Home
Flashcards
Preview
307 - Human Starvation (Dr Hoffer lecture)
Home
Get App
Take Quiz
Create
Automatically remove your image background. Try it now!
https://remove-image-background.com
what is starvation?
Starvation is the physiological condition created in the body by chronically insufficient food intake
what are the 2 types of starvation?
Physiological and Pathological
what is pathological starvation?
Its a disease:
Protein energy malnutrition (PEM)
Starvation disease
Starvation- related malnutrition
what is the reason that people don't survive starvation?
Due to a lack of adaptation
what are the clinical features of PEM?
Reduced body weight
Adipose tissue depletion
Muscle wasting and decreased strength
Reduced respiratory and cardiac muscular capacity
Skin thinning
Deceased metabolic rate
Hypothermia
Apathy
Edema
Immunodeficiency
what are some adaptive mechanisms to inadequate protein and/or energy intake?
Reduced protein store
↓↓ Skeletal muscle mass
↓ Heart muscle mass
↓ Respiratory muscle mass
↓ Protein reserve
Reduced metabolic rate
Hypotension
Bradycardia
Hypothermia
what is a successful adaptation?
Protein and energy balance = 0
Normal serum albumin
what is a failed adaptation?
Continuing protein and fat loss
Hypoalbuminemia
Immune deficiency
how many patients suffer from moderate-to-severe PEM?
> 25%
The Canadian Malnutrition Task Force reports prevalence as 45%
what are the 3 kinds of starvation disease?
1. Starvation related malnutrition (SRM)
2. Chronic disease-related malnutrition (CDRM)
3. Acute disease related malnutrition (ADRM)
what is starvation related malnutrition?
Simple, uncomplicated PEM
Muscle atrophy and fat depletion
caused by
solely by starvation
what is chronic-disease related malnutrition?
Cachexia:
Muscle atrophy and fat depletion caused by a
combination of starvation and chronic systemic inflammation
what is acute disease-related malnutrition (ADRM)?
Not necessarily an existing disease per se
Rapid severe muscle catabolism induced by critical illness of severe trauma or sepsis
Likely mitigated by sufficient protein provision
Patient may or may not have existing PEM
what is a successful adaptation?
PEM
Halts the loss of body mass despite continuing starvation
what does a stable body composition imply?
Cessation of fat loss
Cessation of lean tissue
what happens to the body when there is reduced ↓
resting
energy expenditure?
Reduced ↓ mass of metabolically active tissue (muscle mass) (slow, and takes weeks)
Reduced ↓ energy expenditure
per unit
active tissue (fast, takes days)
what happens to the body when there is reduced
non-resting
energy expenditure?
Reduced work of moving
Reduction of voluntary movements
what happens when there is reduced energy expenditure
per kg active tissues
?
Reduced heart rate and blood pressure
Reduced muscle tone
what happens with reduced protein requirement in starvation?
Diminished ↘ lean tissue mass
More efficient retention of dietary protein
Lean tissue mass
stabilizes
despite continued low protein intake
what happens in terms of mechanism in a successful adaptation?
Involves:
Reduced energy "requirement" for homeostasis
Reduced protein"requirement" for homestasis
what are the benefits of a successful adaptation?
Survival
what are the cost for a successful adaptation?
Lean tissue loss
Fatigue and inactivity
Immunodeficiency
Reduced tolerance to stress
weight reduction is what kind of starvation?
Pathological starvation
Obese people benefit from reducing their excessive body store of adipose tissue to a desirable size
To accomplish this goal, they have to consumme less energy for a long time (aka they must
starve
)
what are the consequences of adaptation to starvation (if obese people starve)?
Muscle atrophy
Lowered basal metabolic rate
Fatigue
Apathy
Hypothermia
what is the cause of Starvation Related Malnutrition (SRM)?
Common cause in the world is involuntary food deprivation
what are the causes of Starvation Related Malnutrition in hospitals (SRM)?
Anorexia
Pain
Nausea
Chewing and swallowing problems
Poverty
Gastrointestinal obstruction
Dysgeusia (when things taste bizarre)
what is Chronic disease-related malnutrition (CDRM)?
starvation disease
combined
with chronic low grade systemic inflammation
what is another name for CDRM?
Cachexia
what are the characteristics of systemic inflammation?
Acute phase response (hypoalbuminemia and increased C-reactive protein concentration)
Increased muscle protein catabolism
Anorexia
Impaired adaptation to starvation
what are the causes of starvation (CDRM) in hospitals?
Anorexia
Pain
Nausea
Chewing and swallowing problems
Poverty
Gastrointestinal obstruction
what are the causes of systemic inflammation (CDRM) in hospitals?
Chronic infection
Autoimmune disease
Chronic kidney
Heart or lung disease
Certain
Cancers
Why are in-hospital starvation diseases so often ignored?
Cardinal features of starvation disease are generalized
muscle atrophy and fat depletion
but
they are easy to detect
2 reasons:
Patients with in-hospital starvation often have a normal BMI
Patients commonly have multiple reasons for muscle atrophy
what is the cardinal feature of starvation disaese is?
Muscle atrophy
(Fat depletion)
what are the 6 causes of muscle atrophy?
1.
C
achexia
- systemic inflammation
2.
H
ormone excess or deficiency
3.
O
ld age
- sarcopenia 9 loss of muscle w/age)
4.
P
rotein energy malnutrition (PEM)
- starvation disease
5.
I
nactivity
- disuse atrophy
6.
N
euromusclar disease
Summary
Starvation can be
Physiological
and
Pathological
Pathological starvation
: Leads to the disease called PEM
PEM
: common + difficult to treat disease in Montreal hospitals
SRM
: simples, uncomplicated PEM (as in AN)
CDRM
:
PEM
+
chronic systemic inflammation
that:
↑ muscle protein catabolism, induces anorexia and impairs the adaptation to starvation
Automatically remove your image background. Try it now!
https://remove-image-background.com
Author
K.A
ID
326083
Card Set
307 - Human Starvation (Dr Hoffer lecture)
Description
nutr
Updated
2016-11-28T19:58:44Z
Show Answers
Home
Flashcards
Preview