Transcript A Model of a Mechanoreceptor and Sensory Circuit in the Fruit Fly

Energetic balance, nutrition,
physiology and pathological
physiology
„block seminar“
Eva Miarkova, Petr Marsalek
warning: the PDF version of this
presentation is not an official study material
First Medical Faculty, Institute of Pathological Physiology
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pathological physiology of
nutrition
- disorders of absorption, digestion and metabolism
- disorders by inadequate (composition of) nutrients
- disorders by imbalanced energy input and output
(obesity, malnutrition)
positive/ negative energetic
balance
• norm - equal energy balance
• energy input (in the time range of several
days) higher then basal/ actual metabolic
demands – weight gain, overeating, positive
energetic balance
• energy input (in the time range of several
days) lower then basal/ actual metabolic
demands – weight loss, malnutrition,
negative energetic balance
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positive energetic balance
anabolism
– positive energetic balance (fats, sugars,
proteins, alcohol)
– insufficient energy output (lack of physical
activity)
– amount of nutrients approaching toxic doses
(see … toxicity of fat soluble vitamins, A, D, K,
elements: Se, Na (?), …)
pathology: immobilization, hypo-thyreosis,
Cushing syndrome (=hyper-cortisolism), et
cetera.
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negative energetic balance,
catabolism
–insufficient input of energy and/ or some of nutrients
–condition of most acute diseases
–metabolic disorders (malabsorbtion, maldigestion)
– metabolic control disorders, thyroid gland disorders
Malnutrition: …
–vitamins (eg. thiamine, riboflavin, B, C, fat soluble: A,D)
–minerals (Ca, Fe, I, Se, F)
–essential fatty acids (linoleic acid)
–esential amino acids (lysine, methionine, tryptofan)
and so on…
positive energetic balance
„Physiological weight gains“
• Young age - growth
• Women – pregnancy, breast-feeding
• Women – hormonal changes
(menopause, age of 50)
• Men – similar age group (age of 40 – 50)
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obesity
Causes of obesity:
– Genetic factors
– High level/ voluntary feeding behaviors
– CNS feeding behaviors control disorders
– Temperature control disorders
– Hormonal disorders (hypothyreosis)
– Hyper-fagia/ (mental) bulimia
– Addictive substance abuse
– Gravidity with associated disorders
– (Classical) stress, long term stress
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types of obesity
• „male type obesity“ (android)
- belly/ visceral fat (type „apple“, „beer
belly“, etc.)
- (relative) insulin resistency and metabolic
(Reaven) syndrome
- higher risk of metabolic and cardiovascular disorders
• „female type obesity“ (gynoid)
- fat thighs/ rear parts (type „pear“)
> „mixed type obesity“ , abdominal, example:
Cushing syndrome
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alternative classifications of obesity types
Primary, secondary, pathologic, etc ...
Hyper-plastic type of obesity
- higher number of adipocytes
- early age and puberty
- low reactivity to dietary measures
Hyper-trofic type of obesity
- enlargement of adipocytes
- after the termination of growth period (age over 20)
- lower insulin and katechol-amin reactivity
- better reactivity to reduction diet
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evaluation of obesity
• according Broca and others:
body height in cm - 100 >=< body mass in kg
• BMI (body mass index)
BMI = body mass (kg)/square of height (in m)
> waist length
> but: paradoxical weight gain in edemas, ascites, etc.
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BMI (body mass index) values
• under 18.5 - low weight
• 18.5 – 24.5 – normal weight
• 25 – 29.9 – over-weight
• 30 – 34.9 - obesity
• 35 – 39.9 – extreme obesity
• 40 and more - clinical (pathological) obesity
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evaluation of obesity
•
•
•
•
Parameters:
waist circumference
waist/ hip ratio (android vs. gynoid, > 0.85
female, > 1.0 male)
front-back body diameter (SAD sagittal
abdominal diameter)
Skin fold thickness: above triceps, under blades,
on the belly, measured by caliper
…some other parameters related to cardiovascular obesity complications, comparable to
BMI.
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epidemiology of obesity
• Czech Republic – alarming rate
alarming obesity in children
• pathologic obesity
• According to the type – abdominal obesity –
highest cardio-vascular risk
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obesity
-vegetative
center:
hypotalamus,
-voluntary
control:
cerebral cortex
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weight reduction diets
• Short term – short term effect – the goal
might be to introduce new feeding behavior,
not efficient, weight fluctuation
• Long term – less drastic, more efficient
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reduction diet sugestions
1. Water ad libitum – hydration is important
2. Lower energy input – down to 30%
3. Controllable amount of nutrients
4. Taste acceptability, variability
5. Not causing hunger and fatigue
(glycemic index ?)
6. Affordable, preparation not time consuming
7. Introducing/ changing dietary habits
8. Goal setting – motivation - 1
9. Health improvement – motivation - 2
10. Should not be in contradiction with other
dietary measures
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wrong weight reduction diets
• mental aspects – aversive reaction to food
(bulimia, anorexia), too fast body weight reduction
can cause health problems
• physiological aspects –insufficient supply of
vitamins and minerals – fatigue, anemia, higher
susceptibility to infections, women – hormonal
problems
Long term dangers
– associated with growth, pregnancy, breast
feeding, metabolic disorders
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malnutrition
• insufficient input of energy and/ or some of
nutrients
• pathological effects – changes in nutritional
demands
• old age, catabolic states
• wrongly applied reduction diets
• diseases in general
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malnutrition
• malnutrition manifests in shortage of following
nutrient factors:
– vitamins (eg. thiamine, riboflavin, B, C, fat
soluble: A)
– minerals (Ca, Fe, I, Se, F)
– essential fatty acids, amino acids (linoleic acid,
lysine, methionine, tryptofan)
– proteins
– energy
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malnutrition in developing countries
• nutritional energy shortage together with lack
of proteins and vitamins, especially the B
group
• malnutrition in children: KWASHIORKOR
• low hygiene, worse access to information,
shortage of basic foods
• bacterial and other microbial contamination of
food
• further nutrient loses by non-adequate food
preparation
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Kwashiorkor – large bellies – ascites caused by lower
plasmatic protein concentration -> low oncotic pressure
-> see Starling hypothesis
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(mental) bulimia
• eating disorder – mental/ psychiatric disorder
• overeating with compulsive and repetitive
induction of vomiting
• alternating periods of compulsive fasting and
overeating, compulsive vomiting, laxative
abuse, with dehydration as a complication
• mostly in teenager women, but higher age
women and men are not exceptions
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Bulimia
consequences/ complications:
• teeth decay and esophagal mucosa erosions - due
to vomiting
• alkalosis and sodium depletion - due to vomiting
• gastric mucosa changes
• cardiovascular complications – Na, K, Cl
imbalances
• psychiatric problems, depressions = real cause of
the disease
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Bulimia
-dominating
cause is
psychiatric
disorder
-besides
organ
changes
shown here
this leads to
pathologic
obesity and
- body
weight
fluctuations
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Pathogenesis: - “simple” way to elicit the vomiting reflex
- food abundance in developed society
-fixation of pathologic dietary habits
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(mental) anorexia
• eating disorder – mental/ psychiatric disorder
• mostly women – estimates up to 3 % of
population
• fasting together with high physical activity –
negative energy balance
• imprinting of “ideal beauty” pattern
- consequences/ complications:
• hormonal imbalance – loss of menstruation,
infertility
• muscle atrophy, internal organ protein and weight
loss
• skin problems, hair and nails loss etc.
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mental anorexia
• Associated psychiatric conditions: depressions,
neurotic disorders, auto-mutilation, hysterical
disorders
• internal organ protein and weight loss leads to
secondary malabsorbtion – vicious circle, parenteral
nutrition indicated
• body weight under 30 kg – life threatening condition
• differential diagnosis – true anorexia = kachexia,
esophagus and swallowing disorders, GIT tumors,
etc.
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anorexia
-dominating
cause is
psychiatric
disorder
-organ
changes are
similar to
“true”
malnutrition
and
starvation
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therapeutic approach to anorexia
• difficult, psychiatry, in-patient section
• prevention – education, psychological view – respect to
self is needed, unfortunately this is domain of psychiatry
• food variety intake regimes
• introduction of new feeding habits
• dangerous, epidemiologically important due to
contemporary TV and other media
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(Czech) standard diets in hospital
0. liquid diet
1. puree, gruel d.
2. non-iritating (GIT favoring) d.
3. balanced d.
4. reduced fats d.
5. fiber free d.
6. low protein content d.
7. low cholesterol d.
8. weight reducing d.
9. diabetic d.
10. low sodium d.
11. re-alimentation d.
12. toddler d.
13. childrens’ d.
0. tekutá
1. kašovitá
2. šetřící
3. racionální
4. s omezením tuků
5. bílk., bezezbytková
6. nízkobílkovinná
7. nízkocholesterolová
8. redukční
9. diabetická
10. neslaná šetřící
11. dieta výživná
12. strava batolat
13. strava větších dětí
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Other specialties
Gluten free diet
- Coeliac (celiac) disease, celiac sprue
Pancreatic diet
- Subsequent procedure from liquid to puree/ gruel
diet, and gradual re-alimentation, dyspeptic
syndrome, chronic pancreatitis
Chronic renal failure diet – low/ defined protein
content diet
-more strict in patients not participating in dialysis
program
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Other specialties
Lactose intolerance diet
- In suspicion of lactase deficiency
Occult GIT bleeding diagnostic diet
- 3 days before GIT functional investigation
Schmidt’s diagnostic diet
- 3 days before GIT functional investigation
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parenteral nutrition
• By-passing GIT
• Intra-venous/ v. subclavia, balanced:
sugars, fat emulsions, amino-acids,
vitamins, minerals
• Complete parenteral nutrition: energy
requirements, water load, osmolarity,
utilisation
• GIT surgery, Crohn’s disease,
postoperative care after acute abdomen
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