Binding to receptors AdipoR1 (skeletal muscle) and AdipoR2 (liver) activate cAMP dependent protein kinase A, which phosphorylates and inactivates acetyl coenzyme A carboxylase, a key enzyme for fatty acid synthesis Decreases glucose production in the liver and increases insulin sensitivity, protecting against the metabolic syndrome

Nutritional Diseases Flashcards by Monica Fatorma

What are some causes/risk factors of malnutrition?

poverty

acute and chronic illnesses

self imposed dietary restrictions

chronic alcoholism

GI diseases

etc

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What is SAM?

severe acute malnutrition

a state characterized by a weight for height ratio that is 3 SD below the normal range

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Cancer cachexia

hypercatabolic state defined by a loss of muscle mass (with or without loss of fat) that cannot be explained by diminished food intake

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What 3 mechanics cause muscle atrophy and muscled degradation leading to cachexia?

1.Proteolysis-inducing factor (PIF) produced by tumors degrades myosin heavy chain through the proteasome

TNF, IL-1, IL-6 produced by tumors and host activate NF-κB which initiates transcription of ubiquitin ligases MAFBx & MuRF1
Alterations in dystrophin-glycoprotein complex leads to dystrophin degradation by the proteasome

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What are the C/F of bulimia?

Electrolyte imbalances (hypokalemia) – predisposes to cardiac arrhythmias
Pulmonary aspiration of gastric contents
Esophageal and stomach rupture

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What is leptin secreted by and what is this secretion regulated by?

Secreted by fat cells, output is regulated by the adequacy of fat stores.

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MOA of leptin.

With abundant adipose tissue, leptin
reduces food intake by stimulating POMC/CART neurons and inhibiting NPY/AgRP neurons

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What is the result of leptin secretion?

Stimulates physical activity, heat production, and energy expenditure

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What is the most common pathogenesis behind how leptin deficiency can lead to massive obesity?

mutations in the melanocortin receptor 4 gene (MC4R) are more common (4% to 5% of patients)

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How does leptin resistance occur?

the anorexigenic response of leptin is blunted in states of obesity despite high levels of circulating leptin

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What is adiponectin refferred to as?

guardian angel against obesity

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Where is adiponectin produced?

in adipose tissue

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Function of adiponectin?

stimulates fatty acid oxidation in skeletal muscle, prevents leptin resistance

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MOA of adiponectin.

Binding to receptors AdipoR1 (skeletal muscle) and AdipoR2 (liver) activate cAMP dependent protein kinase A, which phosphorylates and inactivates acetyl coenzyme A carboxylase, a key enzyme for fatty acid synthesis
Decreases glucose production in the liver and increases insulin sensitivity, protecting against the metabolic syndrome

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Overall effects of adiponectin.

Anti-inflammatory, anti-atherogenic, anti-proliferative, and cardioprotective effects

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What is gherlin? What is it produced by?

produced in stomach, only gut hormone that increases food intake

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What is the MOA of ghrelin?

activates orexigenic NPY/AgRP neurons

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Where is PYY and GLP-1 secreted by?

(peptide YY) and glucagon-like peptide - 1 are secreted from endocrine cells in the ileum and colon, anorexigenic

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MOA of PYY and GLP-1?

Act centrally through NPY/AgRP neurons to decrease food intake

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Indications for GLP-1 agonists?

agonists of GLP-1 receptor have been approved for
treatment of obesity and type 2 diabetes

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Function of BAT?

brown adipose tissue

expends energy by non-shivering thermogenesis.

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What does WAT produce?

white adipose tissue

produces cytokines such as TNF, IL-6, IL-1, and IL-18; chemokines; and steroid hormones creating a chronic proinflammatory state with high levels of CRP

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What is metabolic syndrome?

abnormalities of glucose and lipid metabolism coupled with hypertension and evidence of a systemic proinflammatory state

What are ways obesity can lead to cancer?

1. Hyperinsulinemia promotes growth of both normal and abnormal neoplastic cells 2. Increased synthesis of estrogen can lead to cancers of he endometrium and breasts 3. Reduced adiponectin: adiponectin normally suppresses cell proliferation and promotes apoptosis 4. pro-inflammatory state

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Nitrosamines and nitrosamines are examples of endogenous or exogenous carcinogens?

endogenous

Aflatoxin is an example of endogenous or exogenous carcinogens?

exogenous

High animal fat intake combined with low fiber intake has been implicated and what type of cancer?

causation of colon cancer

Dietary fiber, or roughage is believed to have a preventive effect against what condition of the GI?

diverticulosis of the colon

VIt A has what benefits?

* Normal vision in reduced light * Differentiation of specialized epithelial cells, mainly mucus-secreting cells

What treatments is Vit. A used for?

Clinically used for treatment of Acne as well as Acute Promyelocytic Leukemia

What are he causes of VIt. A deficiency?

diets lacking sufficient green and yellow vegetables, fat malabsorption

Night blindness can be caused by what?

xerophthalmia (dry eye) - (xerosis conjunctivae) - keratin debris in small opaque plaques (Bitot spots) - erosion of roughened corneal surface with softening and destruction (Keratomalacia) - Total blindness

How does follicular/papular dermatosis occur?

hyperplasia hyperkeratization of epidermis with plugging of the ducts of adnexal glands

Desquamation of keratin debris in the urinary tract can lead to what?

renal and urinary bladder stones

Squamous metaplasia of the airways can lead to what?

secondary infection

What are causes of Vit. A toxicity?

megadoses of Vit A

Acute toxicity with Vit. A.

headache, dizziness, vomiting, stupor, and blurred vision (due to increase in intracranial pressure d/d brain tumor

What do synthetic retinoids in pregnancy put the fetus at risk for?

↑ risk of fetal malformations

How does Vit. D affect bone mineralization?

attaches to receptor on osteoblasts, stimulates release of alkaline phosphatase (dephosphorylates pyrophosphate that inhibits bone mineralization)

Osteomalacia and Rickets is caused by what?

Vitamin D deficiency Osteomalacia (in adults) Rickets (in children)

What are some clinical features of Vit. D deficiency.

Deformation of chest, Rachitic rosary, pigeon breast deformity, Harrison groove, deformed pelvis Hypocalemia caused by Vitamin D deficiency can lead to continuous muscle contraction (tetany)

What does Vit D toxicity cause to happen in children?

* In children it may lead to metastatic calcifications of soft tissues like kidney

What are some clinical features of Vit E deficiency?

hemolytic anemia (damage to RBC membrane), peripheral neuropathy, degeneration of posterior column and spinocerebellar tract

What are some causes of Vit K deficiency in newborns?

use of broad spectrum antibiotics, coumarin derivatives, fat malabsorption

What are common clinical features of Vitamin K deficiency.

bleeding diathesis – hemorrhagic disease of newborn in children, Gastrointestinal bleeding in adults

What is another name for Vitamin C?

ascorbic acid

What is a major function of Vitamin C?

1. Activation of prolyl and lysyl hydroxylases from inactive precursors, providing for hydroxylation of procollagen 2. Absorption of iron in duodenum

What is a deficiency in Vitamin C caused by?

diets lacking in fruits and vegetables, cigarette smoking

What are the C/Fs of vitamin C deficiency?

perifollicular hemorrhage bleeding gums hemarthrosis anemia

What is the main cause of thiamine deficiency?

alcoholism

B1 deficiency can lead to what conditions?

Dry and wet beriberi Wernicke-Korsakoff syndrome

What is another name for Vitamin B2?

riboflavin

What does defiance of B2 cause?

cheliosis stomatitis

What is another name for B3?

Niacin

What are the causes of B3 deficiency?

include dietary deficiency (corn based diets which are deficient in tryptophan and niacin), Hartnup disease, Carcinoid syndrome

What C/F can lead to pellagra 3Ds.

dementia, dermatitis, diarrhea

Another name for Vit. B6?

pyridoxine

What are the causes of VIt B6 deficiency?

isoniazid (used in treating TB

What are he C/F of Vit B6 deficiency?

sideroblastic anemia

What is another name for Vit B12?

cobalamin

What are the major functions of Vit. B12?

DNA synthesis myelinization of spinal cord tracts megaloblastic pernicious anemia and degeneration of poster-lateral spinal cord tracts

What is folate crucial for?

DNA synthesis

What are some causes of folate deficiency?

alcohol overutilization in (pregnancy)

What are the complications of folate deficiency?

megaloblastic anemia, Neural Tube Defect

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C/F of zinc deficiency?

acrodermatitis enteropathica

C/F of iron deficiency?

hypochromic microcytic anemia

C/F of iodine deficiency?

goiter and hypothyroidism

C/F of fluoride deficiency?

dental caries

C/F of selenium deficiency?

cardiomyopathy (Keshan disease)