PBL case 1 – Ah Fai and Food (nutrition)

Professional skills
1. BMI calculation: weight (kg) / height (m2)
Doesn’t take into account body fat distribution, obesity paradox phenomenon present
Doesn’t take into account muscle mass or bone density
Underweight: below 18.5
Normal: 18.5-22.9
Overweight: 23-24.9 kg/m2
Obese: 25 or above

2. Waist hip ratio: dividing waist circumference by hip circumference in CM

It’s the distribution of fat that that determines health risk: fat located around the
abdominal cavity (central obesity) is worse, and associated with greater health risk (cardio-
metabolic complications and mortality) than subcutaneous fat
Obese waist circumference for central obesity: M:90cm, F:80cm
Waist:hip ratio for central obesity: M: 0.9, F: 0.85

3. Long term complications of obesity

- Insulin resistance will develop leads to development of diabetes
- NAFLD
- Metabolic syndrome: Hypertension, cardiovascular disease, dyslipidaemia =>
STROKE
- Psychological wellbeing affected: depression, anxiety
- Quality of life: foot pain, ankle pain, bones and joints affected, sleep quality
(obstruction)
- Cancer: breast/ bowel (CRC)/ kidney cancer risk

Population health
WHO recommendation: 2000kcal (women), 2500kcal (men)
up to 5g salt (adult, less for children)
Sugar should be less than 10% of total energy intake
Fat (UNSATURATED) preferred, should be about 30% of total intake, trans-fat always no

1. High salt consumption

- First kidneys have trouble keeping up with the excess salt, glomeruli vessel damage
- Water also drawn into blood, due to greater osmolarity = blood volume increases
- Heart strained: work against greater preload and afterload, HYPERTROPHY
- stiffen and narrowed blood vessels: contributes to HYPERTENSION and heart strain
= heart failure/ stroke risk
- osteoporosis: loss of Ca with increase Na in diet: BONE ADSORPTION
- Liddle syndrome: ENaC not inactivated when plasma Na high, leads to continual Na
absorption = HT, autosomal DOMINANT

2. High sugar content

- Obesity: itself has a lot of negative outcome
- Tooth decay
- Fatty liver: metabolises excess sugar into fatty acids -> NAFLD, which is a contributer
to diabetes
- Heart disease risk (HYPETENSION) and stroke
- Liquid sugar (drinks): affects central appetite control as liquid calories are less
‘satisfying’ than solid calories = increases appetite to consume MORE food
- Obesity, diabetes, hypertension, NAFLD are linked and increases risk of HEART
ATTACK AND STROKE

3. Balance diet and regular exercise in healthy wight management

Total energy expenditure: BMR + physical activity + diet induced thermogenesis
Overweight: imbalance between energy intake and energy expenditure
Important: as reduces the risk of the bad effects of high salt and high sugar intake
Exercise: integral component in total energy expenditure, so is important in weight
control and energy balance

4. Potential strategies to promote healthy eating

a. One health: cooperation between different industries
- supermarket placement of healthy food, and its availability and pricing
- manufacturers incentivised to create more healthy food and encourage
reformulation
- government: public health aspect: TV advertisement, implemented into education
system, leaflets. Education on the negative impacts and positive impacts of healthy
balanced diet
b. infrastructure planning
- local communities to encourage food market: encourage the consumption of fresh
produce
- ensure preschools and schools have healthy food options: food caterers
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