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disease-related malnutrition > Nutrition And Disorders Of The Liver > Flashcards

Nutrition And Disorders Of The Liver Flashcards

1
Q

Intestinal failure: definition and types

A
  • definition: a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of food
  • DAYS (acute): mechanical (intestinal obstruction), non-mechanical (post operative, critical illness paralytic ileus)
  • WEEKS/MONTHS: post-surgery awaiting reconstruction, Crohn’s disease, mesenteric ischaemia, radiation, adhesions, fistulae
  • MONTHS/YEARS: short bowel syndrome, intestinal dysmotility
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2
Q

Causes of intestinal failure: mesenteric ischaemia

A
  • inadequate blood supply to the intestines
  • commonly through superior mesenteric artery (thrombosis/embolism)
  • if not treated causes irreversible infarct of the bowel
  • distal small bowel resection and hemi-colectomy
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3
Q

Causes of intestinal failure: Crohn’s disease

A
  • chronic inflammatory disease of the intestine
  • can affect the full thickness of the intestinal wall and has skip lesions (meaning it can prop up everywhere)
  • epidemiology is increasing, and could be attributable towards a Western diet
  • risk factors include: smoking, genetics, variance in immunity, interactions with the gut microbiome
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4
Q

Causes of intestinal failure: chronic intestinal pseudo-obstruction (CIPO)

A
  • dysmotile bowel: where the bowel doesnt contract properly
  • patients have a colic type pain, causes nausea and vomiting
  • small bowel bacterial overgrowth: leads to production of gas and exacerbation of symptoms
  • may require total parental nutrition
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5
Q

Causes of intestinal failure: fistulae

A
  • occurs post-operatively, crohn’s disease
  • high fistulae may connect between segment of gut or abdomen, may result in functional small bowel syndrome and diversion of fecal contents
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6
Q

Causes of intestinal failure: pancreatic insufficiency

A
  • causes: alcohol, gallstones, autoimmune pancreatitis, cystic fibrosis
  • clinical features: diabetes mellitus, fat/protein/CHO malabsorption, fat soluble vitamin insufficiency
  • need to supplement with additional vitamins and creon
  • pancreas has exocrine functions which help us absorb food, and endocrine functions that help us control blood glucose
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7
Q

Causes of intestinal failure: liver failure

A
  • acute liver failure: viral hepatitis, drug-induced (paracetamol)
  • acute-on-chronic liver failure: such as acute illness with underlying cirrhosis (alcoholic hepatitis, NAFLD, viral hepatitis)
  • this leads to reduction in tissue sensitivity and reduced hepatic glycogenolysis, reduced glycogen stores and increased fat oxidation and gluconeogenesis leading to malnutrition
  • heightened REE (due to systemic inflammatory response, heightened cellular regeneration) which can even persist 1 year post-transplant
  • impaired fat metabolism due to limited bile production
  • vitamins which may be particularly affected by liver failure: vitamin A (usually stored in liver), vitamin K (concentrated and distributed by the liver), vit E (hepatic uptake and released in LDL cholesterol), vitamin D (liver hydroxylation), vit B12 (stored in liver), B6 (stored and converted in the liver), B9 (folate, stored in liver)
  • thiamine deficiencies also common due to poor diets and reduced absorption, leading to WE and Korsakoff’s psychosis
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8
Q

GI diseases where diet is linked to cause: coeliac disease

A
  • gluten-sensitive enteropathy
  • genetic predisposition (HLA-DQ2/8)
  • immunological reaction against Gliadin fragment of gluten (anti-gliadin can be used in diagnosis), leading to villous atrophy
  • malabsorption leads to weight loss and diarrhoea, leading to iron, vitamin D, folate deficiency
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9
Q

GI diseases where diet is linked to cause: metabolic syndrome

A
  • a high fat and sugar diet can lead to obesity which causes disturbances in the gut microbiota (dysbiosis) which perturbs the gut barrier integrity
  • this leads to metabolic endotoxemia and low grade inflammation which causes NAFLD (NASH)
  • NASH: non-alcoholic steatohepatitis
  • dysbiosis means bacteria metabolise dietary choline which can be pathogenic and skew the production of SCFA
  • this alters FA production and lipid transport to the liver
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10
Q

GI diseases where diet is linked to cause: gall stones

A
  • high fat intake and obesity are risk factors
  • there are genetic links
  • can cause short bowel syndrome
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11
Q

GI diseases where diet is the cause: acute pancreatitis

A
  • causes: caused by alcohol or gall stones

- study showed 17% risk reduction for every 2 portions of veg

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12
Q

GI diseases where diet may be the cause: diverticulosis/appendicitis

A
  • diverticulous: hernias, out-pouching of hernias in gut
  • appendicitis
  • may be caused by western diets of low dietary fibre, increased pressure
  • may be reduced by wholegrains
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13
Q

GI diseases where diet may be the cause: alcoholic liver disease

A
  • accumulation of acetaldehyde as cytochrome P450 2E1 is upregulated but acetoaldhyde dehydrogenase doesnt get upregulated in times of high alcohol consumption
  • increases intestinal permeability and causes bacterial endotoxins to leak out into bloodstream and cause inflammation
  • carcinogenic effect
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14
Q

World cancer research fund and most likely causes of cancer

A
  • alcoholic drinks: mouth, pharynx, larynx, oesophagus, liver, colorectal, breast (postmenopause), stomach, breast (premenopause)
  • adult body fatness: oesophagus, pancreas, liver, colorectum, breast (postmenopause), endometrium, kidney, mouth, pharynx, larynx, stomach, gallbladder, ovary, prostate
  • adult weight gain: breast (postmenopause)
  • food preserved by salting: stomach
  • aflatoxins: liver
  • processed meat: colorectal
  • red meat and cantonese style fish: colorectal, nasopharynx
  • arsenic in drinking water: lung, bladder, skin
  • mate: oesophagus
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15
Q

World cancer research fund: decreases risk of cancer

A
  • alcoholic drinks: kidney
  • adult body fatness: breast (premenopause)
  • body fatness in young adulthood: breast pre and post menopause
  • physical activity: colorectum, breast (pre and post menopause), endometrium
  • wholegrains, high dietary fiber: colorectum
  • non-starchy vegetables and fruit: aerodigestive cancer and some other cancers
  • dairy products: colorectum
  • coffee: liver, endometrium
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16
Q

Mechanism for body fat causing cancer

A
  • altered mitochondrial function, increased nutrient uptake in obesity- associated tumours
  • oestrogen, MAPK, ERK causes evasion of growth suppression and sustains proliferation
  • insulin, PI3K and mTOR causes resistance of cell death
  • adipose tissue-associated inflammation, leptin and STAT causes genome instability and mutation, and tumour promoting inflammation
  • adipose stromal cells cause vascularisation and inflammation
17
Q

The protective effect of fiber and cancer

A
  • contributes to a healthy microbiota, which produce SCFA which maintain health of colon, causes cancer cell apoptosis and inhibits chronic inflammation
  • fiber also reduced colon content transit time limiting the exposure to carcinogens
18
Q

Why does red/processed meat cause cancer?

A
  • haem iron can contribute to nitric oxide production in the stomach
  • leads to gut inflammation and ROS
19
Q

Protective effects of dairy and cancer

A
  • may be due to calcium, lipids, vitamin D

- probiotic or symbiotic effects of lactobaccilli

20
Q

Dietary interventions to prevent cancer: folate

A
  • folate fortification introduced in countries as data emerged from canada on decreased colorectal cancer risk
  • however, after fortification in Chile, found increased incidence of colorectal cancer
  • meta-analysis found no association between folate and cancer risk
  • suggest that supplementation just for fertile women?
21
Q

Lifestyle and dietary recommendations from the world cancer research fund

A
  • avoid alcohol
  • maintain weight towards lower BMI range
  • be at least moderately physically active (keeping HR in range of 60-75%)
  • limit consumption of sugar sweetened drinks
  • eat diet with at least 30g of fibre/day
  • include in most meals: wholegrains, non-starchy vegetables, fruits, pulses
  • eat diet high in all types of plant foods including at least 5 portions of non-starchy vegetables and fruit everyday
  • limit red meat to no more than 3 portions per week (<500g)
  • consume very little, if any, processed meats
  • limit consumption of processed foods high in fat, starches or sugar
22
Q

Diseases associated with the gut microbiome: what is affect of diet and how could we establish a causal relationship?

A
  • diseases related with dysbiosis: asthma, eczema, IBD, depression, colon cancer, heart disease, diabetes, obesity, NASH
  • high fat diets decrease bacteriocetes and increase firmicutes, low fat diets have opposite effect
  • could investigate this further using a systems biology approach

disease-related malnutrition (23 decks)

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