Mechanisms of

Nutritional-related
Diseases
Dr. Ashaeryanto
STIKES KARYA KESEHATAN KENDARI
HUBUNGAN STATUS NUTRISI DAN FUNGSI IMUNITAS

Supresi , imun, Rentan

Infeksi
Fungsi Imun Normal Aktivasi imun, rentan
Penyakit Inflamasi
Undernutrisi
Nutrisi optimal
Overnutrisi
 Malnutrition-related Diseases
Undernutrition Overnutrition
 PEM: marasmus,  Obesity related
kwashirkor diseases : Metabolic
 Vitamin deficiency syndrome (diabetes,
diseases: Beriberi (B1), CVD, Hyperlipidemia,
scurvy (vit C), Hypertension),
xerophthalmia (vit A) Osteoarthritis, Gout,
Cancer,
 Mineral deficiency
diseases: Anemia (Fe),  Hypervitaminosis
Osteoporosis (Ca)  Mineral toxicity
SEVERE PROTEIN ENERGY MALNUTRITION (PEM)

MARASMUS

KWASHIORKOR
 MARASMIC-KWASHIORKOR
KWASHIRKOR
KWASHIORKOR MARASMIC-KWASHIORKOR
 Hospital malnutrition
 Malnutrition characterized by
hypoalbuminemia is associated with increased
morbidity, mortality and prolonged hospital
length of stay
Types of Malnutrition

•Marasmus
•Kwashiorkor
•Mixed

Because this is a disease with multiple etiologies, the

best terminology would probably be polydeficient
malnutrition.

Green CJ. Clin Nutr 1999;18(s):3-28

 How common is Malnutrition in surgical
patients?
25% of surgical patients are malnourished on admission!

Does it matter?
80
70
60 Well
50 nourished
Moderately
40
malnourished
30 Severly
20 malnourished
10
0
P<0.005 (infections)
Infections (%) LOS (days) P<0.0001 (LOS)

McWirther, BMJ 1994;308:945-8. Baker, N Engl J Med 1982;306:969-72

OBESITY AND IMMUNE FUNCTION
 Nutrients & Non Nutrients
(Bioactive components)
 Macronutrients: Carbohydrate, Protein, Lipid
 Micronutrients: Mineral, Vitamin
 Phytochemicals (mostly antioxidants):
Carotenoids, Flavonoids, organosulfur,
isothiocyanates, phenolic acids
 MAKRONUTRIENTS

DIETARY
CARBOHYDRATES, FAT AND PROTEIN

Dr. Agussalim Bukhari, M.Med.,Ph.D

Nutrition Department School of Medicine
Hasanuddin University
@2008
DIETARY CARBOHYDRATES
AND FIBRE
To see carbohydrate molecular structures go to:
http://www.fao.org/docrep/x5738e/x5738e06.htm
DIETARY LIPIDS
Play a role in blood cholesterol levels. These substances
occur when polyunsaturated oils are altered through
hydrogenation, a process used to harden liquid vegetable
oils into solid foods like margarine and shortening.

One recent study found that trans-monounsaturated fatty

acids raise LDL cholesterol levels, behaving much like
saturated fats.

Simultaneously, the trans-fatty acids reduced HDL

cholesterol readings. Much more research on this subject
is necessary, as studies have not reached consistent and
conclusive findings.
DIETARY PROTEIN
SEVERE PROTEIN ENERGY MALNUTRITION (PEM)

MARASMUS

KWASHIORKOR
 MARASMIC-KWASHIORKOR
KWASHIRKOR
 Hospital malnutrition
 Malnutrition characterized by
hypoalbuminemia is associated with increased
morbidity, mortality and prolonged hospital
length of stay
Types of Malnutrition

•Marasmus
•Kwashiorkor
•Mixed

Because this is a disease with multiple etiologies, the

best terminology would probably be polydeficient
malnutrition.

Green CJ. Clin Nutr 1999;18(s):3-28

 How common is Malnutrition in surgical
patients?
25% of surgical patients are malnourished on admission!

Does it matter?
80
70
60 Well
50 nourished
Moderately
40
malnourished
30 Severly
20 malnourished
10
0
P<0.005 (infections)
Infections (%) LOS (days) P<0.0001 (LOS)

McWirther, BMJ 1994;308:945-8. Baker, N Engl J Med 1982;306:969-72

OBESITY AND IMMUNE FUNCTION
Fate of Dietary Protein (amino acids) from one meal
during post-absorptive phase (~2 h)
Regulation of Fuel
Utilization
 TISSUE-SPECIFIC
METABOLISM
TISSUE FUEL USED FUEL RELEASED
Brain Glucose Lactate (in prolonged
Ketone Bodies starvation; the brain can
utilize lactate under some
pathological conditions
Skeletal Muscle Glucose, FFA, TG, BCAA Lactate, alanine, glutamine
Heart FFA, TG, Ketone bodies,
Glucose, Lactate
Liver Amino acids, FFA, lactate, Glucose, ketone bodies,
glycerol, glucose, alcohol lactate, TG
Intestine Glucose, glutamine Lactate, alanine
Red blood cells Glucose lactate
Kidney Glucose, FFA, Ketone glucose
bodies, lactate, glutamine
Adipose tissue Glucose, TG Lactate, glycerol, FFA
 40 GLUCOSE UTILIZATION VS TIME IN THE 5 PHASES OF GLUCOSE METABOLISM
I II III IV V
Exogenous
30
Glucose Used (g/h)

20

Gluconeogenesi
Glycogen
10 s
//

//
4 8 12 16 20 24 28 2 8 16 24 32 40
Hours // Days
ORIGIN OF
BLOOD : Exogenous Glycogen, hepatic Hepatic gluconeo- Gluconeogenesis Gluconeogenesis
GLUCOSE gluconeogenesis genesis, glycogen Hepatic and renal Hepatic and renal
TISSUES All except liver & All except liver, muscle Brain, RBC, Renal Brain, at a diminished
USING : All
adipose tissue at
& adipose tissue at Medulla, small rate, RBC, Renal
GLUCOSE rates intermediate
diminished rates between II & IV amount by muscle Medulla
MAJOR
FUEL OF : Glucose Glucose Glucose Glucose, ketone Glucose, ketone
GLUCOSE bodies bodies
 Fatty acid synthesis: Cytosol
 Pyruvate----Acetyl CoA----Malonyl CoA-
FFA-TG
 Fatty acid oxidation: Mitochondria
 FATE OF DIETARY CARBOHYDRATE (GLUCOSE) FROM ONE MEAL DURING THE ABSORPTIVE
PHASE (~2 H). GLUCOSE PROVIDES THE GLYCEROL MOETY FOR TRIACYLGLYCEROL SYNTHESIS

CO2

15 - 20 g
2g 20 g
Triacylglycero Glycogen
l

20 - 45 g

25 g 20 g

Glycogen ATP
Plasma concentrations of fuels during prolonged
starvation
Plasma concentrations of insulin & glucagon during prolonged starvation
DIETARY VITAMINS

 Dr. ASHAERYANTO
DIETARY MINERALS AND WATER