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Chapter 39: Alterations in Nutritional Status

Metabolism (Definitions)

Nutritional Status

Condition of the body related to the availability and use of nutrients

Energy

Measured in heat units called calories or gram calories, required by all body activities

Calorie

The amount of energy needed to raise the temperature of 1 kg of water by 1ºC

Metabolism

The organized process through which nutrients are broken down

Four Types of Energy Expenditure

Basal metabolic rate or resting energy equivalent

Diet-induced thermogenesis

Exercise-induced thermogenesis

Nonexercise activity thermogenesis

Dietary Standards

Dietary Reference Intakes (DRIs) include a set of nutrient-based reference values, RDA, AI, and AMDR.

Hunger, Appetite, and Satiety

Explain that the sensation of hunger is associated with several sensory perceptions, such as the rhythmic contractions of the stomach and that “empty feeling” in the stomach that stimulates a person to seek food.

Explain that hunger and satiety are controlled by a complex group of neurohormones, many of which are produced in the gastrointestinal tract.

Neurohormones and Food Intake

Two centers in the brain interact with various hormones and neurotransmitters to help control food intake and energy output.

These centers receive neural input from the gastrointestinal tract that provides information about stomach filling, chemical signals from nutrients in the blood, and input from the cerebral cortex regarding the smell, sight, and taste of the food.

Basal Metabolic Rate

Basal Metabolic Rate (BMR)

The chemical reactions occurring when the body is at rest

Provides energy for maintenance of temperature, cardiovascular and respiratory function, muscle tone, and other essential activities of tissues and cells

Resting Energy Equivalent (REE)

Used for predicting energy expenditure

Body Mass Index

Uses height and weight to determine healthy weight

BMI = weight (kg)/height (m2)

Between 18.5 and 24.9 has the lowest statistical health risk.

<18.5 is classified as being underweight.

Between 25 to 29.9 is considered overweight.

>30.0 is diagnosed as obesity.

Class I (BMI 30.0 to 34.9)

Class II (BMI 35.0 to 39.9)

Class III or extreme obesity (BMI >40)

Phases of Metabolism

Anabolism

The phase of metabolic storage and synthesis of cell constituents

Does not provide energy for the body; it requires energy.

Catabolism

Involves the breakdown of complex molecules into substances that can be used in the production of energy

Metabolites

The chemical intermediates for anabolism and catabolism

Question #1

Which of the following best describes the phase of metabolic storage and synthesis of cell constituents?

Catabolism

Anabolism

Cannibalism

Metabolism

Answer to Question #1

B. Anabolism

Rationale: Anabolism is the process of cell building and growth.

Glucose Metabolism

Glycogenolysis

The breakdown of glycogen

Controlled by the action of glucagon and epinephrine

Gluconeogenesis

The synthesis or building of glucose

Much of the process occurs in the liver

Mechanisms of Heat Production

Basal metabolic rate or resting energy equivalent

Diet-induced thermogenesis

Exercise-induced thermogenesis

Thermogenesis in response to changes in environmental conditions

Variables Affecting Amount of Energy Used

Age

Body size

Rate of growth

State of health

Question #2

Which of the following is a reflection of a persons metabolic activity?

BMI

BMR

Answer to Question #2

B. BMR

Rationale: BMR is a measure of the reactions that are taking place in the body. The BMR is not a measure of health but just a representation of the resting metabolic activity.

Adipose Tissue

Endocrine and paracrine

Adipokines

Leptin

Cytokines

Growth factors

Adiponectin

Types of Adipose Tissue

Adipocytes contain 90% of body energy.

White fat

Constitutes 10% to 20% of body weight in adult males and 15% to 25% in adult females

Exists as an oil at body temperature

Consists of triglycerides

Brown fat

The site of diet-induced thermogenesis and nonshivering thermogenesis

Recommended Dietary Allowances

RDAs define the intakes that meet nutrient needs of healthy persons in a specific age and sex group.

Components of dietary reference intake (DRI)

Set of at least four nutrient-based reference values

The RDA and adequate intake

The estimated average requirement

The tolerable upper intake level

Components of a Nutritional Assessment

Diet assessment

Recording the amount of food in a 24-hour period

Health assessment

Health history and physical examination

Anthropometric measurements

Assessing body composition

Laboratory studies

Total lymphocyte count

Serum albumin

Delayed hypersensitivity

Creatinine–height index

Health Risks Associated with Obesity

Hypertension

Hyperlipidemia

Type 2 diabetes

Coronary heart disease