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1

insulin resistance: other related conditions (9)

1. infection
2. steroid induced
3. idiopathic
4. lipodystrophic diabetes
5. Werner's syndrome
6. Cushing's syndrome
7. hemochromatosis
8. acanthosis nigricans
9. obstructive sleeping apnea

2

initial observation of diabetes (5)

1. increased thirst: polydipsia in T1DM
2. increased urination: polyuria in T1DM
3. increased hunger: polyphagia in T1DM
4. weight loss in T1DM
5. obesity in T2DM

3

clinical lab tests reveal (3)

1. glucosuria
2. hyperglycermia
3. abnormal glucose tolerance

4

insulin resistance mechanism: cellular mechanism

1. receptor defects: number and affinity (rare)
2. post- receptor second messenger signaling

5

T2DM risk factors (10)

1. age
2. obesity
3. sedentary lifestyle
4. ethnicity
5. family history
6. history of GDM
7. child of a woman with poorly controlled diabetes during pregnancy
8. prediabetes: impaired fasting glucose or impaired glucose tolearance
9. low birth weight and high birth weight
10. polycystic ovary syndrome (PCOS)

6

T1DM short tem complication

1. diabetic ketoacidosis
- increased risk during illness: infection and stress
- symptoms: rapid respiration, acetone breathe, stomach pain, N/V, cognitive changes
2. hypoglycemia

7

T2DM short term complication

1. hypoglycemic episodes
2. Hyperglycemic Hyperosmolar Syndrome:
- dehydration and infection are precipitating factors
- seen with BG> 33mmol/L

8

hypoglycemia symptom

1. neurogenic (adrenergic)- early
- sweating, shakiness, tachycarida, anxiety, sensation of hunger
2. neuroglycopenic- late
- loss of consciousness, coma, poor coordination, blurred vision, weakness, dizziness, confusion

9

hypoglycemia etiology (4)

1. skipped or delayed meal
2. unplanned exercise
3. misdosage of insulin
4. reduced CHO intake without med compensation

10

hypoglycemia treatment rule

15-15 rule
give 15g of fast absorbed CHO, check 15min later, repeat if BG still low

11

severe hypoglycemia tretment

injection of glucagon and glucose

12

long term diabetes complication (2)

microvascular: retinopathy (cataracts, glaucoma, macular edema), nephropathy, neuropathy
macrovascular: CVD, CHD, stroke

13

T1DM: hyperTG is caused by?

defective removal of chylomicron and VLDL resulting from impaired LPL activity (insulin dependent)

14

T1DM: HDL and LDL-C level

may be normal

15

T2DM: Hyper TG is caused by

elevated de novo synthesis from glucose

16

T2DM: HDL and LDL-C

low HDL-C (due to obesity)
LDL-C often elevate but may be normal

17

other common complication of diabetes

erectile dysfunction, poor wound healing, increased susceptibility to infection

18

FPG for IFG

6.1-6.9 mmol/L

19

FPG for diabetes

>= 7.0 mmol/L

20

2hPG in a 75g OGTT for IGT

7.8-11.0 mmol/L

21

2hPG in a 75g OGTT for diabetes

>=11.1 mmol/L

22

A1C for prediabetes

6.0-6.4 mmol/L

23

A1C for diabetes

>= 6.5 mmol/L

24

random PG for diabetes

>=11.1 mmol/L

25

definition of metabolic syndrome

a cluster of closely related metabolic disorders increasing the risk of development of T2DM and CVD
abdominal obesity
insulin resistance and IFG
dyslipidemia
hypertension

26

proposed mechanism of metabolic syndrome (3)

1. direct venous drainage of visceral fat in hepatic portal vein --> increased hepatic FFA delivery
2. insulin resistance
3. macrophage in adipose tissue --> release of inflammatory cytokines that act on insulin resistance and promote release of FFA

27

goals of diabetes diet therapy (6)

1. encourage the attainment and maintenance of a healthy body weight
2. achieve the best possible metabolic control without serious compromising quality of life (glycemic control, BP, lipid profile)
3. delay or prevent complications
4. to provide specific guidelines for different stages in the lifecycle
5. to promote self-care by providing the necessary knowledge, skills, resources and support
6. encourage overall health by practical instructions in optimal nutrition

28

Diabetic dietary approach for CHO

1. 45-60%
2. mini 130g/d
3. <10% added sugar

29

glycemic index

Area under the Curve in blood glucose response of a given food compared to standard (glucose or white bread) for the same content in g CHO

30

Glycemic load

g CHO in normal serving x glycemic index/ 100

31

dietary factors affecting the Glycemic Response (8)

1. digestibility
2. cooking or processing
3. food forms
4. dietary fiber
5. presence of other nutrients
6. interprandial differences
7. fast/ slow eater
8. glucose tolerance effect

32

dietary fiber intake recommendation in DM

25-50g/d or 15-25g/ 1000kcal

33

Diabetic dietary approach for fat

20-35%
1. SFA< 7%
2. NO trans FA
3. PUFA up to 10%
4. MUFA up to 20%

34

Diabetic dietary approach for protein

15-20%
1.0-1.5g/kg/d during weight reduction
0.8g/kg/d if chronic kidney disease

35

Diabetic dietary approach for omega-3

2-3 serving fish/week
no supplement
can reduce TG and platelet aggregation

36

risk of taking alcohol in diabetes (2)

1. masks the symptoms of hypoglycemia
2. increases ketones

37

special concerns with insulin treatment (3)

1. meal spacing and CHO content may help glycemic control
2. snacks may help to avoid hypoglycemia: balance against potential for weight gain
3. bed- time snack containing protein may help avoiding nocturnal hypoglycemia

38

diabetes self- management (5)

1. heart health
2. monitoring
3. physical activity
4. planning
5. medications

39

definition of diabetes

a metabolic disorder characterized by elevated blood glucose concentration and disturbance of CHO, protein and lipid due to defection of insulin secretion and/ or action

40

Could you use CFG as a teaching tool with someone who has diabetes

NO.
CFG is designed for healthy and active adults

41

one exchange Starch

15g CHO
3g protein

42

one exchange fruits

15g CHO

43

one exchange vegetable

5g CHO
2g protein

44

one exchange milk

15g CHO
8g protein

45

one exchange meat and alternatives

8g protein
3g fat, 5, 8, 14

46

one exchange fat

5g fat

47

why are we using average values when we could use a more precise tool to get more precise values

an estimate, if well done, is a good approximation and has the advantage of being quick and convenient

48

Can a diabetic patient have sweets and desserts

yes. sometimes
preferable in small quality as a part of a mixed meal

49

60ml whole nuts/ seeds

1 very high meat and alternative
14g fat, 8g protein

50

1 regular beer

140kcal, 10g CHO, 0g fat, 1g protein

51

three types of insulin

bolus, basal and premixed

52

two types of bolus insulin

1. rapid- acting (Lispro)
2. short- acting (regular)

53

two types of basal insulin

1. intermediate (NPH)
2. long- acting (Glargine)

54

human basal

has the same molecular physical form as human insulin, made from E coli

55

analogue basal

mimic human insulin, but have some specificity, slower release, better action

56

premixed

30/70
30% regular (short- acting): bolus
70% NPH (intermediate- acting): basal

57

conventional insulin regimen (3)

premixed or fixed insulin plan
1. insulin injection (1-3/d) and meals must be consistent from day to day
2. physical activity may lead to hypoglycemia
3. strict meal plan: CHO content, meals should not be skipped

58

interventional insulin therapy (5)

1. multiple daily injection (>3/d) or continuous subcutaneous insulin infusion
2. basal insulin and rapid insulin before meals
3. more flexibility in timing and content of meals: insulin is adjusted according to CHO intake
4. insulin may be adjusted to exercise
5. SMBG frequent

59

insulin delivery (4)

syringe, pen, insulin pump, continuos glucose sensor

60

Metformin mechanism (2)2

1. decreased GNG --> decreased glucose production
2. increased insulin sensitivity --> increased glucose uptake

61

can metformin cause hypoglycemia

no

62

can metformin help with weight control

yes

63

side effects of metformin (2)

1. mostly GI (transient)
2. vitamin B12 deficiency (10-30% cases)

64

contraindications of metformin (2)

1. renal insufficiency
2. heart or liver failure

65

classes of antihyperglycemic agents

1. alpha- glucosidase inhibitors
2. insulin secretagogues
3. incretin mimetics
4. TZD

66

generic name of alpha-glucosidase

acarbose

67

repaglinide

insulin secretagogues
meglitinide

68

glyburide

insulin secretagogues
sulfonylurea

69

sitagliptin

incretin mimetics
DPP-4 inhibitor

70

exenatide

incretin mimetics
GLP-1 receptor agonists

71

pioglitazone
rosiglitazone

TZD

72

alpha glucosidase inhibiot mechanism

delays glucose absorption in the intestine
lower the peak of glucose after the meal

73

meglitinide, sulfonylurea mechanism

stimulate insulin secretion
short-acting (4-7h)
long- acting (once daily)

74

incretin mimetics mechanism

increase insulin secretion and reduce glucagon secretion.
delay gastric empty
increase satiety

75

TZD

increase insulin sensitivity in peripheral and liver tissue

76

agents that can reduce weight

1. metformin
2. GLP-1 receptor agonist
3. SGLT2 inhibitor

77

agents that induce hypoglycemia

1. insulin
2. insulin secretagogue

78

agents that can increase weight

from high to low
1. insulin
2. TZD
3. sulfonylurea
4. meglitinides

79

canagliflozin, dapagliflozin, empagliflozin

SGLT2 inhibitor

80

SGLT2 inhibitor mechanism

block glucose transport in proximal renal tubule --> glucosuria -- >lower blood glucose and body weight

81

SGLT2 inhibitor advantages (3)

rare hypoglycemia, lower BP, raise HDL

82

SGLT2 inhibitor contraindications (3)

1. T1DM
2. loop diuretics
3. renal failure

83

SGLT2 inhibitor side effects (4)

1. risk of urinary tract infection
2. genital mycotic infections
3. hypotension
4.more risk of diabetic ketoacidosis

84

characteristics of cancerous cell (7)

1. can invade other tissues (metastasis)
2. can develop a blood supply (angiogenesis)
3. can avoid immune surveillance
4. can replicate indefinitely
5. can avoid programmed cell death
6. can alter energy metabolism
7. escape normal growth signals

85

multistage modern view of carcinogen

mutation inactivates tumor suppress gene --> cell proliferate --> mutation inactivates DNA repair gene --> mutation of proto- oncogene creates an oncogene --> mutation inactivates several more tumor suppressor genes --> cancer

86

proto- oncogene

promote cell growth and division

87

tumor suppress gene

inhibit cell growth and survival

88

anti- initiation strategies (4)

1. ROS
2. enhance carcinogen detoxification
3. enhance DNA repair
4. alter carcinogen metabolism

89

anti- progression/ promotion strategies (6)

1. enhance immunity
2. suppress proliferation
3. enhance apoptosis
4. decrease angiogenesis
5. ROS
6. decrease inflammation

90

definition of mutation

structural change in the base pair sequence of DNA

91

two causes of mutation

1. inherited
2. exogenous

92

definition of polymorphisms

structure of the gene varies among individual

93

SNP

single nucleotide polymorphism:
influence the response to the exposure

94

epigenetic changes

affects gene structure, function and expression

95

DNA methylation

hypermethylation in the promotor region of tumor suppression genes --> silencing

96

acetylation of the histones

affects chromatin folding

97

two examples of epigenetic changes

1. DNA methylation
2. acetylation of the histones

98

possible causes of cancer

1. tobacco
2. diet& obesity
3. lack of physical activity
4. pollution
5. infection
6. UV rays
7. professional exposure
8. alcohol

99

what can cause oxidative DNA damage

1. oxidized PUFA
2. free iron
3. carcinogens found in the food

100

what can decrease the oxidative DNA damage

1. antioxidant nutrients (vitamin C and E)
2. cofactors in antioxidant enzyme (selenium and copper)

101

examples of nutrients affecting gene function

1. oxidative damage to DNA
2, folate in DNA repair, synthesis and methylation
3. vitamin A and D interact on the promotor region of many genes, regulate ell proliferation and differentiation
4. catechins in green tea, apples and chocolate affect gene expression in cell culture
5. flavonoid affect gene expression in cell culture
6. a group of nuclear receptor (PPAR alpha) is activated by oxidized fats

102

three highest incidence cancer in men

1. prostate
2. colorectal
3. lung

103

three highest incidence cancer in women

1. breast
2. lung
3. colorectal

104

three highest mortality cancer in men

1. lung
2. colorectal
3. prostate

105

three highest mortality cancer in women

1. lung
2. breast
3. colorectal

106

design of studies addressing diet and cancer
(order in the strength of associations between diet and cancer)

1. descriptive
2. case control
3. prospective cohort
4. interventional

107

descriptive design

1. cancer rates in populations have different diets are compared
2. best used to generate hypothesis

108

case- control design

1. early diets reported by patients with a specific type of cancer are compared with matched control without cancer

109

prospective cohort design

1. incidence of cancer is compared in persons whose diets are determined before follow- up begins

110

interventional design

1. incidence of cancer in 2 group randomized to specific interventions is compared

111

limitation of descriptive

1. diet is only one of the variables
2. nutrient intake date is difficult to collect

112

limitation of case- control

1. possible recall bias
2. selection bias
3. proxy respondents with rapidly fatal FA

113

limitation of prospective cohort

1. thousands of people need to be enrolled and health monitored for many years for statistical power
2. difficult for rare type of CA

114

limitation of interventional

1. adherence to dietary challenges is difficult
2. blinding is often not possible
3. optimal dosages need to be ascertained
4. duration is unknown

115

what are two indicators of energy balance

1. growth rate
2. body size

116

rapid growth rate before puberty play an important role in future risk of which cance

breast cancer

117

in what case will obesity associate with breast cancer

only after menopause

118

what is colon cancer related to

excess weight and low physical activity

119

what do red meat and processed meat associate with

1. stomach
2. colorectal

120

what is the potential mechanism related with red meat and processed meat

1. frying, broiling, grilling -->polycylic aromatic hydrocarbons and heterocyclic amines
2. heme promotes the formation of N- nitroso compounds (nitrosamine)

121

what is the proposed mechanism of dietary fiber (5)

1. reduce pH
2. serve as substrates to flora producing short- chain FA
3. alter colonic flora
4. limit contact with mucosa by speeding transit
5. dilute or bind potential carcinogen

122

what types of cancer are associated with alcohol

oral cavity, larynx, esophagus, and liver

123

what is the proposed mechanism of alcohol

direct contact and toxicity in the liver

124

what is the proposed mechanism associated with calcium (3)

1. bind toxic secondary bile acids and ionized fatty acids to form soaps in the lumen
2. reduce proliferation
3. induce apoptosis in the mucosal cells

125

recommendation for mea group

eating lean meat

126

recommendation for dietary fiber

increase the intake of high- fiber foods

127

recommendation for Ca

to reach the RDA with foods, then supplements if needed

128

with greater sun exposure, lower risk of which cancer (3)

prostate, breast, and colon

129

recommendation for Vitamin D

large studies ongoing

130

potential associated with vitamin C and E

through antioxidant properties by neutralizing reactive oxygen species that cause DNA damage

131

Se + vitamin E supplements on prostate cancer

no decrease

132

selneoproteins function

defend against oxidative stress

133

low intake of folate associates with which type of caner (3)

colorectal, breast and cervical

134

recommendation for folate

no supplement

135

convincing level of evidence of decreased risk of cancer

physical activity (colon)

136

convincing level of evidence of increased risk of cancer

1. obesity and overweight on many cancer
2. processed meat on colorectal
3. alcohol on oral cavity, larynx, esophagus, pharynx, liver and breast

137

probable level of evidence of decreased risk of cancer

1. physical activity on breast
2. daily products and calcium on colon
3. whole grains and fiber on colon
4. coffee on liver and uterus

138

probable level of evidence of increased risk of cancer

1. red meat on colorectum
2. salt preserved foods on stomach

139

limited suggestive level of evidence of decreased risk of cancer

1. foods containing carotenoids, foods containing vitamin C= fruits and vegetables (oral cavity, oesophagus, stomach, colorectum)
2. fish and vitamin D

140

limited suggestive level of evidence of increased risk of cancer

1. grilled and barbecued meat and fish
(polycyclic aromatic hydrocarbon, nitrosamine, heterocyclic amines)

141

AST can come from which tissues

liver
kidney
cardiac muscle
skeletal muscle

142

ALT can come from which tissues

liver

143

what is general assessment of liver injury

hepatocellular enzymes

144

what does liver injury result in

"leak" of enzymes from hepatocyte

145

what does hepatocellular enzyme elevation indicate

parenchymal injury

146

cholestatic enzymes (2)

1. alkaline phosphatase
2. gamma- glutamyl transferase

147

where is ALP from

1. bone
2. placenta
3, liver

148

where is GGT from

liver

149

what do cholestatic enzyme indicate

indicate disease to biliary system

150

ALP

signify the problem in the drainage of liver through the biliary tree whether id small duct or in large duct

151

what indicates the raise in bilirubin or the presence of jaundice

problem in the biliary tree

152

what are the symptoms of acute hepatitis

1. fatigue
2. anorexia
3. nausea
4. jaundice

153

what does AST> ALT indicate

alcohol hepatitis, and vitamin B deficiency

154

symptoms of cholestasis

fatigue and pruritus

155

what is cirrhosis characterized by

regenerative nodules surrounded by fibrous tissue

156

variceal hemorrhage

veins around stomach bleed

157

ascites

fluid of the abdomen

158

encephalopathy

build of ammonia in brain

159

from compensated cirrhosis to decompensated cirrhosis, development of complications (4)

1. variceal hemorrhage
2. jaundice
3. encephalopathy
4. ascites

160

what are two results from cirrhosis

1. portal hypertension
2. liver insufficiency

161

a hyperdynamic circulatory state in cirrhosis

1. decreased mean arterial pressure
2. increased cardiac index
3. decreased peripheral resistance

162

splanchnic and systemic vasodilatation lead to hyperdynamic circulatory state in cirrhosis

more dilation around the liver to regulate the blood flow. too much of the dilation, very little effective artery circulation, the amount of the blood sensing through vital organs like kidney is low. kidney will wrap up RAAS to try retain Na and water which leads to plasma volume expansion. increase the pressure further and fluid leaks out. the fluid leaks out from liver, little blood sensed by kidney, RAAS, retain more water, liver works worse. fix the sodium.

163

nutrition in cirrhosis is hard to assess due to ?

sarcopenia

164

what do obese children with NASH have evidence of ?

early systolic and diastolic dysfunction

165

NAFLD

steatosis by imaging or histology in the absence of secondary causes

166

metabolic risk factors of NASH (4)

1. hypertension
2. diabetes
3. obesity
4. hyperlipidemia

167

major risk factors for advanced liver disease

1. older age
2. obesity
3. long- standing diabetes
4. TG> 5.65
5. AST>ALT

168

4 advantages of fibroscan

1. immediate results
2. rapid
3. bedside/ outpatient
4. painless

169

effective, durable weight loss

duodenal switch

170

effective for resolution of diabetes

duodenal switch

171

effective resolution of hyperlipidemia

duodenal switch

172

primary tumor

first tumor identified, classified according to size and the invasion of surrounding tissues

173

secondary tumor

other tumors of the same histological origin as the primary, located nearby

174

regional lymph nodes

classified according to distance from primary tumor

175

metastasis

invasion of distant tissues and organs

176

effects of cancer of digestive tract

1. obstruction (dysphagia, vomiting, nausea, anorexia, malabsorption)
2. anemia from occult losses

177

effects of lung cancer

1. obstruction of respiratory tract
2. shortness of breath

178

effects of bone cancer

pain

179

effects of gynecologic

1. fertility
2. ascites
3. intestinal obstruction

180

radiotherapy

ionizing radiation altering DNA to control growth or kill malignant cells

181

side effects on head and neck

mucositis, dysgeusia, xerostomia, dysphagia, odynophagia

182

severe esophaitis

risk of malnutrition

183

can radiotherapy target to the tumors with damage to surrounding tissues

limited damage

184

chemotherapy

cytotoxic drugs that block DNA and RNA synthesis or cell division at different stages

185

will chemotherapy cause any side effects

many systemic side effects (also healthy cells)

186

immunotherapy or biological response modifiers

use body's own immune system to eradicate cancer cells

187

does immunotherapy or biological response modifiers have any side effects

bone pain, fatigue, fever, anorexia, rashes, flu- like symptoms

188

hematopoietic stem cell transplantation targets which cancer type

blood cancer

189

cisplatin, carbopatin

alkylating agents

190

cisplatin side effects

renal toxicity

191

5-FU, gemcitabine

indirect DNA agents

192

5-FU side effects

hepatotoxicity

193

doxorubicin

antitumor antibiotics

194

doxorubicin side effects

cardiotoxicity

195

irinotecan, topotecan

topoisomerase inhibitors

196

vincristine, vinblastine, paclitaxel

antimitotics

197

common side effects of chemotherapy agents and side effects

bone marrow suppression
- anemia, neutropenia, thrombocytopenia
N/V
stomatitis
diarrhea
alopecia
anorexia

198

definition of cancer cachexia

complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass.

199

what does chronic illness cause

1. anorexia
2. hypogonadism
3. anemia
4. inflammation
5. insulin resistance

200

muscle wasting predicts poor cancer- associated outcomes (5)

1. increased fatigue
2. increased tx- induced toxicity
3. decreased host response to tumor
4. decreased performance status
5. decreased survival

201

cachexia occurs more frequently in certain types of cancer:

1. upper gastro- intestinal cancer
2. lung cancer

202

pathophysiology of cachexia

dual contribution of metabolic change and reduced food intake causes the negative energy and protein balance

203

acute phase response

coordinated adaptations of the body to limit and clear the tissue damaged caused by hydrolases released from inflammatory, injured or malignant cells

204

the acute- phase response is modulated by what

cytokines

205

where are cytokines secreted

from immunocompetent cells: lymphocytes and macrophages

206

where do cytokines act

locally (paracrine and autocrine)
systemically (endocrine)

207

cytokines are produced by what?

produced by tumors and/ or host

208

pro- inflammatory cytokines types

1. interleukin 1, 6 and 8
2. leukemia inhibitory factor
3. tumor- necrosis factor alpha
4. interferon gamma

209

other effects of cytokines (6)

1. decreased GI function: decreased mobility and decreased gastric emptying
2. decreased blood flow
3. inhibit lipoprotein lipase
4. induce insulin resistance (IL-6)
5. decreased appetite
6. inhibit growth hormone and IGF-1 signaling

210

metabolic alterations in lipids in cachexia

increased turnover of FA
1. decreased LPL activity
2. increased lipolysis, FFA, VLDL
3. hyperTG

211

metabolic alterations in glucose in cachexia

1. increased GNG and increased proteolysis (muscle)
2. tumor produce lactate --> cori cycle
3. insulin resistance (IL-6)

212

metabolic alterations in protein in cachexia

1. increased protein turnover
2. increased or normal muscle proteolysis: provides AA for GNG
3. decreased or normal muscle protein synthesis
4. increased hepatic protein synthesis

213

three pathways of proteolysis

1. Ca dependent (calpains)
2. lysosomal (caspases)
3. ATP- dependent ubiquitin- proteasome pathway

214

POMC

anorexigenic signals
inhibit feeding
increased energy expenditure

215

early satiety may be resulted from what

1. reduced GI motility
2. increased gastric empty

216

early satiety may be caused by (2)

1. autonomic dysfunction
2. opioid analgesics

217

what are two consequences of antineoplastic therapies

1. chemosensory abnormalities
2. nausea

218

nausea may occur as (5)

1. side effect of drugs
2. abdominal disease
3. GI stasis
4. intracranial metastases
5. metabolic derangements

219

to define severity and phenotype and target appropriate treatment

1. anorexia or reduced food intake
2. catabolic drive
3. muscle mass and strength
4. functional and phychosocial effects

220

agents to increase appetite (3)

1. progestational agents
2. corticosteroids
3. cannabicoids

221

megestrol acetate

progestational agents
1. increased appetite and weight gain but not lean mass

222

progestational agents side effects

oedema
thromboemblism

223

corticosteroid

1. transient increase in appetite and well- being

224

corticosteroid side effects

1. insulin resistance
2. muscle wasting
3. osteopenia

225

therapeutic agents for cancer patients

1. antidepressents
2. anti GI motility agents
3. corticosteroids
4. antiemetics (prevent vomiting)
5. nacrotics and other analgesics

226

thalidomide

anti-inflammatory agents, cytokine- directed
inhibits TNF-alpha, may attenuate weight loss

227

pentoxifylline

anti-inflammatory agents, cytokine- directed
inhibits TNF-alpha, no proven benefits

228

proteasome inhibitor

anti-inflammatory agents, cytokine- directed
no proven benefits

229

do growth hormone have proven benefits to treat cachexia?

no

230

do melatonin have proven benefits to treat cachexia

no

231

selective androgen receptor modulators

increased LBM
muscle power
+/- stair climbing

232

anamorelin

Ghrelin receptor agonist
increased appetite, weight gain and lean mass
not handgrip strength

233

anti-IL-6 antibody

muscle gain
improved lung symptoms and reverse fatigue

234

3- methyhistidine is the marker of what

myofibrillar protein degradation

235

bioelectrical impedance

free fat mass

236

DXA

measures bone, soft and fat tissue --> total lean body mass and appendicular muscle mass

237

PG-SGA

patient- Generated- Subjective Global Assessment

238

beta- sitosterol

phytosterol
1. inhibit cholesterol absorption
2. inhibit incorporation of cholesterol into micelles, destroy micelles

239

garcinia cambogia

hydroxycitric acid
weight loss

240

NPH weight loss mechanism

1. increase fat oxidation or reduce fat synthesis
2. increase satiety
3. increase energy expenditure
4. modulate CHO metabolism
5. block dietary fat absorption
6. increase water elimination

241

potential mechanism of anticarcinogen activity

1. anti-hormone function
2. anti- inflammation
3. bind with bile acids or other potential carcinogen
4. cell signaling pathway
5. detoxication
6. potentiation of immune response