chapter 5 Flashcards
1
Q
Young adulthood (20-35)
A
- sexual maturity
- max. Ht
- peak bone mass
2
Q
3rd decade (20s)
A
- loss of bone density
- max. muscle mass, then decline
3
Q
5 year after maxi. Ht
A
max. strength, endurance, agility
4
Q
30s
A
- catabolic phase slighter higher anabolic unless PA
- ↓ muscle mass–> ↓ BMR–> ↓ calorie needs
5
Q
Middle adulthood (50-69)
A
- catabolism > anabolism–> imbalance
- ↓ muscle mass–> ↓ BMR–> ↓ calorie needs
- average Wt ↑ till 7th (60s)
6
Q
aging person fails to adjust cal. intake to energy expenditure
A
xs. body Wt+ fat–> accumulate in wastline
prevent by PA
7
Q
PA
A
prevent/ slow down ↓ bone/ muscle mass
8
Q
↑ waistline
A
↑↑↑ risk of HTN, diabetes, CVD, chronic heart disease
9
Q
BMI > 25–> OBESITY
A
morbidity of obesity ↑ - Overwright > 25lb --> ↑ risk of CHD in female by 2-3X --> ↑LDL, ↓HDL , ↑LDL/HDL metabolic chronic disorder--> diabetes, CVD, HTN, liver disease, cancer (breast, colon, prostate)
10
Q
shift in industrialization
A
- shift in natural composition of diet
- ↑intake of animal fat, ↓complex CHO+ fibre
- cancer, CHD, obesity, dental disease
11
Q
fruit+ vegetable
A
protection
- > =5 serving–> ↓ premenopausal breast CA
- rich in Vit C/ β-carotene
12
Q
Key aspect accelerate aging, ↑ chronic disease
A
- ↑ in sat.fat, alcohol, Na, sugar+ ↓ in fiber
- smoking, little exercise, high stress
13
Q
educate health diet and exercise
A
- delay onset of aging and chronic disease
- ↑ optimal function for longer period
- ↑ quality of life
14
Q
unified dietary guidelines
A
- eat a variety of foods
- plant source
- > =5 serving of fruit and vegetable daily
- > =6 bread, pasta, cereal grains
- ↓ high fat food, ↓ animal source
- minimum simple sugar
15
Q
population ageing
A
occur when ↑ median age of a country/ region due to ↑ life expectancy and/ or ↓birth rate
16
Q
aging, time dependent changes
A
↓ organ mass
↓ # of GI cell
↓ function of organ (kidney)
–> mortality and morbidity rate happen elderly
17
Q
usual aging
A
- process accelerated by disease& lifestyle factor
- poor exercise habit and alcohol and tobacco abuse
18
Q
successful ageing
A
- age- related change not due to disease& lifestyle
- have sound nutritional habits, exercise regularly, regular BP
- non-smoker, no Xs alcohol, no diabetes, no obesity
19
Q
Nutritional factor effect ageing
A
- Vit E–>Influence immune function
- Multivitamin+ mineral–> ↓1/2 infection rate
- malnutrition
- age-related disease (cataract , dementia) inhibited by supplement
- green vegetable (Vit C/ E)
- folate supplement
- fish, fish oil
20
Q
nutritional intervention
A
a practical approach for modulating immune function compared to pharmacological intervention
21
Q
Immunosenescence
A
age-related alteration in immune response–> decline in T-cell
22
Q
Vitamin E
A
immune enhancing effect
-bio. active form Alpha tocopherol, most effective
improve T-cell
–> inhibits prostaglandin E2 in macrophages
–>reverse altered cytokine profile of T-cell
–> - Th1 cytokin IL-1 and IFN-γ production, IL-2 receptor expression
23
Q
Best predictor of total number of visit to hospital or physician
A
Malnutrition
24
Q
green vegetable (Vit C/ E)
A
- boost immune function
- ↓ incidence of cataract
- improve mental ability+ prevent some forms of dementia
25
folate supplement
- ↓ dementia, ↑ mental function
- deficiency--> 3X risk of dementia
- early dementia--> Wt loss--> folate metabolism
26
fish, fish oil
- ↑ cognitive perforce
| - ↓ dementia
27
Body composition of elderly
skinny fat
obesity
1. ↓ LBM+ ↑ fat (↓ cell mass, ↓ bone mineral)--> ↑ Wt
- due to ↓ PA+ hormonal change
1. ↓ growth hormone
2. ↓ estrogen+ testosterone--> BMD
3. ↓ testosterone --> ↓ muscle mass--> inability to maintain protein store
- ↓ LBM before ↓ BMD ↓ BMR
28
indicator of true fat mass and hence obesity of elderly
1. fat mass, not BMI-->BMI cannot distinguish between fat mass and muscle mass
2. Perfect body fat (male> 30 PBF, female> 40)
3. Wast circumference> 40inch male, >30 women--> T2DM& heart disease (cannot discriminate visceral vs. subcutaneous fat)
HTGW (hypertriglyceridemic waist)+ visceral fat+ TG--> CVD
4. visceral fat--> fat liver--> ↑TG by liver--> insulin resistance
decline in resilience of hypothalamus-pituitary-adrenal (HPA) axis
29
↑ intramyocellular fat mass
↑ insulin resistance
30
key to sustain muscle mass
adequate caloric/ protein+ PA
31
cytokine
↑ adipose tissue--> ↑ cytokine--> ↑ low grade inflammation--> ↓ muscle protein meta.+ func.--> ↑ protein degradation in myofibrillar--> ↓ protein syn. --> muscle wasting
32
sarcopenia
age-related loss of muscle mass+ function
loss capacity for myofibrillar to contract
prevent by resistance training
33
Chronic disease
1. CVD (due to heart condition/ HTN)
2. Cancer (leading cause of death)
3. diabetes
4. hypertension
5. high blood cholesterol
6. obesity
7. visual impairment
8. dementia
9. osteoporosis (arthritis)
use of drugs--> influence nutrient requirement, absorption, utilization, excretion
34
frail elderly
>=3
1. muscle weekness
2. slow walking speed
3. exhaustion
4. low physical activity levels
5. unintentional weight loss
- -> risk of fall, hospital admission, death in several years
35
theories of ageing
↓ caloric intake--> ↓ accumulation of FR--> better ability to handle oxidative damage--> ↑ lifespan--> conferring protection to chronic disease
1. cellular mutations
2. ↓ hormonal recreation
3. cross-linking
4. free radicals
5. immune system deterioration （immunosenescence）
6. pre-programmed ageing under genetic control
36
1. cellular mutations
- drugs, UV light, mutagens, radiation--> DNA damage, ↓DNA repair activity--> error in DNA replication, transcription, translation--> error of RNA & protein synthesis, ↓ function of cell
- environmental stressor--> damage & kill cells, apoptosis
- DNA methylation+ methyl group on cytosine nucleotide--> predator of mortality, biological age, epigenetic clock
- difference between (+)DNA methylation predicted age and (-)chronological age--> heritable trait, associated with ↑ risk of mortality
37
2. ↓ hormonal recreation
1. ↓ growth hormone--> ↑ adipose tissue--> ↓ LBM
2. ↓ testosterone--> ↓ ability to maintain protein store& bone mass
3. ↓ estrogen--> ↓ ability to maintain protein store
4. insulin
38
3. cross-linking
- glycated protein --> crossing-linking
| - glucose molecule attach to another molecule--> advanced glycation end product (AGE)--> intracellular damage+ apoptosis
39
4. free radicals
environmental exposure via radiation, natural body process
macromolecular damage
↓ caloric intake= ↓ FR accumulation
40
5. immune system deterioration （immunosenescence）
- ↓ immune competence-->↓ T& B cell function
- autoimmune disorder+ chronic inflammatory disease
- thymic involution--> ↓ thymocytes mature to T cell--> ↓ T cell
- ↓ cell-mediated immunity/ immune competence/ immune dysregulation
41
6. pre-programmed ageing under genetic control
- natural limit to cell division
- death gene P53
- age--> protective function of telomere fail--> DNA repair machinery/proliferation (require P53 to stop)--> apoptosis for rapid turnover cell (blood cell) -->cell senescent
42
3 ways of cell senescent
1. telomere shortening (replicative senescent)
2. over-exposure to oncogene (over reactive--> cancer)
3. DNA damaging
senescent cell--> biochemical detrimental to normal function neighbouring cell
43
Malnutrition in older adult
1. ↓ body function
2. chronic disease
3. multiple medication
4. need assistance with self-care
5. tooth loss or oral pain
6. eating poorly
7. economic hardship
8. reduced social contact
- -> progressive undernutrition
44
changes in organ function
1. ↓ # and function of taste buds
2. ↓ salivary secretion--> xerostomia
3. ↓ esophageal function
4. ↓ gastric function/ emptying
5. ↓ liver/ biliary function (↓ drug metabolism--> overdose )
6. ↓ pancreatic secretion
7. change in intestinal morphology
8. change in renal morphology (glomerulonephritis)
45
Antivitamin drugs
- inhibit vitamin absorption
- bind to them, unavailable to body
- ↑ catabolism
- ↑ excretion
- inhibit forming active form
46
drugs side effect
↓or ↑ appetite, taste change
47
polypharmacy
strong predictor of malnutrition
48
movement of drugs
absorption
distribution
metabolism (liver-cytochrome p450)
excretion
49
grape/ fruit juice
inhibit intestinal metabolism (cytochrome p450 3A4 enzyme)
| Ca channel blocker, HMG-CoA inhibitors, anti-anxiety agents--> ↑ risk of toxicity--> 72hr, no fruit
50
warfarin (anti-coagulate) vs. Vit K
1. warfarin prevent Vit k to active form
| 2. Vit K--> more coagulating factor--> drug less effective
51
Methotrexate (cancer drug) vs. pyrimethamine (for malaria)
folic acid antagonists--> reduced form--> folanic acid--> folic acid deficiency
-folanic acid not require to form active form, not require dihydrofolate reductase to active
52
alcohol
gastric irritant with NSAID--> GI bleed
| alcohol cannot consume with hepatotoxic drug
53
cholesterol lowering drug--> bile acid sequestrant
1. cholestyramine--> antihyperlipidemic bile acid sequestrant--> adsorb vitADEK+ folic acid
2. X reabsorption of bile salt--> ↓ fat soluble vit. absrp.
3. require supple.
54
Drugs damage to GI tract
1. drug-nutrient interaction
2. food- drug interaction
1. ↓ nutrition absorption from antibiotic drug (neomycin)
2. destroy intestinal mucosa, villi, microvilli, inhibit brush border enzyme
chemotherapeutic agents, NSAID, antibody
- alter ability to absorb mineral, Fe+ Ca
- damage gut mucosa
drug effect intestinal transport--> gochisin, anti-inflammatory agent
55
anti-inflammatory drugs
1. inhibit lactase
| 2. damage on gut--> ↓fat+ micronutrient absorption
56
laxatives contain emollients, mineral oil
- keep water in stool and intestine
- -> dissolve fat+ fat soluble vit. --> excrete, not absorption
- -> ↓ transit time--> ↓ absorption of nutrient, Ca+ K loss
- higher fiber--> ↓ absorption of tricyclic anti-depressant
57
anti-ulcer drug (cimetidine)
1. ↓ HCL product--> ↑ pH--> X absorb Ca, Fe, Zn, folic acid, β-carotene
2. ↓ amount of B12 from food
3. ↓ B12 available for binding intrinsic factor for absorption
4. ↓intrinsic factor secretion
58
loop diuretics for bp (furosemide)
1. ↑ renal excretion of thiamine --> cardiac abnormality
2. inhibit co-transporter Na-K-Cl on kidney
3. ↑ excretion of K, Mg, Na, Cl, Ca
4. needs supple. electrolytes
59
diuretics (thiazide)+ corticosteroid
1. ↑ K, Mg excretion, ↓ Ca excretion--> hyperclacemia--> vasodilation --> risk of cardiac arrhythmia
2. corticosteroid--> ↓ Na excretion, ↑K, Ca excretion--> supplement of Ca+ Vit D--> ↓ risk of osteoporosis
60
aspirin increase folate excretion
1. bind folate binding site in plasma protein
| 2. gastric bleeding
61
low albumin
- make drugs more potent by increasing availability to tissue
- low albumin--> low dosage
62
Body composition--drug
↑ adipose tissue--> fat soluble drugs accumulate--> ↑ toxicity
63
alendronate (fosamax)--> anti-osteoporosis
must sit upright for 30 mins after taking--> avoid esophagitis
64
drug induced diarrhea
diarrhea= >=3 unformed bowel action in 24hours
1. Acute: episode of diarrhea lasting < 2 weeks
2. Chronic: diarrhea for at least 3-6 weeks
- frequency and severity of dehydration & electrolyte loss--> sever nutrient deficiency
- ageing affect immune/ non immune defense
65
drug associated diarrhea contributing factor
1. polypharmacy, self-medication, noncompliance regarding to usage
2. inappropriate drug prescribing
66
drug associated diarrhea
1. antibiotics (alter colonic bacteria)
2. osmotic agent--> antacid (Mg trisillicate, Mg hydroxide)
3. antineoplastic--> damage immature epithelial cell
4. antimetabolites
5. laxative
67
Bone remodelling
- replacement of old bone with newly synthesized bone tissue
- osteoblasts synthesize bone matrix
- osteoclasts dissolve bone mineral with acids and digest bone matrix+ recruitment of phagocytes to remove protein
regulated and coordinated cycle of removal of old bones followed by compensation of the new bone done by osteoblasts, in response to micro-damage in many mechanical loading
68
women menopause
rapid bone mass loss 3-5%/yr for 6-8yrs--> new set point
| - ↓ serum 17b-estradiol, serum estrone
69
main determinant of peak bone mass 30yr
Ca intake
70
max rate of accretion of bone mass
pubertal growth spurt
71
low Ca intake
deplete bone calcium to maintain blood Ca level
72
factor increase osteoporosis
1. men: larger skeleton, bone loss starts later and slower, no rapid hormonal change
2. aging: older, lager risk, ↓ GH from anterior pituitary gland--> ↓ hepatic IGF1/ ↑ IGF2--> ↓growth factor bing proteins
3. body size: smaller thin bone female higher risk
4. family history
5. ↓ estrogen
6. low Ca, malnutrition
7. amenorrhea (loss menstrual period)
8. anorexia nervosa
9. glucocorticoids--> steroid hormone--> inhibit osteoblast, IGF1 synthesis--> loss bone mass
10. ↓ testosterone in men
11. ↓ PA
12. Cigarette
13. Alcohol
14. caucasian, asian
73
Type 1 osteoporosis
trabecular bone loss (skeleton)
- ↑ osteoclast--> rapid bone loss
- female ↓ estrogen, male ↓ testosterone
- PTH mobiliza Ca from bone to blood-->↑ osteoclast osteoclast
- female: male= 6:1
- 50-70
- rapid
74
estrogen
1. ↑ osteoclast precursor cell apoptosis, ↓ differentiation
2. transforming growth factor beta induce osteoclast apoptosis, bone structure
3. formation TGF-beta
4. suppress production of bone-resorbing cytokine and prostaglandins
75
Type 2 osteoporosis
cortical bone loss
1. senile osteoporosis, age-related
2. slow, steady
3. 40yr
4. osteoblast under activity
5. female: male= 2:1
6. accumulation of bone marrow fat at expense of osteoblast genesis
7. adiposity inhibit osteoblast
8. sacropenia
9. estrogen deficiency
10. ↑ PTH in men--> resorption--> ↑ osteoclast
11. Ca& Vit D deficiency--> 2nd hyperparathyroidism--> ↑ osteoclast
12. ↓ 25 (OH)D--> ↓1-25 (OH)2D and Ca absorption--> ↑NPTH--> ↓decrease intestinal Ca absorption and intake
76
Calcitriol
analogue alfacalcidol
- prevent osteoporosis
- goog for female BM with postmenopausal osteoporosis
- metabolically active form
77
exercise for women
1. aerobic exercise 20min, 3times/week
2. weight training
improve muscle strength and coordination
↓ risk of fall-related fracture
