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Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s Programmes at the University of Pécs and at the University of Debrecen Identification number: TÁMOP-4.1.2-08/1/A-2009-0011.

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slide1

Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen

Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

nutrition physical status body composition sarcopenia part 2

Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat the University of Pécs and at the University of Debrecen

Identification number: TÁMOP-4.1.2-08/1/A-2009-0011

Erika Pétervári and Miklós Székely

Molecular and Clinical Basics of Gerontology – Lecture 4

Nutrition,physical status,body composition, sarcopeniapart 2
slide3

Consequences

What is the consequence of

  • body weight gain in middle-aged individuals?
  • the anorexia/cachexia in old populations?
changes in body composition with age
Changes in body compositionwith age

The water content of the body changes proportionately with FFM

  • Water content of the FFM is stable.
  • Ratio of intracellular / extracellular volume is unknown.
  • Bone minerals change proportionately with FFM
  • By 65 it decreases by 10 – 15 %.
  • Infemales the rate of decrease is enhanced after menopause. This dramatic fall can be prevented by estrogen supplementation.
  • In active athletes the rate of decrease is similar, but the peak bone mass is higher.
  • 4 months chronic bedrest – 1.4% deficit, not regained even after 6 months.
changes in body composition with age1
Changes in body compositionwith age

Muscle mass and strength diminishes slowly until 50, then the rate is enhanced – SARCOPENIA

  • Between 30 and 80 there is a 30-40 % decrease (also in athletes).
  • Especially the quick, dynamic contractions are impaired.
    • The number of motoneurons/motor units fall.
    • The production of muscle proteins decreases (especially that of type II fibers)
  • Muscle hypertrophy may be elicited by intensive training even in the elderly (12 weeks – 3 times a week – +10%)
fat fat free mass and cell mass of males and females at various ages
Fat, fat-free mass and cell mass ofmales and females at various ages

Fat , fat-free mass, and cell massofmales () and females ()at various ages, values are given, and the number of subjects in each age group is noted.

60

58

33

27

37

42

50

18

40

44

33

89

72

Absolute weight (kg)

54

13

30

20

10

18–25

25–35

35–45

45–55

55–65

65–85

Age (years)

partial incomplete starvation
Partial/incomplete starvation

Composition of loss in BMI & MR

  • Adipose tissue 95%
  • Liver 50%
  • Skeletal muscles 30%
  • Bones 8%
  • Brain 3%
  • BMR 30%
  • Starvation (aging anorexia) protein breakdown
slide8

Decay of Nature

Decay of Nature, or Senile Marasmus, has the greatest number of deaths attributed to it. Their ages vary from 69 to 92 years. The inmates affected with this gradual wasting of body, which approaches very slowly, have usually their mental faculties clear and unclouded till the last, but complain of loss of appetite, bowels costive, pulse small, quick and weak, and sleepless nights, feel no pain, and look on death with seeming indifference and carelessness, in many cases as a happy release. With regards to treatment, medicines are of little use.

(H. S. Purdon, 1868)

slide9

Anorexia

(leads to sarcopenia)

  • frailty
  • functional disorders
  • cognitive disorders
  • decubitus (bed-sore, pressure ulcer)
  • hip fractures
  • quality of life 
  • mortality 
pathogenesis and functional vs metabolic consequences of sarcopenia
Pathogenesis and functional vs. metabolic consequences of sarcopenia

Malnutrition

Increased

oxidative stress

Low testosterone,

estrogen, GH, IGF-1

Decreased

physical activity

Cytokines

Decreased

food intake

SARCOPENIA

Decreased

walking speed

Impaired

balance

Osteoporosis

Falls

Decreased

BMR

Impaired

thermoregulation

Decreased

physical activity

Impaired ADLS

GH = growth hormone;

IGF-1 = insulin-like growth factor-1;

BMR = basal metabolic rate;

ADLS = activities of daily living

the spectrum of caloric intake from insufficient to excessive calories
The spectrum of caloric intake from insufficient to excessive calories

 Longevity

 Cancer

 Autoimmune disease

 Oxidative stress

Positive

effects

Regulated diet

↑ Calories

Negative

effects

Hypothetical U-shaped curve over the spectrum of caloric intake from insufficient to excessive calories, emphasizing negative physiologic effects at both extremes and positive or hormetic effects within a range of normal (regulated) caloric intake.

Energy

deficit

Energy

excess

Parenchymal cell number

Loss of function

Starvation

Death

 Longevity

 Cancer

 Autoimmune disease

 Oxidative stress

slide12

Mechanisms

Main mechanisms which lead to

  • weight gain of middle-aged groups
  • anorexia of the old
dysorexia in the elderly insufficient adaptation to overfeeding
Dysorexia in the elderly: insufficient adaptation to overfeeding

Younger Men

Older Men

140

3

*

130

*

2

120

110

Body Weight Change During and After Overfeeding (kg)

1

Energy Intake(% of Weight-Maintenance Value)

100

90

0

80

–1

70

20

29

41

77

Lowest Weight

Study Day

60

1

2

3

4

5

6

7

8

9

10

Phase 2

Overfeeding

Phase 3

Ad Libitum

Time After Overfeeding (d)

Regulatory disorder!

dysorexia in the elderly insufficient adaptation to underfeeding
Dysorexia in the elderly: insufficient adaptation to underfeeding

Younger Men

Older Men

140

2

*

*

130

*

1

120

0

110

Body Weight Change During and After Underfeeding (kg)

Energy Intake(% of Weight-Maintenance Value)

100

–1

90

–2

80

–3

70

20

29

41

77

Highest Weight

Study Day

60

1

2

3

4

5

6

7

8

9

10

Phase 2

Underfeeding

Phase 3

Ad Libitum

Time After Underfeeding (d)

Regulatory disorder!

components of energy balance
Components of energy balance

FI

MR

HL

Feedingstate

Tc

FI = food intake

MR = metabolic rate

HL = heat loss

Tc = core temperature

Nutritional state

Body weight

metabolic rate mr
Metabolic rate (MR)
  • BMR, RMR, energy expenditure decrease with age (especially in men).
  • Possible causes:
  • FI ( specific dynamic activity of nutrients, thermic effect of food, diet-induced thermogenesis as well)
  •  T3-level
  •  sensitivity to norepinephrine
  •  muscle mass and muscle strength
  •  activity of Na-K-ATP-ase
food intake fi frequent causes of undernutrition in the elderly
Food intake (FI):frequent causes of undernutrition in the elderly
  • Social factors
    • poverty
    • problems with independent shopping, cooking etc.
    • social isolation (lack of partners, table setting )
  • Psychological factors
    • deprivation, sorrow, anxiety, mourning
    • dementia
    • depression
  • Physical factors
    • immobilization
    • need for assistance at feeding (e.g. difficulties in slicing the food)
    • problems of dental health and oral hygiene
    • problems of dental prosthesis
frequent causes of undernutrition in the elderly pathological conditions
Frequent causes of undernutrition in the elderly:pathological conditions
  • Effort to eat (e.g. COPD, congestive heart failure)
  • Food intake associated pain (e.g. abdominal ischemia)
  • Recurrent infections, tumors (e.g. TNF)
  • Ectopic hormon production (e.g.bombesin)
  • GI disorders (e.g. meteorism, malabsorption, circulatory disorders)
  • Endogenous toxicosis (e.g. uremia)
  • Endocrine disorders (e.g. Sheehan syndrome, Addison’s disease)
  • Medication (e.g.digoxin, theophyllin) or its withdrawal
  • Neuropsychiatric disorders (e.g. stroke, aging anorexia nervosa)
real age related anorexia aging anorexia
Real age-related anorexia“aging anorexia”
  • 1Decreased requirement
    • low MR
    • low activity
  • 2Decreased hedonic value
    • taste
    • smell
    • vision
  • 3Depressed “feeding drive”
    • neurotransmitters (e.g. opioids, amines, peptides)
    • nutritional factors (eg. Zn, nutrients, metabolites)
  • 4Enhanced satiety factors
    • cholecystokinin (CCK)
basal metabolic rate bmr and mean daily caloric intake by age groups
Basal metabolic rate (BMR) and mean daily caloric intake by age groups

While BMR fell by less than 20%, kcal intake fell by about 35% between 20 and 70 years.

Chronic disease  MR   rapid progression.

regulation of fi and mr
Regulation of FI and MR
  • Short-term regulation
  • 1 Nutrients
  • 2 Metabolites
  • 3 Gastrointestinal hormones
  • 4 Neural signals
  • Long-term regulation
  • 1 Insulin
  • 2 Leptin
hypothalamic regulation of fi
Hypothalamic regulation of FI

Activates

NPYrelease

NPY/AgRPneuron

Orexigenicpathway

Ghrelin

AgRPrelease

Inhibititon of melanocortin pathways

Inhibits

POMCneuron

Anorexigenicpathway

MC4receptors

MSHrelease

Leptin

Activates

Arcuate nucleus

Paraventicular nucleus

age related changes in the regulation
Age-related changesin the regulation
  • In the middle-aged
  • orexia, body weight (FM) increases
  • CCK effects , leptin/insulin effect ,NPY, POMC 
  • In the old
  • anorexia, relative starvation, protein-calorie-malnutrition,  muscle mass
  • CCK-effects , leptin/insulin effects  ,NPY , POMC effect 
age related changes in the regulation1
Age-related changesin the regulation
  • The central hypothalamic regulation of food intake and metabolic rate depends on the dynamic balance between anabolic and catabolic mediator systems.
  • Age-related changes in the central regulation may contribute to the development of obesity in middle-aged and sarcopenia/cachexia of aging.