Fndm

• The cerebellum is the part of the brain that controls balance, coordination, and fine motor skills.
• Nutritional status


  The assessment of the state of nourishment of a subject or patient
• Nutritional intake


  Amount of energy consumed through dietary intake
• Nutritional/Energy balance


  Not just about energy (calories) (Kcal), it is important to get the right macronutrient and micronutrient balance in your diet
• Signs of being nutritionally balanced

  • Maintain a stable healthy bodyweight
  • Low blood cholesterol
  • Healthy BP
  • Steady blood glucose
• Negative energy balance


  Expenditure is greater than input - undernutrition
• Positive energy balance


  Expenditure is less than input - malnutrition - Overweight/obesity
• Energy balance


  1. Intake (consumed amounts)

  2. Expenditure (expelled - used)

  3. Balance (intake=expenditure)
• Malnutrition is when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function
• Undernutrition is when the body does not get enough essential nutrients. The body is using them or excreting them more rapidly than they can be replaced
• Malnutrition


  • Can occur as a result of undernutrition as well as obesity
  • Concerned with quality of food
  • Observed in unintentional weight loss or clinical signs of a specific deficiency
  • Causes are complex and not just simply related to a lack of food intake
  • Can arise from malabsorption of nutrients
  • A burden for both developed and developing countries
  • Preventing malnutrition is a public health priority globally
• Undernutrition


  • Used to be associated more with developing countries but a lack of food (increased poverty rates) are now becoming a problem for developed countries
  • Food Banks are becoming more of a familiar sight in developed countries
  • Poverty in developed countries has received a lot of media attention in the last few years
• Starvation


  • Inactive/taking water only, survival = 50+ days before death
  • Fast < 2 weeks - no serious adverse effects (evolution of systems to cope with dramatic reductions in energy intake)
• Short term control of blood glucose during starvation

  1. Initial response is to maintain 'euglycaemic' state

  2. Glucagon causes the release of glucose from the liver

  3. Liver can supply ~12 hrs
• Hormonal adaptations during starvation

  1. Glucagon:insulin ratio increases

  2. Mobilisation of muscle (amino acids) for gluconeogenesis & free fatty acids for oxidation

  3. After > 3 days - 'protein sparing' is essential (max ~ 4kg protein for glucose synthesis)

  4. Continued elevation of glucagon:insulin ratio leads to FFA oxidation in liver & ketone body synthesis (fuel for CNS)

  5. After > 1 week, ketone bodies are main fuel for brain and muscle and used in preference to FFA
• Ketosis in starvation is not the same as the pathological ketoacidosis of diabetes
• Causes of undernutrition


  • War
  • Sanctions
  • Drought
  • Crop failure
  • Poverty
  • Political
  • Environmental
• Protein energy malnutrition (PEM)


  • Too little energy/protein in diet
  • Children especially vulnerable as limited body stores of kcals & protein available
• Syndromes of undernutrition in children

  • Kwashiorkor - (oedematous PEM) failure to grow, skin lesions, fatty liver, oedema, irritability
  • Marasmus - generalized wasting, stunting, lethargy
• Kwashiorkor occurs where cassava, yam, plantain, corn and rice are staples but rarely in wheat growing regions
• Both kwashiorkor and marasmus cause 'stunting' - catch up growth cannot compensate fully
• Anorexia Nervosa


  • Cause unknown, several popular models including societal pressure, fear of maturity, disturbance in brain chemistry, cry for help
  • Other 'psychologically' mediated causes of undernutrition include mental illness, depression, schizophrenia, drug abuse
• Clinical undernutrition


  • Caused by surgery, reflux, pain, obstruction, chemotherapy - leading to reduced intake
• Obesity


  • Calculated by a person's body mass index (BMI) - weight in kg divided by height in m2
  • BMI > 25 = overweight, BMI > 30 = obese
• Waist-to-hip ratio


  Measure of fat distribution, desired ratio < 0.8 for women, < 1.0 for men
• Obesity is caused by energy in > energy out (positive energy balance)
• Causes of obesity


  • Hypertrophy of existing adipocytes
  • Hyperplasia development of new adipocytes
  • Evolutionary adaptation - 'thrifty gene' theory
  • Genetic factors - obese parents frequently have obese children and obese pets
  • Metabolic factors - very rare that basal metabolic rate is lower in obese
  • Disease factors - hypothyroidism, Cushing's disease
  • Drugs - corticosteroids, female hormone treatments, some antidepressants, recreational drugs
  • Reduced activity level - frequently reduced in obese (cause or effect?)
  • Socioeconomic factors - where food is cheap and plentiful obesity increases
• Obesity increases the risk of various health problems
• Overweight individuals


  • Usually higher metabolic rate than lean counterparts
• Metabolic rate


  Related to body mass and therefore increases as body mass increases
• Disease


  May contribute to being overweight
• Hypothyroidism


  • Patients show moderate increase in weight
• Abnormalities/injury to hypothalamus


  • Can contribute to obesity
• Cushing's disease


  • Caused by high levels of steroid hormones → obesity
• Drugs that can contribute to obesity

  • Corticosteroids
  • Female hormone treatments (e.g. oral contraceptives)
  • Some antidepressants
  • Recreational drugs
• Activity level


  Frequently reduced in obese (cause or effect?)
• Little good study evidence regarding role of inactivity in obesity
• Much epidemiological evidence (TV watching, use of cars, etc) that inactivity is linked to obesity
• Correlation does not show causality
• Socioeconomics


  Where food is cheap and plentiful obesity is higher, where food is hard to obtain obesity is lower