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DEMS > Exam 2 Metabolism Part 1 > Flashcards

Exam 2 Metabolism Part 1 Flashcards

1
Q

What fraction of TEE is made up by resting energy expenditure (RMR)?

A

75%

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2
Q

What is the primary determinant of RMR?

A

Lean body mass (fat free mass)

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3
Q

Define thermic effect of food? Which foods have a high/low TEF?

A

Energy cost of digesting and distributing food
Accounts for 8% of TEE
Protein>carb>fat

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4
Q

What makes up energy expended in physical activity (EEPA) and what fraction of TEE does it make?

A

EEPA = Non-exercise activity thermogenesis and physical activity
EEPA is variable but up to 30-40%

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5
Q

TEE = ?

A

TEE = RMR + TEF + EEPA

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6
Q

Average daily TEE = ?

A

25-35 kcal/kg/day (30)

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7
Q

kcal/g for diet sources?

Energy pool?

A

EtOH = 7 kcal/g (no pool)
Protein (no pool) and glucose (glycogen) = 4 kcal/g
Fat = 9 kcal/g (large storage pool)

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8
Q

Liver metabolism in fed state

A

Glucose uptake
G6P conversion to glycogen
Acetyl CoA via PDH which favors FFA and TCA
HMP Shunt

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9
Q

Muscle metabolism in fed state

A

GLUT4/hexokinase
G6P to glycogen
AA uptake and protein synth
Minimal diet fat uptake (low LPL activity)

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10
Q

Brain metabolism in fed state

A

Most of brain not insulin sensitive (GLUT1 and 3)

Aerobic metabolism of glucose

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11
Q

Adipose metabolism in fed state

A

HSL is not active
De novo lipogenesis via glucose to FA to TG
Increased LPL action and chylomicron TG uptake

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12
Q

Liver metabolism in fasting state

A

Glycogen degradtation
Gluconeogenesis
Glucose release into blood

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13
Q

Muscle metabolism in fasting state

A

Gluconeogenesis via muscle protein (AA transported to liver)
Some glycogen breakdown
FFA main source for energy during fasting (increased LPL activity)
Lactate via Cori

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14
Q

Brain metabolism in fasting state

A

Brain is obligate glucose user. Hepatic glycogenolysis and gluconeogenesis maintain concentrations

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15
Q

Liver metabolism in starvation state

A

Gluconeogenesis from muscle protein, glycerol (low level)
Fatty acid oxidation occurs at high levels
Ketone body formation

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16
Q

Muscle metabolism in starvation state

A

Catabolism releasing protein

FFA dependence for energy sparing ketone bodies for brain

17
Q

Brain metabolism in starvation state

A

Ketone body use necessary with decreasing BG

Also spares BG for RBC use

18
Q

Review glucose tests and levels for dx

A

Fasting glucose: <100, 100-125, >126
OGTT: <140, 140-199, >200
HbA1C: <5.7%, 5.7-6.4%, >6.5%

19
Q

Impaired glucose tolerance/pre-diabetes risk

A

Increased risk for macrovascular disease but not microvascular disease

20
Q

Symptoms of diabetes

A
  1. Polyuria
  2. Polydipsia
  3. Blurry vision (lens swelling)
  4. Weight loss
21
Q

Gestational diabetes

A

Pregnancy, hormone changes, and weight gain all predispose to insulin resistance
Increased risk for T2DM in the future (mom and kid)
Goal of tx is to prevent hyperglycemia in kid

22
Q

Features of hyperinsulinism in newborn

A

Large for gestational age
Glucose infusion to support normoglycemia
Large (>40) changes in BG after glucagon (suggests increased glycogen from increased insulin)

23
Q

Pancreatic diabetes

A

Caused by removal/injury or pancreatitis

Often accompanied by symptoms of etiology

24
Q

Estimate of energy expendature

A

EE (per day) = 25-35 kcal * kg

25
Q

Polyols

A

Sugar alcohols - reduced sugar, can’t absorb, gas and fermentation
Glucose -> glucitol (sorbitol)

26
Q

Glycemic index

A

For same 100g (amount of carbs), differences in glucose excursion
Low GI = less BG spike over time
High GI = more BG spike over time

27
Q

Low glycemic index examples

A

sourdough bread, apple juice, pumpernickel, oatmeal, pasta, Indian basmati rice

28
Q

Intermediate glycemic index examples

A

croissant, Coca-cola, raisin bran, whole grain bread

29
Q

High glycemic index examples

A

white bread, corn flakes, doughnut, white rice

30
Q

Glycemic load = ?

A

Glycemic index x amount of food

Increased GL = increased risk of adverse health outcomes

31
Q

Fructose metabolism enters glycolysis where?

What kind of adverse health outcomes?

A

After PFK-1, downstream in the 3 carbon section
Therefore more readily cleared by liver and converted to pyruvate
Adverse health outcomes: increased insulin resistance and hypertriglyceridemia

32
Q

Different ways to research diet and health (and what is the gold standard)

A

Animal studies
Epidemiological studies
Small RCTs with surrogate marker
Large RCTs with dz specific endpoints (Gold standard)

33
Q

Starches

A

Amylopectin: highly branched, rapid absorption
Amylose: long, unbranched, slow absorption (gas)
Resistant corn starch: slowly absorbed, role in therapy for congenital illness

34
Q

Fiber

A

Soluble: Bulk forming, lower LDL, lower prandial glucose spike
Insoluble: no water absorption

35
Q

Functions of Fatty acids

A
  1. membranes
  2. energy storage
  3. hormone precursers

DEMS (10 decks)

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