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Endo > SM_191b: Starvation and Metabolic Adaptation > Flashcards

SM_191b: Starvation and Metabolic Adaptation Flashcards

1
Q

Starvation is ___

A

Starvation is physiologic state of negative energy ± protein balance

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2
Q

Starvation-associated malnutrition or protein energy malnutrition is ___

A

Starvation-associated malnutrition or protein energy malnutrition is prolonged deficit of energy and/or protein, which results in clinical manifestations

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3
Q

Disease associated malnutrition (cachexia) occurs with ___, is characterized by ___, and is induced by ___

A

Disease associated malnutrition (cachexia) occurs with illness, is characterized by increased protein catabolism, and is induced by inflammatory cytokines

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4
Q

Caloric restriction is ___

A

Caloric restriction is volitional reduction in energy intake (below needs), with adequate intake of protein and micronutrients

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5
Q

Sarcopenia is ___

A

Sarcopenia is loss of muscle mass associated with aging

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6
Q

Total energy expenditure = ____ + ____ + ____

A

Total energy expenditure = basal metabolic rate + thermic effect of food + energy expenditure of physical activity

(TEE = BMR + TEF + EEPA)

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7
Q

Total energy expenditure (TEE) is ___

A

Total energy expenditure (TEE) is energy expended by an individual in one day

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8
Q

Basal metabolic rate is ____

A

Basal metabolic rate is energy expended for vegetative functions of the body (respiration, body temperature regulation, etc)

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9
Q

Thermic effect of food is ___

A

Thermic effect of food is increase in energy expenditure observed after the consumption of a meal

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10
Q

Energy expenditure of physical activity is ____

A

Energy expenditure of physical activity is energy used during daily physical activity (exercise + non-exercise)

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11
Q

Total energy expenditure consists of ____, ____, and ____

A

Total energy expenditure consists of basal metabolic rate (60%), energy expenditure of physical activity (30%), and thermic effect of food (10%)

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12
Q

Determinants of basal metabolic rate are ___, ___, ___, ___, and ___

A

Determinants of basal metabolic rate are body composition, age, gender, nutritional status, and health status

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13
Q

Most usable energy stores are ____

A

Most usable energy stores are fatty acids

(then protein, then glycogen)

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14
Q

Fuel metabolism during starvation first involves ____, then ____, then ____

A

Fuel metabolism during starvation first involves exogenous, then glycogen, the gluconeogenesis

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15
Q

During starvation, origins of new blood glucose are ___ and ___

A

During starvation, origins of new blood glucose are liver (50-80%) and kidneys (20-50%)

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16
Q

During starvation, substrates for gluconeogenesis are ____, ____, ____, ____, and ____

A

During starvation, substrates for gluconeogenesis are lactate, pyruvate, alanine, glycerol, and glutamine (used by kidney)

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17
Q

During starvation, other fuel sources are ____ and ____

A

During starvation, other fuel sources are free fatty acids and ketone bodies

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18
Q

In fuel usage by tissue (late starvation), brain mainly uses ____

A

In fuel usage by tissue (late starvation), brain mainly uses ketone bodies

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19
Q

Describe changes in energy expenditure during starvation

A

Changes in energy expenditure during starvation

  • TEE: decreased
  • BMR: decreased
  • TEF: decreased
  • EEPA: decreased
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20
Q

Ghrelin and glucagon ____ during starvation

A

Ghrelin and glucagon increase during starvation

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21
Q

Leptin, insulin, T3 / T4, LH, FSH, estrogen, and testosterone ___ during starvation

A

Leptin, insulin, T3 / T4, LH, FSH, estrogen, and testosterone decrease during starvation

22
Q

____ occurs after weight loss

A

Metabolic adaptation occurs after weight loss

23
Q

During weight loss in obesity, ____, ____, and ____ are decreased

A

During weight loss in obesity, leptin, energy expenditure, and T3 / T4 are decreased

24
Q

During weight loss in obesity, ____ and ____ are increased

A

During weight loss in obesity, ghrelin and muscular efficiency are increased

25
Q

____ is modified after weight loss in obesity

A

Neural activity on brain fMRI in response to visual food cues is modified after weight loss in obesity

26
Q

After weight loss, gap between ____ and ____ is wider

A

After weight loss, gap between increased hunger and decreased energy expenditure is wider

27
Q

Describe metabolic and hormonal changes of weight loss in obesity that are reversed with leptin

A

Reversed with leptin?

Deecreased

  • Leptin: yes
  • Energy expenditure: yes
  • T3 and T4: yes

Increased

  • Ghrelin: no
  • Muscular efficiency

Modified

  • Neural activity on brain fMRI in response to visual food cues: yes
28
Q

Metabolic adaptation to weight loss ___ long-term persistence

A

Metabolic adaptation to weight loss has long-term persistence

29
Q

Describe metabolic responses to starvation

A

Metabolic responses to starvation

  • Decreased energy expenditure
  • Use of alternative fuelds (free fatty acids and ketone bodies) can reduce protein catabolism
  • Intake of minimal dietary carbohydrate (100 g) can suppress protein catabolism and gluconeogenesis
30
Q

Describe metabolic responses to illness

A

Metabolic responses to illness

  • Increased energy expenditure
  • Markedly increased protein catabolism
  • Glucose does not suppress protein catabolism
31
Q

In illness, basal metabolic rate ____ due to ____, ____, and ____

A

In illness, basal metabolic rate increases due to catecholamine / sympathetic nervous system stimulation, fever, and inflammation / cytokines

(BMR may increase by 30-100%)

32
Q

In illness, protein catabolism ____ due to ____, ____, and ____

A

In illness, protein catabolism increases due to inflammation and cytokines, increased cortisol, and insulin resistance

33
Q

Which increases protein catabolism the most?

A. Sepsis

B. Hysterectomy

C. Hip fracture

D. Major burn

E. Starvation

A

Which increases protein catabolism the most?

A. Sepsis

B. Hysterectomy

C. Hip fracture

D. Major burn

E. Starvation

34
Q

____ and ____ cause malnutrition

A

Starvation and disease cause malnutrition

35
Q

Marasmus involves a deficit of ____

A

Marasmus involves a deficit of calories

36
Q

Describe marasmus

A

Marasmus: deficit of calories

  • Very low body weight
  • Wasted appearance with loss of muscle and fat
  • Liver function is usually normal
  • ± hypoalbuminemia
  • Dry, inelastic skin
37
Q

Kwashiorkor involves a deficit of ____

A

Kwashiorkor involves a deficit of protein

38
Q

Descrube kwashiorkor

A

Kwashiorkor: deficit of protein

  • Low or normal body weight
  • Edema may mask weight loss
  • Distended abdomen
  • Fatty liver / liver dysfunction
  • Marked hypoalbuminemia
  • Skin and hair changes
39
Q

Flag sign, flaky pain rash, and depigmentation of hair occur in ___

A

Flag sign, flaky pain rash, and depigmentation of hair occur in kwashiorkor

(flag sign: alternating areas of hypo and hyperpigmentation of hair)

40
Q

8 month old infant fed on demand with rice, milk, bananas, and sweet potatoes for the past 4 months may have ___, ___, ___, and ___

A

8 month old infant fed on demand with rice, milk, bananas, and sweet potatoes for the past 4 months may have normal body weight, edema, ascites, and desquamative rash

41
Q

Pathogenesis of kwashiorkor may involve ____, ____, and ____

A

Pathogenesis of kwashiorkor may involve primary protein deficiency, inadequate antioxidant capacity, and gut microbiome

42
Q

Malnutrition can result in ___ in childhood

A

Malnutrition can result in stunted growth in childhood

43
Q

Describe physiologic changes in malnutrition

A

Physiologic changes in malnutrition

  • Hypothermia
  • Cardiovascular: hypotension, bradycardia, and decreased cardiac output
  • Pulmonary: decreased respiratory muscle mass and function, decreased respiratory drive
  • Endocrine: hypogonadotrophic hypogonadism, osteoporosis
  • GI: delayed gastric emptying
  • Hematologic: anemia, leukopenia
  • Neurologic: decreased volume of gray matter, decreased sympathetic activity
44
Q

Behavioral changes seen during starvation are ____, ____, ____, ____, and ____

A

Behavioral changes seen during starvation are

  • Preoccupation with food
  • Hoarding and stealing food
  • Abnormal taste preferences
  • Binge eating
  • Depression, apathy, irritability, and other personality changes
45
Q

Oral nutrition involves ____ or ____

A

Oral nutrition involves whole foods or supplements

46
Q

Nutrition support to patients who cannot or will not eat involves ____ or ____

A

Nutrition support to patients who cannot or will not eat involves enteral nutrition or parenteral nutrition

47
Q

Enteral nutrition is via the ___

A

Enteral nutrition is via the gut

(if the gut works, use it)

48
Q

Parenteral nutrition formulas contain ____, ____, ____, and ____

A

Parenteral nutrition formulas contain water, macronutrients (dextrose, amino acids, emulsified lipids), electrolytes (minerals), and vitamins / trace elemtns

49
Q

Total parenteral nutrition ___

A

Total parenteral nutrition meets energy and protein needs

  • High osmolality requires administration into vena cava via a central line due to risk of phlebitis
50
Q

Peripheral parenteral nutrition usually ____

A

Peripheral parenteral nutrition usually cannot meet energy or protein needs

  • Lower osmolality so can be infused through smaller peripheral veins
51
Q

Refeeding syndrome occurs when ____

A

Refeeding syndrome occurs when food is introduced too quickly after a period of malnourishment

  • Shifts in electrolytes can cause severe complications: seizures, heart failure, and comas

Endo (25 decks)

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