#6 NST160 Lecture _6 PCM 0410

#6 NST160 Lecture _6 PCM 0410 - Protein-Calorie...

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  NST 160 Marc K. Hellerstein, M.D., Ph.D. Professor of Human Nutrition (D.H. Calloway Chair), University of California Berkeley; Professor of Endocrinology, Metabolism and Nutrition, Dept. of Medicine, University of California at San Francisco Protein-Calorie Malnutrition (Starvation)
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Outline: Protein-Calorie Malnutrition (PCM) I) How well orchestrated is the response to starvation? Reasons why. II) Mechanisms and consequences of adaptive response to starvation: benefits achieved III) Relevance to daily life: growth, reproduction, weight loss, diabetes, etc. IV) Lifespan and incidence of cancer V) When does starvation response fail? Interaction of starvation with infection VI) Examples in modern life: wasting in cancer, AIDS
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Physiology of Protein-Calorie  Malnutrition(PCM) Limited body stores of protein: consequences of lean tissue depletion during starvation Normal nitrogen/tissue losses if you stop eating Consequences of lean tissue loss on survival Tissue conservation achieved during adapted starvation (extended duration possible in humans) Why is nitrogen lost during starvation? Glucose for brain (after body glycogen stores gone) Source: amino acids from muscle protein Fat utilization – interaction with nitrogen losses Homeostatic consequences (“purpose”) of adaptations to starvation
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Metabolic Response to Prolonged Fasting Phase 1: Glycogen depletion; nitrogen losses; baseline fuel mixture Phase 2: Fatty acid oxidation; ketosis; reduced nitrogen and tissue-losses Phase 3: Brain keto-adaptation; greatly reduced nitrogen and tissue losses; further adaptations (kidney, endocrine, behavioral)
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Orchestrated Role of Different Tissues in  Metabolic Response to Starvation Liver : Glycogen depletion; reduced glucose release into blood; fatty acid oxidation/ketosis; reduced gluconeogenesis from amino acids Pancreas : Reduced insulin secretion Adipose : Increased lipolysis and fatty acid release into blood Muscle : Reduced glucose oxidation; increased fat oxidation; reduced protein breakdown and amino acid release Brain : Keto-adaptation (can use ketones); reduced glucose oxidation Kidney : Conservation of ketones Endocrine organs : Multiple adaptations
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#6 NST160 Lecture _6 PCM 0410 - Protein-Calorie...

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