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Summary all lectures 1-10 Nutrition in Health and Disease
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Summary all lectures of nutrition in health and disease - master Health sciences
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SUMMARY NUTRITION INHEALTH AND DISEASE
LECTURES 2018-2019
PIEN AKKERSDIJK 1
,Lecture 1 – Monday September 3rd
Rules & regulations
Clinical vs public health nutrition
- Clinical: Nutritional care for individual patients or patient groups – changes in nutritional
requirements due to illness, treatment and malnutrition
- Public: Health control and prevention of public health
http://www.ccmo.nl/en/your-research-does-it-fall-under-the-wmo
PIEN AKKERSDIJK 2
,lecture 2 – Thursday September 6th
Gastrointestinal Tract
Chapter of digestion and absorption: exam stof
Difference digestion and absorption
Digestion: starts in the mouth (enzymes, saliva)
Absorption: starts in intestines
Heath and disease
Health
- Energy in balance, Water Minerals, nutrients all in balance stable metabolism
Disease
- Weight loss, dehydration/oedema, catabolism, (pro-)inflammatory changes à due to imbalance
GI tract
Mouth, stomach, pancreas, bile tract, small intestine, colon
Poop 100-150gr a day
Every day 6/7 liters of juice is going through the GI
Esophagus
Muscle like structure for the contractions to transfer the food downwards
Structure: muscle (circular and longitudinal)- connective tissue (mucus-forming glands in connective
tissue) - mucous
Stomach
- Temporary storage food
- Gastric juice production
- Kneading and mixing food with gastric juice
- Gradual release of food to small intestine
Longitudinal muscles and circular muscles
G-cells make gastrin (make gastric juice à to digest the
proteins)
Pyloris functions as a “door” à the muscle contracts
(closed) when the food needs to stay in the stomach, and
opens when the food can enter the intestines
Ghrelin is low in obesity patients and too high in anorexia
patients causing in obesity patients not to feel full after a
meal, and the opposite for anorexia patients
For your small intestine to function you need a higher pH than gastric juice (pH = 2) à bicarbonate
increases the pH to neutralize the pH
Vitamin B12 is present in meat, liver, eggs, cheese and milk. Absorption of vitamin b12 in the ileum,
resorption only possible after connection with the intrinsic factor (…)
Biliary tract
Function
- Detoxification
- Digestion of fat
- Coagulation )stolen
Liver can grow itself
Bile juice is important for the digestion of fat. Gall bladder is to store bile juice, but you can live without
it. When fat food enters your duodenum the autonomic nervous system is stimulated and the
gallbladder muscle contraction and relaxation sphincter
PIEN AKKERSDIJK 3
,Release bile through two mechanisms:
1. Taste and smell stimulates brain – vegetative nervous system -> release of
bile in duodenum
2. Fatty foods in duodenum stimulates autonomic nervous system ->
gallbladder muscle contraction
and relaxation sphincter
Bile is made from cholesterol in the liver, and it’s needed to break down fat.
Breaks fat down in small droplets, leading to an increase in surface of fat. After
digestion bile is reabsorbed by intestinal cells, the return goes via the hepatic
portal vein. Also bile gives the brown colour to stool.
Pancreas
In the head most of the enzymes are made, and in the tail most of the insulin
is made
Head: exocrine tissue, tail: endocrine tissue
Endocrine function: insulin – glucagon – somatostatin
Exocrine function: ± 1 to 3 liters of enzymes non-active form per day
enzymes: trypsin, amylase, lipase and peptidase (needed for digestion of food)
Bicarbonate to neutralize stomach acid. Drainage technique enzymes and bicarbonate after
using pancreatic duct duodenum -> activating
Small intestine
Increase of absorption surface by villi and microvilli (widens the absorption capacity), 5 to 6 meters
For B12 the terminal part of the ileum is important, but besides that large parts can be removed, you
only need 150cm for a good function, while we have about 5 meters
Colon
Bacteria help digest fibers
Colon is responsible for absorption of vitamin K
Absorption overview
Stomach Alcohol (20%)
Water
Duodenum (25 cm) Sodium Magnesium
Potassium Phosphate
Iron Calcium
Zinc Alcohol (80%)
Jejunum (2-2,5 m) Proteins (amino acids)
Fat (fatty acids)
Carbohydrates (mono-dissaccharides)
Sodium
Potassium
Vitamin C, In fat soluble vitamins (ADEK)
B vitamins except for B12
Ileum (3-3,5m) Vitamin B12
Bile salts
Vitamins and minerals if not digested already in
jejunum
PIEN AKKERSDIJK 4
,Carbohydrates digestion:
Starch: when you eat starch (carbohydrate) you need your pancreas (amylase), and your small intestinal
cells (maltase, sucrase, lactase)
Fiber: when you eat fiber you need your bacterial enzymes in your colon
Fat digestion:
For fat you need bile acid and pancreatic lipase
Protein digestion:
For protein pancreatic trypsine, stomach pepsine, and in the small intestines tripeptidase and
dipeptidase is needed
Overall the autonomous or vegetative nervous systems is needed. It’s divided in orthosympathetic
(catabolic processes à energy release system, during exercise) and the parasympathic (anabolic
processes à muscle break down, build up again)
Hormonal secretion
Product Result
Acid stomach contents into contact with Secretin release
duodenum
Secretin (duodenum) Gastrin inhibited secretion
Secretin Water and bicarbonate secretion
Bile acids Stimulation of pancreatic lipase release
Amino acids and fatty acids Stimulation of CCK release
CCK (duodenum – jejunum) Hormone: stimulation pancreas and gall bladder
-> enzymes and bile release
Neurotransmitter -> stop hunger
Enterokinase (duodenum) Stimulation trypsin (pancreas) release
Trypsin Pro-active form -> active enzyme
Health Disease
Energy in balance Weight loss
Water in balance Dehydration/oedema
Minerals in balance Hypo/hyper…
Nutrients in balance Catabolism
Stable metabolism (pro-) inflammatory
changes
case
Mrs Pepper: pancreatoduodenectomy (head pancreas, duodenum and gallbladder are removed)
When she got home, there was mud leaking from her open wound. What could it be?
Bile, stomach acids, chyme (food or actually small intestinal fluid), blood, pancreatic juice
Diseases of the esophagus
- Esophagitis – not a problem for digestion or absorption, however it hurts so bad that you
probably can’t eat normally
- Barett’s disease – reflux which damages the esophagus, might develop tumour
- Achalasia – no easy flow to your stomach à namely eating problems, not a problem for
digestion or absorption
- Carcinoma
PIEN AKKERSDIJK 5
, Adenocarcinoma esophagus
In the last part of the esophagus and the risk factors are reflux and obesity
Squamous carcinoma
Upper and middle part of esophagus, key risk factors are smoking, consumption of alcohol and
nutrition (nutrition: hot tea and burnt meat e.g.).
After esophagectomy the main problem is that the pylorus can’t hold the food in the “stomach”, it
enters the duodenum too soon.
Potential causes of vitamin B12 deficiency
- Insufficient vitamin b12 food consumption
- Insufficient bound of consumed vitamin B12 to intrinsic factor
- Suboptimal vitamin b12 absorption
- Total gastrectomy
- Autoimmune gastritis = reduced production of HCl, intrinsic factor and pepsinogen
- Atrophic gastritis
- Bacterial overgrowth
- Lack intrinsic factor in stomach
Diseases of the biliary tract
- HCC (hepatocellular carcinoma)
- Cholangiocarcinoma
- Gallbladder carcinoma
- Cirrhosis
- Hepatitis
Loss of bile juice in rats
Omlaag digestion, resorption, postoperative recovery, food intake, body weight
Hypothesis: loss of bile in humans affects nutritional status and body weight
Pancreatic carcinoma
Without therapy: median survival after diagnosis is only 4-6 months
5 years survival is 10-20%
Symptons:
Phase 1: weight loss, abnormal bowel habits, loss of appetite
Phase 2: pain (stomach/back), jaundice, discolored faeces
Phase 3: itching, nausea, vomiting, intestinal bleeding, closure, swelling belly
Causes are multi factorial: hereditary pancreatic cancer. It is more common in people who suffer
from chronic pancreatic inflammation, smoke, have excessive alcohol consumption. Increasing
risk by low fibre diet.
75% is in the head of the pancreas à give them enzyme supplementation to prevent
malnutrition and reduce of complaints.
Diseases of the small intestine
- Crohn’s disease = inflammatory bile disease à you can develop stenosis (bile closed)
Risk factors: we are too clean (hygiene)
- Coeliac disease: “allergic” for gluten à villi are destroyed, so no villi in your bile which decreases
the surface so the absorption is bad
- Cancer
Disease of the colon
- Cancer
- Without the colon you lose a lot of sodium causing dehydration
PIEN AKKERSDIJK 6
, Lecture 3 Energy and protein requirements in health and disease
Topics
- Malnutrition in health
- Disease related malnutrition
- Energy requirements in health
- Energy requirements in disease
- Protein requirements in health
- Protein requirements in disease
Malnutrition in health
Clinical features of protein energy malnutrition (PEM)
Ø Reduced body weight
Ø Decreased metabolic rate
Door een inadequate eiwit en/of energie
inname past ons metabolisme zich aan en
verliezen we gewicht. Dit komt omdat er
een verminderde eiwit opslag is waardoor
onze skeletspiermassa het meest zal
afnemen, naast de hartspiermassa,
longspiermassa en eiwitreserves. Door een
verminderde metabolische activiteit is er
kans op hypotensie, bradycardie (lage
hartslag) en hypothermie (onderkoeling).
Ons lichaam kan zich aanpassen aan deze
nieuwe omstandigheden dankzij bepaalde
mechanismen, waardoor we langer in deze
toestanden kunnen overleven. Als we er
niet slagen ons aan te passen aan de nieuwe
omstandigheden, blijven we eiwit en vet
verlies hebben en tast dit ons
immuunsysteem aan (immuundeficiëntie)
en kan het leiden tot hypoalbuminemie.
à als je niet eet dan zal het metabolisme zich aanpassen en je verliest gewicht, verminderde eiwit store
(verliest spiermassa, omdat eiwitten naar andere plekken gaan), energie verbruik gaat omlaag (als je
hier succesvol in bent, dan heb je kans om langer te leven (adaptatie)) à stikstof en energie balans
Als je ernstige ziekte oploopt dan heb je kans dat adaptatie faalt, met dood als gevolg.
Helft van eiwit zit in spiermassa en de helft hiervan zit in je bovenbeen
Lever en hersenen en vetweefsel à onder normale omstandigheden, tussen twee maaltijden in dan
ben je in gevoede toestand, dan gebruik je glucose uit een “glucose potje”. Belangrijkste orgaan die
glucose nodig heeft zijn de hersenen, die halen dit uit het bloed na glucose inname of uit glycogeen
opgeslagen in de lever. Spieren halen glucose uit vetweefsel energie.
Na vasten begint de glycogeenvoorraad op te raken à is er nog wel, maar niet veel à Glucose voor de
hersenen wordt gereguleerd, nieuw glucose gemaakt (uit aminozuren) of door glycogeen. Als je weinig
koolhydraten hebt, dan is het lastiger om vet te verbranden. Diabetes is lastiger op glucose in cel te
krijgen en beschikbaar te maken. Verbranding van vet is niet volledig, omdat je glucose nodig hebt voor
verbranding van vet. Ontstaan ketonen.
PIEN AKKERSDIJK 7
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