350 exam 1 Flashcards
What are the implications of the Keyes research to population groups with cyclical food availability?
“Keys also stressed the dramatic effect that starvation had on mental attitude and personality, and argued that democracy and nation building would not be possible in a population that did not have access to sufficient food.”
What might happen to the capacity to work with undernutrition?
• Decrease drastically
4 types of malnutrition
Overnutrition
Secondary malnutrition
Micronutrient malnutrition
Protein calorie/energy malnutrition
Define overnutrition
Too many calories and not enough exercise
Define secondary malnutrition
Results from condition that prevents proper ingestion, digestion or absorption and metabolism
Define micronutrient malnutrition
dietary deficiencies of vitamin A, iodine, iron, and others
Define PEM
extremely deficient intake of protein and kcalories; made worse by accompanying illness
What is “environmental enteropathy” and what is its’ proposed mechanism?
- Small intestinal disorder triggered by constant ingestion of feces
- Results in “leak” of bacteria through intestinal walls into blood stream
- Results in low-grade infections that require large amounts of energy to fight (leaves fewer nutrients for growth)
What is the relationship between toilets and stunting?
Sanitary waste disposal is important in reducing secondary malnutrition
o Poor sanitation may cause more than half of the stunting issues worldwide
o “Children who grow up surrounded by feces - animal and human - ingest it constantly which can trigger a disorder of the small intestine called “environmental enteropathy”. The intestinal walls of children who have this condition constantly “leak” bacteria into the blood stream causing chronic low-grade infections that consume vast amounts of energy to fight, leaving less nutrients available for growth.”
What explains the difference in average height between Indian and African children?
• “A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families.”
What is a problem in both industrialized and developing countries and why?
• Overnutrition—parts of that country that are very rich like the industrialized middle-class families
How did the subjects in the Keyes study adapt to semistarvation?
- Loss of active tissue caused relatively high loss of lean body mass
- Reduced activity costs were main part of energy savings caused decreased BMR, less thermic effect of food, and reduced body weight
- Reduction in tissue metabolism and in physical activity
What were the physical symptoms exhibited during the semistarvation in the Keyes study?
o Body weight decreased about 25%
o Exhibited lack of ambition, self-discipline, and poor concentration
o Were often moody and depressed
o Became less able to laugh heartily, sneeze and tolerate heat
o Heart rate and muscle tone decreased
What were the psychological symptoms exhibited during the semistarvation in the Keyes study?
o Hunger subsides after 2-3 days o Defecation ceases after 3-4 days o Urine output drops after 1 week o Blood glucose levels drop o Nausea occurs in about 1/3 of people o Hormonal changes
How long did full recovery take in these study subjects?
• 3 months were given to them, but took as long as 2 years
How does the body adapt metabolically to malnutrition?
• Gradual shift in metabolic fluids
o Glucose is produced from protein breakdown to provide energy
• Then fat breakdown and metabolism provides ketones
• Serum fatty acid levels increase
• Serum albumin is normal until late in starvation
• Weight loss
• Basic metabolic rate and total energy expenditure decrease in prolonged starvation
o Decreased activity, increased sleep; decrease in body temperatures
• Negative nitrogen balanced
What nutrient is required for energy production and where does it come from when not in the diet?
• Calories, carbohydrates—protein is broken down if carbohydrates are not available
How does the body adapt physiologically to PEM?
- Low insulin levels
- Decreased secretion of non-vital hormones (i.e. sex hormones)
- Red blood cell production decreases due to decreased oxygen demands (from lower body mass)
- Heart muscles reduce in size
- Cardiovascular and kidney changes
What is the result of the changes in the immune system during protein energy malnutrition?
- Depletion of lymphocytes
* Phagocytosis, chemotaxis, and intracellular killings are impaired
What happens to the functional capacity of the heart during protein calorie malnutrition? The lungs?
o Smaller size of ventricles
What happens to the functional capacity of the lungs during protein calorie malnutrition?
o Decreased respiratory muscle strength, maximum voluntary ventilation, vital capacity
What is the effect of electrolyte changes on muscle tissue?
- Total body potassium is reduced
- Decreased amounts of ATP
- Increased intracellular sodium—water goes with sodium, so may be intracellular over-hydration
- Increased fatigability and reduced strength of skeletal muscle
Why is there diarrhea with severe PEM?
• Decrease in gastric, pancreatic, and bile productions
• Low blood protein levels lead to intestinal edema which decreases luminal absorption, leading to diarrhea
o Worsens malabsorption and can further decrease nutritional status
What is the major effect of early life PEM?
• Decreased brain growth (cell number and growth), nerve myelination, neurotransmitter production, velocity of nervous conduction
2 types of PEM
• Kwashiorkor and marasmus
Define kwashiorkor
o Increased fat production in liver from excess carbohydrate
o Lack of protein
Define marasmus
o Wasted appearance
o Lack of protein and calories (energy)
What has been linked to the microbiome?
- Kwashiorkor
* Gut microbiome influences growth and differentiation of gut epithelial cells
