Beruflich Dokumente
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obesity to height
Desirable range is b/w 20 &
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Energy metabolism
Metabolism of food stuff
exergonic reaction & endergonic reaction
energy expenditure by the body for two
resions
1, utilization for physical work
2, utilization for involuntary work
this part of expenditure is constant and at a
basal rate.
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CALORIC VALUE OF FOOD
On burning different foodstuffs different
amount of energy
How much heat will be obtained by burning
a particular food stuff is expressed by “caloric
value”
Definition
The amount of heat energy obtained by burning
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Basal metabolism
Energy required = varies
but
the rate of energy production in
individual by its overall cellular
metabolism is more or less constant under
some standard /basal conditions
basal conditions are
1.Person should be awake but
2.At complete rest both physically and mentally
3.Post absorptive state(12-18 hrs after meal)
4.Should be in reclining position
5.Environmental temp-2o˚c - 25˚c
6.Comfortable humidity and pressure
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BMR
Rate of energy production under basal
conditions per unit of time and per sq meter
of body surface
Normal in adult male =40C/sqm/hr
in adult female= 37C/sqm/hr
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Factors influencing BMR
1.age
2.sex
3.surface area
4.climate
5.state of nutrition
6.body tem-
7.barometric pressure
8.habits
9.drugs
10.hormones
11.pregnency
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Variations in BMR
PATHOLOGICAL
Fever
Diseases having increased cellular activity
Endocrine disease
hyperthyroid
hypothyroid
Cushing's disease
addision,s disease
IMPORTANCE OF BMR
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QUOTIENT(RQ)
or respiratory coefficient
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RQ
Normal RQ = 0.85 in healthy adult, on mixed
diet.
• Carbohydrates ~ 1.0
Protein ~ 0.81. ( due to the complexity of the
various ways in which different amino acids
can be metabolized, no single RQ can be
assigned to the oxidation of protein in the diet.
• Lipids ~ 0.7
• Excess glucose leads to a RQ > 1.0. The excess
glucose, converted to CO2, increases minute
ventilation in order to prevent respiratory
acidosis.
• An RQ > 1 indicates net lipogenesis
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Factors affecting RQ
1, DIET
carbohydrates (C6 H12 O6) = RQ = 1.
(the volume of CO2 produced is the
same as the volume of O2 consumed)
the amount of O2 present is just
sufficient to oxidize the H present in the
same molecule. 6o2 6CO2
C6H12O6 + =
+ 6H2O
CO2 produced/O2 consumed=6/6=1
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RQ of Fat
It is lowest
As fat is a O2 poor compound.
Oxidation of
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RQ for protein
RQ =0.8
2C3H7O2N + 6O2 → (NH2)2CO + 5CO2 + 5H2O
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2, effect of interconversion in
the body
When CHO are converted into Fat
RQ will rise
O2 rich compound is converted into O2
rises
A reversal when Fat is converted into CHO
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Clinical conditions are
In acidosis = RQ , CO2 out put > then O2
consumption.
In alkalosis = RQ ↓
In febrile conditions =RQ ↑ due to> breathing
> CO2 production >CO2 wash.
In diabetes mellitus, RQ fall
In starvation = fall
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SIGNIFICANCE OF RQ
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Caloric or energy
requirements
the average dietary energy intake
predicted to maintain an energy balance
in a healthy adult of a defined age, gender,
and height whose weight and level of
physical activity are consistent with good
health.
Or
70/1.7 = 41 C/sq
metre/hr
1.7ᵡ 41ᵡ 24 =1672 c/ day
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2, Thermic effect of food or
SDA
The production of heat by the body
increases as much as 30% above
the resting level during the
digestion and absorption of food.
This effect is called the thermic
effect of food or diet-induced
thermogenesis. Over a 24–hour
period, the thermic response to
food intake may amount to 5–10%
of the total energy expenditure
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3, physical activity
Influence of muscular work on total
metabolism
Influence of mental work on total metabolism
Influence of sleep on total metabolism
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Obesity
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INTRODUCTION
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Definition
Obesity is an abnormal accumulation of body
fat, usually 20 percent or more over an
individual's ideal body weight.
Definition of Overweight &
Obesity
Using BMI
ITEMS BMI GRADE
28
A graph of body mass index . World Health Organization .
29
TYPES OF OBESITY
A immediate
1, EXOGENOUS
2, ENDOGENOUS
B pathological
1, HYPERPLASTIC
2,HYPERTROPHIC
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Factors predispose to
obesity
Genetic – familial tendency.
Sex – women more susceptible .
Activity – lack of physical activity.
Psychogenic – emotional deprivation,
depression .
Social class – poorer classes.
Alcohol – problem drinking.
Smoking – cessation smoking.
Prescribed drugs – tricyclic derivatives.
Metabolic changes in
obesity
Not permanent can be changed by wt
reduction
usually hyperinsulinaemia
in fat metabolism
TG level will rise
Serum cholesterol will be high
FFA normal
2. in CHO metabolism
More conversion to fat
3. acid base changes (obesity hypoventilation
syndrome)
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LEPTIN 32
Leptin
Protein hormone secreted by adipocytes
Levels correlate with lipid content of cells
Leptin acts on the hypothalamus to reduce
hunger and to stimulate energy expenditure
Ghrelin
Hormone secreted in the stomach
Acts on the hypothalamus to stimulate appetite
Levels peak just before meals and drop
afterward
Health Consequences of Obesity
Increase in risk of:
Major cause of Hypertension
preventable death Dyslipidemia
Increase in mortality Diabetes type 2
from all causes Coronary artery
Increase in risk for disease
these cancers Stroke
Endometrium Gallbladder disease
Breast Osteoarthritis
Prostate Sleep apnea &
Colon respiratory
problems
BALANCED DIET
A DIET when it include
proportionate quantities of food items form
different food groups
to supply
the essential nutrients in complete fulfillment of
the requirement of the body
BASED ON
1.easily available,
2.within economic means.
3.easily digestible
4.should fit with local food habits
5.Should contain enough roughage material
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BASIC FUNCTION OF
NUTRIENTS
Carbohydrate energy production
Fats
Protein protection against
infections
growth &
repair
Vitamins
Minerals
water regulation of tissue
functions
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Plan of balanced diet
Age
Sex
physical activity
special nutritional needs
Economic status
Need for minimum cost
Varieties from basic food groups
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protein in nutrition
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protein(essential AA)
Biological value
AA composition
Balance of AA
Availability of amino acid from foods
Relation ship of AA
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A, BIOLOGICAL VALUE
The % age of absorbed Nitrogen which is retained
in the body.
Several methods of calculation
By measurement
1.wt gain in gms / gms of protein consumed
2. on retention of absorbed N2
First animal is kept protein free diet for two days,
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Quantity of protein
Optimum requirement = 1gm/kg of body wt
Critical intake level = 0.25 – 0.33 gms/kg body
wt
+ve & - ve nitrogen balance
chemical score
It is the ratio b/w the contents of the most
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Protein deficiency
Causes
Consequences
Growth retardation
Weigh loss
Anemia
Delayed wound healing
Fatty liver
due to impaired apoprotein synthesis
Decreased plasma proteins
Infections
Hormone def-.
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Protein calorie
malnutrition
A pathological state resulting from absolute or
relative deficiency of one or more essential
nutrients
Primary malnutrition
Secondary malnutrition
CLASSIFICATION
Gomez classification
1st degree
Wt is 75 – 95 % of the expected wt
2nd degree
Wt is 60 – 75 % of the expected wt
3rd degree
Below 60 % of expected wt
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Assessment of Nutr
status
Direct
Clinical
Anthropometric
Dietary
Laboratory
Indirect
Health statistics
Ecological variables
Clinical Assessment
Useful in severe forms of PEM
Based on thorough physical examination
for features of PEM & vitamin
deficiencies.
Focuses on skin, eye, hair, mouth &
bones.
Chronic illnesses & goiter to be excluded
ANTHROPOMETRY
Objective with high specificity &
sensitivity
Measuring Ht, Wt, MAC, HC, skin fold
thickness, waist & hip ratio & BMI
Reading are numerical & gradable on
standard growth charts
Non-expensive & need minimal training
KWASHIORKOR
Cecilly Williams, a British nurse, had
introduced the word Kwashiorkor to the
medical literature in 1933. The word is
taken from the Ga language in Ghana &
used to describe the sickness of
weaning.
ETIOLOGY
Kwashiorkor can occur in infancy but its
maximal incidence is in the 2nd yr of life
following abrupt weaning.
Kwashiorkor is not only dietary in origin.
Infective, psycho-socical, and cultural
factors are also operative.
ETIOLOGY (2)
Kwashiorkor is an example of lack
of physiological adaptation to
unbalanced deficiency where the
body utilized proteins and
conserve S/C fat.
One theory says Kwash is a result
of liver insult with
hypoproteinemia and oedema.
Food toxins like aflatoxins have
been suggested as precipitating
CONSTANT FEATURES OF KWASH
OEDEMA
PSYCHOMOTOR CHANGES
GROWTH RETARDATION
MUSCLE WASTING
USUALLY PRESENT SIGNS
MOON FACE
HAIR CHANGES
SKIN DEPIGMENTATION
ANAEMIA
OCCASIONALLY PRESENT SIGNS
HEPATOMEGALY
SIGNS OF INFECTIONS
DD of Kwash Dermatitis
Acrodermatitis Entropathica
Scurvy
Pellagra
Dermatitis Herpitiformis
MARASMUS
The term marasmus is derived from the
Greek marasmos, which means wasting.
Marasmus involves inadequate intake of
protein and calories and is characterized
by emaciation.
Marasmus represents the end result of
starvation where both proteins and
calories are deficient.
MARASMUS/2
Marasmus represents an adaptive
response to starvation, whereas
kwashiorkor represents a maladaptive
response to starvation
In Marasmus the body utilizes all fat
stores before using muscles.
EPIDEMIOLOGY & ETIOLOGY
Seen most commonly in the first year of
life due to lack of breast feeding and
the use of dilute animal milk.
Poverty or famine and diarrhoea are the
usual precipitating factors
Ignorance & poor maternal nutrition are
also contributory
Clinical Features of Marasmus
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Daily FAT requirements
20 – 35 % of energy should be provided by
fat/day
Ω -6- PUFA ------- 5 – 10 %
Ω-3- PUFA --------- 0.5 – 1.2 %
PLASMA CHOLISTEROL & C H D
2, endogenous
Transported as lipoprotein.
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Thank You!