Nutritional Support of the Burn Patient

Size: px
Start display at page:

Download "Nutritional Support of the Burn Patient"

Transcription

1 Nutritional Support of the Burn Patient Objectives To understand the principles of normal nutrient utilization and the abnormalities caused by burn injury To be able to assess nutrient needs To be able to understand and implement nutritional support

2 Defining the nutrient needs of the hypermetabolic catabolic burn patient Measuring caloric needs using Indirect Calorimetry Table of Contents I. Indications for Nutritional Support II. Principle of Nutrient Utilization III. Assessment of Nutritional Status IV. Assessment of Nutritional Needs V. Method of Delivery of Nutritional Support VI. Summary VII. References

3 I. INDICATIONS FOR NUTRITIONAL SUPPORT As presented in the section on Metabolic Changes in the Burn Patient it is clear that the stress response needs to be treated. One of the key anabolic strategies, to a catabolic state, is nutritional support. A major burn patient needs to have good nutrition initiated to avoid excessive lean mass loss and resulting weakness. Immediate nutritional support is indicated to manage the severe stress response because of the marked catabolism which will rapidly ensue. Immediate nutrition is also indicated for the patient already malnourished. The degree of nutritional support corresponds with burn size. The presence of a smoke inhalation injury further increases the metabolic demands. The increased protein, energy and micronutrient demands need to be met before complications caused by loss of body weight, mainly lean mass, and protein energy malnutrition develop Because the maladaptive hormonal environment and inflammatory focus will persist, nutrition will attenuate but not eradicate the stress response as discussed in the metabolism section. Controlling the underlying stressors is still necessary for nutritional therapy to obtain optimal beneficial effects. The addition of anabolic activity is needed to decrease the utilization of protein for fuel, the metabolic abnormality in nutrient partitioning caused by stress. II. PRINCIPLES OF NUTRIENT UTILIZATION Adequate nutritional support, that is, adequate provisions of energy and protein substrate, is an essential aspect of the management of the surgical patient. The use of nutrients by the cell for energy and tissue synthesis requires an adequate delivery of oxygen to the cells. Maintenance of tissue, oxygen, delivery, and hemodynamic stability are essential for nutritional management. Energy requirements are defined in terms of the calorie. One calorie is the energy required to increase the temperature of 1 gram of water by 1 degree centrigrade. The calorie used to define human metabolic needs is actually a kilocalorie (1000 calories). Protein requirements are defined in terms of nitrogen needs, nitrogen making up about 15 percent of a protein. The respiratory quotient (RQ) is the ratio of carbon dioxide production during metabolism to the amount of oxygen consumed. RQ equals CO 2 produced (Moles) /O 2 consumed (Moles). The RQ value for carbohydrate is 1.0, for fat 0.7 and for protein 0.8: The grams of nitrogen in protein = grams of protein/6.25. The calorie: nitrogen ratio is the number of calories per gram of nitrogen. Nutrient Calories/gm Carbohydrates 4 (3.4 hydrated) Fat 10 Protein 4 A. Carbohydrate Metabolism

4 Carbohydrate is the primary fuel in man accounting for 60-70% of calories. In its anhydrous form 1 gram of carbohydrate generates 4 calories. However, carbohydrate is stored and used, for example, in solution in its hydrated form from which 3.4 calories is generated per gram metabolized. Insulin is required for glucose to enter the cell to be used for energy. Only small amounts of glucose are stored. About 150 grams can be stored in the adult liver and 300 grams in muscle as glycogen, which can be rapidly mobilized to glucose for when needed. Glucose requires phosphorylation to initially enter the cell, and it cannot subsequently leave that cell. The total number of stored glucose calories is less than 1500 in the normal adult. Excess glucose cannot be stored beyond that which is needed for energy and a small amount of glucogen which tissues can use. Excess glucose is rapidly conversed to fat. This process requires energy, and the respiratory quotient exceeds 1.0, resulting in a marked excess I carbon dioxide production. Glucose + O 2 = CO 2 + Energy (RQ=1.0) Glucose (excess) + Energy = Fat + CO 2 (RQ=8) Carbohydrate cycling occurs with the stress response, via activation of the Cori cycle. Carbohydrate to lactate and back to carbohydrate. This process yields only a fraction of the ATP produced with the complete burning of carbohydrates to CO 2 and water. In addition, the hormonal stimulus for gluconeogenesis exceeds demands and a relative insulin resistant state is present due to elevated anti-insulin hormone activity. Providing sufficient carbohydrate (60% of total calories) is still necessary to attenuate the drive to breakdown protein with amino acids used to make glucose. B. Fat Metabolism Fat is used fuel in unstressed man, accounting for about percent of the calories, depending on the diet. Fat is used for 85-90% of fuel in starvation. Fat is composed of triglycerides, which in turn comprise glycerol and fatty acids. The glycerol is burned like carbohydrate, while the fatty acids enter the Krebs cycle via a process called beta-oxidation whereby two carbon segments are cleaved off. Ketones are then produced. The ketones enter the Krebs cycle as acetylcoenzyme A, generating energy at a respiratory quotient of 0.7 with 9 to 10 calories per gram of fat. Increased ketosis signals the predominant use of fat through ketones for energy. This situation is seen in the starved surgical patients with a lack of available carbohydrate where ketones become the predominant fuel. With a large carbohydrate load, fat utilization is depressed. In addition to the availability of carbohydrate, fat breakdown is dependent on the endocrine environment. Insulin decreases the utilization for energy in preference to carbohydrate while catecholamines, and growth hormone increase fat breakdown. The number of available calories in stored fat in the normal adult with 10 kg of fat is about 100,000 about 100 times more than that in stored carbohydrate. With the stress response fat is not used to decrease amino acid use for energy. Instead there is an increase in the cycling of fatty acid to fat and back. However, fat may provide up to 50% of fuel in the absence of adequate carbohydrates. Ketosis is not usually seen in the stressed surgical patient reflecting the decreased fat utilization compared to that seen in starvation. C. Protein Metabolism In normal man, almost all the energy comes from carbohydrate and fat as long as they are present in sufficient amounts in the diet. With a carbohydrate or fat deficit or a protein excess, the amino acids are metabolized to produce calories. Approximately 4 calories are generated per gram of protein.

5 Normally for every 300 calories, 1 gram of nitrogen (6.25 grams of protein) is ingested in the normal diet, the majority of the nitrogen being used for protein synthesis. With surgical trauma, or infection and its altered endocrine and inflammatory environment, more than 20 percent of the total energy comes from the use of protein as fuel. The RQ value for protein is 0.8. The three branched chain amino acids- valine, leucine, and isoleucine-can be utilized directly by tissues for energy via the Krebs cycle and mitochondria. The remaining amino acids require deamination in the liver with conversion to keto-acids which can be transported to all tissues for burning using the Krebs cycle. Protein synthesis is vital in the maintenance of the integrity of all cells, in particular those that have a rapid protein turnover. Deamination of amino acids in the liver leads to liver urea production. Adequate renal clearance is necessary to avoid a rapid increase in the blood urea concentration, especially during a catabolic state. The rate of protein synthesis depends on the available amino acid substrate, tissue demands and the hormonal environment, especially the activity of anabolic hormones. Sufficient protein intake in the form of amino acids is necessary to keep up with necessary new protein formation and net losses seen in the surgical patient. In a normal uninjured man this usually requires about 1 gram of nitrogen (6.25 grams of protein) for every 300 calories less than 1 gram of protein per kilogram of body weight. With increased tissue demands and the increased use of protein for energy, as seen in injured patients, protein needs, increase to approximately 1.5 grams per kilogram of body weight, with a ratio of calories to nitrogen of 100:1 to as low as 80:1. Growth hormone, androgens, and insulin increase protein synthesis, whereas glucocorticoids and the catecholamines increase protein breakdown. D. Micronutrient Metabolism Micronutrients are essential for cellular function. They are called nutrients because of their key role in metabolism, but these of their key role in metabolism, but these compounds and elements also are involved in many other aspects of homeostasis, including wound healing, antioxidant protection, and immune function. The term micro is used because of the extremely small amounts found in the circulation tissues. Their concentration is critical to cellular function. Micronutrients usually are divided into the organic compounds (vitamins) and inorganic compounds (trace minerals). The microminerals are used in a variety of metabolic pathways often used as cofactors for enzymatic reactions. Both need to be provided and both are utilized and lost in increased quantities to metabolic response to stress seen in the surgical patient. Deficiency states therefore can occur easily. Because measurement of adequate levels is difficult, if not impossible, prevention of a deficiency often is accomplished only by increasing intake. Vitamins are organic substances that are essential in humans for growth and homeostasis A few of their characteristics are: Essential organic micronutrients involved in fundamental body functions Supplied mainly by food Each vitamin has multiple, unrelated functions No chemical relationship among the group The term vitamin was first used by a biochemist who discovered one of the first of these essential elements, which happened to be an amine, thus vitamin. Vitamins are found in very small

6 quantities in the body. Each has a name defined by a letter as well as a chemical name. These compounds play a key role in metabolism, growth, and homeostasis and therefore are especially important in surgical critical illness, in which hypermetabolism, healing, and immune function are so important for survival. A deficiency state, which can occur readily, clearly will amplify the magnitude of disease. It is important to point out that trace elements are absorbed from food and mineralized water, which means an intact, functioning gut and food intake are critical. Tube feeding solutions and TPN contain insufficient quantities of these nutrients for the critically ill. The addition of trace elements in increased amounts to enteral and parenteral feeding regimens is of major importance in managing the surgical patient considering their importance in metabolism, healing, and immune defenses. III. ASSESSMENT OF NUTRITIONAL STATUS Not all surgical patients require immediate nutritional support. However, any catabolic patient described in the table or with pre-existing weight loss and malnutrition requires early nutritional intervention. Assessment begins with determining the current nutritional and metabolic status of the patient and then determining the status of the surgical illness or injury. Both factors dictate the timing of support as well as the quantity. As stated, the presence of a pre-existing protein energy malnutrition in the now stressed patient necessitates beginning nutritional support. Assessment of Needs Current Status Status of surgical illness or burn injury A. Current Status There are a number of risk factors for a pre-existing or evolving (PEM) protein energy malnutrition.

7 Risk Factors for Protein Energy Malnutrition Elderly, disabled Chronic illness Cancer Presence of a catabolic state Presence of a wound Assessment is based on a history of past and current nutritional intake as well as a history or evidence of a recent involuntary weight loss. As described, a weight loss of over 10% of normal weight over 6 months, or a 5% decrease in 30 days, is a good marker for malnutrition. Findings on physical exam of impaired nutrition include wasting, weakness, delayed wound healing and CNS depression. However, obvious physical findings will not be present with early malnutrition. Current Status History of past and present nutrient intake Physical exam Evidence of significant involuntary weight loss Biochemical markers

8 Is this patient malnourished? Biochemical markers are often more sensitive. Albumin levels have been frequently used. However, it is not a very sensitive marker. The half-life of albumin is over 30 days so it takes a long time to see a change. In addition, albumin synthesis is decreased with onset of the stress response after burns. Acute phase protein synthesis increases and albumin decreases unrelated to nutritional status. Pre-albumin (transthyretin) levels are much more sensitive as the half-life is only a few days. This protein is not an albumin precursor. A value 15mg/dl reflects early malnutrition and the need for nutritional support. Physical Findings Wasting, weakness CNS depression Dementia, glossitis Delayed wound healing

9

Chapter 25: Nutrition, Metabolism, and Temperature Regulation

Chapter 25: Nutrition, Metabolism, and Temperature Regulation Chapter 25: Nutrition, Metabolism, and Temperature Regulation I. Nutrition A. Nutrients 1. What are nutrients? 2. List the six major classes of nutrients: a. d. b. e. c. f. 3. Which of these are the major

More information

: The Body s Energy Shuttles. *The body s energy shuttles NADH, FADH 2

: The Body s Energy Shuttles. *The body s energy shuttles NADH, FADH 2 Chapter 8 Metabolism Chapter Outline I. Energy: Fuel for Work. *Energy is necessary to do any kind of work. The body converts chemical energy from food sources carbohydrates, proteins, and fats into a

More information

Section 1: Overview Metabolism. Fuel Metabolism Overview (Chapter 1)

Section 1: Overview Metabolism. Fuel Metabolism Overview (Chapter 1) Section 1: Overview Metabolism Fuel Metabolism Overview (Chapter 1) Student Learning Outcomes: To explain briefly an overview of human metabolism: To explain the differences in the fed vs. fasting states

More information

Endocrine Control of Fuel Metabolism Once Nutrients are Processed by Digestion

Endocrine Control of Fuel Metabolism Once Nutrients are Processed by Digestion Endocrine Control of Fuel Metabolism Once Nutrients are Processed by Digestion Food intake Dietary protein Dietary carbohydrat e Dietary triglyceride fat D I G E S T I O N Ingested food molecules are broken

More information

chapter Bioenergetics of Exercise and Training

chapter Bioenergetics of Exercise and Training chapter 3 Bioenergetics of Exercise and Training Chapter Objectives Understand the terminology of bioenergetics and metabolism related to exercise and training. Discuss the central role of ATP in muscular

More information

CHAPTER 5. Respiration. and Metabolism. Chapter 5 Outline. Metabolism. and the Lactic Acid Pathway. Metabolism of Lipids and Proteins

CHAPTER 5. Respiration. and Metabolism. Chapter 5 Outline. Metabolism. and the Lactic Acid Pathway. Metabolism of Lipids and Proteins CHAPTER 5 Cell Respiration and Metabolism Chapter 5 Outline Glycolysis and the Lactic Acid Pathway Respiration Metabolism of Lipids and Proteins Aerobic Metabolism Is all reactions in body that involve

More information

Enzymes and Metabolic Pathways Un-lecture.part II. NOTE: number corresponds to slides posted on the website.

Enzymes and Metabolic Pathways Un-lecture.part II. NOTE: number corresponds to slides posted on the website. Enzymes and Metabolic Pathways Un-lecture.part II NOTE: number corresponds to slides posted on the website. 44. ETS and Oxidative phosphorylation: When we completed the Krebs cycle, all of the bonds between

More information

Amino Acid Metabolism

Amino Acid Metabolism Amino Acid Metabolism Protein Degradation Constant turnover of proteins 1. Store nutrients and break down in times of need (muscle) 2. Eliminate abnormal proteins 3. Regulation of pathways Controlling

More information

Unit 3 Lecture 11 METABOLISM

Unit 3 Lecture 11 METABOLISM Unit 3 Lecture METABOLISM Anabolism is defined as the chemical reactions that combine simple substances into more complex molecules (requires energy). Examples of anabolism include glycogenesis (conversion

More information

coupled reactions ATP energy coupler

coupled reactions ATP energy coupler Metabolism - 1 Our discussions of proteins, carbohydrates and lipids included the role of these nutrients as fuel or energy-providing molecules. For humans, the major function of carbohydrates is to provide

More information

5/30/2014. Nutrition in the ICU. Disclosures. Objectives. Health Care Associated Malnutrition NONE

5/30/2014. Nutrition in the ICU. Disclosures. Objectives. Health Care Associated Malnutrition NONE Disclosures NONE Nutrition in the ICU Lee-lynn Chen May 30, 2014 Objectives Define health care associated malnutrition Review evidence related to optimal nutrition List strategies to improve nutritional

More information

ACE s Essentials of Exercise Science for Fitness Professionals. BIOENERGETICS (Ch 2 & 5)

ACE s Essentials of Exercise Science for Fitness Professionals. BIOENERGETICS (Ch 2 & 5) ACE s Essentials of Exercise Science for Fitness Professionals BIOENERGETICS (Ch 2 & 5) Energy production ATP: the energy source used to drive muscle contraction ATP is manufactured by the mitochondria

More information

Fitness: Physical Activity, Nutrients, and Body Adaptations

Fitness: Physical Activity, Nutrients, and Body Adaptations Fitness: Physical Activity, Nutrients, and Body Adaptations Chapter 14 Fitness Depends on physical activity and exercise Regular physical activity Promotes health Reduces risk of developing many diseases

More information

NUTRITION OF THE BODY

NUTRITION OF THE BODY 5 Training Objectives:! Knowledge of the most important function of nutrients! Description of both, mechanism and function of gluconeogenesis! Knowledge of the difference between essential and conditionally

More information

Cell Metabolism. K. Muma Bio 6

Cell Metabolism. K. Muma Bio 6 K. Muma Bio 6 Cell Metabolism Study Objectives: 1. Define oxidation and reduction. 2. Describe the mechanisms of ATP synthesis: substrate level phosphorylation vs. oxidative phosphorylation 3. Write the

More information

Food is... Energy! Review concepts

Food is... Energy! Review concepts Food is.... Energy! Review concepts Catabolism: Metabolic reaction pathways that break down food molecules and release biochemical energy. Anabolism: Metabolic reactions that build larger biological molecules

More information

TEST # 2 (Chapter 3) Read each question carefully and mark your answer on the Scantron.

TEST # 2 (Chapter 3) Read each question carefully and mark your answer on the Scantron. TEST # 2 (Chapter 3) Read each question carefully and mark your answer on the Scantron. NUTRITION B10 1. Cells can best be described as: a. the basis of the body's design b. the vital components of foods

More information

Energy Production In A Cell (Chapter 25 Metabolism)

Energy Production In A Cell (Chapter 25 Metabolism) Energy Production In A Cell (Chapter 25 Metabolism) Large food molecules contain a lot of potential energy in the form of chemical bonds but it requires a lot of work to liberate the energy. Cells need

More information

Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older.

Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older. Eligibility The NCSF online quizzes are open to any currently certified fitness professional, 18 years or older. Deadlines Course completion deadlines correspond with the NCSF Certified Professionals certification

More information

Bio& 242, Human A&P 2 Unit 1/Lecture 5

Bio& 242, Human A&P 2 Unit 1/Lecture 5 Bio& 242, Human A&P 2 Unit 1/Lecture 5 Overview of Energy and Metabolism 1. The food we eat (carbohydrates, lipids, proteins, and nucleic acids) are our only source of energy for doing the biological work

More information

Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 24 Nutrition, Metabolism, and Body Temperature Regulation SP 12

Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 24 Nutrition, Metabolism, and Body Temperature Regulation SP 12 Human Anatomy & Physiology, 8e (Marieb/Hoehn) Hazlewood Chapter 24 Nutrition, Metabolism, and Body Temperature Regulation SP 12 Matching Questions Figure 24.1 Using Figure 24.1, match the following: 1)

More information

Chapter 20. Nutrition and Metabolism. Copyright 2010, John Wiley & Sons, Inc.

Chapter 20. Nutrition and Metabolism. Copyright 2010, John Wiley & Sons, Inc. Chapter 20 Nutrition and Metabolism Nutrients Nutrients are chemicals the body uses for growth, maintenance, and repair Essential nutrients: ones needed in the diet because the body cannot make sufficient

More information

General characteristics

General characteristics Carbohydrates General characteristics The term carbohydrate is derived from the french: hydrate de carbone Compounds composed of C, H, and O Empirical formula: (CH 2 O) n Our body derives energy from the

More information

GLUCOSE HOMEOSTASIS-II: An Overview

GLUCOSE HOMEOSTASIS-II: An Overview GLUCOSE HOMEOSTASIS-II: An Overview University of Papua New Guinea School of Medicine & Health Sciences, Division of Basic Medical Sciences Discipline of Biochemistry & Molecular Biology, M Med Part I

More information

So, how can we influence anabolism within our body so that our metabolism is building muscle, repairing tissues, and not storing excess body fat?

So, how can we influence anabolism within our body so that our metabolism is building muscle, repairing tissues, and not storing excess body fat? The Two Sides of Metabolism By Tad Inoue Your body s metabolism has two distinct sets of processes that work synergistically and will either enable you to accomplish your body goals or hinder you. This

More information

What is a Vitamin? Lecture 11: Vitamins and Metabolism. Coenzymes. Vitamins and Metabolism

What is a Vitamin? Lecture 11: Vitamins and Metabolism. Coenzymes. Vitamins and Metabolism Lecture 11: Vitamins and Metabolism What is a Vitamin? Organic compound (made mainly of carbon, hydrogen, and oxygen) Nutrition 150 Shallin Busch, Ph.D. Essential nutrients (must be consumed in the diet,

More information

Chapter 5 Fundamentals of Human Energy Transfer

Chapter 5 Fundamentals of Human Energy Transfer Chapter 5 Fundamentals of Human Energy Transfer Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College 6.18.11 Objectives 1. Describe the first law of thermodynamics

More information

Respiration. ATP (Adenosine triphosphate) Mitochondria. Page 1 of 5

Respiration. ATP (Adenosine triphosphate) Mitochondria. Page 1 of 5 Respiration Respiration is a set of metabolic reactions and processes that take place with in the cells of organisms. It stores biochemical energy within adenosine triphosphate (ATP) molecules. There are

More information

Metabolism, Energy Balance, and Body Composition Cengage - Wadsworth

Metabolism, Energy Balance, and Body Composition Cengage - Wadsworth Metabolism, Energy Balance, and Body Composition Chemical Reactions in the Body Metabolism is the sum total of all chemical reactions that go on in living cells. Anabolism is the building up of body compounds

More information

2) If a person's urine contains unusually high concentrations of urea, which one of the following diets has he or she probably been eating recently?

2) If a person's urine contains unusually high concentrations of urea, which one of the following diets has he or she probably been eating recently? Section 11 Multiple Choice 1) Glutamate is metabolically converted to α-ketoglutarate and NH 4 + by a process described as : A) deamination. B) hydrolysis. C) oxidative deamination. D) reductive deamination.

More information

Nutrition Tips. The Ins and Outs of Macronutrients, Micronutrients, and Resting Metabolic Rate

Nutrition Tips. The Ins and Outs of Macronutrients, Micronutrients, and Resting Metabolic Rate Nutrition Tips The Ins and Outs of Macronutrients, Micronutrients, and Resting Metabolic Rate What are Macronutrients? Macronutrients are nutrients that provide calories or energy. Nutrients are substances

More information

CHAPTER 9 CELLULAR RESPIRATION: HARVESTING CHEMICAL ENERGY. Section C: Related Metabolic Processes

CHAPTER 9 CELLULAR RESPIRATION: HARVESTING CHEMICAL ENERGY. Section C: Related Metabolic Processes CHAPTER 9 CELLULAR RESPIRATION: HARVESTING CHEMICAL ENERGY Section C: Related Metabolic Processes 1. Fermentation allows some cells to produce ATP without the help of oxygen 2. Glycolysis and the Krebs

More information

Class XI Chapter 14 Respiration in Plants Biology. 1. It is a biochemical process. 1. It is a physiochemical process.

Class XI Chapter 14 Respiration in Plants Biology. 1. It is a biochemical process. 1. It is a physiochemical process. Question 1: Differentiate between (a) Respiration and Combustion (b) Glycolysis and Krebs cycle (c) Aerobic respiration and Fermentation (a) Respiration and combustion Respiration Combustion 1. It is a

More information

Summary of Metabolism

Summary of Metabolism Summary of Metabolism Basic Strategies of Catabolic Generate ATP Metabolism Generate reducing power Generate building blocks for biosynthesis ATP Universal currency of energy High phosphoryl-transfer potential

More information

The work of Life. Consumers need complex carbon compounds for energy building blocks C6H12O6 + 6O2 ==> 6CO2 + 6H2O

The work of Life. Consumers need complex carbon compounds for energy building blocks C6H12O6 + 6O2 ==> 6CO2 + 6H2O Nutrition The work of Life Consumers need complex carbon compounds for energy building blocks To release energy, oxidize glucose: C6H12O6 + 6O2 ==> 6CO2 + 6H2O 686 Cal released per mole of glucose. The

More information

The Advanced Nutrition Protocols The Ketogenic Diet By Ru Anderson

The Advanced Nutrition Protocols The Ketogenic Diet By Ru Anderson The Advanced Nutrition Protocols The Ketogenic Diet By Ru Anderson The ketogenic diet falls within the first of our advanced nutrition protocols due to its complex nature and highly debated methodology.

More information

CHM 132 Spring 2011 NAME

CHM 132 Spring 2011 NAME CHM 132 Spring 2011 NAME Exam #3 100 points 1. Which of the following makes up about 60 percent of the body s weight? C a. major minerals b. protein c. water d. trace mineral 2. The most beneficial source

More information

NUTRIENT CHEMISTRY. You are what you eat (with a few hundred chemical reactions in between).

NUTRIENT CHEMISTRY. You are what you eat (with a few hundred chemical reactions in between). NUTRIENT CHEMISTRY You are what you eat (with a few hundred chemical reactions in between). NUTRIENTS Nutritive chemicals allow burning in your body. OK, actually it s oxidation - very slow burning. OK,

More information

Cellular Metabolism 1.

Cellular Metabolism 1. Metabolic Pathways: a summary Uncoupling proteins (UCP) in inner mitochondrial membrane of mammals Allow some H + leakage, bypassing ATP-synthase. Burn fuel stores without generating ATP May be important

More information

IFA Sports Nutrition Certification Test Answer Form

IFA Sports Nutrition Certification Test Answer Form IFA Sports Nutrition Certification Test Answer Form In order to receive your certification card, take the following test and mail this single page answer sheet in with your check or money order in US funds.

More information

Copyright 2010 Pearson Education, Inc. Chapter Twenty Three 1

Copyright 2010 Pearson Education, Inc. Chapter Twenty Three 1 23.2 Glucose Metabolism: An Overview When glucose enters a cell from the bloodstream, it is immediately converted to glucose 6- phosphate. Once this phosphate is formed, glucose is trapped within the cell

More information

Chapter 25: Metabolism and Nutrition

Chapter 25: Metabolism and Nutrition Chapter 25: Metabolism and Nutrition Chapter Objectives INTRODUCTION 1. Generalize the way in which nutrients are processed through the three major metabolic fates in order to perform various energetic

More information

BioImpedance Analysis

BioImpedance Analysis Page 1 of 11 BioImpedance Analysis Overview The measurement Process Prices More Details Overview BIA systems provide a very good indication of the following aspects of health and offers a method of monitoring

More information

Summary of Metabolic Pathways (Ch 21,23 and 25)

Summary of Metabolic Pathways (Ch 21,23 and 25) Summary of Metabolic Pathways (Ch 21,23 and 25) 21.1 Energy and Life Energy can be converted from one form to another, but can t be created or destroyed. -A consequence of this is that we need a constant

More information

Physical Fitness. Lecture 20: Fitness. To Achieve Fitness. What is exercise?

Physical Fitness. Lecture 20: Fitness. To Achieve Fitness. What is exercise? Lecture 20: Fitness Nutrition 150 Shallin Busch, Ph.D. Physical Fitness The ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time

More information

Bioenergetics. and Training

Bioenergetics. and Training chapter Bioenergetics of Exercise And Training 2 Bioenergetics of fexercise and Training Key Terms bioenergetics: The flow of energy in a biological system; the conversion of macronutrients into biologically

More information

Name Period _. Regents Biology Date _ REVIEW 1: CHEMISTRY OF LIVING CREATURES

Name Period _. Regents Biology Date _ REVIEW 1: CHEMISTRY OF LIVING CREATURES Name Period _ Regents Biology Date _ REVIEW 1: CHEMISTRY OF LIVING CREATURES HOMEOSTASIS All organisms live as a balancing act. They must maintain their internal conditions within an acceptable range.

More information

CHM 132 Spring 2011 NAME

CHM 132 Spring 2011 NAME CHM 132 Spring 2011 NAME Exam #2 100 points 1. Cholesterol is the best known of the: C a. phospholipids. b. lipids. c. sterols. d. triglycerides. 2. All of the following are found mainly in foods that

More information

NUTRITION AND METABOLISM

NUTRITION AND METABOLISM NUTRITION AND METABOLISM I. NUTRITION -Food is metabolic fuel; that is, it is OXIDIZED (see later) and transformed into ATP. *energy value of food is measured in KILOCALORIES (kcal or C ). NOTE: what most

More information

Metabolism. Metabolism. Total of all chemical reactions that occur in the body. Bioenergetics. 1. Anabolic reactions Synthesis of molecules

Metabolism. Metabolism. Total of all chemical reactions that occur in the body. Bioenergetics. 1. Anabolic reactions Synthesis of molecules Metabolism Metabolism Total of all chemical reactions that occur in the body 1. Anabolic reactions Synthesis of molecules 2. Catabolic reactions Breakdown of molecules Bioenergetics Converting foodstuffs

More information

CHAPTER 15: ANSWERS TO SELECTED PROBLEMS

CHAPTER 15: ANSWERS TO SELECTED PROBLEMS CHAPTER 15: ANSWERS T SELECTED PRBLEMS SAMPLE PRBLEMS ( Try it yourself ) 15.1 ur bodies can carry out the second reaction, because it requires less energy than we get from breaking down a molecule of

More information

The diagram below summarizes the effects of the compounds that cells use to regulate their own metabolism.

The diagram below summarizes the effects of the compounds that cells use to regulate their own metabolism. Regulation of carbohydrate metabolism Intracellular metabolic regulators Each of the control point steps in the carbohydrate metabolic pathways in effect regulates itself by responding to molecules that

More information

Copyright Mark Brandt, Ph.D. 28

Copyright Mark Brandt, Ph.D. 28 Gluconeogenesis In animals, glucose is required by the brain, and is important to the proper functioning of most tissues. A fall in plasma glucose can result in unconsciousness, and, if untreated, can

More information

CATABOLISM AND ANABOLISM METABOLISM ENERGY TRANSFER ATP MOLECULE & ENERGY OXIDATION AND REDUCTION

CATABOLISM AND ANABOLISM METABOLISM ENERGY TRANSFER ATP MOLECULE & ENERGY OXIDATION AND REDUCTION METABOLISM Functions of food source of energy essential nutrients stored for future use Metabolism is all the chemical reactions of the body some reactions produce the energy which is stored in that other

More information

Nutrition in the Critically Ill. Britney Grayson Bonus conference January 2, 2013

Nutrition in the Critically Ill. Britney Grayson Bonus conference January 2, 2013 Nutrition in the Critically Ill Britney Grayson Bonus conference January 2, 2013 In critically ill patients, underfeeding is associated with weakness, infection, an increased duration of mechanical ventilation

More information

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College Regulation of Metabolism By Dr. Carmen Rexach Physiology Mt San Antonio College Energy Constant need in living cells Measured in kcal carbohydrates and proteins = 4kcal/g Fats = 9kcal/g Most diets are

More information

LESSON 2.3 WORKBOOK. Part one: Glucose homeostasis in the blood storing energy

LESSON 2.3 WORKBOOK. Part one: Glucose homeostasis in the blood storing energy LESSON 2.3 WORKBOOK Part one: Glucose homeostasis in the blood storing energy Glucose metabolism takes place in all cells to make ATP. The liver plays an important role in regulating the levels of glucose

More information

Name Period _. Regents Biology Date _ REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS

Name Period _. Regents Biology Date _ REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS Name Period _ Regents Biology Date _ REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS NUTRITION AND METABOLISM All living organisms need energy and nutrients. The energy is used for many purposes, such

More information

Macromolecules, Food and What s in food?

Macromolecules, Food and What s in food? Macromolecules, Food and What s in food? Digestion Protein Lipids (Fat) Macromolecules Many small molecules connect to form Macromolecules Monomers Small Molecules (Building Blocks) Range in size from

More information

10.1 The function of Digestion pg. 402

10.1 The function of Digestion pg. 402 10.1 The function of Digestion pg. 402 Macromolecules and Living Systems The body is made up of more than 60 % water. The water is found in the cells cytoplasm, the interstitial fluid and the blood (5

More information

Clinical biochemistry second stage lecture 2

Clinical biochemistry second stage lecture 2 General Amino Acid Metabolism The main role of amino acids is in the synthesis of structural and functional proteins. Unlike carbohydrates and fats, there is no storage form of proteins in the body.the

More information

Cellular Respiration (Chapter 8) Outline. A. All active organisms, including the infamous killer bees, use energy on a steady basis.

Cellular Respiration (Chapter 8) Outline. A. All active organisms, including the infamous killer bees, use energy on a steady basis. The Killers Are Coming! The Killers Are Coming! Cellular Respiration (Chapter 8) Outline A. All active organisms, including the infamous killer bees, use energy on a steady basis. B. Carbon dioxide and

More information

Regents Biology REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS

Regents Biology REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS Period Date REVIEW 3: NUTRITION, RESPIRATION & PHOTOSY/NTHESIS NUTRITION AND METABOLISM All living organisms need energy and nutrients. The energy is used for many purposes, such as synthesis building

More information

Integration of metabolism. Jana Švarcová Alice Skoumalová

Integration of metabolism. Jana Švarcová Alice Skoumalová Integration of metabolism Jana Švarcová Alice Skoumalová Transport and fate of major carbohydrate and amino acid substrates and metabolites Note that there is little free glucose in muscle, since it is

More information

Chapter 6: Proteins & Amino Acids. Copyright 2012 John Wiley & Sons, Inc. All rights reserved.

Chapter 6: Proteins & Amino Acids. Copyright 2012 John Wiley & Sons, Inc. All rights reserved. Chapter 6: Proteins & Amino Acids Copyright Student learning outcomes: At the end of this chapter, you should be able to: Describe the role of proteins and amino acids in health and disease Plan a diet

More information

NUTRITION, DIGESTION & ABSORPTION OF CARBOHYDRATES

NUTRITION, DIGESTION & ABSORPTION OF CARBOHYDRATES NUTRITION, DIGESTION & ABSORPTION 1 BIOMEDICAL IMPORTANCE Diet must provide: metabolic fuels (mainly carbohydrates and lipids) protein (for growth and turnover of tissue proteins) fiber (for bulk in the

More information

Chapter 4 Carbohydrates: Sugar, Starches and Fiber

Chapter 4 Carbohydrates: Sugar, Starches and Fiber Chapter 4 Carbohydrates: Sugar, Starches and Fiber Carbohydrates in Our Diet Carbohydrates make up most of the energy in a healthy diet. Grains are sources of carbohydrates. Refined carbohydrates lack

More information

CLASS XI BIOLOGY. Plant Respiration. Finish Line & Beyond send your queries to

CLASS XI BIOLOGY. Plant Respiration. Finish Line & Beyond send your queries to CLASS XI BIOLOGY Plant Respiration 1. Differentiate between (a) Respiration and Combustion (b) Glycolysis and Krebs cycle (c) Aerobic respiration and Fermentation (a) Respiration takes place in cells of

More information

Microbiology - Problem Drill 05: Microbial Metabolism

Microbiology - Problem Drill 05: Microbial Metabolism Microbiology - Problem Drill 05: Microbial Metabolism No. 1 of 10 1. Anabolism is a metabolic process where are turned into molecules. (A) Complex, simple (B) Simple, ATP (C) Simple, ATP (D) Simple, complex

More information

Marasmus. Kwashiorkor

Marasmus. Kwashiorkor Chapter 8 NUTRITION Poor nutrition can negate all the benefits of proper wound care or advanced medical interventions. Studies have shown that malnourished patients often require longer hospitalizations,

More information

CHM 132 Spring 2011 NAME

CHM 132 Spring 2011 NAME CHM 132 Spring 2011 NAME Test #1 100 points 1. Effects of physical activity on the body include all of the following except: A a. decreased bone density. b. reduced risk of cardiovascular diseases. c.

More information

Endocrine Responses to Resistance Exercise

Endocrine Responses to Resistance Exercise chapter 3 Endocrine Responses to Resistance Exercise Chapter Objectives Understand basic concepts of endocrinology. Explain the physiological roles of anabolic hormones. Describe hormonal responses to

More information

Nutrition in Oncology: The case of Micronutrients. Oncology Reports October 2010, Vol. 24, pp

Nutrition in Oncology: The case of Micronutrients. Oncology Reports October 2010, Vol. 24, pp Nutrition in Oncology: The case of Micronutrients 1 Oncology Reports October 2010, Vol. 24, pp. 815-828 Alexander Strohle, Kurt Zanker, Andres Hahn This article has 188 references KEY POINTS FROM THIS

More information

Introduction to Anatomy & Physiology & Homeostasis

Introduction to Anatomy & Physiology & Homeostasis PowerPoint Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College Introduction to Anatomy & Physiology & Homeostasis 1PART A The Human Body An Orientation Anatomy Study

More information

Metabolism of Lipids and. Proteins

Metabolism of Lipids and. Proteins Chapter 35 Metabolism of Lipids and Whale oil, extracted from blubber, is used to make soap, leather dressing, lubricants, and hydrogenated fats. Proteins Introduction to General, Organic, and Biochemistry,

More information

Essentials of Anatomy and Physiology, 5e (Martini/Nath) Chapter 17 Nutrition and Metabolism. Multiple-Choice Questions

Essentials of Anatomy and Physiology, 5e (Martini/Nath) Chapter 17 Nutrition and Metabolism. Multiple-Choice Questions Essentials of Anatomy and Physiology, 5e (Martini/Nath) Chapter 17 Nutrition and Metabolism Multiple-Choice Questions 1) The sum of all of the biochemical processes going on within the human body at any

More information

Malnutrition Topic 5

Malnutrition Topic 5 Malnutrition Topic 5 Module 5.1 Undernutrition Simple and Stress Starvation Lubos Sobotka Peter Soeters Remy Meier Yitshal Berner Learning Objectives To know how the body reacts to short-term and long-term

More information

Cellular Respiration 1. Occurs in the Mitochondria 2. How are cells produce ATP (energy)

Cellular Respiration 1. Occurs in the Mitochondria 2. How are cells produce ATP (energy) Cellular Respiration 1. Occurs in the Mitochondria 2. How are cells produce ATP (energy) Consider the energy released by a burning peanut How is this like cellular respiration? Hyperlink What happened

More information

Nutrients. Macro Micro What is the point of each?

Nutrients. Macro Micro What is the point of each? Nutrients Macro Micro What is the point of each? What are Nutrients? Organic* (contain Carbon) & Inorganic molecules in food that are critical to human growth and function Carbohydrates * Lipids (Fats

More information

What is the Endocrine System?

What is the Endocrine System? Endocrine System (part 1) & General Adaptation Syndrome Keri Muma Bio 6 What is the Endocrine System? Composed of glands that secrete hormones Responsible for continuous processes such as growth, cell

More information

With what you have learned from your last several NUTRI-SPEC LETTERS, you have magical powers to offer your patients. You are without exaggeration

With what you have learned from your last several NUTRI-SPEC LETTERS, you have magical powers to offer your patients. You are without exaggeration THE NUTRI-SPEC LETTER Volume 18 Number 12 From: Guy R. Schenker, D.C. December, 2007 Dear Doctor, With what you have learned from your last several NUTRI-SPEC LETTERS, you have magical powers to offer

More information

Molecular Structure & Biochemical Function of Glucagon And Somatostatin Learning Objectives Glucagon Glucagon Synthesis

Molecular Structure & Biochemical Function of Glucagon And Somatostatin Learning Objectives Glucagon Glucagon Synthesis Molecular Structure & Biochemical Function of Glucagon And Somatostatin Learning Objectives By the end of this presentation the students should be able to understand the: Hormones released form the endocrine

More information

NUTRITIONAL MANAGEMENT IN METABOLIC STRESS (CRITICALLY ILL PATIENTS)

NUTRITIONAL MANAGEMENT IN METABOLIC STRESS (CRITICALLY ILL PATIENTS) NUTRITIONAL MANAGEMENT IN METABOLIC STRESS (CRITICALLY ILL PATIENTS) - Metabolic stress (as in trauma, surgery, burns) result in a profound metabolic alterations starting at the time of injury and persisting

More information

Energy Transformation: Cellular Respiration Outline 1. Sources of cellular ATP 2. Turning chemical energy of covalent bonds between C-C into energy

Energy Transformation: Cellular Respiration Outline 1. Sources of cellular ATP 2. Turning chemical energy of covalent bonds between C-C into energy Energy Transformation: Cellular Respiration Outline 1. Sources of cellular ATP 2. Turning chemical energy of covalent bonds between C-C into energy for cellular work (ATP) 3. Importance of electrons and

More information

Artificial Nutrition

Artificial Nutrition Nutrition in the Elderly 36.4 Artificial Nutrition Stéphane M. Schneider, MD, PhD Nutritional Support Unit, Nice University Hospital, France In which of the following patients is nutritional support NOT

More information

Balancing Nutrition and Breathing

Balancing Nutrition and Breathing Balancing Nutrition and Breathing Maria Browning RD CNSC IU Health Methodist and University Hospitals Transplant and Adult Cystic Fibrosis Objectives Define basic nutrition terminology and feeding routes

More information

Endocrine System: Practice Questions #1

Endocrine System: Practice Questions #1 Endocrine System: Practice Questions #1 1. Removing part of gland D would most likely result in A. a decrease in the secretions of other glands B. a decrease in the blood calcium level C. an increase in

More information

Wound Healing. Outline. Normal Wound Healing. Wounds and nutrition refresher UPHS evidence-based guideline for. wounds

Wound Healing. Outline. Normal Wound Healing. Wounds and nutrition refresher UPHS evidence-based guideline for. wounds Wound Healing Clinical Nutrition Support Service Hospital of the University of Pennsylvania Jung Kim, RD CNSD, LDN Tricia Stefankiewicz, MA, RD, CNSC, LDN Outline Wounds and nutrition refresher UPHS evidence-based

More information

Bacterial cells are similar to plant and. biogenic and trace elements, as well as in basic chemical substances.

Bacterial cells are similar to plant and. biogenic and trace elements, as well as in basic chemical substances. Chemical structures of bacteria Bacterial cells are similar to plant and animal cells in their contents of biogenic and trace elements, as well as in basic chemical substances. The basic substances can

More information

Amino Acid Degradation and Nitrogen Metabolism. Overview. Amino acid catabolism 12/2/2015. Chapter 30, Stryer Short Course. Amino Acid Catabolism

Amino Acid Degradation and Nitrogen Metabolism. Overview. Amino acid catabolism 12/2/2015. Chapter 30, Stryer Short Course. Amino Acid Catabolism Amino Acid Degradation and Nitrogen Metabolism Chapter 30, Stryer Short Course Overview Amino Acid Catabolism Nitrogen removal Urea Cycle Metabolism of carbon backbone Amino acid catabolism Amino acids

More information

Click here for title. Indication and Appropriate use of TPN (Total Parenteral Nutrition) Click here for subtitle

Click here for title. Indication and Appropriate use of TPN (Total Parenteral Nutrition) Click here for subtitle Indication and Appropriate use of TPN (Total Parenteral Nutrition) Click here for title Click here for subtitle Charles Posternack, MD, FACP, FRCPC Chief Medical Officer Boca Raton Regional Hospital Definition

More information

1. The diagram below represents a biological process

1. The diagram below represents a biological process 1. The diagram below represents a biological process 5. The chart below indicates the elements contained in four different molecules and the number of atoms of each element in those molecules. Which set

More information

ESPEN Congress Geneva 2014 LLL LIVE COURSE: ICU NUTRITION AND PROBLEM SOLVING

ESPEN Congress Geneva 2014 LLL LIVE COURSE: ICU NUTRITION AND PROBLEM SOLVING ESPEN Congress Geneva 2014 LLL LIVE COURSE: ICU NUTRITION AND PROBLEM SOLVING Energy and protein target: how to present underfeeding, overfeeding and refeeding syndrom M. Hiesmayr (AT) How to maintain

More information

Unit 4: Cellular Processes Practice Questions Date:

Unit 4: Cellular Processes Practice Questions Date: Name: Unit 4: Cellular Processes Practice Questions Date: 1. Base your answer to the following question on the diagram below which represents the fluid-mosaic model of a cell membrane. 3. The diagram below

More information

Cellular Energy: ATP & Enzymes. What is it? Where do we get it? How do we use it?

Cellular Energy: ATP & Enzymes. What is it? Where do we get it? How do we use it? Cellular Energy: ATP & Enzymes What is it? Where do we get it? How do we use it? Energy The capacity to perform work; ability to rearrange matter Energy is required to drive reactions 2 forms: Potential

More information

Amphibolic nature of Krebs Cycle. How what we are is what we eat

Amphibolic nature of Krebs Cycle. How what we are is what we eat Amphibolic nature of Krebs Cycle How what we are is what we eat In aerobic organisms, the citric acid cycle is an amphibolic pathway, one that serves in both catabolic and anabolic processes. Since the

More information

HORMONAL SECRETION OF PANCREAS (PANCREAS 1)

HORMONAL SECRETION OF PANCREAS (PANCREAS 1) HORMONAL SECRETION OF PANCREAS (PANCREAS 1) LEARNING OBJECTIVE: At the end of lecture student should be able to know: What is pancreas. Endocrine and exocrine portion of pancreas, Insulin secretion. Insulin

More information

6. Draw a cell as we have done regularly. Label the section of the cell that performs the same chemical reaction as bacteria in your gut.

6. Draw a cell as we have done regularly. Label the section of the cell that performs the same chemical reaction as bacteria in your gut. Week 4 Exam: 1. What 2 factors mainly speed up rate of glycogen depletion from muscles? a. time of day b. intensity c. ambient temperature (air temp) d. duration e. mood 2. Name the section of the cell

More information

Lecture 8 Cell Biolog y ٢٢٢ ١

Lecture 8 Cell Biolog y ٢٢٢ ١ Lecture 8 ١ Mitochondria Function The most prominent roles of mitochondria are to produce ATP (i.e., phosphorylation of ADP) through respiration And to regulate cellular metabolism. The central set of

More information