Professional Documents
Culture Documents
Nutrition
Nutrition
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Brain storm
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Introduction to Medical Biochemistry
Biochemistry is the science concerned with the chemical basis /constituents of life
It deals with the normal and abnormal function of cells at molecular level
It deals with metabolism and its interrelationship, fate of diet, mechanism of action of
drug.
It is a laboratory based science that brings together biology and chemistry concepts.
By using chemical knowledge and techniques, biochemists can understand and solve
biological problems
The aim of Biochemistry
To understand life at the molecular level and all of the chemical processes
associated with living cells
Via isolate the numerous molecules found in cells to determine their structures &
analyze how they function by using techniques likes
Chromatography
Electrophoresis
Ultracentrifugation
Human body is composed of about 60% water, 15% proteins, 15% lipids, 2% carbohydrates and
8% minerals.
Polysaccharides
lipids
Nucleic acids
Electrostatic attraction between an electronegative atom and a hydrogen atom covalently bonded to a
second electronegative atom called hydrogen bond
NUTRITION AND NUTRITIONAL BIOCHEMISTRY
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Nutritional Biochemistry
When biochemistry is linked with diet, health and disease susceptibility it known
as nutritional biochemistry.
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Nutrition
Nutrition: is the science that study the interaction of nutrients and other
substances in food in relation to health and maintenance, growth, reproduction,
and disease of an organism.
It is also deal with the process by which the organism ingests, digests, absorbs,
transports, utilizes and excretes food substances ===>natural science origin
It concerned with social, economical, and cultural implications of food and eating
===>social science origin
Nutritional science studies the relationship between diet with states of health
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Nutrition as a science can study six main categories of food components
protein minerals
fat vitamins
carbohydrate water
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FOOD
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What is food?
o Food is any substance that can be eaten, drunk or taken in order to sustain life,
give energy, growth and etc.
o Food: is defined as anything edible as defined based on specific culture, religion,
etc.
o It includes all foods and drinks acceptable to be ingested by certain society.
o Nutrient: Is an active chemical component in the food that play specific structural
or functional role in the body.
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Food composition
Food
Other compounds
Nutrients
-Fibers
-Phytochemicals
1-Macronutrients
-Pigments
2-Micronutrients
-Additives
-Alcohols and others
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Function of food
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Function of food
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DIET
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Diet
Diet: Is the total of foods that one consumes in sequence and balance in each day.
It deal with quantity, quality and frequency of food consumption daily by
individual
Diet -The quality of our diet affects the quality of health and the risk of chronic
diseases
o Others may eat four times in a day (breakfast, lunch, snack and Dinner)
o Still others may remain munching all the day round, etc.
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Balanced diet/Healthy diet
It is a diversified diet that contains all the essential nutrients in the appropriate
proportion that is required for optimal health.
Your Menu Should be colourful!
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Deadly obese( overnutrition)
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Underweight (undernourished)
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Normal weight
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Eat to
Live to Eat!
Live!
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“EAT TO LIVE”
Intake = Expenditure
Weight Stable
“LIVE TO EAT”
Intake > Expenditure
Obese
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Healthy Eating Pyramid
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Principles of Good Nutrition
1. Adequacy
2. Balance
3. Energy Control
4. Nutrient Density
5. Moderation
6. Variety
ABCDMV
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Elements of a Healthy Diet - ABCMV
If we want to fulfill the dream our country, we will have to educate our
people regarding what to eat to build a nation of strong and healthy citizens.
Good Diet Good Health
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Causes of Deaths: Groups I, II and III
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Two Types of Nutrients
Macronutrients Micronutrients
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Body Requirement for Nutrients
carbohydrate Energy-yielding
nutrients
fats
organic
protein
vitamins
minerals
water
The human body and foods are made of the same materials, arranged in different
ways.
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“ You are what you eat”
“ Whatsoever
was the father
of a disease, an
ill diet was the
mother”
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Variables which affect nutrient needs:
1. Age
2. Gender
3. Activity Level
4. Climate
5. Health
6. State of nutrition
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Global Trends in Nutrition
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From Ancient to Modern Work
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From Traditional to Modern Leisure
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From Traditional to Modern Economic Work at Home
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From Ancient to Modern Transport
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New Remote Control Can Be Operated by Remote
Television watching became even more convenient with Sony’s introduction of a new
remote-controlled remote control.
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World Then & Now!
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From Traditional to Modern Snacking
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61% of new cases DM is the result of uncontrolled overweight
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Why nutrition transition
Globalization: globalised food tastes such as westernised habits of meat eating, more
dairy which takes more energy to produce and drives future grain consumption.
Media encourages the food transition from traditional diets of grains and vegetables to
often high protein and fats and sugars, westernised dietary habits and lower physical
activity levels.
With rising income rising middle classes in transition economies changing their food
habits
Urbanization: More choices and less active life style in urban than rural
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Higher energy density
Lower energy density
This 144-gram breakfast delivers 500
This 450-gram breakfast
kcal, for an energy density of 3.5
delivers 500kcal, for an energy
density of 1.1 (500 kcal/450 (500 kcal/144 g = 3.5 kcal/g)
g = 1.1 kcal/g)
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PART-II Nutritional assessment
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Nutrients
Nutrient is the active ingredients of the food necessary to sustain normal function of the cell
Energy rich nutrients are fats, carbohydrates, protein, and in some diets, ethanol
The requirement and intake of these energy-rich molecules is larger than that of the other
dietary nutrients
Those nutrients needed in lesser amounts, vitamins and minerals, are called the
micronutrients
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Diet
Diet
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Dietary reference intake
• Dietary reference intake(DRI) is set of reference values used to plan and assess
nutrient intakes of healthy people
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Components of DRI
1. The EAR is the average of daily dietary intake estimated to meet the requirement of healthy
individuals in a particular life stage and gender group by half(1/2 th )
2. Recommended Dietary Allowance (RDA): is daily dietary intake that is sufficient to meet the
nutrient requirements of individuals or group by (97–98%).
3. An adequate intake(AI) is the average of nutrient level consumed daily by a typical healthy
population that is assumed to be adequate for the population's needs.
This use only when the data from EAR or RDA is not available
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DRI cont.…
• For example, the AI for young infants, for whom human milk is the recommended sole source
of food for the first four to six months, is based on the estimated daily mean nutrient intake
supplied by human milk for healthy, full-term infants who are exclusively breast-fed.
4. Tolerable Upper Intake Level (UL): The UL is the highest average daily nutrient intake that
is likely do not pose adverse health effects to almost all individuals in the general population
• As intake increases above the UL, the potential risk of adverse effects may increase.
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Comparison of the components of the Dietary Reference Intakes.
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Important points in DRI
Intakes below the EAR need to be improved because the probability of adequacy is 50%
or less
Intakes between the EAR and RDA likely need to be improved because the probability of
adequacy is less than 98%
Intakes between the UL and the RDA can be considered to have no risk for adverse effects
Intake above upper limit is consider as risk to pose adverse health effect.
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e nt
re m
ui
re q
n al
iti o
u tr
N
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Nutritional requirement
Definition
• The amount of nutrient from food that allows an individual to maintain normal
physiological and structural functions, replenish storage levels and maintain
circulating levels of a nutrient.
• This definition does not included additional need for pathological and physiological
conditions which demand an additional intake (eg. Illness, exercise, pregnancy).
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Why to know nutritional requirements of an individual or group?
• to determine whether the food available in the stock is adequate to feed the
household or nation for a certain duration of time.
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Cont.…
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Conti..
In order to estimate nutritional requirements of individuals or groups, we need to
consider the following factors:
• Body size and composition: what the general build is of a person or group
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Acceptable Macronutrient Distribution Ranges
are defined as a range of intakes for a particular macronutrient that is associated with
reduced risk of chronic disease while providing adequate amounts of essential nutrients
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Fat in AMDR
Consumption of saturated fats is strongly associated with high levels of total
plasma cholesterol and LDL cholesterol, and an increased risk of CHD.
The main sources of saturated fatty acids are dairy and meat products and some
vegetable oils, such as coconut and palm oils a major source of fat
Unsaturated fatty acids are generally derived from vegetables and fish(olive oil).
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About bad fat
Trans fatty acids do not occur naturally in plants, but occur in small amounts in
animals.
However, trans fatty acids are formed during the hydrogenation of liquid
vegetable oils
Trans fatty acids are a major component of many commercial baked goods, such
as cookies and cakes, and most deep-fried foods.
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Quality of proteins
The quality of a dietary protein is a measure of its ability to provide the essential
amino acids required for tissue maintenance
Proteins from animal sources: Proteins from animal sources (meat, poultry,
milk, and fish) have a high quality
B/C they contain all the essential amino acids in proportions similar to those
required for synthesis of human tissue proteins
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Quality of proteins cont.…
Proteins from plant sources: Proteins from wheat, corn, rice, and beans have a
lower quality than do animal proteins.
However, proteins from different plant sources may be combined in such a way
that the result is equivalent in nutritional value to animal protein
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Estimation of energy requirement
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Estimation of Energy Requirement
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Estimation of energy
Requirement
Energy Energy
Requirement = Expenditure
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Energy requirement in human
Definition: The amount of energy intake from food that replaces energy expenditure
compatible with normal health and allows an individual to be involved in economically
necessary and socially desirable activities(FAO/WHO/UN,1985).
It is difficult to accurately predict persons daily energy requirement due to various factors.
The average daily requirement for energy is either 2,000 or 2,500 kcal/day
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Daily energy requirement by different person
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Major function of energy in body
The energy generated by metabolism of the macronutrients is used for three energy-requiring
processes that occur in the body:
Resting metabolic rate,
Physical activity
1. Resting metabolic rate/basal metabolic rate (BMR). The energy expended by an individual in a
resting or postabsorptive state
It represents the energy required to carry out the normal body functions to maintain cellular
integrity
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Components of Total energy Expenditure (TEE)
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BMR
• Energy is continuously expended in such involuntary works throughout the life period for which
we are not conscious.
• This part of expenditure is relatively constant and expenditure in such involuntary works occurs at
a basal rate.
• About 70% of the energy we use every day is due to our organs functioning to keep us
alive and healthy
• So when there is no physical activity our daily energy intake should be 70% of the total.
• The remaining 30% is broken down into digestion of food (10%) and energy needed for
activity (20%).
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What is considered to measure BMR?
Post absorptive state: is the time at which GIT is empty and source of
energy come from reserve
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Cont..
This period is to avoid effects of digestion and absorption and to prevent any chance of
starvation.
Functions of viscera like the kidney, liver and brain for the maintenance of the body
temperature.
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Cont.…
• The total metabolism in childhood is relatively much greater than, in adult life.
• The physical activity of children is usually greater, despite the fact that their
period of sleep is longer than that of an adult.
• The food intake, therefore, must cover the caloric needs in addition to the extra
food required for growth.
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How to calculate BMR
E.g. 30 years old woman, 5 feet 3 inches tall (or 63 inches) and weighs 130 pounds.
2.5 centimeters in one inch and 2.2 pounds in one kilogram, that means that our
volunteer's height is 157.5 cm and about 59 kg. P=1263 kcal.
women need to eat this much to maintain her current weight at rest.
If she eat calorie less than 1263.4 she will lose weigh if she eat greater she will gain
weight
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Caloric value of the food
• Calories is defined as the amount of heat required to raise the temperature of 1.0 gm of water by
1oC (specifically from 15oC to 16oC).
• Caloric value is the amount of energy obtained by burning 1.0 gm of the food stuff completely in
the presence of O2.
• The amount of energy required for any individual varies directly with the degree of activity and
environmental conditions
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How energy content of the food measured?
In vitro the energy content of food is calculated from the heat released by the total
combustion of food in a calorimeter
Note that the energy content of fat is more than twice that of carbohydrate or
protein
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exercise
Kasim is a moderate active who has consumed 250gm of an oxen meat, a meat contain 60g
of saturated FA and 10gm of unsaturated FA, 10gm of CHO and 30 gm of protein.
Additionally, he drank 2 bottles of coca having 20gm of CHO. Finally, he added 30gm of
vitamin C and 20gm of fibers to his eating.
4. What do you think his weight if his daily consumption and current activity continue in
this way?
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Energy Energy
Intake = Expended
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Positive Energy Balance
Energy
Energy > Expended
Intake
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Negative Energy Balance
Energy
Intake
< Energy
Expended
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Diet Induced thermogenesis(Thermic effect of food)
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Fibers
• Fibers are complex and indigestible carbohydrate usually found in food derived from
plants
• Children and adults need at least 25 to 35 grams of fiber per day for good health
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Complex Carbohydrates
Dietary Fiber
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Is too much of fiber good????
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Glycemic index
The glycemic index (GI) is a value used to measure how much and how quickly
specific foods increase blood sugar levels
The GI measure of the power of foods to raise glucose levels after being eaten.
Foods are classified as low, medium, or high glycemic foods and ranked on 0-100GI.
Foods with a high GI score contain rapidly digested carbohydrate, which produces
a large rapid rise and fall in the level of blood glucose.
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Glycaemic index (GI)
In contrast, foods with a low GI score contain slowly digested carbohydrate, which
produces a gradual, relatively low rise in the level of blood glucose.
Foods that has no Carbohydrate are not assigned a GI and include meat, fish,
poultry, nuts, seeds, herbs, spices, and oils
• Knowing the glycemic index of the carbohydrates you eat can help you fine-tune
your meals to keep your blood sugar within a normal range.
1. Low GI = 55 or less
2. Medium GI = 56 – 69
3. High GI = 70 or more
• To determine the glycemic index of a food, volunteers are typically given a test
food that provides 50 grams of carbohydrate and a control food (white bread or
pure glucose) that provides the same amount of carbohydrate on different days.
• Blood samples for the determination of glucose are taken prior to eating and at
regular intervals after eating over the next several hours.
• The glycemic index is calculated as the area under the glucose curve after the test
food is eaten, divided by the corresponding area after the control food is eaten.
• Higher index faster and greater rise of postprandial glucose and/or insulin
• low glycemic index supposedly helpful in reducing glucose load via reduced insulin
response required
GI = X 100
Blood glucose area after reference food
A healthy, low glycemic diet should comprise mostly low GI foods, such as:
white rice
Herbs and spices: turmeric, black pepper, cumin, dill, basil, rosemary, cinnamon
• Low GI carbs reduce hunger and keep you fuller for longer
• High GI carbs help re-fuel carbohydrate stores after exercise – muscle glycogen.
Fibers content
Ripeness,
Type of Starch
Amylose Amylopectin
• Absorbs less water • Absorbs more water
• Molecules form tight • Molecules are more open
clumps • Faster rate of digestion
• Slower rate of digestion
Cooking
Cooking swells starch molecules and
softens foods, which speeds up the rate of
digestion.
Sugar Content
sugar sucrose glucose + fructose
(GI 60) (GI 100) (GI 19)
Acid Content
Acid slows down gastric emptying, and
thus, slows down the digestion of starch.
Food Processing
Highly processed foods require less
digestive processing.
• Glycemic load accounts for how much carbohydrate is in the food and how much
each gram of carbohydrate in the food raises blood glucose levels
• GL = (GI x CHO/serving)/100
• Ratings of glycemic loads
• Low GL = 0-10
• Medium GL = 11-19
• High GL = >20
Glycemic Index alone does not provide enough information about the glycemic affect of a food.
Similarly, 100g serve of water melon with a GI of 72 has 5.6 g per serve.
72 x 5.6/100 = GL = 4
YES!
BG levels type 2 DM risk
weight
Instead…
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A Better Idea
• What is the problem when blood glucose is above normal and below normal?
Diabetes mellitus
• Dm is not a single disease/a group of metabolic derangement characterized by chronic
hyperglycemia
• It is also the major cause of renal failure, heart attacks, and strokes.
• The incidence and prevalence of T2DM is relatively higher than T1DM due to sedentary life style
Comparison of type-1 and type-2 DM
Pathophysiology of type-1 DM
• Beta cell of pancreases is damaged by autoimmune attack and islet of Langerhans infiltrated with
activated T-lymphocytes leads to insulitis
• The autoimmune attack on the β cells gradually leads to depletion of the β-cell population
• However, symptoms appear abruptly when 80–90% of the β cells have been destroyed
• Because at this point, the pancreas fails to respond adequately to ingestion of glucose
• β Cell destruction requires both a stimulus from the environment (such as a viral infection) and a
genetic determinant that allows the β cells to be recognized as “no self
• Among identical twins, if one sibling develops Type 1 diabetes mellitus, the other twin has only a
30–50% chance of developing the disease
• In type-2 in which genetic influence is stronger both identical twins virtually become diseased.
Diagnosis of Type-1 DM
• Patients with Type 1 diabetes can usually be recognized by the abrupt appearance of polyuria,
polydipsia, and polyphagia.
• These symptoms are usually accompanied by fatigue, weight loss, and weakness
• The diagnosis is confirmed by a fasting blood glucose (FBG) greater than or equal to 126 mg/dl
• Fasting is defined as no caloric intake for at least 8 hours and FBG 100–125 mg/dl is categorized
as an impaired FBG
Metabolic changes in Type 1 diabetes
Elevated levels of blood glucose and ketones are the hallmarks of untreated Type 1 diabetes mellitus
The main cause of hyperglycemia is hepatic production of glucose and diminished plasma glucose
uptake by peripheral cells
Ketosis results from increased mobilization of fatty acids from adipose tissue and accelerated hepatic
fatty acid β-oxidation and synthesis of 3-hydroxybutyrate and acetoacetate
Acetyl coA from β-oxidation is the substrate for ketogenesis and the allosteric effector of pyruvate
carboxylase, a gluconeogenic enzyme
Metabolic changes in Type 1 diabetes
2. Hypertriacylglycerolemia:
Not all the fatty acids flooding the liver can be disposed of through oxidation or ketone body
synthesis.
These excess fatty acids are converted to triacylglycerol, which is packaged and secreted in very-
low-density lipoproteins (VLDL).
Chylomicrons are synthesized from dietary lipids by the intestinal mucosal cells increased b/c
lipoprotein lipase activated by insulin decrease its function
Metabolic changes in Type 1 diabetes
Treatment of T1DM
• Type 1 diabetics must rely on exogenous insulin injected subcutaneously to control the
hyperglycemia and ketoacidosis
• Hypoglycemia caused by excess insulin is the most common complication of insulin therapy,
occurring in more 90% of patients
Type-2DM
• Type 2 diabetes is the most common form of the disease, afflicting approximately 90% of the
diabetic population
• Patients with Type 2 diabetes have a combination of insulin resistance and dysfunctional β cells
• Typically, Type 2 diabetes develops gradually without obvious symptoms and obtained by routine
screening
• However, Type 2 diabetes have symptoms of polyuria and polydipsia of several weeks duration
• the inadequate insulin secreted in T2DM restrain ketogenesis and blunts the development of DKA
What is insulin resistance
• Insulin resistance is the decreased ability of target tissues, such as liver, adipose, and muscle, to
respond properly to normal circulating concentrations of insulin
• Insulin resistance alone will not lead to Type 2 diabetes unless impaired β-cell function occurred
• Micro vascular complication are specific to diabetes . The major cause of diabetic
microangiopathy is nonenzymatic glycation of vascular protein and lipid components
Lipolysis and beta oxidation take place increase FFA acid and precursor for gluconeogenesis
• High proton in DKA is buffered by extracellular(HCO3) and intracellular by exchange with K
• When proton inters cell K leave cells leads to hyperkalemia, then K will be secreted and lost
• FFA acid released from adipose tissue to liver has three fates
Normally the energy expenditure is balanced with energy gain otherwise misbalance is pathologic
In primitive societies 'daily life required a high level of physical activity and food was only
available intermittently
Therefore, genetic tendency favoring storage of excess calories as fat for a survival value only.
How to assess obesity
It is very difficult to measure directly the excess fat accumulated in body of individual
Measuring the waist size with a tape measure is also used to screen for obesity
B/C this measurement reflects the amount of fat in the central abdominal area of the body.
The presence of excess central fat is associated with an increased risk for morbidity and mortality
A waist size ≥ 40 inches in men and ≥ 35 inches in women is considered a risk factor
Regulation of body weight
The body weight of most individuals tends to range within ten percent of a set value
Each individual has a biologically predetermined “set point” for body weight.
The body attempts to add adipose tissue when the body weight falls below the set point
Our body also tend to lose weight when the body weight is higher than the set point
However, genetic, behavioral and environmental factors that influence energy balance are constant
Factors contribute for obesity
1. Environmental factors
Factors like availability of palatable, energy-dense foods, play a role in the increased prevalence of obesity.
Furthermore, sedentary lifestyles, encouraged by TV watching, automobiles, computer usage, and energy-sparing
devices in the workplace and at home, decrease physical activity and enhance the tendency to gain weight
2. Eating behaviors
Eating behavior such as snacking, portion size, variety of foods consumed, an individual's unique
food preferences, and the number of people with whom one eats also influence food
consumption and the tendency toward obesity
3. Genetic factors
If both parents are obese, there is a 70–80% chance of the children being obese.
In contrast, only 9% of children were fat when both parents were lean
mutations in the gene for the adipocyte hormone leptin or its receptor produce hyperphagia
(increased appetite for and consumption of food) and massive obesity
• Based on the location of fat accumulatio obesity can be classified as upper and low body obesity
• Excess fat in the central abdominal area is called android, “apple-shaped,” or upper body obesity
• Central obesity is defined as a waist to hip ratio of more than 0.8 for women and more than 1.0 for
men
• In contrast, fat distributed in the lower extremities around the hips or gluteal region is call gynoid,
“pear-shaped,” or lower body obesity. It is common for female and low risk for disease
• It is defined as a waist to hip ratio of less than 0.8 for women and less than 1.0 for men
Anatomic location of fat distribution
Biochemical difference of central and lower obesity
• Abdominal fat cells are much larger and have a higher rate of fat turnover than lower body fat
cells
• Therefore, abdominal fat tend to mobilize fatty acids more quickly than those from the lower body
depots
• Visceral adipocytes are the most metabolically active and hormonally more responsive
• Due to quick mobilization of abdominal fat, male generally lose weight more readily than women
• Furthermore, fat released from abdomen are absorbed via the portal vein and, direct access to the
liver
• Fatty acids taken up by the liver may lead to insulin resistance b/c increased synthesis of
triacylglycerols, which are released as very-low-density lipoprotein (VLDL)
• By contrast, free fatty acids from gluteal fat enter the general circulation, and have no preferential
action on hepatic metabolism.
Effect of adipocytes for obesity
• When triacylglycerols are deposited in adipocytes, the cells initially show a modest increase in
size
• However, the ability of a fat cell to expand is limited, and when its maximal size is reached, it
divides
• Obesity is, therefore, thought to involve an increase in both the number and size of adipocytes
• Thus, when an obese individual loses weight, the size of the fat cells is reduced, but the number of
fat cells is not affected
Function of adipocytes
Endocrine role
White adipose tissue is a passive reservoir of TAGs and play an active role in body weight
regulation
Leptin is produced proportionally to the adipose mass and informs the brain the fat store level
Leptin's secretion is suppressed by depletion of fat stores (starvation) and enhanced by expansion
of fat stores (well-fed state).
leptin increases the metabolic rate and decreases appetite through suppression hunger
When we consume fewer calories than we need, body fat declines, and leptin production from
the fat cell decreases
At this The body adapts by minimizing energy utilization (decreasing activity) and increasing
appetite
Since the level of leptin correlate to body mass it is high in obese individual, but resistant
Adiponectin reduces levels of FFAs in the blood and has been associated with improved lipid
profiles,
Action of leptin in maintaining fat store(long term
effect)
Short term-signals control feeding
Short-term signals from the gastrointestinal tract control hunger and satiety
This regulation affect the size and number of meals over a time course of minutes to hours.
In the absence of food intake (between meals), the stomach produces ghrelin an orexigenic
(appetite-stimulating) hormone that drives hunger
As food is consumed, gut hormones (cholecystokinin (CCK) and peptide YY), among others,
induce satiety (an anorexigenic effect) thereby terminating eating
Obesity and health
• Obesity is correlated with an increased risk of death and is a risk factor for a number of chronic
conditions, including
• T2D, dyslipidemias, hypertension, heart disease, nonalcoholic fatty liver disease, and sleep apnea
Obesity management
• The goals of weight management in the obese patient are, first, to induce a negative energy
balance to reduce body weight, that is, decrease caloric intake and/or increase energy expenditure
• Typically, a prescription for weight reduction combines dietary change; increased physical
activity; and behavioral modification
• Persons who combine caloric restriction and exercise with behavioral treatment may expect to lose
about 5%–10% of initial body weight over a period of 4–6 months.