ABOM Review Flashcards by heather shelton

3 afferent pathways in energy balance

Environmental sensing (GI , sensory organs)
Metabolic needs (liver, muscle, bone)
Energy stores (adipose, liver, muscle)

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Leptin:
what is the primary problem in obesity?
are levels high or low?
binds to ?
anorexigenic or orexigenic?

leptin resistance
high
leptin receptor in hypothalamus
anorexigenic

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Adiponectin:
low or high in obesity?
anorexigenic or orexigenic?
what induces expression of adiponectin?

low
anorexigenic
PPAR-Y agonizts - TZDs

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effects of adiponectin on skeletal muscle, liver, cardiac muscle

skeletal muscle: increases glucose uptake, increases fatty acid uptake, increases mitochondrial mass and oxidative capacity
liver: insulin-like and insulin sensitizing effects
cardiac muscle: remodeling, vasodilation, anti-inflammatory, anti-atherosclerotic

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low adiponectin is independently associated with

t2DM, MetS, fatty liver, cad, endothelial dysfunction, MI, chf, htn

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3 adipokines are

secreted by

leptin adiponectin resistin

adipokines

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5 incretins are

secreted by

GLP-1
PYY
ghrelin
GIP
oxyntomodulin
intestinal L cells, stomach fundus

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GLP-1 (glucagon like peptide 1) :
anorexigenic or orexigenic
high or low in obesity
sites of action/ function

anorexigenic
low (post prandial)
pancreas - increases insulin release
gut delays carb absorption and decreases gastric secretion/ motility
brain increases satiety

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how does GLP-1 increase satiety in brain?

inhibits NPY

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Peptide YY (PYY):
anorexigenic or orexigenic
high or low in obesity
sites of action/ function

anorexigenic
low (post prandial)
afferent vagus and hypothalamus
increases satiety and stimulates glucose-mediated insulin secretion

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what is the only circulating orexigenic hormone

ghrelin

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ghrelin:
stands for
secreted by
peaks when
function
high or low in obesity before meals, post prandially
suppressed longest by

growth hormone release inducing peptide
fundus
before meals
stimulate food intake
low before meals (appropriate) , post prandially less suppression
protein

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DPP4 degrades what

GLP-1 and PYY

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pharmacologic GLP-1 agonists are

exenatide, liraglutide

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pharmacologic DPP4 inhibitors are

sitagliptin

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satiety factor secreted by pancreas

amylin, or islet amyloid polypeptide

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pharmocologic actor on amylin

pramlintide

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what is the first myokine?
action?
what stimulates it

irisin
stimulates browning of white fat, induces insulin secretion, leads to weight loss and improved glucose control
exercise and cold

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what are the anorexigenic neurotransmitters released from first order neurons?
where are they located?

POMC (proopiomelanocortin) and CART (cocaine and amphetamine related transcript)
arcuate nucleus of hypothalamus

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what are the orexigenic neurotransmitters released from first order neurons?
where are they located?

AgRP (agouti related peptide) and NPY (neuropeptide Y)

arcuate nucleus of hypothalamus

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what stimulates POMC/ CART

insulin, leptin

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what stimulates AgRP/ NPY

ghrelin

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what do POMC/ CART stimulate?

effect?

MC4R receptors of paraventrcular nucleus (PVN) and lateral hypothalamus
decreased food intake, increased energy expenditure

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what do AgRP / NPY stimulate?
inhibit?
effect?

Study These Flashcards

Y1R receptor on neurons in paraventricular nucleus (PVN) and lateral hypothalamus
MC4R receptors in PVN and LH
MC3R receptors in first order neurons in arcuate nucleus
increased food intake, decreased energy expenditure

how does activation of melanocortin receptor (MC4R) cause increased energy expenditure

increased brown adipose tissue thermogenesis increased white adipose tissue lipolysis increased locomotor and myocardial activity increased muscle glycogenolysis, glucose and fatty acid oxidation, and protein synthesis

noradrenergic neurons originate in

locus coeruleus, lateral tegmental field of hypothalamus

what causes vagal efferent activation? anatomy? effect?

low leptin signaling, persistent orexigenic signaling (ghrelin) lateral hypothalamus and paraventricular nucleus 2nd order neurons stimulate medial longitudinal fasiculus and dorsal motor nucleus of the vagus increased energy storage

mechanisms of vagally mediated increased energy storage?

reduced HR and o2 consumption increased peristalsis and pyloric opening increased post prandial insulin secretion and fat deposition increased glucose and FFA uptake into adipose tissue and increased insulin sensitivity

adult DRI for fat

20-35%

adult DRI for carbs

45-65%

adult DRI for protein

10-39% | 0.8 g/kg/d

diet to lower TG

atkins

diet to decreased cvd, dm

ornish, vegan

diet to decrease BP

dash (high carb, <25%fat, 2-3 low fat dairy, high in ca, mg, k fiber, low in meats, sweets, snacks

diet to decrease cvd

mediterranean

diet to decrease seizures

ketogenic

diet to treat short gut and malabsorption

medium chain triglycerides

which is more important , diet type or adherence?

adherence

does macronutrient mix predict weight loss

dietary strongest evidence of treatment benefit (wt loss)

meal replacements

what is more important than caloric intake

energy density

very low calorie diets require how much protein?

1.5 g/kg/d

contraindications to very low calorie diet

renal insufficiency, type I dm, esld, pregnancy, pancreatitis

side effects of very low calorie diet

gallstones, constipation, fatigue, coldness, hair loss, irregular menses

weight regain following VLCD

40-50% within 1-2 years

B1 thiamine (function, findings, deficiency)

pyruvate dehydrogenase, neuropathy,cardiomegaly, beri beri, wernicke korsakoff

B2 riboflavin (function, findings, deficency)

FAD, mouth/tongue pain, chelitis

B3 niacin (FFD)

NAD, desquamative dermatitis sun exposed, dementia, diarrhea, death, pellagra

B6 pyridoxine

transamination, polyneuropathy, anemia

B12 cobalmin

methyltransfer, neuropathy periph/central, pernicious anemia

folate

dna synthesis, glossitis, stomatitis, megaloblastic anemia

vitamin C

collagen synthesis, perifollicular petechiae, poor wound healing, scurvy

calcium, phos, mg affected area, deficency

bones, enzymes, conduction, osteopenia, arrhythmia, sz

zinc

metalloenzymes, growth, acrodermatitis enteropathica

copper

metalloenzymes, menkes kinky hair

selenium

glutathione peroxidase, kershan disease, cardiomyopathy

chromium

glucose tolerance, glucose intolerance

what is refeeding syndrome? | who is at risk?

depletion phos, mg, K with feeding causing heart failure | alcoholics, NPO 7 days, bariatric surgery postop, elderly, esld, anorexia

most common nutrient problems after bariatric surgery | less common

ca, vitamin D, iron, b12 | thiamine, zinc , copper

ABOM Review Flashcards

(59 cards)