diarrhea, and neutropenia. It addresses special considerations for enteral and parenteral nutrition in cancer patients. Finally, it lists some online resources for patient and caregiver education.
Physiological Determinants of Malnutrition in Elderly_ Crimson publishersCrimsonpublishersNTNF
This document discusses physiological determinants of malnutrition in the elderly. It begins by noting changes in body composition that occur with aging, including increases in fat mass and decreases in lean muscle mass. It then examines multiple factors that can cause poor appetite and reduced food intake in older adults, such as changes in taste/smell, dental issues, poverty, and medical/psychological conditions. It also discusses how conditions like cachexia and micronutrient deficiencies can negatively impact nutritional status. Finally, it notes how acute/chronic infections can increase metabolic demands and decrease the ability to meet those demands, potentially leading to malnutrition.
This document provides an overview of nutrition science, including definitions of key terms and descriptions of major nutrients. It discusses the study of nutrients and how the body processes them. Major topics covered include macronutrients like carbohydrates, fats, proteins, micronutrients like vitamins and minerals, nutrient deficiencies, and how genetics and genomics relate to nutrition and disease.
This document provides an annotated bibliography summarizing research on the relationship between dietary fiber consumption and the prevention of type 2 diabetes. Several studies found that high intake of dietary fiber, particularly from whole grains, is associated with a significantly reduced risk of developing type 2 diabetes. Combining data from multiple cohort studies, daily consumption of two servings of whole grains was shown to decrease the risk of type 2 diabetes by 21%. While the studies were mostly epidemiological, they consistently showed that increased fiber intake, especially from whole grains and cereals, can play a protective role against type 2 diabetes.
Nutrition in Cancer Prevention and TreatmentTim Crowe
This presentation will help you to understand the influence that dietary and lifestyle factors play in the prevention and causation of cancer. It outlines the important nutritional considerations for patients undergoing treatment for cancer and reviews procedures to improve patient safety by knowing the risks and benefits of antioxidant supplementation during cancer treatment
The document summarizes research on dietary changes in Crete, Greece over time. It compares data from a 1948 survey of the traditional Cretan diet to data from 2006-2007. The traditional Cretan diet was high in plant foods like olive oil, cereals, pulses, and vegetables. Animal products and bread were consumed in moderation. The modern Cretan diet still incorporates many traditional foods but has seen an increase in foods like fast food, soft drinks, and a decrease in cereal consumption from the traditional diet. While longevity in Crete remains high compared to other regions, chronic disease risks are rising with the dietary shifts away from the original Mediterranean diet.
Yogurt consumption for a healthier diet and lifestyle: overview from cohorts ...Yogurt in Nutrition #YINI
Yogurt is generally considered as a healthy food because of its nutrient composition, its profile of fermented food, and its link with an improved metabolic fitness. Population studies show that yogurt consumers report a greater intake of some nutrients,
e.g. calcium and protein, and fruits and vegetables compared to non-consumers. This is concordant with recent data demonstrating that diet quality is improved in yogurt consumers. Other cohort studies have shown that yogurt consumption is
associated with a reduced body weight over time. Our research experience with the Quebec Family Study reveals that yogurt consumption might be the “signature of a healthy lifestyle”. Indeed, female yogurt consumers report a better macronutrient
composition of the diet than non-consumers; they are also more physically active and display feeding behaviors which are more compatible with body weight stability. This agrees with results of the Infogene Study demonstrating that yogurt consumers
are more prone to adhere to a Prudent dietary pattern whereas non-consumers tend to exhibit a Western pattern. In summary, currently available cohort studies tend to show that yogurt consumption is associated with a healthy eating pattern
and lifestyle.
The document discusses the management of obesity through various means including assessing severity, etiology, medical problems associated with obesity, medical management, guidelines for treatment, and surgical management. It provides details on criteria for surgical treatment, preoperative preparation, and types of bariatric surgeries.
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
The document provides nutrition guidelines for pressure ulcer management based on a patient's Braden scale score and presence of ulcers or wounds. It recommends protein and calorie intake levels, fluid goals, vitamin/mineral supplements, and conditionally essential amino acids like arginine and glutamine to support wound healing. It also discusses use of oxandrolone to reduce catabolism and promote tissue repair in patients experiencing weight loss or skin breakdown. Regular monitoring of intake, weight, and wound status is advised to evaluate response to the nutrition interventions.
The document discusses obesity, inflammation, and diabetes. It provides an overview of the Mediterranean diet and its benefits, including improved glycemic control, reduced cardiovascular risk, and decreased inflammation. The Mediterranean diet is highlighted as an anti-inflammatory dietary pattern due to its high fiber, antioxidant, and unsaturated fat content.
This ppt covers the role of diet in various diseases and the effects of excessive stress and gives an overview of the optimal diet in various non-communicable diseases.
Dr B Ravinder Reddy
Care Hospital, Hyderabad, India
This document discusses the epidemiology of diabetes mellitus. It begins with defining diabetes and classifying its various types. Globally, the prevalence of diabetes has been increasing rapidly and is projected to continue rising significantly. In India specifically, diabetes prevalence is around 8.6% currently with over 50% of cases being undiagnosed. Key risk factors include obesity, physical inactivity, and diet. Prevention efforts focus on promoting healthy lifestyles while management involves screening, treatment, and self-care education to control blood sugar and prevent complications.
Protein malnutrition, also referred to as protein deficiency, is a condition that occurs when an individual's diet lacks an adequate amount of protein, leading to various negative health consequences. This form of malnutrition can manifest in different ways, with two distinct clinical presentations known as kwashiorkor and marasmus.
Kwashiorkor is a severe form of protein malnutrition often seen in children. It occurs when there is a deficiency of high-quality protein in the diet, despite an adequate caloric intake. The lack of protein results in a disruption of important physiological processes, leading to various symptoms and complications. Common signs of kwashiorkor include edema, which is the accumulation of fluid in tissues, particularly in the legs, feet, and face. Additionally, individuals with kwashiorkor may experience muscle wasting, growth stunting, and impaired immune function. Other symptoms can include thinning hair, brittle nails, poor wound healing, fatigue, and anemia.
Marasmus, on the other hand, is a form of protein-energy malnutrition that occurs when there is a severe deficiency in overall calorie intake, including both protein and energy. Unlike kwashiorkor, individuals with marasmus experience significant weight loss and muscle wasting. The body enters a state of extreme catabolism, breaking down muscle tissue to meet energy needs. The characteristic appearance of marasmus includes a "skin and bones" appearance, with prominent ribs, thin limbs, and a lack of subcutaneous fat.
Protein is essential for the growth, development, and maintenance of various body tissues, including muscles, organs, and the immune system. It plays a crucial role in the synthesis of enzymes, hormones, and antibodies, and is involved in numerous biochemical processes. Inadequate protein intake deprives the body of these vital functions, leading to the manifestations seen in protein malnutrition.
Protein malnutrition is often associated with poor dietary diversity, limited access to quality protein sources, and socio-economic factors such as poverty, famine, and humanitarian crises. Vulnerable populations, such as children and the elderly, are particularly at risk. In children, inadequate protein intake during critical growth periods can result in long-term consequences, affecting physical and cognitive development.
Diagnosis of protein malnutrition involves a comprehensive assessment of dietary history, physical examination, and sometimes laboratory tests. Medical professionals evaluate the presence of characteristic signs and symptoms, such as edema or muscle wasting, to determine the severity and type of malnutrition. Blood tests may reveal abnormal levels of proteins and other nutrients, further aiding in diagnosis and treatment planning.
The treatment of protein malnutrition involves nutritional rehabilitation, addressing both the underlying protein deficiency and overall energy intake.
Nutrigenomics is the study of how nutrients and foods affect gene expression. It examines the interactions between an individual's genetics, diet, and health. The summary discusses three key areas:
1. Nutrigenomics research focuses on preventing chronic diseases like cancer, cardiovascular disease, and obesity by deactivating disease signaling pathways through nutrient supplements.
2. Specific nutrients can prevent these diseases. For example, polyunsaturated fatty acids can prevent cancer by regulating genes involved in cell growth, inflammation, and proliferation.
3. Personalized nutrition is an outcome of nutrigenomics and can be used to promote health through prevention and treatment of diseases, weight control, and immunity improvement.
The document discusses obesity, diabetes, and the Mediterranean diet. It defines obesity using BMI and describes the increasing rates of obesity in the US. It explains that obesity develops from an energy imbalance where intake exceeds expenditure. The risks of diseases like diabetes and heart disease rise with increasing BMI. Diabetes is classified into types 1 and 2 and criteria for diagnosis are provided. The roles of insulin and glucagon in glucose homeostasis are outlined. Guidelines for the Mediterranean diet emphasize plant foods, olive oil, fish and limits on red meat and sweets.
Malnutrition can be divided into under-nutrition, where nutrients are undersupplied, and over-nutrition, where nutrients are oversupplied. It has various causes like low income, infections, and metabolic disorders. Disorders from malnutrition include protein-energy malnutrition like kwashiorkor and marasmus, vitamin and mineral deficiencies, and obesity. Prevention strategies involve increasing food production, educating people, fortifying foods, and providing nutrition assistance to vulnerable groups.
Diabesity sthoola prameha - a life style disorderDrAbdulSukkurM
1) The document discusses diabesity, a condition characterized by both diabetes and obesity resulting from lifestyle factors like poor diet and lack of exercise.
2) It explains how Ayurveda recognizes similar conditions like Sthoola Prameha and provides dietary and lifestyle recommendations for management.
3) These include consuming a low-calorie, low-glycemic index diet of foods that are light, dry, and bitter/astringent in taste as well as practicing regular exercise and yoga. Strictly following Ayurvedic principles of diet and lifestyle can help prevent diabesity and other disorders.
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017Gianfranco Tammaro
PROF. ANTONIO GASBARRINI - Convegno "Il Presente ed il Futuro della Nutrizione Clinica" - 24/03/2017 - Sala Rita Levi Montalcini - Ospedale S.Eugenio - ROMA
Sito ASMaD: http://www.asmad.net
Canale Youtube: https://youtu.be/FYlsQzE8xfk
Disorders related to nutritional imbalance Arooj Attique
Nutritional imbalance can be caused by an inability to absorb nutrients or a poor diet, leading to unpleasant side effects and diseases. Malnutrition is a state of under or over consumption of nutrients required for growth and body functions. Key types of malnutrition include marasmus caused by lack of proteins, carbohydrates and fats, and kwashiorkor primarily caused by insufficient protein intake. Nutritional imbalances can cause disorders like overweight/obesity from excessive calorie intake, diabetes from high sugar/carb intake, and cardiovascular diseases from risk factors like high blood pressure and cholesterol.
This document discusses diabetes mellitus (DM), a metabolic disorder caused by factors that result in chronic hyperglycemia. It begins with background on DM and how it is an increasing health problem. DM is classified into type 1, caused by autoimmune destruction of insulin-producing beta cells, and type 2, caused by insulin resistance. Signs and symptoms of DM include frequent urination, excessive thirst, hunger, and weight loss. DM is diagnosed through blood tests measuring glucose levels when fasting and after consuming glucose. Treatment depends on the type, with type 1 requiring insulin injection and type 2 often controlled through diet, exercise and oral medication.
This document discusses nutrition support in cancer patients. It begins by reviewing cancer mortality statistics and trends in the US. It then describes common nutritional alterations in cancer patients, such as early satiety, dysphagia, nausea/vomiting, taste changes, and cachexia. The document outlines nutritional assessments for cancer patients, including screening tools, physical exams, laboratory tests, and quality of life assessments. It provides criteria for nutritional intervention and goals of therapy. The document discusses nutritional management strategies for issues like mucositis, diarrhea, and neutropenia. It addresses special considerations for enteral and parenteral nutrition in cancer patients. Finally, it lists some online resources for patient and caregiver education.
Physiological Determinants of Malnutrition in Elderly_ Crimson publishersCrimsonpublishersNTNF
This document discusses physiological determinants of malnutrition in the elderly. It begins by noting changes in body composition that occur with aging, including increases in fat mass and decreases in lean muscle mass. It then examines multiple factors that can cause poor appetite and reduced food intake in older adults, such as changes in taste/smell, dental issues, poverty, and medical/psychological conditions. It also discusses how conditions like cachexia and micronutrient deficiencies can negatively impact nutritional status. Finally, it notes how acute/chronic infections can increase metabolic demands and decrease the ability to meet those demands, potentially leading to malnutrition.
This document provides an overview of nutrition science, including definitions of key terms and descriptions of major nutrients. It discusses the study of nutrients and how the body processes them. Major topics covered include macronutrients like carbohydrates, fats, proteins, micronutrients like vitamins and minerals, nutrient deficiencies, and how genetics and genomics relate to nutrition and disease.
This document provides an annotated bibliography summarizing research on the relationship between dietary fiber consumption and the prevention of type 2 diabetes. Several studies found that high intake of dietary fiber, particularly from whole grains, is associated with a significantly reduced risk of developing type 2 diabetes. Combining data from multiple cohort studies, daily consumption of two servings of whole grains was shown to decrease the risk of type 2 diabetes by 21%. While the studies were mostly epidemiological, they consistently showed that increased fiber intake, especially from whole grains and cereals, can play a protective role against type 2 diabetes.
Nutrition in Cancer Prevention and TreatmentTim Crowe
This presentation will help you to understand the influence that dietary and lifestyle factors play in the prevention and causation of cancer. It outlines the important nutritional considerations for patients undergoing treatment for cancer and reviews procedures to improve patient safety by knowing the risks and benefits of antioxidant supplementation during cancer treatment
The document summarizes research on dietary changes in Crete, Greece over time. It compares data from a 1948 survey of the traditional Cretan diet to data from 2006-2007. The traditional Cretan diet was high in plant foods like olive oil, cereals, pulses, and vegetables. Animal products and bread were consumed in moderation. The modern Cretan diet still incorporates many traditional foods but has seen an increase in foods like fast food, soft drinks, and a decrease in cereal consumption from the traditional diet. While longevity in Crete remains high compared to other regions, chronic disease risks are rising with the dietary shifts away from the original Mediterranean diet.
Yogurt consumption for a healthier diet and lifestyle: overview from cohorts ...Yogurt in Nutrition #YINI
Yogurt is generally considered as a healthy food because of its nutrient composition, its profile of fermented food, and its link with an improved metabolic fitness. Population studies show that yogurt consumers report a greater intake of some nutrients,
e.g. calcium and protein, and fruits and vegetables compared to non-consumers. This is concordant with recent data demonstrating that diet quality is improved in yogurt consumers. Other cohort studies have shown that yogurt consumption is
associated with a reduced body weight over time. Our research experience with the Quebec Family Study reveals that yogurt consumption might be the “signature of a healthy lifestyle”. Indeed, female yogurt consumers report a better macronutrient
composition of the diet than non-consumers; they are also more physically active and display feeding behaviors which are more compatible with body weight stability. This agrees with results of the Infogene Study demonstrating that yogurt consumers
are more prone to adhere to a Prudent dietary pattern whereas non-consumers tend to exhibit a Western pattern. In summary, currently available cohort studies tend to show that yogurt consumption is associated with a healthy eating pattern
and lifestyle.
The document discusses the management of obesity through various means including assessing severity, etiology, medical problems associated with obesity, medical management, guidelines for treatment, and surgical management. It provides details on criteria for surgical treatment, preoperative preparation, and types of bariatric surgeries.
Importance of nutrition in hospitalized patientsAzam Jafri
Malnutrition is common in hospitalized patients and is associated with increased complications, prolonged hospital stays, and higher mortality rates. Proper nutrition is important for recovery, as malnutrition can weaken the body and impair the healing process. Oral nutritional supplements have been shown to improve patient outcomes by helping maintain muscle mass and support recovery from illness, surgery, or injury. Hospitals should screen patients for risk of malnutrition and consider supplemental nutrition to improve health outcomes.
The document provides nutrition guidelines for pressure ulcer management based on a patient's Braden scale score and presence of ulcers or wounds. It recommends protein and calorie intake levels, fluid goals, vitamin/mineral supplements, and conditionally essential amino acids like arginine and glutamine to support wound healing. It also discusses use of oxandrolone to reduce catabolism and promote tissue repair in patients experiencing weight loss or skin breakdown. Regular monitoring of intake, weight, and wound status is advised to evaluate response to the nutrition interventions.
The document discusses obesity, inflammation, and diabetes. It provides an overview of the Mediterranean diet and its benefits, including improved glycemic control, reduced cardiovascular risk, and decreased inflammation. The Mediterranean diet is highlighted as an anti-inflammatory dietary pattern due to its high fiber, antioxidant, and unsaturated fat content.
This ppt covers the role of diet in various diseases and the effects of excessive stress and gives an overview of the optimal diet in various non-communicable diseases.
Dr B Ravinder Reddy
Care Hospital, Hyderabad, India
This document discusses the epidemiology of diabetes mellitus. It begins with defining diabetes and classifying its various types. Globally, the prevalence of diabetes has been increasing rapidly and is projected to continue rising significantly. In India specifically, diabetes prevalence is around 8.6% currently with over 50% of cases being undiagnosed. Key risk factors include obesity, physical inactivity, and diet. Prevention efforts focus on promoting healthy lifestyles while management involves screening, treatment, and self-care education to control blood sugar and prevent complications.
Protein malnutrition, also referred to as protein deficiency, is a condition that occurs when an individual's diet lacks an adequate amount of protein, leading to various negative health consequences. This form of malnutrition can manifest in different ways, with two distinct clinical presentations known as kwashiorkor and marasmus.
Kwashiorkor is a severe form of protein malnutrition often seen in children. It occurs when there is a deficiency of high-quality protein in the diet, despite an adequate caloric intake. The lack of protein results in a disruption of important physiological processes, leading to various symptoms and complications. Common signs of kwashiorkor include edema, which is the accumulation of fluid in tissues, particularly in the legs, feet, and face. Additionally, individuals with kwashiorkor may experience muscle wasting, growth stunting, and impaired immune function. Other symptoms can include thinning hair, brittle nails, poor wound healing, fatigue, and anemia.
Marasmus, on the other hand, is a form of protein-energy malnutrition that occurs when there is a severe deficiency in overall calorie intake, including both protein and energy. Unlike kwashiorkor, individuals with marasmus experience significant weight loss and muscle wasting. The body enters a state of extreme catabolism, breaking down muscle tissue to meet energy needs. The characteristic appearance of marasmus includes a "skin and bones" appearance, with prominent ribs, thin limbs, and a lack of subcutaneous fat.
Protein is essential for the growth, development, and maintenance of various body tissues, including muscles, organs, and the immune system. It plays a crucial role in the synthesis of enzymes, hormones, and antibodies, and is involved in numerous biochemical processes. Inadequate protein intake deprives the body of these vital functions, leading to the manifestations seen in protein malnutrition.
Protein malnutrition is often associated with poor dietary diversity, limited access to quality protein sources, and socio-economic factors such as poverty, famine, and humanitarian crises. Vulnerable populations, such as children and the elderly, are particularly at risk. In children, inadequate protein intake during critical growth periods can result in long-term consequences, affecting physical and cognitive development.
Diagnosis of protein malnutrition involves a comprehensive assessment of dietary history, physical examination, and sometimes laboratory tests. Medical professionals evaluate the presence of characteristic signs and symptoms, such as edema or muscle wasting, to determine the severity and type of malnutrition. Blood tests may reveal abnormal levels of proteins and other nutrients, further aiding in diagnosis and treatment planning.
The treatment of protein malnutrition involves nutritional rehabilitation, addressing both the underlying protein deficiency and overall energy intake.
Nutrigenomics is the study of how nutrients and foods affect gene expression. It examines the interactions between an individual's genetics, diet, and health. The summary discusses three key areas:
1. Nutrigenomics research focuses on preventing chronic diseases like cancer, cardiovascular disease, and obesity by deactivating disease signaling pathways through nutrient supplements.
2. Specific nutrients can prevent these diseases. For example, polyunsaturated fatty acids can prevent cancer by regulating genes involved in cell growth, inflammation, and proliferation.
3. Personalized nutrition is an outcome of nutrigenomics and can be used to promote health through prevention and treatment of diseases, weight control, and immunity improvement.
The document discusses obesity, diabetes, and the Mediterranean diet. It defines obesity using BMI and describes the increasing rates of obesity in the US. It explains that obesity develops from an energy imbalance where intake exceeds expenditure. The risks of diseases like diabetes and heart disease rise with increasing BMI. Diabetes is classified into types 1 and 2 and criteria for diagnosis are provided. The roles of insulin and glucagon in glucose homeostasis are outlined. Guidelines for the Mediterranean diet emphasize plant foods, olive oil, fish and limits on red meat and sweets.
Malnutrition can be divided into under-nutrition, where nutrients are undersupplied, and over-nutrition, where nutrients are oversupplied. It has various causes like low income, infections, and metabolic disorders. Disorders from malnutrition include protein-energy malnutrition like kwashiorkor and marasmus, vitamin and mineral deficiencies, and obesity. Prevention strategies involve increasing food production, educating people, fortifying foods, and providing nutrition assistance to vulnerable groups.
Diabesity sthoola prameha - a life style disorderDrAbdulSukkurM
1) The document discusses diabesity, a condition characterized by both diabetes and obesity resulting from lifestyle factors like poor diet and lack of exercise.
2) It explains how Ayurveda recognizes similar conditions like Sthoola Prameha and provides dietary and lifestyle recommendations for management.
3) These include consuming a low-calorie, low-glycemic index diet of foods that are light, dry, and bitter/astringent in taste as well as practicing regular exercise and yoga. Strictly following Ayurvedic principles of diet and lifestyle can help prevent diabesity and other disorders.
GASBARRINI A. Nutrizione Clinica e Gastroenterologia. ASMaD 2017Gianfranco Tammaro
PROF. ANTONIO GASBARRINI - Convegno "Il Presente ed il Futuro della Nutrizione Clinica" - 24/03/2017 - Sala Rita Levi Montalcini - Ospedale S.Eugenio - ROMA
Sito ASMaD: http://www.asmad.net
Canale Youtube: https://youtu.be/FYlsQzE8xfk
Disorders related to nutritional imbalance Arooj Attique
Nutritional imbalance can be caused by an inability to absorb nutrients or a poor diet, leading to unpleasant side effects and diseases. Malnutrition is a state of under or over consumption of nutrients required for growth and body functions. Key types of malnutrition include marasmus caused by lack of proteins, carbohydrates and fats, and kwashiorkor primarily caused by insufficient protein intake. Nutritional imbalances can cause disorders like overweight/obesity from excessive calorie intake, diabetes from high sugar/carb intake, and cardiovascular diseases from risk factors like high blood pressure and cholesterol.
Systemic diseases, or conditions themselves do not cause periodontitis but alter host tissues to increase the progression of periodontal disease. Systemic diseases and conditions can influence the course of periodontitis or affect the periodontal supporting tissues independent of the presence of dental plaque. Most commonly affecting diseases are diabetes, neoplasms.
• Coeliac disease is a genetically-determined chronic inflammatory intestinal disease induced by an environmental precipitant, gluten.
• Patients with the disease might have mainly non-gastrointestinal symptoms, and as a result patients present to various medical practitioners.
• Epidemiological studies have shown that coeliac disease is very common and affects about one in 250 people.
• The disease is associated with an increased rate of osteoporosis, autoimmune diseases, and malignant disease, especially lymphomas.
• The mechanism of the intestinal immune-mediated response is not completely clear, but involves an HLA-DQ2 or HLA-DQ8 restricted T-cell immune reaction in the lamina propria as well as an immune reaction in the intestinal epithelium.
Cancer is a chronic disease characterized by uncontrolled cell growth and the ability to spread to other parts of the body. It is the second leading cause of death worldwide and the fourth in Indonesia, where 30% of cases are related to diet and lifestyle factors. Cancer development is a multistep process involving genetic and environmental risk factors like diet. Nutritional management of cancer patients aims to prevent weight loss and deficiencies through early screening, dietary adjustments tailored to the individual, and addressing symptoms caused by the disease or its treatment.
This document discusses obesity and its management through diet and exercise. It provides definitions of obesity based on BMI and waist circumference. Obesity is a risk factor for many health conditions. Dietary intervention is key to weight loss, including low-calorie, low-fat, low-carbohydrate diets, and very low-calorie diets. Exercise alone does not lead to significant weight loss but helps maintain weight lost through diet. Combining calorie restriction and exercise can result in 5-9% weight loss over 6 months.
This document discusses pathophysiology of food intake and obesity. It covers neuroendocrine regulation of appetite, factors influencing food intake like hormones and metabolism. Obesity is defined using Body Mass Index and its complications are explained. Leptin's role in obesity is discussed along with theories on leptin resistance. Inflammation in adipose tissue of obese individuals and alterations in appetite-regulating gut hormones are also covered. The document concludes by discussing anorexia nervosa and potential biotechnological approaches for treating obesity and increasing omega-3 fatty acids.
This document discusses surgical nutritional support, including the history and importance of artificial nutrition, metabolic adaptations in catabolic states, nutritional assessment, and approaches to enteral and parenteral nutrition. It covers indications for nutritional support, routes of administration, considerations for formulas including calorie-nitrogen ratios, and potential complications of enteral and parenteral nutrition administration. Metabolism in stress and starvation states and the regulation of protein synthesis and degradation are also summarized.
This document discusses surgical nutritional support, including the history and importance of artificial nutrition, metabolic adaptations in catabolic states, nutritional assessment, and approaches to enteral and parenteral nutrition. It covers indications for nutritional support, routes of administration, considerations for formulas including calorie-nitrogen ratios, and potential complications of enteral and parenteral nutrition administration. Metabolism in stress and starvation states and the regulation of protein synthesis and degradation are also summarized.
This document provides an overview of obesity including its definition, epidemiology, etiology, pathophysiology, investigations, management, prevention, and conclusions. Some key points:
1. Obesity is defined as excess body fat that may impair health, and it has become a global epidemic recognized by the WHO in 1997.
2. Worldwide prevalence of obesity more than doubled between 1980-2014, with at least 13% of adults globally being obese.
3. Obesity results from an interplay of genetic and environmental factors like diet, sedentary lifestyle, and certain drugs or medical conditions.
4. Management involves diet, exercise, medications like Orlistat, and sometimes bariatric surgery
Celiac disease is an autoimmune disorder triggered by gluten that affects the small intestine and results in damage to the intestinal villi. It is estimated to affect at least 1% of the population. The only effective treatment is a lifelong gluten-free diet. Researchers are studying enzyme and drug therapies to allow ingestion of small amounts of gluten. Advances in diagnostic tests and screening tools may help reduce undiagnosed cases of celiac disease.
1) Diabetes is a group of metabolic disorders characterized by high blood sugar levels. It includes defects in insulin secretion, insulin action, or both.
2) The document discusses the classification, pathogenesis, epidemiology, diagnostic criteria and methods, and control and prevention of diabetes globally and in India.
3) It provides statistics on the prevalence of diabetes worldwide and in India, making it one of the most common non-communicable diseases. Prevention and control involves lifestyle changes, medication and national programmes.
This document provides an overview of basic bacteriology. It begins with objectives related to distinguishing between prokaryotic and eukaryotic cells, bacterial taxonomy and classification, bacterial cell components and their functions, mechanisms of bacterial infection, and topics related to antibiotic resistance and healthcare-associated infections. The introduction discusses the early history of microbiology and key figures like Leeuwenhoek, Pasteur, and Koch. It also notes that bacteria were among the earliest life forms and are widespread across Earth's habitats. The document then covers various topics in detail, including bacterial cell structure, flagella, pili, the cell envelope, genetic material, ribosomes, inclusions, and endospores. Comparisons are made between
Oedema, or swelling, is caused by an abnormal accumulation of fluid in the interstitial tissue spaces. There are two main types - localized oedema affecting an organ or limb, and generalized oedema known as anasarca. The physiology of oedema involves a balance between hydrostatic pressure pushing fluid out of blood vessels and oncotic pressure pulling fluid back in. Disruptions to this balance that can cause oedema include decreased oncotic pressure, increased hydrostatic pressure, lymphatic obstruction, and increased capillary permeability. Common causes of oedema include cardiac, renal, and hepatic diseases.
Dokumen ini membahas tentang patofisiologi dan penatalaksanaan batuk. Batuk dapat diklasifikasikan menjadi akut, subakut dan kronik, dengan penyebabnya meliputi iritasi, mekanis, infeksi, dan penyakit paru. Penatalaksanaan batuk meliputi evaluasi, pemeriksaan penunjang, serta terapi antitusif dan protusif sesuai dengan penyebabnya seperti UACS, asma, GERD, TB paru, atau kanker par
Tes makroskopik dan mikroskopik cairan otak memberikan informasi penting untuk diagnosis penyakit. Tes makroskopik melihat warna, kekeruhan, dan bekuan cairan, sementara tes mikroskopik menghitung dan mengidentifikasi jenis sel untuk mendeteksi infeksi. Hasil tes dibandingkan dengan nilai normal untuk mendiagnosis kondisi seperti meningitis dan tumor.
Virologi Dasar ( sifat-sifat umum dan multiplikasi virus, patomekanisme dan pemberantasan infeksi virus) merupakan mata kuliah yang diajarkan pada Blok BMD
Fungi have various body forms including unicellular, filamentous hyphae that aggregate to form mycelium, and multicellular structures. They are heterotrophs that can be saprophytes, symbionts, or parasites. Hyphae are tubular and multinucleate with a chitin cell wall, and grow at their tips. Mycelium is the feeding structure of fungi. Fungi can cause superficial, intermediate, or systemic infections in humans, with true pathogens causing diseases like histoplasmosis, coccidioidomycosis, and blastomycosis through inhalation of spores. Antifungal therapies target ergosterol in fung
This document summarizes the roles of chemical mediators in acute inflammation in 3 phases: vascular changes, chemotaxis, and other effects. It describes how histamine, bradykinin, C3a, C5a, prostaglandins, leukotriene B4, leukotrienes C4 and D4, platelet-activating factor, IL-1, TNF, and chemokines mediate increased vascular permeability, chemotaxis of leukocytes, pain, fever, and tissue damage during acute inflammation. It also outlines the pathways of leukotriene and prostaglandin synthesis from arachidonic acid and their functions in inflammation.
Acute inflammation involves increased blood flow and permeability of blood vessels, allowing neutrophils to adhere to vessel walls, transmigrate into tissues, and phagocytose pathogens through adhesion, engulfment, and degradation. This triggers neutrophils to release inflammatory products, while defects can increase infection risk. The key events are vasodilation, increased permeability, neutrophil adhesion and migration to injured sites, phagocytosis, and release of leukocyte products.
This document discusses cellular adaptation, injury, and death. It covers topics like hyperplasia, hypertrophy, atrophy, metaplasia, causes of cell injury including hypoxia and free radicals, necrosis and apoptosis. It provides detailed descriptions of the morphological changes that occur during cellular injury and the mechanisms of necrosis, apoptosis and intracellular accumulation.
- Umbilical hernia is an abnormal protrusion of internal organs in the abdomen through a defect in the belly button (umbilicus).
- Umbilical hernias occur in 10-20% of babies, most under 6 months old. During pregnancy, the umbilical cord (umbilicus) protrudes through a small hole in the baby's abdominal muscles. If this hole does not close completely after birth, intestines can protrude through the weak area in the abdominal wall.
- Treatment depends on size and symptoms - hernias over 2 cm or not closing spontaneously require surgery between ages 2-3, while smaller or asymptomatic hernias may close on their own with
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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2. Objective Learning
To understand mechanism of Nutritional related
Diseases
To be able to explain types of Malnutrition
To comprehend Basic of Clinical Nutrition
To Understand Metabolism of Macronutrients
(Carbohydrate Protein, and Fat)
To Understand Metabolism of Micronutrients
(Vitamin dan Mineral) and water
To comprehend Nutrient Interrelation
2
5. Daftar Masalah Gizi (SKDI)
Nafsu Makan Hilang/Kurang
Gangguan Gizi (Gizi buruk, Kurang, Lebih
(obesitas))
Berat Bayi Lahir rendah
Penurunan berat badan mendadak/drastis
5
6. Level Kompetensi Dokter (SKDI)
Level 1: Mengenali dan menjelaskan
Level 2: Mendiagnosis dan merujuk
Level 3: Mendiagnosis, melakukan
penatalaksanaan awal dan merujuk
Level 3A: Kasus Bukan gawat darurat
Level 3B: Kasus Gawat Darurat
Level 4: Mendiagnosis, melakukan
penatalaksanaan secara mandiri dan Tuntas
Level 4 A: dicapai saat lulus dokter
Level 4 B: dicapai setelah internship dan PKB 6
7. Level Kompetensi Pokok Bahasan Gizi
7
TOPIK Level Kompetensi Blok
Anoreksia Nervosa 2 Neuropsikiatri
Bulimia 2 Neuropsikiatri
Pica 2 Neuropsikiatri
Alergi Makanan 4A Imun-hema
Intoleransi makanan 4A Imunhema
Keracunan Makanan 4A Emergency?/Gastrohep?
Anemia def. besi 4A Imunhema
Malnutrisi energi protein 4A BMD/MDP/CSL1
Def. Vitamin 4A BMD/MDP/CSL1
Def. Mineral 4A BMD/MDP/CSL1
Dislipidemia 4A endokrin
Obesitas 4A Endokrin
Hiperurisemia 4A Musculo
9. Optimal
Nutritional status
Normal Immune
Function Immune activation,
Susceptible to
Inflammatory disease
Overnutrition
Undernutrition
CORRELATION BETWEEN NUTRITIONAL STATUS AND IMMUNE FUNCTION
Immune suppression
Susceptible to Infection
9
10. Pathogeneses of Nutritional
related Diseases
Malnutrition
Starvation
Undernutrition
Specific Deficiency
Imbalance
overnutrition
Toxicity
Vitamin
Mineral
Amino acid (Genetic disorder e.g. phenylketonuria)
10
15. Nutrients Reserve Time
Asam amino Bbrp jam
KH 13 jam
Lemak (12% BB) 27 hari
Thiamin 30-60 hari
Ascorbic acid 60-120 hari
Niacin 60-180 hari
Riboflavin 60-180 hari
Vit A 90-365 hari
Iron (menstruating women) 125 hari
Iron (post menopausal women and men) 750 hari
Iodine 2500 hari
ESTIMATION OF SOME NUTRIENTS RESERVE
15
22. Oedema in kwashiorkor
Traditionally considered as direct result of low
albumin and associated with low protein intake
with normal calorie intake
Inflammation induced by infection is currently
regarded responsible for the oedema via 3
mechanism:
Transcapillary loss of albumin due to increase
vascular permeability
Increased albumin catabolism
Decreased albumin synthesis
22
23. Malnutrition without inflammatory state (Non
catabolic state): Low intake due to poverty or
voluntarily (anorexia nervosa, bulimia)
marasmus type
Malnutrition with inflammatory state
kwashiorkor or marasmic-kwashiorkor type
(depending on BW)
Acute inflammation (high grade inflammation):
Sepsis, Burn, pneumonia, typhoid fever
Chronic Inflammation (Low grade inflammation):
TB, Liver Cirrhoris, Chronic kidney disease, Cancer,
HIV-AIDS, Colitis. ( 23
Malnutrition
24. Hospital malnutrition
Malnutrition characterized by
HYPOALBUMINEMIA is associated with:
Increased morbidity,
Increased mortality and
Prolonged hospital length of stay
24
26. Types of Malnutrition
• Marasmus
• Kwashiorkor
• Mixed
Because this is a disease with multiple etiologies, the
best terminology would probably be polydeficient
malnutrition.
Green CJ. Clin Nutr 1999;18(s):3-28
26
27. How common is Malnutrition in surgical patients?
25% of surgical patients are malnourished on admission!
Does it matter?
McWirther, BMJ 1994;308:945-8. Baker, N Engl J Med 1982;306:969-72
0
10
20
30
40
50
60
70
80
Infections (%) LOS (days)
Well
nourished
Moderately
malnourished
Severly
malnourished
P<0.005 (infections)
P<0.0001 (LOS)
27
58. INDEKS GLISEMIK (IG)
Pasien DM dianjurkan untuk mengkonsumsi
makanan dengan IG rendah
Karbohidrat kompleks/serat tinggi memiliki IG
relatif rendah dibanding Gula sederhana
IG 70 = tinggi
IG 56 – 69 = sedang
IG 55 = Rendah
58
66. Glycemic Load
66
The glycemic load (GL) of food is a number that
estimates how much the food will raise a person's blood
glucose level after eating it. One unit of glycemic load
approximates the effect of consuming one gram of
glucose.[1] Glycemic load accounts for how much
carbohydrate is in the food and how much each gram of
carbohydrate in the food raises blood glucose levels.
Glycemic load is based on the glycemic index (GI).
Glycemic load is defined as the grams of available
carbohydrate in the food x the food's GI / 100
67. Glycemic Load
67
Glycemic load estimates the impact of carbohydrate
consumption using the glycemic index while taking into account
the amount of carbohydrate that is consumed. GL is a GI-
weighted measure of carbohydrate content. For instance,
watermelon has a high GI, but a typical serving of watermelon
does not contain much carbohydrate, so the glycemic effect of
eating it (and therefore its GL) is low. Whereas glycemic index is
defined for each type of food, glycemic load can be calculated
for any size serving of a food, an entire meal, or an entire day's
meals.
68. Glycemic Load
68
GL greater than 20 = high,
GL of 11-19 = medium,
GL of 10 or less = low.
Foods that have a low GL in a typical
serving size almost always have a low GI.
Foods with an intermediate or high GL in a
typical serving size range from a very low to
very high GI.
89. Play a role in blood cholesterol levels. These substances
occur when polyunsaturated oils are altered through
hydrogenation, a process used to harden liquid vegetable oils
into solid foods like margarine and shortening.
One recent study found that trans-monounsaturated fatty
acids raise LDL cholesterol levels, behaving much like
saturated fats.
Simultaneously, the trans-fatty acids reduced HDL
cholesterol readings. Much more research on this subject is
necessary, as studies have not reached consistent and
conclusive findings.
89
109. Protein metabolism
Protein is absorbed in form of amino acid
Amino acid especially important to build new tissue
or to replace the old one.
Protein from diet and tissue catabolism form amino
acid pool
Amino acid from this pool will be burnt as energy in
state of limit source of energy
Inter-conversion amongst amino acid and catabolic
metabolite from CH and fat takes place through the
process of transamination, deamination, and
amination
110. Protein metabolism
Leucine, isoleucine, phenylalanine, and tyrosine
are called ketogenic amino acids since they are
converted to ketone bodies; acetoacetic acid
Threonine and valine (by irreversible reaction)
and other amino acids (by reversible reaction)
are glucogenic or gluconeogenic
113. Transaminase enzymes (aminotransferases) catalyze
the reversible transfer of an amino group between two
a-keto acids.
H
R1 C COO
-
+ R2 C COO
-
NH3
+
O
Transaminase
H
R1 C COO
-
+ R2 C COO
-
O NH3
+
114. Example of a Transaminase reaction:
Aspartate donates its amino group, becoming the
a-keto acid oxaloacetate.
a-Ketoglutarate accepts the amino group,
becoming the amino acid glutamate.
aspartate a-ketoglutarate oxaloacetate glutamate
Aminotransferase (Transaminase)
COO
CH2
CH2
C
COO
O
COO
CH2
HC
COO
NH3
+
COO
CH2
CH2
HC
COO
NH3
+
COO
CH2
C
COO
O+ +
115. Transaminase Roles
Transaminases equilibrate amino groups among
available a-keto acids.
This permits synthesis of non-essential amino acids,
using amino groups from other amino acids & carbon
skeletons synthesized in a cell. Thus a balance of
different amino acids is maintained, as proteins of varied
amino acid contents are synthesized.
Although the amino N of one amino acid can be used
to synthesize another amino acid, N must be obtained
in the diet as amino acids (proteins).
116. Essential Amino Acids
Essential amino acids must be consumed in the diet.
Mammalian cells lack enzymes to synthesize their
carbon skeletons (a-keto acids). These include:
Isoleucine, leucine, & valine
Lysine
Threonine
Tryptophan
Phenylalanine (Tyr can be made from Phe.)
Methionine (Cys can be made from Met.)
Histidine (Essential for infants.)
117. The prosthetic group of Transaminase is
pyridoxal phosphate (PLP), a derivative of
vitamin B6.
pyridoxal phosphate (PLP)
N
H
C
O
P
O
O
O
OH
CH3
C
H O
H2
118. In the resting state, the aldehyde group of pyridoxal
phosphate is in a Schiff base linkage to the e-amino
group of an enzyme lysine residue.
N
H
C
O
P
O
O
O
O
CH3
HC
H2
N
(CH2)4
Enz
H
+
R
H
C COO
NH2
Enzyme (Lys)-PLP Schiff base
Amino acid
119. The a-amino group of a substrate amino acid displaces the enzyme
lysine, to form a Schiff base linkage to PLP.
PLP’s (+) charged N is thought to act acts as an electron sink, to
facilitate catalysis. Lysine extracts H+, promoting tautomerization,
followed by reprotonation & hydrolysis.
N
H
C
O
P
O
O
O
O
CH3
HC
H2
N
H
C
H
+
R COO
EnzLysNH2
Amino acid-PLP Shiff base (aldimine)
120. What was an amino acid leaves as an a-keto acid.
The amino group remains on what is now pyridoxamine phosphate
(PMP). A different a-keto acid reacts with PMP and the process
reverses, to complete the reaction.
N
H
C
O
P
O
O
O
OH
CH3
CH2
NH2
H2
R C COO
O
EnzLysNH2
Pyridoxamine phosphate (PMP)
a-keto acid
121. Several other enzymes that catalyze metabolism or
synthesis of amino acids also utilize PLP as prosthetic
group, and have mechanisms involving a Schiff base
linkage of the amino acid to PLP.
N
H
C
O
P
O
O
O
O
CH3
HC
H2
N
H
C
H
+
R COO
EnzLysNH2
Amino acid-PLP Shiff base (aldimine)
122. Chime Exercise
Each student should pair up with a neighboring student
and each should display as recommended of one of the
following:
Transaminase with PLP in Schiff base linkage to the
active site lysine residue.
Transaminase in the PMP form, with glutarate, an
analog of a-ketoglutarate, at the active site.
Students should then show and explain the structure
displayed by them to the neighboring team.
123. Deamination of Amino Acids
In addition to equilibrating amino groups among
available a-keto acids, transaminases function to funnel
amino groups from excess dietary amino acids to those
amino acids (e.g., glutamate) that can be deaminated.
Carbon skeletons of deaminated amino acids can be
catabolized for energy, or used to synthesize glucose or
fatty acids for energy storage.
Only a few amino acids are deaminated directly.
124. Glutamate Dehydrogenase catalyzes a major reaction that effects net
removal of N from the amino acid pool.
It is one of the few enzymes that can use NAD+ or NADP+ as e
acceptor. Oxidation at the a-carbon is followed by hydrolysis, releasing
NH4
+.
OOC
H2
C
H2
C C COO
O
+ NH4
+
NAD(P)+
NAD(P)H
OOC
H2
C
H2
C C COO
NH3
+
H
glutamate
a-ketoglutarate
Glutamate Dehydrogenase
H2O
125. Summarized above: the role of transaminases in
funneling amino N to glutamate, which is deaminated via
Glutamate Dehydrogenase, producing NH4
+.
Amino acid a-ketoglutarate NADH + NH4
+
a-keto acid glutamate NAD
+
+ H2O
Transaminase Glutamate
Dehydrogenase
126. Some other pathways for deamination of amino acids:
1. Serine Dehydratase catalyzes:
serine pyruvate + NH4
+
2. Peroxisomal L- and D-amino acid oxidases catalyze:
amino acid + FAD + H2O
a-keto acid + NH4
+ + FADH2
FADH2 + O2 FAD + H2O2
Catalase catalyzes: 2 H2O2 2 H2O + O2
HO CH2
H
C COO
NH3
+
C COO
OH2O NH4
+
C COO
NH3
+
H2C H3C
H2O
serine aminoacrylate pyruvate
Serine Dehydratase
127. Most terrestrial land animals convert excess nitrogen to
urea, prior to excreting it. Urea is less toxic than ammonia.
The Urea Cycle occurs mainly in liver.
The 2 nitrogen atoms of urea enter the Urea Cycle as NH3
(produced mainly via Glutamate Dehydrogenase) and as
amino N of aspartate.
The NH3 and HCO3
(carbonyl C) that will be part of urea
are incorporated first into carbamoyl phosphate.
H2N C
O
NH2
urea
128. Carbamoyl Phosphate
Synthase (Type I) catalyzes
a 3-step reaction, with
carbonyl phosphate and
carbamate intermediates.
NH3 is the N input.
The reaction, which
involves cleavage of 2 ~P
bonds of ATP, is essentially
irreversible.
H2N C OPO3
2
O
H2N C O
O
HO C
O
OPO3
2
HCO3
ATP
NH3
ADP
ATP
Pi
ADP
carbonyl phosphate
carbamate
carbamoyl phosphate
129. Alternate forms of
Carbamoyl Phosphate
Synthase (Types II & III)
initially generate ammonia
by hydrolysis of glutamine.
X-ray crystallographic
analysis has shown that the
type II enzyme includes a
long internal tunnel through
which ammonia & reaction
intermediates such as
carbamate pass from one
active site to another.
H2N C OPO3
2
O
H2N C O
O
HO C
O
OPO3
2
HCO3
ATP
NH3
ADP
ATP
Pi
ADP
carbonyl phosphate
carbamate
carbamoyl phosphate
130. Carbamoyl Phosphate Synthase is the committed step of
the Urea Cycle, and is subject to regulation.
Carbamoyl Phosphate Synthase is allosterically activated
by N-acetylglutamate. This derivative of glutamate is
synthesized when cellular [glutamate] is high, signaling
excess of free amino acids due to protein breakdown or
dietary intake.
H2N C OPO3
2
O
HCO3
+ NH3 + 2 ATP
+ 2 ADP + Pi
Carbamoyl Phosphate
Synthase
carbamoyl phosphate
131. H2N C OPO3
2
O
CH2
CH2
CH2
HC
COO
NH3
+
NH3
+
CH2
CH2
CH2
HC
COO
NH3
+
NH
CO NH2
COO
CH2
HC
COO
NH2
CH2
CH2
CH2
HC
COO
NH3
+
NH
C NH2
+
COO
CH2
HC
COO
H
N
AMP + PPi
ATP
CH2
CH2
CH2
HC
COO
NH3
+
NH
C
NH2
+
H2N
COO
HC
CH
COO
C NH2H2N
O H2O
Pi
ornithine
urea
citrulline
aspartate
arginino-
succinate
fumarate
arginine
carbamoyl
phosphate
Urea Cycle
1
2
3
4
Urea Cycle
Enzymes in
mitochondria:
1. Ornithine
Trans-
carbamylase
Enzymes in
cytosol:
2. Arginino-
Succinate
Synthase
3. Arginino-
succinase
4. Arginase.
132. For each cycle, citrulline must leave the mitochondria, and
ornithine must enter the mitochondrial matrix.
Carrier proteins in the inner mitochondrial membrane facilitate
transmembrane fluxes of citrulline & ornithine.
cytosol
mitochondrial matrix
carbamoyl phosphate
Pi
ornithine citrulline
ornithine citrulline
urea aspartate
arginine argininosuccinate
fumarate
133. Fumarate is converted to oxaloacetate via Krebs Cycle enzymes
Fumarase & Malate Dehydrogenase.
Oxaloacetate is converted to aspartate via transamination (e.g., from
glutamate). Aspartate then reenters Urea Cycle, carrying an amino group
derived from another amino acid.
cytosol
mitochondrial matrix
carbamoyl phosphate
Pi
ornithine citrulline
ornithine citrulline
urea aspartate
arginine argininosuccinate
fumarate
Cytosolic isozymes
of Krebs Cycle
enzymes are
involved in
regenerating
aspartate from
fumarate.
134. Hyperammonemia Disease
Hereditary deficiency of any of the Urea Cycle
enzymes leads to hyperammonemia - elevated
[ammonia] in blood.
Total lack of any Urea Cycle enzyme is lethal.
Elevated ammonia is toxic, especially to the brain. If
not treated immediately after birth, severe mental
retardation results.
Information about such genetic diseases may be found
in the OMIM (Online Mendelian Inheritance in Man)
web site.
135. Postulated mechanisms for toxicity of high [ammonia]:
1. High [NH3] would drive Glutamine Synthase:
glutamate + ATP + NH3 glutamine + ADP + Pi
This would deplete glutamate – a neurotransmitter & precursor for
synthesis of the neurotransmitter GABA.
2. Depletion of glutamate & high ammonia level would drive
Glutamate Dehydrogenase reaction to reverse:
glutamate + NAD(P)+ a-ketoglutarate +
NAD(P)H + NH4
+
The resulting depletion of a-ketoglutarate, an essential Krebs Cycle
intermediate, could impair energy metabolism in the brain.
136. Hyperammonemia Disease
Treatment of deficiency of Urea Cycle enzymes
(depends on which enzyme is deficient):
limiting protein intake to the amount barely
adequate to supply amino acids for growth, while
adding to the diet the a-keto acid analogs of
essential amino acids.
Liver transplantation has also been used, since
liver is the organ that carries out Urea Cycle.
140. Interrelation amongst Metabolism
of CH, fat, and protein
Although the the early metabolic process of
those substances are distinct , they will
eventually enters a shared process called
krebs cycle, for oxidative metabolism yielding
a chemical energy (ATP)
141. Protein
(amino acids)
Carbohydrate
(glucose, fructose, galactose)
Fat
(glycerol, fatty acids)
Intra cells : amino acids
Glucose, glycerol, fatty acid
Excretion:
as feces, urine,
Sweats, lung CO2
Utilization :
Form energy, heat,
enzymes, hormones, growth
Metabolism of carbohydrate, fat, protein
142. food
CHprotein fat
glucoseglycerolFatty acid
Amino acid
Pyruvic acdAcetoacetic acidGlucogenic AAKetogenic AA
Acetyl CoA
Oxaloacetic acid
Malonyc acidIsocitric acid
Fumarate acid
a- ketoglutarate
acid
succynate acid
Interrelation amongst metabolism of CH, fat, and protein
144. The role enzymes in metabolism
It consists of a protein part synthesized in body
(apoenzyme).
To activate apoenzyme we need coenzyme (a non-
protein molecule)
The coenzyme initially inactive and activated by vitamin
B complex
The bond between apoenzyme and coenzyme is called
holoenzyme.
Some holoenzymes need minerals to work effectively.
145. The role enzymes in metabolism
As every component of the system needed
simultaneously in sufficient amount, that any single
deficiency of those nutrients would interfere with
the entire system.
Despite one single vitamin only as a component of
one coenzyme, the coenzyme might participate in
other enzymes.
Therefore, a deficiency in one vitamin could
negatively affect some metabolic pathways
Refer to the reference handout for more detail
146. The role of hormones
Play important roles in coordinating lots of
metabolic process.
These hormones are created to meet the normal
condition of human being, in both anabolic and
catabolic states.
For instances : Insulin is an anabolic hormone, while
cortisol is a catabolic
Growth hormone has a mixed properties; to
synthesize protein by catabolizing Ch and fat
Refer to the reference handout for more detail
166. TISSUE-SPECIFIC
METABOLISM
TISSUE FUEL USED FUEL RELEASED
Brain Glucose
Ketone Bodies
Lactate (in prolonged
starvation; the brain can
utilize lactate under some
pathological conditions)
Skeletal Muscle Glucose, FFA, TG, BCAA Lactate, alanine, glutamine
Heart FFA, TG, Ketone bodies,
Glucose, Lactate
Liver Amino acids, FFA, lactate,
glycerol, glucose, alcohol
Glucose, ketone bodies,
lactate, TG
Intestine Glucose, glutamine Lactate, alanine
Red blood cells Glucose lactate
Kidney Glucose, FFA, Ketone
bodies, lactate, glutamine
glucose
Adipose tissue Glucose, TG Lactate, glycerol, FFA 166
167. /
/
4 8 12 16 20 24 28 2 8 16 24 32 40
/
/
I II III IV V
40
30
20
10
/
/
Hours Days
Exogenous
Gluconeogenesis
GlucoseUsed(g/h)
ORIGIN OF
BLOOD
GLUCOSE
TISSUES
USING
GLUCOSE
MAJOR
FUEL OF
GLUCOSE
:
:
: Exogenous Glycogen, hepatic
gluconeogenesis
Hepatic gluconeo-
genesis, glycogen
Gluconeogenesis
Hepatic and renal
Gluconeogenesis
Hepatic and renal
All
All except liver &
adipose tissue at
diminished rates
All except liver, muscle
& adipose tissue at
rates intermediate
between II & IV
Brain, RBC, Renal
Medulla, small
amount by muscle
Brain, at a diminished
rate, RBC, Renal
Medulla
Glucose Glucose Glucose Glucose, ketone
bodies
Glucose, ketone
bodies
GLUCOSE UTILIZATION VS TIME IN THE 5 PHASES OF GLUCOSE METABOLISM
Glycogen
167
168. /
/
4 8 12 16 20 24 28 2 8 16 24 32 40
/
/
I II IIIa
40
30
20
10
/
/
Hours Days
Exogenous (dietary glucose)
Gluconeogenesis
GlucoseUsed(g/h)
GLUCOSE UTILIZATION VS TIME IN THE 5 PHASES OF GLUCOSE METABOLISM
Glycogen
I Fed state Most glucose is provided by diet
II Fasted state
(Post absorptive)
Most glucose is provided by breakdown of liver glycogen stores; increasing
amounts are provided by gluconeogenesis
III Starved state Most glucose comes from gluconeogenesis; the breakdown of protein and fat
provides amino acids and glycerol, substrate for gluconeogenesis
total glucose
IIIb
169. /
/
4 8 12 16 20 24 28 2 8 16 24 32 40
/
/
I II IIIa
40
30
20
10
/
/
Hours Days
Exogenous (dietary glucose)
Gluconeogenesis
GlucoseUsed(g/h)
Glycogen
total glucose
IIIb
State Time course Major fuels used Hormonal control
I. Fed 0-4 h following a meal Most tissues use glucose insulin results in; glucose uptake by peripheral
tissues, glycogen, TG, and protein synthesis
II. Fasted
(post-absorptive)
4-12 h after a meal Brain: glucose
Muscle and liver: fatty acids
glucagon and Noradrenaline stimulate breakdown of
liver glycogen and TG
insulin
IIIa. Early starvation 12h-16 days without food Brain: glucose and some ketone bodies
Liver: fatty acids
Muscle:mainly fatty acids and some ketone bodies
glucagon and NoradrenalineTG hydrolysis and
ketogenesis
cortisolbreakdown of muscle protein, releasing
amino acids for gluconeogenesis
IIIb. Prolonged starvation >16 days without food Brain: uses more ketone bodies and less glucose to preserve body protein
Muscle: only fatty acids
glucagon and Noradrenaline
170. 170
State Time course Major fuels used Hormonal control
I. Fed 0-4 h following a
meal
Most tissues use glucose insulin results in; glucose
uptake by peripheral tissues,
glycogen, TG, and protein
synthesis
II. Fasted
(post-absorptive)
4-12 h after a meal Brain: glucose
Muscle and liver: fatty acids
glucagon and
Noradrenaline stimulate
breakdown of liver glycogen
and TG
insulin
IIIa. Early
starvation
12h-16 days
without food
Brain: glucose and some
ketone bodies
Liver: fatty acids
Muscle:mainly fatty acids and
some ketone bodies
glucagon and
NoradrenalineTG
hydrolysis and ketogenesis
cortisolbreakdown of
muscle protein, releasing
amino acids for
gluconeogenesis
IIIb. Prolonged
starvation
>16 days without
food
Brain: uses more ketone
bodies and less glucose to
preserve body protein
Muscle: only fatty acids
glucagon and
Noradrenaline
Three States of glucose homeostasis
172. Glucose
90 g
Brain
15-20 g
Liver
20 g
Muscle
20-45 g
Adipose
tissue
2 g
Glycogen
Glycogen ATP
Triacylglycerol
CO2
FATE OF DIETARY CARBOHYDRATE (GLUCOSE) FROM ONE MEAL DURING THE ABSORPTIVE
PHASE (~2 H). GLUCOSE PROVIDES THE GLYCEROL MOETY FOR TRIACYLGLYCEROL SYNTHESIS
20 g25 g
20 g2 g
20 - 45 g
15 - 20 g
172