N- Eating disorders, diabetes, cancer Flashcards
1
Q
Methods to measure body shape…
A
BMI
Skin fold thickness
Waist to hip ratio
Dual energy x-ray absorptiometry (DXA)
2
Q
The eating disorders (3)
A
- Anorexia nervosa (av duration 8yr but…)
- Bulimia nervosa – in the 1970s (av duration 5 yr but..)
- Binge eating disorder (BED)
3
Q
Scoff Test
A
- Sick make yourself because feel full
- Control worry over loss of in relation to food
- One stone lost in 3m
- Fat see yourself as fat when others don’t
- Food dominates life
4
Q
Why might someone develop an eating disorder?
A
- Peer/ family pressure
- Media eg very thin models in fashion magazines
- Stress
- Genetic component- esp in Anorexia
- Sports, hobbies such as gymnastics and ballet
- Social media
- Role of Serotonin
- Leptin & ghrelin function
5
Q
Prevalence of anorexia in UK
A
- 1: 150 15 year old girls
* 1:1000 15 year old boys
6
Q
What is Anorexia Nervosa?
A
- Fear of gaining weight so eat little
- 15% below wt. for ht./age
- BMI < 17.5
- Body Image dysfunction
- Denial of low weight
- If reproductive years –amenorrhoeic for @ least 3m
7
Q
Medical consequences of AN?
A
- Starvation and dehydration; circulatory problems, kidney/heart fail
- Long term - stunting of growth, osteoporosis possibly fertility problems
- 5% DIE or commit suicide
- Dehydrated- kidney failure
- Cardiac (all the muscles are wasting)- heart failure… death
8
Q
General treatment for AN/BN
A
- Cognitive therapy in improving mental health (but W/L)
- Individual / group/ psychotherapy
- Life skills; nutritional advice
- Drugs (BN – SSRIs eg fluoxetine)
- In – patient care may be necessary
9
Q
Specific tx for AN
A
- Early intervention best
- Aim to attain viable weight
- Alter feelings about body image/food
10
Q
Prognosis AN
A
- 50% recover after treatment
- 30% retain partial symptoms
Approximately:
- 20% become chronic
- 5% die –
- starvation, heart failure or suicide
- AN has one of highest rates of suicide of all psychiatric illnesses
11
Q
Dental considerations for AN?
A
- Halitosis: pear drops (ketosis)
- Dry mouth- TCAs
- Drug doses
- Reduced immune response: periodontal disease, angular chelitis (malnutrition)
- Medical emergencies: vasovagal syncope (faint), cardiac arrest
12
Q
What is Orthorexia Nervosa?
A
- Obsession with eating pure or clean foods
- Feelings of extreme guilt if something unhealth is eaten
- Judging others
- Management: therapies to tackle underlying mental health disorder (CBT, counselling)
13
Q
Clinical features of Orthorexia nervosa?
A
- Fatigue
- Poor immune response
- Malnutrition; angular cheilitis, recurrent aphthous ulceration
- Deficiencies e.g. B12
14
Q
What is Bulimia Nervosa (BN)?
A
- May be of any weight
- Eating pattern
- Binge eating (recurrent) of high calorie food, followed by secret purging.
- Food hidden in secret places
- Use of laxatives & diuretics to control weight fluctuations
15
Q
Prevalence of BN
A
- Female : Male = 20:1
- Mainly young people
- Up to 20% females binge @ some time
- Anorexia- 0.25% population
- Bulimia – approx 1%
16
Q
Medical consequence of BN
A
- GI -cramps, constipation , diarrhoea
- Electrolyte imbalance
- Damage oesophageal sphincter, muscles
- Lower bowel damage
- Throat ulcers
17
Q
Oral presentation of BN, may have:
A
- Dental erosion (gastric acid PH 2.9)
- Dry mouth ( ↓ salivary flow)
- Inflamed palate
- Dry, chapped lips
- Parotid enlargement
18
Q
Dental features: erosion from bulimia
A
- Vomit pH is roughly 3.8
- Palatal surfaces of incisors
- Perimylolysis (molars)
- Caries
• Treat teeth as needed when BN under control
19
Q
Dental erosion- diagnostic criteria for BN
A
- Palatally on upper incisors (often extensive)
- Palatal aspects upper posterior teeth “cupping”
- Occlusal & buccal surfaces U & L posterior teeth (variable)
- “Squeaky clean “ teeth but could have gingivitis
20
Q
Management of OW/OB- Long term plans & goals to be approached incrementally
A
• Control of diet • Behaviour management • Regular Exercise • Drug treatment • Surgery ON-GOING MONITORING & REINFORCEMENT
21
Q
Effect of increasing levels OW/OB on dental care
A
- More diabetic patients, (periodontal problems, care with appointment times)
- Cardio – vascular disease (anti coagulants, high BP
- Arthritis (mobility problems)
- More chronic periodontal disease to treat 1
- Increased caries? Decreased stimulated salivary flow rate 2
- Bariatric equipment may be needed
- Increased GA & sedation risk
22
Q
Uses of blood glucose
A
- Muscle storage for later use (glycogen)
- Energy source for muscle and other tissues
- Storage as fat (triglycerides)
- Excretion in urine with high blood sugar, 160mg/dL
- Energy for CNS and brain (60-70%)
- Liver storage for later use (glycogen)
23
Q
What is Diabetes Mellitus?
A
- Metabolic disorder of carbohydrate metabolism
- Characteristic: Hyperglycaemia ( blood glucose)
- High morbidity & mortality
24
Q
Blood Glucose levels fasting:
Normal and diabetic?
A
Normal Fasting conditions: 3 to 5 mmol/l
Diabetic Fasting conditions: 4-7 mmol/l
25
Blood Glucose levels after a meal?=
Normal and diabetic?
Normal: less than 10 mmol/l 90 min post food
Diabetes: >20 mmol/l
26
Symptoms of diabetes?
- Blurry vision
- Increased thirst and need to urinate
- Feeling tired/ill
- Recurring skin, gum, bladder infections
- Dry itchy skins
- Unexpected weight loss
- Slow healing cuts and bruises
- Loss of feeling in feet
27
Types of diabetes...
1- Type 1 (insulin dependent)
2- Type 2
3- Gestational diabetes
4- Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)
28
What is Type I diabetes?
* Chronic (generally) childhood disease
* Affects 18-20 per 100 000 children in UK
* Genetic susceptibility shown
* Linked to viral infection (e.g. congenital rubella syndrome)
* Lack of insulin production
* Thought to be autoimmune mediated disorder
* Affects islets of Langerhans
* Beta cells are killed by antibodies
* Therefore, lack of insulin production
* Most cases <40
29
Type 2 Diabetes
| Non-insulin dependent or adult-onset diabetes
Can be caused by hyperglycaemia
- Obesity
- Multiple genetic susceptibilities...
- Primary beta-cell defect
- Damaged/inadequate insulin secretion
30
Main symptoms of type 2 diabetes
1. Polyuria (frequent urination due to osmotic diuresis)
2. Polydisia (Increased thirst & increased fluid intake due to polyuria)
3. Polyphagia (Increased appetite)
Other symptoms:
Dry mouth, itchiniess, increased incidence of thrush, cramps, skin infections
31
What is Gestational Diabetes?
* 2-5 % of all pregnancies
* Onset in late 2nd trimester (20-28 weeks)
* Predisposing factors
age (>35 although can occur in younger mums)
ethnic group
Obesity
32
Symptoms of Gestational diabetes?
excessive thirst
frequent urination
increased appetite
No obvious external symptoms
33
Causes of gestational diabetes?
Hormonal changes cells less responsive to insulin
Increase resistance to insulin
... Increased blood glucose
34
Long term effect of gestational diabetes
* Larger babies
| * Mum at risk of Type 2 diabetes
35
How are diabetes & pre-diabetes diagnosed?
- Glucose testing
| - Fructosamine test
36
Describe the 3 glucose tests for diabetes
• Fasting plasma glucose (FPG)
– Measures blood glucose when the person has not eaten for at least 8h (detect diabetes & pre-diabetes)
• Oral glucose tolerance test (OGTT)
– Measures glucose after an individual has fasted for at least 8h and 2h after consuming a glucose containing drink (detect diabetes & pre-diabetes)
• Random plasma glucose test
– Casual plasma glucose test; i.e. measures glucose irrespective of whether the person has eaten or not (diagnoses diabetic only)
37
How to monitor/ maintain control of diabetes test...
| Using red cells and glycated haemoglobin A1c
Red cells have a span of 8-12 weeks!
Hb1Ac in red cells gives an indication of the average glucose levels for 8-12 weeks.
```
Normal= 3.5-5.5%
Diabetes= 6.5%
```
38
What is the Fructosamine test?
• Fructosamine is formed from serum proteins such as albumin
– (reaction between fructose & amine)
• Used in cases of:
– blood loss
– haemolytic anaemia
– sickle cell anaemia
* Gives an average results for the last 2-3 weeks
* Tends to be basis of over-the-counter tests
39
What else could cause hyperglycaemia?
Steroids
Antipsychotics
Diuretics
Antihypertensive
40
What else could cause Hypoglycaemia
Alcohol
Hormone deficiencies
Prolonged starvation
41
Management of diabetes- aim: to lower blood glucose levels
• Type 1
– Insulin (Essential)
– Exercise
– Diet (low in fat, cholesterol & simple sugar)
```
• Type 2
– Weight reduction
– Diet
– Exercise
– If above not successful then,
• Oral hypoglycaemic medications & then insulin
```
42
Managing diabetes...
• Sugar
– Avoid adding sugar to food
– Avoid foods sweetened with sugar or honey
• Cholesterol & fat
– Increase carbohydrates before sustained exercise
– Limit intake of saturated and hydrogenated fats and cholesterol
• Monitor blood glucose regularly
• Regular meal times
• Important to follow-up care
43
Treatments- Oral hypoglycaemic agents
Biguanides (Metformin)- Type 2 diabetes & Type 1 with insulin therapy
Sulphonylureas
44
What do Biguanides do?
* Inhibits glucose production by the liver (gluconeogenesis)
* Useful in patients who are obese
Unwanted effects:
• GI disturbance
• Lactic acidosis (contraindicated for those with renal, severe pulmonary or cardiac conditions)
45
What do Sulphonylureas do?
Increase amount of insulin made in pancreas (requires functional islets of Langerhans)
Long lasting effect
• Problem: hypoglycaemia in elderly patients or those with kidney problems
```
Unwanted effects:
• Appetite stimulants (weight gain)
• Hypoglycaemia
• GI upsets (3% of patients)
• Potentially teratogenic (do not use in pregnancy or planning one)
```
46
• Some drugs AUGMENT hypoglycaemic effects of sulfonylureas e.g.
* NSAIDs
* Alcohol
* Antibacterial (Sulphonamides, trimethoprim, chloramphenicol)
* Antifungal (Miconazole, fluconazole)
47
• Some drugs DECREASE the actions of sulfonylureas e.g
* Diuretics
| * Corticosteroids
48
Dental diseases due to diabetes.. gum disease is very common
Red & swollen gums
Increased bleeding while brushing
Increased plaque
Results in periodontitis & gingivitis
Gum disease followed by tooth decay
Inflamed & sore tissues, ulcers
49
Dental hygiene, diabetes & heart problems:
Bacteria can enter blood stream - endocarditis
| Cholesterol build up in blood stream – atherosclerosis
50
How to dental care with diabetics
- Diet control
- Morning app
- Medication taken?
- Tx breaks...
- Regular visits
- Antibiotic requirements
51
Collecting the evidence linking diet and cancer: Human studies
- Ecological studies
- Case-control studies
- Prospective cohort studies
- Randomised controlled trials
52
Investigating mechanisms
- In vitro
- Exfoliated cells
- Cells in culture
- Animal models
- Human studies
53
Mechanisms for the role of diet in carcinogenesis
Diet may influence the chance of developing cancer by:
– Increasing exposure to chemical carcinogens (Chinese style salted fish)
– Facilitating the action of viruses (HPV)
– Influencing effects of hormones (adiposity and oestrogen, fibre and steroids)
– Minimising oxidant and other damage to DNA
– Influencing DNA repair genes
