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Metabolism

Metabolism

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1
Energy Metabolism and
Normal Nutritional
R
i
t
R
equ
i
remen
t
s
FERNANDO L. LOPEZ, MD, FPCS
Professor of Surgery
UST Department of Surgery
OBJECTI VES
\ue003To review normal protein,
carbohydrate and lipid metabolism
\ue002
T o u n d e rs ta n d th e m e c h a n is m s th a t
\ue002
T o u n d e rs ta n d th e m e c h a n is m s th a t
regulate substrate utilization and
energy production
\ue003To demonstrate methods for
calculating nutritional requirements
NUTRI ENTS
\ue003Protein
4 kcal / g
\ue003Carbohydrates
enteral
4 kcal / g
parenteral
3.4 kcal / g
\ue003Lipids
9 kcal / g
\ue003Water
\ue003Vitamins
\u2013 Water soluble
\u2013 Fat soluble
\ue003Minerals
\u2013 Electrolytes
\u2013 Trace elements and ultra trace minerals
Glucose Metabolism
Glucose
Glucose
Cori
CYTOPLASM
MITOCHONDRIA
Pyruvate
Lactate
Lactate
Cycle
M IT O C H O N D R IA
Pyruvate
AcetylCoA
Krebs
Cycle
ATP
Lieberman MA, Vester JW. Carbohydrates. In: Nutrition and Metabolism in the Surgical Patient.
Boston, MA: Little, Brown and Company;1996:203-236.
Fatty Acid Metabolism
CYTOPLASM
MITOCHONDRIA
CAPILLARY
Triglycerides
Fatty Acids
C a r n itin e
Fatty Acids
+
Glycerol
Fatty Acids
ATP
\u00df Oxidation
Triglycerides
C a r n itin e
Fischer JE, ed. Nutrition and metabolism in the surgical patient. Boston, MA: Little, Brown and
Company; 1996.
Amino Acids
\u2022ESSENTIAL

\u2212Leucine
\u2212Lysine
\u2212Valine
\u2212Threonine

\u2022CONDITIONALLY ESSENTIAL
\u2212Glutamine
\u2212Arginine
\u2022NON-ESSENTIAL
\u2212
A la n in e

\u2212Isoleucine
\u2212Phenylalanine
\u2212Methionine
\u2212Histidine
\u2212Tryptophan

A la n in e

\u2212Tyrosine
\u2212Aspartic Acid
\u2212Glutamic Acid
\u2212Cysteine
\u2212Glycine
\u2212Serine
\u2212Proline

Fischer JE, ed. In: Nutrition and Metabolism in the Surgical Patient. 1st ed. Lippincott Williams and
Wilkins Publishers; 1996.
2
COOH
Chemical Structure of an Amino Acid
R
NH3
Fischer JE, ed. In: Nutrition and Metabolism in the Surgical Patient. 1st ed. Lippincott Williams
and Wilkins Publishers; 1996.
Nitrogen Balance
NB = IN \u2013 (UN + RNL)
NB:
Nitrogen Balance
IN:
Ingested Nitrogen
UN:
24-Hour Urine Nitrogen
RNL:
Remaining Nitrogen Loss (3.1 g/d)
Respiratory Quotient (RQ)
RQ =VCO2
VO2
VO2
RQ:

Respiratory Quotient
VCO2: CO2 Produced
VO2:

Oxygen Consumed
Respiratory Quotient (RQ)
RQ
\u2022Glucose oxidation
6/6 = 1.0
1 glucose + 6 O2= 6 CO2+6H20
\u2022Fat oxidation
16/23 = 0.7
1 palmitate + 23 O2= 16 CO2+ 16 H2O
\u2022Protein oxidation
4.1/5.1 = 0.8
1 amino acid + 5.1 O2= 4.1 O2+ 2.8 H2O
\u2022Lipogenesis
> 1.0 \u2013 8.0
Nutrient Utilization
\u2022Regulation
\u2013
N u trie n t a v a ila b ility
\u2013
N u trie n t a v a ila b ility
\u2013 Hormonal environment
\u2013 Inflammatory state
Excess Glucose Supply
Glucose
Glucose
CYTOPLASM
Acetyl CoA
Triglycerides
Lipogenesis
CO2
Pyruvate
MITOCHONDRIA
Pyruvate
Acetyl CoA
Krebs
Cycle
ATP
3
Excess Fatty Acid Supply
CYTOPLASM
F
t t
A
i d
Free Fatty Acids
MITOCHONDRIA
Fatty Acids
Fatty AcidsAcetyl CoA
\u00df Oxidation
Carnitine
Ketones
Triglycerides
high insulin
low insulin
Inflammatory Response
Glucose
Glucose
CYTOPLASM
Pyruvate
Lactate
Lactate
Cori
Cycle
MITOCHONDRIA
Pyruvate
Acetyl CoA
Krebs
Cycle
ATP
X
TNF\u03b1
IL1
IL6BLOCKAGE
Inflammatory Response
CYTOPLASM
CAPILLARY
T rig ly c e rid e s
F a tty A c id s
TNF, IL-1
MITOCHONDRIA
T
r
i
g
l
ycer
i d
es
Fatty Acids
+
Glycerol
F
a
t t
y
A
c
i d
s
Fatty Acids
ATP
\u03b2Oxidation
Triglycerides
Carnitine
TNF
Energy Substrate Utilization
\u2022Fasting state:
De
p
ends on nutrient availabilit
y
p
y
\u2022In stress:
Depends on hormonal environment and
inflammatory response
Body Composition
Weight (kg)
70
60
Total Water (L)
42
31
Intracellular
28
19
Extracellular
14
12
Total Solids (kg)
28
28.8
Fat (kg)
12.5
17
BCM
Protein (kg)
12.5
9
Minerals (kg)
3
3BCM = Body Cell Mass
Malnutrition
Ideal Weight
Actual Weight
g
In malnutrition, energy expenditure must be calculated
based on actual body weight.

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