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Obesity & Nutrition

ATP Adenosine triphosphate is in cytoplasm of all cells and provides energy for cellular needs
kcal measurement of ATP 1 kcal = amt of energy required to raise 1 kg of water 1 degree 40% converted to ATP 60% used for heat
Basal Metabolic Rate (BMR) Rate of energy used in resting tissue after 12-hour fast BMR in children > adults Declines with age ~2% per decade Body composition: lean vs. fat mass Other: Nutritional status, sleep, fever, temp, stress
Carbohydrates 4 kcal per gram 2 Sources: Milk & Plants 100% converted to glucose (used for energy) Protein-sparing 50-60% of diet Glycemic Index (GI): the rate at which blood glucose levels rise
Monosaccharides (type/examples) Glucose, fructose: fruits, roots, corn, honey
Disaccharides (type/examples) Sucrose, Lactose, Maltose: sugar cane, sugar beets, molasses, maple sure
Polysaccharides (type/exmaples) Complex CHO, Starch, Dietary Fiber: grains seeds legumes vegetables Eat these!
Benefits of Dietary Fiber Aids regular bowel elimination Aids in weight control-increases satiety Reduces glycemic index-possibly slows the rate in which blood glucose levels rise Aids in reducing serum cholesterol levels Reduces risk of cancer
Hormonal Actions on Carbohydrates (4 types) Insulin, Glucagon, Catecholamines, Cortisol
Hormonal action by insulin on CHO glucose uptake by insulin-sensitive cells stimulates glycolysis. gluconeogenesis
Hormonal action by glucagon on CHO Stimulates glycogen breakdown in liver gluconeogenesis.
Hormonal action by catecholamines on CHO Maintain glucose levels. glucose uptake at liver and muscle cells glycogenolysis
Hormonal action by cortisol on CHO gluconeogenesis. cellular glucose uptake
Info about Proteints 1 gram PRO = 4kcal 20% of diet Found in all foods: highest in meats, nuts, legumes Contains nitrogen Tissue growth and repair Synthesis/maintenance Hormones, collagen, antibodies, DNA & RNA, hemoglobin Prevents edema: maintains vascular osmotic pre
Hormones and Protein Metabolism Insulin Amino acid transport into cells. Protein synthesis. Glucagon Increases amino acid movement into hepatic cells. Cortisol Protein breakdown
Fats Most calorie-dense 9 Calories per gram Digested slowly: only @10% converted to glucose Limit to 30% of total calories: Promotes absorption of fat-soluble vitamins Insulate organs in body Steroid, cell membrane synthesis Adds flavor
Dietary fats (types and examples) Saturated solid at room temperature meat/dairy and coconut/palm oils Hydrogenated or trans fats Polyunsaturated safflower,sunflower oils, fish, walnuts Monounsaturated Lowers LDL/maintains HDL canola/olive oil, nuts, avocados
Hormonal Actions on Fats Insulin fatty acid uptake into cells. glucose uptake into fat cells. Glucagon Promotes fat cell lipolysis. Catecholamines fat mobilization. serum FFAs Cortisol fat cell membrane permeability.
Nutrient Deficiencies (types) Vitamin B12 & Folate deficiency Iron Calcium Vitamin D
Vitamin B12 & Folate deficiency RBC formation, cell growth, tissue repair, DNA synthesis Macrocytic, megaloblastic anemias Vitamin B12 deficiency: neuropathy Folate deficiency in pregnant women: Low birth weight, prematurity, neural tube defects
Iron deficiency Most common nutrient deficiency in U.S. Most common anemia
Calcium (dfn and sources) Most abundant mineral 99% stored in bones/teeth Muscle contraction Vascular regulation Sources Dairy: 8 oz. low-fat milk/yogurt, 1.5 oz unprocessed cheese Kale, broccoli Fortified products
Calcium deficiency: reasons and results Adequate vit. D necessary 4 ca absorb Most Americans do not meet recommended intake Calcium deficiency: Loss of bone mass-osteopenia/osteoporosis Possible risk for HTN, CA Adequate calcium intake: High Ca++ may decrease risk for stones Weight man
Vitamin D Fat-soluble vit Necessary 4 Ca absorb in gut Bone growth/remodeling Neuromuscular & immune fcn Inflam Sources: food: fatty fish, beef liver Sunlight, added to foods, dietary supplement in inactive form
Vitamin D deficiency Deficiency Ricketts in children-rare, seen in AA Osteomalacia in adults Obesity-sequestered in fat and less entering blood
Nutriton-related Chronic Disease Cardiovascular disease Type 2 diabetes Hypertension Overweight & Obesity
Obesity background and dfn >100 mil american adults 1.6 bil adults worldwide 20 mil children worldwide Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher.
disease obesity can contribute to Hypertension Type 2 diabetes Coronary heart disease Gallbladder disease Certain cancers Dyslipidemia Stroke Osteoarthritis Sleep apnea
Obesity as a disease state Chronic, relapsing neurochemical disease Deranged neural circuitry responding inappropriately to a toxic environment
Abdominal Obesity and Insulin Resistance Fat compartments: Intra-ab (visceral fat) Ab subQ (peripheral fat) Products of abdominal adipose tissue causing insulin resistance Excess free fatty acid release Adiponectin Inflammatory cytokines
Adipose tissue Connective tissue made up of adipocytes expands by Hypertrophy: the normal, 1st response 2 incr caloric intake & growth Hyperplasia: when hypertrophied adipocytes reach a critical vol hyperplasia occurs & the number & size of adipocytes increases signi
FFA: dfn Lipolysis is the breakdown of stored fat into FFA Insulin blocks this In states of insulin resistance (caused by gen & environ factors) FFA secretion is up. FFA are taken up by the liver.
FFAs: results The liver packages FFA into TG rich lipoproteins (VLDL) ->hypertriglyceridemia. Met of high levels of VLDL lead to drops in HDL & sm dense more atherogenic LDL particles.
Products of Adipose tissue: cytokines and plasminogen activator inhib 1 Inflam cytokines (TNF alpha & IL-6) – Enhance endothelial inflam – Incr C-reactive prot (CRP) Plasminogen activator inhibitor 1 (PAI-1): prothrombotic substance
Products of Adipose tissue: Adiponectin & Leptin Adiponectin – adipose tissue product that fights insulin resistance. Decreased in obesity. • Leptin – protein that affects satiety. Obesity possibly r/t “leptin resistance”
Weight Assessment: BMI BMI: weight Lbs./height (in)2 x 705 weight in Kg/height in meters2 18.5-24.9 kg/m2 Healthy weight 25 - 29.9 kg/m2 Overweight > 30 kg/m2 Obese
Weight Assessment: Waist circumference and waist-hip ratio Waist circumference: men < 102 cm or 40 in, women < 88 cm or 35 inches Waist-to-hip ratio 0.95 men 0.8 women waistline measurement (in) Hip measurement (in)
Hypertension Despite insulin resistance in adipose & muscles kidneys remain insulin sensitive. High insulin increases renal na retention 50% of pts w/ essential htn have insulin resistance. Insulin resis pts with HTN are at more risk of CVD than non-insulin resis p
Polycystic Ovarian Syndrome Sex specific metabolic Syndrome XX 5-10% prevalence. Multigenetic characterized by hyperandrogenemia & insulin resis. Muscle & adipose cells are resistant to insulin -> hyperinsulinemia, ovary is normal responsive to insulin. -> more ov testosterone pr
Polycystic Ovary Disease High risk of other insulin resistant problems • Glucose metabolism – By 4th decade patients have • 35% risk of IGT • 10% risk of DM2 • Sleep Apnea • Lipid abnormalities • Coronary artery disease
Nonalcoholic Fatty Liver Disease • Resis of insulin action on adipose -> increased FFA release. • If the liver takes up these FFA, converts them to TG but lags behind in packaging the TG in VLDL particles, fatty liver results. • Correlates better with insulin resistance than obesity.
Obesity Etiological Factors Energy Density & Food Intake – Energy density of diets is increasing. – Avail of processed foods/super-sizing Reduced phys activity, sedentary Behavioral / Social factors Poverty
Increased Energy Density of food Standard food portions have increased over the last 20 years
Metabolic syndrome dfn Cluster of mult metabolic risk factors Atherogenic dyslipidemia Elevated blood pressure Elevated plasma glucose Prothrombotic state Proinflammatory state
Underlying Risk Factors of the Metabolic Syndrome Overweight/obesity (esp. abdominal obesity) Insulin resistance Additional underlying factors Physical inactivity Aging Endocrine dysfunction Genetic factors
ATP III Definition of Cardiometabolic syndrome (CMS) Must have three of the following: Fasting glucose > 110 Waist circumference > 40" in men & > 35" in women Triglycerides > 150 mg/dl HDL Cholesterol levels <40mg/dL in men and < 50mg/dL in women ● Blood pressure > 130/85
Metabolic Concomitants of Insulin Resistance Atherogenic dyslipidemia -High TG/HDL-C ratio Higher bp Hyperinsulinemia and hyperglycemia/impaired glucose tolerance Prothrombotic and proinflammatory states Endothelial dysfunction and microalbuminuria Fatty liver
Obesity therapy Lifestyle changes Behavioral Therapy Pharmacological interventions
Sibutramine (Meridia) Seratonin-norepinephrine reuptake inhibitor Contraindicated: uncontrolled HTN CAD, HF, arrhythmias, stroke Patients on SSRIs or MAOs
Orlistat (Xenical, Alli) Pancreatic lipase inhbitor Decreased intestinal absorption of fat May interfere with absorption of fat-soluble vitamins Severe GI side effects-require adherence to low-fat diet
Nutrition and the Nursing Process Assessment Anthropometrics; weight, BMI Skin integrity Lab values; glucose, cholesterol, albumin, hemoglobin Physical/cognitive abilities I & O’s Diet history-cultural/religious preferences Food preferences
The Five A’s of Nutrition Intervention Ask about current eating habits and knowledge Advise about desirable changes and why Assist in identifying/making changes that the patient is willing to make Arrange for support Adopt a follow up plan
Created by: Marissagostanian