NUTRITION

1. NUTRITION

2. BMR(basal metabolic rate) Is the energy required by an awake individual during physical, digestive and emotional rest. Is influenced by many factors: hormons, fever, regular exercise routine, starvation, exposure to cold etc. =weight (kg) X100Kj/day or weight (kg)x24kcal/day Additional energy demand, depending on activity: 30% for sedentary, 40% for moderate activity and 50% for heavy activity

3. DIET REQUIREMENTS Carbohydrate 55%, lipids 30%, proteins 15% Saturated fatty acids less than 10% , a ratio for fatty acids ?-6/?-3<5/1, cholesterol<300 mg/day At least five servings of vegetable and fruits <5 g salt/day 25-30 g fibers/day

4. O-3 fatty acids Sources: fish (fat), soybean oil, nuts They reduce the risk for cardiovascular events through mechanisms: -reduced serum triglycerides and LDL -reduced platelet aggregation and coronarian spasm -reduced blood pressure -reduced migration of monocytes

5. MEDITERRANEAN DIET An easy to follow diet Fish once/week, read meat (pork, beaf) twice/month, and more chicken. Plant oils A lot of vegetable and fruits Food rich in fibers Reduces risk of heart attack

6. DIETARY RECOMMANDATION FOR CANCER PREVENTION Avoid obesity Decrease total fat intake to <30% of total calories (ideally < 25%) Decrease saturated fat intake to <10% of total calories (ideally < 7%) Increase the intake of whole-grain food, fibers 20-30 g/day Increase the intake of dark green, deep yellow, and orange vegetables rich in ßCarotene and vitamin C

7. DIETARY RECOMMANDATION FOR CANCER PREVENTION Increase the intake of cruciferous vegetables (broccoli, cauliflower); ONION, GARLIC Reduce the amount of salt-cured and smoked meat as well as nitrite-cured food Either avoid or reduce alcohol intake Supliments with: probiotics, selenium 200 micrograms/day, vit B12 , 1mg/day, fitoestrogens, vitamin D 1000u/day or sun exposure Avoid: sugar, read meat, rafinated white flower

8. POTENTIAL ANTICANCER EFFECTS OF DIETARY CONSTITUENTS Vitamin C reacting with nitrosamines in stomach. Tocopherols, carotenoides and flavonoides scavenge RS in the GI tract Inhibitors of P450 (grapefruit juice, garlic, parsley, chilis), upregulated by broccoli Resveratrol, flavonoids and other phenolic compounds inhibit lipoxygenase/ COX inhibitors from GI tract Catechins has an anticancer effect (telomesase inhibitors) Isoflavonoids are antagonists of estrogen’s action in promoting growth of certain tumors Flavonoids inhibit matrix metalloproteinases and so inhibit metastases; carotenoids may enourage cell-cell comunication in transformed cells Genistein (isoflavonoid), epigallocatechin gallate inhibit angiogenesis

9. POTENTIAL ANTICANCER EFFECTS OF DIETARY CONSTITUENTS Fibre increase speed of movement of faeces through colon; dilutes carcinogens and/or slows their formation Carotenoids stimulates immune response Selenium modulates GPx activity and has anticancer effect Resveratrol (grapes, wines) has antioxidant and anti-inflammatory effects Phytates, phosphates, flavonoids may decrease iron uptake. It has been speculated that high iron body stores are a risk factor for cardiovascular disease and cancer. Capsaicin, caffeic acid phenethyl ester, resveratrol, sulphoraphane are down regulators of transcription factors (NF-kB) Several flavonoids, as well as lutein and curcumin, can bind to the aryl hydrocarbon receptor and decrease the toxicity of dioxin

10. CARCINOGEN POTENTIAL OF RED AND FAT MEAT Fat diet increases the secretion of billiary salts; they will injure the colon cells DNA and will stimulate proliferation Fat diet stimulate lipid peroxidation Fat diet increase free estrogen and estrogen metabolites that produse hormon imbalances which predispose to increased risk for breast, ovarian, endometrial and prostate cancer Meat=iron=ROS meat prepared at high temperature contains carcinogenic heterocycle amines Meat contains mutagenic N-nitroso compounds

11. ANTICARCINOGEN EFFECT OF FIBERS reduce the exposure time of colonic epithelium to lithocholic acid Absorb water and dilutes mutagenic compounds in the colon Reduce the pH of the stool which favors lithocholic acid elimination

12. STRONG INVERSE CORRELATIONS BETWEEN stomach cancer and vitamin C Folic acid and colon cancer Vitamins C, E , caroten and cataract Broccoli and esofagus and breast cancer Cruciferous vegetables and lung cancer Tomatoes and prostate cancer Garlic and colon cancer, cataract, osteoporosis Lactobacillus acidofilus and colon cancer Fibers and colon cancer Fish fat and breast, pancreas and prostate cancer

13. DIET IN DIFFERENT DISEASES cardiovascular diseases Low Immunity Aging Osteoporosis Inflammatory diseases Chronic liver and renal diseases

14. Defects in type 2 diabetes mellitus In the pancreas there is impaired insulin secretion with high levels of glucagon being secreted, which drives liver glucose production. There is uncontrolled hepatic glucose output and the liver hypersecretes triglyceride-rich particles. There is dysregulation of adipocytes. Visceral fat is an important issue with regards to high levels of free fatty acids and secretion of proinflammatory cytokines. There are low levels of adiponectin, the only protective adipocytokine that increases insulin sensitivity and is anti-inflammatory. There are issues with regards to defective skeletal glucose uptake and defective oxidative glucose metabolism.

15. DIABETES MELLITUS

16. DIABETES MELLITUS

17. DIABETES MELLITUS saturated fat worsens dyslipidemia and insulin resistance It is a lot more important to be a little overweight and physically fit than to be lean and lazy. The critical importance of postprandial glucose control is probably not just in terms of microvascular complications, but it is also probably a major factor in macrovascular complications. If we do not measure it, we will never find out. Increased intake of fiber is also important, which will not only have beneficial effects on lipids, but it will also decrease the absorption and the rapidity of the absorption of glucose from the GI tract and blunt postprandial glycemic excursions. physical activity is a major player in all of this, in terms of maximizing insulin sensitivity and improving cardiovascular outcomes.

18. DIABETES MELLITUS If we have a patient with impaired glucose tolerance, a patient who is at high risk for developing diabetes and cardiovascular disease, and we put the patient on a program of diet and exercise, can we prevent diabetes? The answer is yes. The Diabetes Prevention Program (DPP) showed a 58% risk reduction for developing type 2 diabetes in patients at the stage of impaired glucose tolerance. the major reduction in the development of diabetes is more through exercise than diet. In terms of diet, there was only a 5% reduction in body weight; most of the benefit was related to physical activity. I always tell patients that nonpharmacologic therapy is never obsolete. In terms of survival and preventing death, physical fitness is the greatest predictor of survival.

19. DEFINITIONS OF Obesity a body weight > 20% above the ideal body weight or a BMI>30kg/m2 Kwashiorkor refers to protein deficiency in the presence of normal caloric intake(primarily carbohdrates) Marasmus is a total calorie deprivation

20. ENTERAL AND PARENTERAL NUTRITION In stroke, head trauma,severe malnutrition Enteral nutrition by nasogastric tube Parenteral nutrition by infusion Enteral nutrition is better than parenteral one Lower cost Lower risk for lung infection A better immune system at the mucosal intestinal level

21. ALCOHOL Liver metabolism (reactions) Effects on organ system:memory loss, psychoses, cardiomyopathy,myopathies, gastritis, fatty liver, cirrhosis, anemia, thrombocytopaenia,impotence, fetal alcohol syndrome. How much can we drink?

22. BLOOD MARKERS OF CHRONIC ALCOHOL INGESTION Hyperuricaemia Elevated gamaGT (induced by phenytoin) Elevated serm triglyceride Increased MCV>100% Isoforms of transferins

23. GOOD EFFECTS OF MODERATE ALCOHOL CONSUMTION Increases HDL Reduces Lp(a) and fibrinogen Inhibits platelet aggregation Reduces TXA2 Scavenger of HO.radical Inhibits AGE may increase bone mineral density (BMD) in men and postmenopausal women

24. CONCLUSIONLIFESTYLE TO PREVENT DIABETES MELLITUS Practice physical activity, no smoking, waist circumferenceless than 80 cm(female) or 92 cm (man), fibers in diet, low glicemic index carbohydrates, ratio PUFA/saturated FA>5/1. COLON CANCER -lifestyle changes could prevent more colorectal cancer than screening-so it lead to a 26% reduction -reduced red meat consumption, fruits and vegetable more than 5 servings a day, physical activity, moderate alcohol consumption -calcium intake prevent colon cancers in men and all cancers in women

25. CONCLUSIONLIFESTYLE TO PREVENT STROKE -no smoking -practice physical activity -moderate alcohol consumption -more than 5 servings of fruits and vegetables/day -cofee intake associated with decreased stoke risk in women; cofee also reduce the risk of type 2 diabetes mellitus