Essentials of Pathophysiology CHAPTER 10 DISORDERS OF NUTRITIONAL STATUS PRE LECTURE QUIZ (TRUE/FALSE) F F F F T The incidence of childhood obesity has remained stable over the last 10 years. More then 90% of body energy is stored in the skeletal tissues of the body. Energy requirements are decreased during growth periods. Both anorexia nervosa and bulimia nervosa involve weight fluctuations that may drop to dangerously low levels. Vitamins A, D, E, and K are known as fatsoluble vitamins. PRE LECTURE QUIZ circumference Height Marasmus Obesity Recommended The ______________ Dietary Allowances (RDAs) define the average daily intakes that meet the nutrient needs of almost all healthy persons in a specific age and sex group. The body mass index (BMI) uses ____________ and weight to determine healthy weight. ______________ is defined as a condition characterized by excess body fat. Waist ______________ is used to determine the distribution of body fat. _______________, a condition of malnutrition, represents a progressive loss of muscle mass and fat stores owing to inadequate food intake that is equally deficient in calories and protein. CALORIES IN = CALORIES USED + CALORIES STORED Caloric intake is controlled by appetite Hunger and satiety centers in hypothalamus Calorie use is controlled by metabolic rate - Set by: Thyroid hormones and Activity levels Exercise, physical activity, etc. Calories are stored in adipose tissue White adipose tissue Brown adipose tissue QUESTION Tell whether the following statement is true or false. A calorie measures the energy used to break down nutrients. ANSWER False Rationale: A calorie is simply energy measured in heat units (the amount of heat or energy required to raise the temperature of 1 g of water 1° Celsius). Metabolism is the breakdown of nutrients. SCENARIO: You just ate a big dinner. Question: How did you know when to stop eating? How do you know you are still full? What will make you feel hungry again? SHORT-TERM REGULATION Food detected by GI tract oral receptors detect tasting, chewing, swallowing GI tract secretes hormones insulin glucagon-like peptide-1 cholecystokinin hypothalamus satiety center feeling of “fullness” stomach stretches INTERMEDIATE AND LONG-TERM REGULATION EAT excess calories Feeling of Well Being Decreasess increased blood glucose adipose cells release hormones leptin Feeling of Well Being Stresses of Life hypothalamus satiety center feeling of “fullness” increased blood ketoacids INTERMEDIATE AND LONG-TERM REGULATION Hypothalamus (-) Leptin (+) Hunger Center Neuropeptide Y (-) Adipose cells release leptin Triglycerides (-) Stresses of Life EAT excess calories Feeling of Well Being (+) QUESTION What part of the brain controls both hunger and the feeling of fullness? a. Cerebral cortex b. Hypothalamus c. Reticular formation d. Thalamus e. b and d ANSWER b. Hypothalamus Rationale: The feeding center for hunger and satiety is contained in the hypothalamus. The hypothalamus takes in information from the GI tract, blood, and cerebral cortex in order to determine when to begin eating and when to stop. ASSESSING NUTRITIONAL STATUS Body weight Relative weight = actual weight/desirable weight Body mass index = weight (kg)/height (in meters)2 1M= 39.4 in 1 kg = 2.2 lb Percentage of body fat LBS 1 KG BMI 2.2 LBS IN 1M 2 ( ) 39.4 IN CALCULATE YOUR BODY MASS INDEX (BMI) If your BMI >= 25 Overweight If your BMI>= 30 Obese If your BMI>= 40 Morbidly Obese Weight in Pounds 200 = 2.2 72 39.4 Height in inches 2 = Weight in Pounds 90.9 = 2.2 27.2 3.3 Height in inches 39.4 then square it Divide this by this and put it here this is your BMI UPPER VS. LOWER BODY OBESITY Courtesy of Ahmed Kissebah, M.D., Ph.D., Medical College of Wisconsin, Milwaukee CLINICAL MANIFESTATIONS OF OBESITY QUESTION Tell whether the following statement is true or false. A BMI that is greater than normal increases an individual’s risk of developing type 2 diabetes mellitus. ANSWER True Rationale: Normal BMI = 18.5 – 24.9. BMI >25 places individuals at increased risk for type 2 diabetes, cardiovascular disease, and hypertension. The higher the BMI is above normal, the greater the risk of health problems. MALNUTRITION Marasmus [muh-raz-muhs] Too few calories in diet and Too little protein in diet Kwashiorkor (kwah-shee-awr-kawr) Adequate calories in diet but Too little protein in diet CLINICAL MANIFESTATIONS OF KWASHIORKOR Adequate Calories but a lack of protein CLINICAL MANIFESTATIONS OF MARASAMUS Basic Starvation lack of protein and Calories PROTEIN-CALORIE MALNUTRITION Question: Based on your knowledge of organ functions, what might happen if protein production decreases in the: Liver GI tract Heart Diaphragm EATING DISORDERS Anorexia nervosa Bulimia nervosa Binge eating Question: Which would be the least serious? Why? Which would be the most serious? Why?