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Pathophysiology > Alterations in Energy Balance: Starvation, Obesity > Flashcards

Alterations in Energy Balance: Starvation, Obesity Flashcards

1
Q

Basal metabolic rate is influenced by: 6 things

A

Age, Body Surface, Temperature, Sex, Degree of Nutrient Supply, Emotional State

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2
Q

25 y/o 65kg male has what BMR? With light physical activity, what is his total calorie needs in a day?

A

BMR 1680 kcal/day

With light phys activity, 2600 kcal/day

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3
Q

How is indirect calorimetry measured?

A

Measure exhaled CO2 and inhaled O2 in an isolated system

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4
Q

Some conditions with increased energy needs

A

pregnancy, fever, infection, wound-healing, trauma/burning injury, tumor, some medications

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5
Q

What are the target organs of energy regulation?

A

Liver, adipose tissue, muscle

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6
Q

How much protein mass does an avg 70kg person have

A

12kg

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7
Q

How much carb mass does an avg 70kg person have

A

0.2kg

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8
Q

How much fat mass does an avg 70kg person have

A

15kg

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9
Q

What are 3 stimulatory effects of insulin on the slide?

A

Enhances glycogen, protein, and fat synthesis

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10
Q

What are 2 inhibitory effects of insulin on the slide?

A

Inhibits lipolysis and gluconeogenesis

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11
Q

What are 3 stimulatory effects of glucagon and epinephrine on metabolism from the slide?

A

Enhance lipolysis, gluconeogenesis, and glycogenolysis

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12
Q

What are 2 stimulatory effects of cortisol on metabolism?

A

Enhances gluconeogenesis and proteolysis

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13
Q

ACTH, STH, and thyroid hormone all do what to fat?

A

enhance lipolysis

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14
Q

2 examples of substrate-level fat regulation:

A
  1. elevated glucose levels increase fat synth (increasing cytoplasmic citrate and NADPH concentrations, also providing a glycerophosphate source)
  2. elevated FFA levels at starvation (inhibit cellular glucose uptake, enhance glycogenolysis and gluconeogenesis)
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15
Q

How much kcal energy does an avg 70kg person’s fat hold?

A

100,000 to 150,000 kcal

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16
Q

How many days does it take for starvation to be “adapted”

A

3 days

17
Q

Clinical conditions causing ketosis:

A
  1. Fasting, starvation
  2. untreated DM I -> DKA
  3. alcoholism
  4. ketogenic diet
  5. vomiting (mostly in children)
18
Q

A ketogenic diet may help what 2 things (from slide)

A

Epilepsy and of course to lose weight

19
Q

Which protein-energy intake deficiency in children has edema? which one does not?

A

Kwashiorkor has ascites/edema. low albumin level, fatty liver.

Marasmus: no edema. elevated glucocorticoid levels, less pronounced decrease in albumin levels

20
Q

How high can the mortality rate for anorexia nervosa be?

A

10%

21
Q

Malnutrition is suspected if:

A

10% unwanted weight loss in 3 months
Body mass <90% of ideal
BMI <18.5 kg/m2

22
Q

What laboratory tests suggest malnutrition?

A

Low albumin, transferrin, lymphocytes, Zn, Mg, vitamins

23
Q

What physical examination findings suggest malnutrition?

A

Decreased fat and muscle mass, skin/hair/nail symptoms, edema, bleeding tendencies

24
Q

What might cause increase nutrient loss, especially w/ hospitalized patients?

A

Malabsorption, diarrhea, bleeding, nephrosis, fistula drainage, protein losing enteropathy

25
Q

What is cachexia?

A

Significant weight loss that cannot be explained by decreased calorie intake alone. Increases toxicity of chemotherapeutic agents and frequency of infections

26
Q

What is one idea of how tumors induce cachexia

A

Activates ubiquitin-proteosome system, causing inflammatory mediators (TNFa, IL-6, IL-1B) and mediators produced by the tumor (proteolysis inducing factor)

27
Q

What are some treatment options for cachexia?

A

Increase caloric intake (not very effective), stimulate physical activity, progresterone/cannabis to boost appetite, inhibit inflamm mediators

28
Q

How do you measure BMI? what is the ideal range?

A

weight in kg times height in m^2

Ideal ~ 19-25 (kg/m2)

29
Q

Broca Index is what?

A

Take the height in cm and subtract 100, and that’s the kg

this is even dumber than BMI

30
Q

What 4 places do you check skinfold thickness when measuring obesity?

A

Subscapular area, triceps, biceps, suprailiac

31
Q

What’s “pre-obesity” with BMI?

A

25-30 kg/m2

32
Q

What’s obesity class I in BMI?

A

30-35 kg/m2

33
Q

What’s Obestiy class II in BMI?

A

35-40 kg/m2

34
Q

What’s obesity class III in BMI?

A

> 40 kg/m2

35
Q

What is hyperplastic vs hypertrophic obesity?

A

hyperplastic stards in childhood, get overall more adipocytes. worse outcome

hypertrophic: starts in adulthood, and it’s easier to lose weight

36
Q

Waist circumference in men vs women should be less than..

A

102 cm in men

88 cm in women

37
Q

What is the genetic component of obesity?

A

40-80%

38
Q

Leptin has what effect related to obesity

A

decreases appetite

Pathophysiology (14 decks)

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