NUTR 3336 1st Edition Lecture 3Outline of Last Lecture ObesityI. What do these terms mean? Pathophysiology Pathogenesis Epidemiology EtiologyII. What is Obesity An excess of adipose tissue A proportion of body wt composed of adipose tissue (percent body fat) that exceeds a range that is considered “healthy”III. Assessments for Measuring Body Fat Skinfold test Underwater weighing Bioelectrical impedance Air-displacement plethysmography Dual-energy x-ray absorptiometryIV. Body Mass Index Body Mass Index (BMI) Kg/m² OR(weight in pounds x 703)/(height in inches)²V. Body Mass Index BMI Classifications:Underweight < 18.5Normal 18.5-24.9Overweight 25-29.9Obesity (class 1) 30-34.9Obesity (class 2) 35-39.9Extreme Obesity (class 3) > 40VI. Body Fat Distribution 2 Types► Abdominal or Centralo Usually in maleso Apple or android shape► Lower bodyo Usually in femaleso Pear or GynoidVII. Epidemiology of ObesityThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute. Obesity is an “EPIDEMIC”► “Globesity” According to WHO (World Health Organization) Less than 5% in some nations to greater than 75% in others.VIII. Obesity in AmericaIX. Epidemiology of Obesity Obesity in the United States► From 1976-1980 to 2011-2012 the percentage of obesity increased from 15-34.9%o 34.9% of US adults are obeseo 17% of children (ages 2-19yr) are considered obese► Results from NHANES 1999-2002, indicate 65% of US adults are overweight or obese► JAMA. 2014;311(8):806-814. doi:10.1001/jama.2014.732.X. Epidemiology of Obesity► Race/Ethnicity► Socioeconomic Status► AgeXI. Etiology of Obesity► Etiology of Obesityo The original theory is that obesity develops when chronic energy intake exceeds energy expenditureo Etiology of obesity is very elusive!o It seems like a simple concept but is actually a heterogeneous group of disordersXII. Etiology of Obesity► Obesity can be caused by:o Medical Disorderso Medical Treatmentso Geneticso Obesigenic EnvironmentXIII. Etiology of Obesity► Obesity can be caused by:o Obesigenic Environment► Average Energy Consumption Increases Year 1971-1974 1999-2000US adult Males 2450 kcals 2618 kcalsUS adult Female 1542 kcals 1877 kcalsXIV. Etiology of Obesity► How does lack of energy expenditure contribute to obesity?o Automated work environmento Neighborhood environmento Busy lifestyleso Convenient tools to assist with householdo Reduction in physical education programs in schoolsXV. Pathogenesis/Pathophysiology of Obesity► Multifactorialo Effect of glandular conditions o Hormonal involvemento Genes= inconsistent resultso overconsumption of energy without adequate energy utilizationXVI. Pathogenesis of Obesity► Leads to MANY comorbidities including:o Cardiovascular Diseaseo Blood Lipid Problemso Diabeteso Hyperinsulinemia and Insulin ResistanceXVII. Pathogenesis of Obesity► Leads to MANY comorbidities including:o Hypertensiono Respiratory Problemso Gallbladder Diseaseo ArthritisOutline of Current Lecture ► Renal Disease► Kidneys► Anatomy Each nephron is made up of glomerulus► Afferent arteriole► Efferent arterioleUltrafiltrate formed by the glomerulus as blood passes throughFiltrate then modified as it passes through tubules by either reabsorption of AA, glucose, selective minerals, water or by secretion or solutes► Kidneys► Physiology Kidney has 3 functions:► Excretory► Metabolic► Endocrine Synthesizes Erythropoietin (EPO) which stimulates erythropoiesis► Renal Disease► NEPHROTIC SYNDROME (NS) Characterized by loss of protein in the urine (proteinuria)  Marked deficiency of albumin in the blood (hypoalbuminemia)► Renal Disease► NEPHROTIC SYNDROME (NS) Epidemiology:► Occurs in 2 in every 10,000 people► Results from an underlying disease► Most prevalent in children► Renal Disease► NEPHROTIC SYNDROME (NS) Etiology:► DM► Lupus► Focal Segmental Glomerulosclerosis (FSGS)► Amyloidosis► Renal Disease► NEPHROTIC SYNDROME (NS) Symptoms:► Anorexia► Malaise► Puffy eyelids► Abdominal pain► Muscle Wasting► Ascites► Anasarca► Renal Disease► NEPHROTIC SYNDROME (NS) Pathogenesis:► Oliguria► ARF► Hypoalbuminemia► Edema► Atherosclerosis► Renal Disease► CHRONIC KIDNEY DISEASE (CKD) A syndrome in which progressive irreversible loss of kidney function due to kidney damage Progression to end stage renal disease (ESRD) (CKD stage 5) results in need for RRT or kidney transplantation► GFR stages of Kidney Function► Renal Disease► CHRONIC KIDNEY DISEASE (CKD) Epidemiology:► The number of individuals expected to receive RRT or transplantation in 2010 (651,000)► 22% mortality rate► Renal Disease► CHRONIC KIDNEY DISEASE (CKD) Etiology:► DM► HTN► Glomerulonephritis► Hereditary cystic and congenital renal dz► Interstitial nephritis and polynephritis► Renal Disease► CHRONIC KIDNEY DISEASE (CKD) Signs and symptoms are R/T the kidney’s inability to perform normal homeostaticcontrol functions► Such as: fluid and electrolyte balance► Results in:Edema Uremia HyperphosphatemiaMetabolic Acidosis Azotemia OliguriaHTN Anemia Bone mineral disordersMicrocytic anemia Iron deficiency► Renal Disease► ACUTE RENAL FAILURE (ARF) Characterized by decrease in GRF and decrease in kidney’s ability to excrete metabolic waste Etiology:► Dehydration► Trauma► Drugs► Cancer► Renal Disease► ACUTE RENAL FAILURE (ARF) Pathogenesis:► Loss of LBM► Toxicity► Metabolic Disturbances► Energy and Protein Malnutrition Symptoms:► Fluid and electrolyte imbalances► Azotemia► Wasting► Renal Disease► NEPHROLITHIASIS (Kidney Stones) Epidemiology:► 7 to 21 per 10,000 Etiology:► Risk factors: Family Hx Hypercalciuria Hyperuricosuria Hyperoxaluria Low urine volume► Renal Disease► NEPHROLITHIASIS (Kidney Stones) Symptoms:► Pain► Nausea/Vomiting► Pain Urinating► Urgency to urinate► Diseases of the Hematological SystemNutrition PathophysiologyCarla Ferrell MS, RD, LD► The Hematological System► Involves: Bone marrow and spleen Lymph system Liver Endothelial vasculature ► The Hematological System► Dietary factors closely tied to hematopoiesis