GHM L1 Flashcards
Macronutriens
- Fats
- Carbohydrates
- Proteins
Fat
Major constituent of membrane phospholipids
ESSENTIAL Precursors of eicosanoids
Eicosanoids
- Thromboxane
- Prostaglandins
- Prostacyclin
Carbs
ESSENTIAL Plant origin. Except lactose + small amount of glycogen
Essential
Something we cannot make ourselves
Amino Acids
Synthesising:
New proteins
Thyroid hormones
Neurotransmitters
Catecholamines
DIAGRAMS OF MACRONUTRIENTS
RECOGNISE THEM!!!!
What happens if we get too little fat in diet?
Fatty acids are essential
Failure in growth
Reproductive problems
What happens if we get too little carbs in diet?
Carbs not needed.
But, too little carbs leads to protein sparring effect.
This leads to acidosis. This where carbohydrate starvation leads to glycolysis to stop and lypolysis to start. This is to provide energy.
This leads to ketoacids being produced. This increases irrersible damage + acidity
Hypoglycemia - drop in blood sugar levels, fatigue
Muscle wasting - amino acids used up for energy
What happens if we get too little protein in diet?
Kwashiorkor
- Very severe permananet intellectual disability
- Severe oedema
- Dermatitis
- Liver enlargement
Marusmus
<60% of weight for age
Deficiency in calorie intake
Kwashiorkor
60-80% of weight for age
Oedema
Protein deficiecny
Marasmus Kwashiorkor
<60% of weight for age
Oedema
Underweight
60-80% of weight for age
No oedema
Malnutrition
Failure to thrive
Types of malnutrition
- Marasmus
- Kwashiorkor
- Marasmus Kwashiorkor
What happens if we get too much fat in diet?
CVD - Cardiovascular Disease
What happens if we get too much carbs in diet?
Diabetes Mellitus
Glucose Toxicity
What happens if we get too much protein in diet?
- Some cancers
- Calcium stones in Urinary Tract
-Osteoperosis
-Kidney disease
How can too much of all macronutrients cause obesity?
DIAGRAM L1
All macronutrients are eventually broken down into AcetylCoA
Body Fat %
New Born: 14% (male/female)
10 year old: male: 13% female: 19%
ADULT essential fat: male: 5% female: 13%
ADULY normal weight male: 15% female: 28%
Obese ADULT male: 25+ % female: 32+%
BMI (KG/M2)
<18.5: underweight
18.5-25: healthy
25-30: overweight
30-35: obese I
35-40: obese II
40>: OBESE III
Why is obesity harmful?
Endocrinology (affects endocrine system) leading to:
-Diabetes Mellitus
-Polycistic Ovary Syndrome
-Infertility
-Menstrual Disorders
Gastrointestinal Problems:
-Fatty liver disease (2 types, AFLD, NAFDL)
-Non-alcoholic cirrhosis
-GERD
-Gall Stones
13 Cancers associated with being overweight + obesity
Non-Alcoholic Fatty Liver Disease
Causes cirrhosis im liver
Linked to soft drinks
Linked to insulin resistance
TREATMENT:
Anti-diabetic medication
Diet
Exercise
Bariatric surgery
Gall Stones
Crystallisation caused by excess cholestrol or lack of bile salts
Symptoms:
- Pain when gall bladder contracts
- Blockage of bile duct leading to bile retention
- Jaundice
-Secondary infection by intestinal bacteria
Risk Factors:
- Obesity
-Cirrhosis
-Sickle cell disease
Treatment:
-Removal, dissolution, sonication of gallstones
Non-vegetarian have 9x higher incidence
Gastro-oesophagul reflux disease (GORD)
Reflux of stomach contents from stomach into oesophagus. Causes pain + mucosl inflammation of oesophagus - oesophagitis
Causes heart burn (restrosternal burning pain) when lying down / after a meal
Causes of GORD
- Sleep apnoea
-Gallstones (i.e. failure to neutralise the gallstones)
-Obesity
-Transient relaxations of lower oesophagul sphincter
Non-pharmacological treatment for GORD
Ensure 2 hour gap between meal and sleep
Elavate head during sleep
Reduce Fat + alchohol intake
What factors influence energy requirements
- Basal Metabolic Rate (KJ/Hour/Kg of body weight)
- Physical activity
- Growth, pregnancy, lactation
- Muscle mass
- Age BMR DECREASES WITH AGE
- Environmental temp
- Diet induced thermogenesis
Metabolic Syndrome
Where a patient has:
- Cardiovascular disease
- Type 2 Diabetes
- High blood pressure
- NAFLD
- TOFI (thin outside, fat inisde)
Metabolic Syndrome Causes
Glycogen metabolised in different ways
Fructose only metabolised in liver
Small amount of fructose, when its metabolised, is used to produce glycogen in liver
Large amounts of it is strored as fat therefore, too much fructose in diet can lead to metabolic syndrome
This leads to NAFLD and insulin resistance
Fructose safe to eat when in fruit / vegetables. The fibre is crucial.
Satiety
Sensation of being full
Hunger hormones
- Ghrelin
- Leptin
Leptin
Supress appetite by inhibiting release of neuropeptide Y
Satiety is dependent on leptin + insulin
Leptin signals state (fullness) of fat stores:
-its plasma conc
-reflects size of fat stores
Insulin signals state (fullness) of carb stores
Ghrelin
Appetite stimulant
When levels of leptin + insulin low, ghrelin + NPY released from stomach + hypothalamus
Risk factors for obesity
- Less physical activity
- Heavy alcohol consumption
- Smoking cessation (quit smoking)
- Bad sleep
- Endocrine disorders (hypothyroidism)
- Genetic factors (thrifty genes)
- Drugs (steroids, anti-depressants)
- Immobilising diseases (restrict movement)
- Gut flora
Weight Loss Diets
- Low Fat Diet
- Low Carb Diet
- Low Calorie Diet
Low Fat Diet
Fat intake 15% of total calorie intake
- reduces calorie intake
- Reduces risk of CVD
- Small weight loss
Low Carb Diet
Carb intake 20% of total calories
More effective at reducing fat mass
More weight loss due to lower calorie intake
Low calorie diet
800kcal or less calorie intake
- Rapid, substantial weight loss in obese patients with T2D
-increases insulin sensitivity
problems:
-gallstones
-constipation
however, indicated for obese patients where healh risk of obesity is worse than the diet itself
Drugs for weight loss + obesity
LOSTI
Leptin - Does not work due to leptin resistance in obese patients
Orlistat - reduces fat absorption
Sibutramine - increases seratonin conc, decreases appetite, now withdrawn
Thyroid Hormone Treatment - Danger of death
Insulin - Danger of death, does not work due to insulin resistance in obese patients
Surgey for weight loss
SSLR
Stomach banding
Stomach stapling
Liposuction
Resection of intestine
PROBLEM:
DIFFICULT AFTERCARE
HIGH RISK
Too much Vitamin A
- Increased bone turnover (leads to osteoperosis + spontaneous bone fractures)
- Hair loss, mouth ulcers
Too less Vitamin A
- Hyperkeratosis - abnormal thickening of outerlayer of skin
- Nightblindness
Vitamin B1
Thiamine
Too much Vitamin B1
Drowsiness
Too less Vitamin B1
- Wenricke-Korsakov Syndrome (pyschosis)
-BeriBeri - affects peripheral nervous system, leads to problems walking, therefore, leads to paralysis
Osteoporosis
Condition that weakens bones, makes them fragile + more likely to break
Too much vitamin D
- Calcium stones
-Hypercalcemia
-Bone pain
Too less vitamin D
- Osteoperosis
- Rickets
-Asthma + other inflammotry coniditions
Vitamin C function
Collagen synthesis
Too much Vitamin C
kidney stones
Too little vitamin C
Scurvy
Mucous membrane bleeding
Open wounds
Lose gums
Lose teeth
death from bleeding
all of this = fatigue
