Final Section 1: Food Insecurity and Alcohol

Question 1

2016 mortality from malnutrition stats

Answer 1

5,600,000 children under 5 died
90,000,000 undernourished and underweight worldwide
particularly in African, India, Asia, and South America

Question 2

Severe Acute Malnutrition

Answer 2

SAM
WHO says weight for height -2 is wasting, +2 overweight from median Child Growth Standards for children under 5
-3 STD is severe wasting
any degree of wasting has elevated risk of death

Question 3

top causes of death for children due to SAM

Answer 3

neonatal (following birth), pneumonia, diarrhea, malaria, measles, HIV/AIDS, injuries, other

Question 4

PEU acute and chronic effects

Answer 4

acute: stunting, low weight for height
chronic: stunting, low weight for height and low height for age

Question 5

definition of stunting

Answer 5

compromised growth in length/height and growth of vital organs

Question 6

classes of PEU

Answer 6

1°: malnutrition due to inadequate intake, poverty, low food supply, poor quality food
linked with armed conflicts, political turbulence and natural disasters

2°: malnutrition due to disease state, decreased intake, decreased absorption/utilization, increased losses, increased requirement

Question 7

Marasmus

Answer 7

“successful” adaptation to PEM, inadequate general nutrition
under 2 years of age, under 60% weight for age
skin and bones appearance
due to severe deprivation or impaired absorption
develops slowly
severe weight loss, muscle wasting, including heart
anxiety and apathy
good appetite sometimes

Question 8

Kwashiorkor

Answer 8

“unsuccessful adaptation”, due to inadequate protein intake/absorption due to infection
presents with additional health issue: edema, fatty liver
loss of appetite
60-80% weight for age
rapid onset, earlier onset during weaning period (age 1-3), earlier than marasmus

Question 9

why does kwashiorkor lead to loss of appetite and fatty liver?

Answer 9

fluid retention leads to loss of appetite
no proteins to transport fats from the liver can lead to fatty liver

Question 10

edema explanation

Answer 10

plasma proteins leave leaky blood vessels and go into tissues, which attracts water
pressure leaves indentation in skin

Question 11

long term PEU consequences

Answer 11

decreased development of all kinds, productivity in adulthood, reproduction, potential of society as a whole

Question 12

infections due to PEU

Answer 12

lack of antibodies, anemia due to hemoglobin not synthesized, dysentery, fever, fluid imbalance, heart failure

infections common: diarrhea, pneumonia, UTI, measles, tuberculosis, parasitic infections (Fe and vitamin A deficiency)

Question 13

how to rehabilitate someone with PEU

Answer 13

restore fluid and electrolyte imbalances
slow increase of protein (meal replacement shake)
treat infections
involve locals

Question 14

malnutrition in socioeconomically transitioning countries

Answer 14

double burden of under and over nutrition (mortality vs. chronic diseases)
ex. Indonesia
34% of health care burden is childhood PEU
- also iron, vit A, and iodine deficiency
11% overweight/obesity and growing, largest % type II

Question 15

food security definition

Answer 15

all people at all times have access to sufficient, safe, and nutritious food and clean water to maintain a healthy active life

Question 16

how does food insecurity lead to under and over nutrition

Answer 16

poverty –> food insecurity/hunger –> inadequate intake –> malnutrition
poverty –> food insecurity –> excess intake of energy, fat and sugar –> obesity

Question 17

food insecurity in canada

Answer 17

1 in 6 children in Canada
most affordable foods are unhealthy

Question 18

old Canada alcohol recommendations

Answer 18

moderation, max 4
males - 1-2 drinks/day
females - 1 drink/day
with food
avoid if pregnant, operating machinery, or can’t control intake

Question 19

new Canada alcohol recommendations

Answer 19

max 2 drinks per week males and females
3-6 drinks per week increases breast and colon cancer risk
>7 drinks per week increases risk of heart disease and stroke

Question 20

1 drink =

Answer 20

1/2 oz pure ethanol
5 oz wine
12 oz beer
1.5 oz shooter
10 oz wine cooler

Question 21

alcohol effect on the brain

Answer 21

narcotic sedative and depressant
brain cells cannot regenerate, liver can regenerate to a point

.05% - judgement and reasoning
0.1% - vision and speech
0.15% - coordination of voluntary muscles
0.3% - stupor, confusion
0.4% - respiration and heart action

Question 22

alcohol metabolism pathway ADH

Answer 22

absorbed quickly through stomach/SI, passes directly into blood
non-inducible system, enzyme is always produced, 70% metabolism
1. ethanol (by alcohol dehydrogenase) –> NADH + H+
2. acetaldehyde + coA (by acetaldehyde dehydrogenase) –> NADH + H+
3. acetyl coA
located in liver and stomach of men

Question 23

alcohol metabolism pathway MEOS

Answer 23

Microsomal Ethanol Oxidizing System, mitochondria of liver
absorbed quickly through stomach/SI
inducible system
20% of metabolism
1. Ethanol, NADPH + H+, 1/2 O2 (microsomal ethanol oxidizing system) –> NADP + H2O
2. Acetaldehyde + NAD+ (acetaldehyde dehydrogenase) –> NADH + H+
3. acetyl CoA

Question 24

what does it mean that MEOS is inducible?
how does this lead to tolerance of drugs and alcohol?

Answer 24

enzyme produced when alcohol is present in blood
when drugs are processed, decreased alcohol processing and vice versa (system is busy)
system kicks in later, when consistently triggered there is always enzymes available and increases metabolism of alcohol/drug leading to tolerance

Question 25

percent alcohol released through breath and urine

Answer 25

10%

Question 26

how does alcohol abuse lead to fatty liver?

Answer 26

the enzymes of MEOS are busy and cannot process all the alcohol
acetyl coA cannot enter TCA and instead is turned into fatty acids and then triglycerides

Question 27

what causes fibrosis and then cirrhosis of the liver?

Answer 27

liver tissues damaged by prolonged presence of acetaldehyde, leading to decreased protein synthesis and cell damage, and then fibrosis
when liver tries to regenerate with fibrosis, it leads to cirrhosis (irreversible)

Question 28

how does alcohol cause acidosis?

Answer 28

increase H+ production through metabolism pathway to acetyl coA including reduction of NAD+

acetyl coA produces fat and ketones which are acidic

decreased gluconeogenesis leads to ketosis

less NAD+ available and so pyruvate produces lactate rather than acetyl coA

Question 29

alcohol effects on nutrition

Answer 29

empty calories, 7 kcal/g
compromises status of thiamine, folate, vit D, and B6
dehydration
increased FA synthesis, decreased AA synthesis and gluconeogenesis, increased AA catabolism

Question 30

Wernicke-Korsakoff syndrome

Answer 30

thiamine destruction from alcohol intake

Question 31

Anemia from alcohol

Answer 31

due to folate excretion

Question 32

vitamin D consequences of alcohol

Answer 32

decreased vitamin D activation in liver

Question 33

B6 consequences from alcohol

Answer 33

B6 loss from binding protein

Question 34

fetal alcohol syndrome causes

Answer 34

irreversible brain damage, growth restriction, cognitive impairment, facial abnormalities, vision abnormalities

Question 35

Health Canada and Pediatric Society recommendations for alcohol with pregnancy

Answer 35

stop drinking as soon as planning to get pregnant to avoid 1-9 out of 1000 fetal alcohol syndrome births

Question 36

what is the French paradox?

Answer 36

low CVD despite high saturated fat intake
high red wine consumption, resveratrol helps protect against LDL oxidation
alcohol increases HDL levels

Question 37

moderate alcohol consumption increases risk of:

Answer 37

hypertension, stroke, cirrhosis, cancers, ulcers, osteoporosis, depression, fetal alcohol syndrome, drunk driving, insomnia, alcoholism, 200$ billion per year in medical costs

Question 38

personal strategies to reduce risk of alcohol

Answer 38

drink in moderation, drink slowly, drink with food, don’t drive, seek help if needed
1 drink can be metabolized in 1 hour (.5oz ethanol by ADH pathway)

Question 39

CAGE

Answer 39

questions you’ve asked yourself which indicate a problem:
cut down?
annoyed by criticism?
guilty about drinking?
eye-opener?

Question 40

treatment for alcoholism

Answer 40

2 years active treatment, AA, abstinence, medications like antabuse (blocks AcAld DH and gives hangover instantly) and reviva (decreases craving and high effect by blocking binding of opioid receptors)

Question 41

cirrhosis definition

Answer 41

irreversible liver damage caused by alcohol, hepatitis B or C, or iron toxicity due to hematochromatosis
leads to carinoma

as the liver constantly repairs, accumulation of fibrosis tissue, scars and nodules and connective tissue leading to impaired function

Question 42

steatosis

Answer 42

fatty accumulation in the liver due to cirrhosis

Question 43

alcoholic hepatitis

Answer 43

inflammation of the liver due to cirrhosis

Question 44

liver resection

Answer 44

removal of part of the liver as a treatment for cirrhosis instead of a transplant