REGULATION OF FOOD INTAKE
AND NUTRITIONAL STATE
INTAKE OUTPUT
CENTER OF SATIETY CENTER OF HUNGER
(permanently active)
ncl.
ventromedialis in hypothalamus lateral hypothalamus
(nucleus under fasciculus telencephalicus medialis)
FEELING OF SATIETY
FOOD INTAKE
Chewing
movements
Receptors in
nose, mouth,
oesophagus,
intestine
Mechanoreceptors of
stomach
GIT
chemoreceptors
SATIETY
PRERESORPTIVE FEEDING
RESORPTIVE FEEDING
Central
gluco-
thermo-
lipo-
receptors
COMPILING THE INFORMATION IN CNS
(CENTER OF SATIETY = ncl. ventromedial in hypothalamus)
FEELING OF HUNGER
LACK OF FOOD
Hungry
contractions of
stomach
Decreased
glucose
availability
Decreased
heat
production
Changes of lipid
metabolism
Mechanoreceptors Glucoreceptors Internal termoreceptors
(hypothalamus)
„Liporeceptors“
HUNGER
SHORT-TERMED REGULATION
LONG-TERMED REGULATION
Compensation of dietary mistakes
HYPOTHESIS:
1. Lipostatic
2. H. of GIT peptides
3. Glucostatic
4. Thermostatic
REGULATION OF FOOD INTAKE
OREXIGENIC FACTORS
• Neuropeptide Y
• Orexin A and B (hypocretin 1 and 2)
• Hormon concentrating melanin
• ARP (agouti-related peptide)
• Ghrelin (lenomorelin) – s.-c. hormone of hunger (released from
„empty“ stomach)
• Insulin
• Sugars (fructose)
ANOREXIGENIC FACTORS
• POMC – derivative MC4-R
• CRH (corticoliberin)
• CART (cocaine- and amphetamine-regulated transcript)
• Peptide YY (pankreatic peptide; L-cells in ileum and colon,
suppresses gastric motility, increases absorption)
• CCK (cholecystokinin)
• glucagon
MEDICAMENTS !!!
LEPTIN (ob-protein)
Secreted by adipocytes into the blood
Binding proteins
Effect on CNS (regulation of body mass and stability of adipose tissue)
• Pulsative and diurnal character of plasmatic levels
• Free and bound form (in serum)
• SLIM PEOPLE HAVE 2x MORE OF BOND FORM THAN OBESE PEOPLE
• LEPTIN REZISTANCE: often in obese patient with insulin resistance
RECEPTORS from cytokin family
• Peripheral (gonads)
• Central (hypothalamus, pituitary)
Transduction system is not elucidated
Modulates expression of genes for estrogens.
Regulation of obesity by leptin mediated by NPY and MSH.
Leptin controls adipose tissue by coordination of food intake, metabolism,
autonomous nervous system and energy balance.
ADIPOSE TISSUE
INCREASE OF BODY MASSLOSS OF BODY MASS
- LEPTIN +LEPTIN
HYPOTHALAMUS
HYPOTHALAMUS
NPY
RESPONSE TO FASTING
MSH
RESPONSE TO OBESITY
NPY RECEPTOR
MSH RECEPTOR
+ Food intake
- Reproduction
- Temperature
- Energy expenditure
- Food intake
+ Energy expenditurePARASYMPATHETIC
ACTIVITY
SYMPATHETIC
ACTIVITY
POMC derivatives
LEPTIN RESISTANCE
(MC4-R)
(Y1, Y2, Y5)
EXAMINATION METHODS
ANTROPOMETRIC METHODS
Inspection
Body mass (kg)
BMI
Waist circumference, waist-to-hip ratio
Percentage of body fat (calliper, impedance methods, densitometry, CT)
Percentage of ABM (%, underwater weighting)
Measurement of big muscle groups
BIOCHEMICAL METHODS
Total nitrogen balance
Loss of nitrogen in urine
Plasmatic values of proteins
Incorporation of AA
Plasmatic levels of prealbumins, transferin
Levels of vitamins or their metabolites in urine…
IMMUNOLOGICAL METHODS
NUTRITION
RECOMMENDED
SPECIAL DIETS
ASPECTS: evolutional
religious
historical
PRINCIPLES OF RECOMMENDED NUTRITION
• Quantity
• Quality
• Special components
• Aesthetics
• Economy
Essential components in nutrition:
AA, FA, vitamins…
Nutritional habits: cultural and historical aspects
social and economical
OBESITY (OVERWEIGHT)
Pathological increase of body mass caused by enormous increase
of body fat with serious complications.
INCIDENCE
2008 in CR: 52% population with higher body mass (35%
overweight, 17% obesity), age over 45 – only 30% of population
has normal body mass (men – 72% vs. women – 60%)
The percentage of children with obesity increases !!! (2014:
24% boys, 23% girls)
TYPES OF OBESITY:
ALIMENTARY (EXOGENOUS) – overeating
SECONDARY, SYMPTOMATIC
REASONS OF OVEREATING
Family habits vs. GENETIC PREDISPOSITION
Free food
Psychic disorders (depression, food intake disorders)
Religious reasons
Frequency of obesity negatively correlates with education
PROBLEMS RELATED TO OBESITY
1. Non-agreeable appearance (social isolation, partnership problems,
problems to find a corresponding job…)
2. Economical problems (increased expenses for food)
3. Early deterioration of joints (knees, hips, backbone)
4. Varices, thromboses, embolization
5. Diabetes mellitus
6. Dyslipidemia
7. Hypertension
8. Myocardial infarction
9. Brain stroke
10. Malignant tumors !!!
11. Fertility disorders (potency, period)
Fat people die earlier, have worse life and suffer by number of
vexatious diseases
+ RISK BEHAVIOUR
FAT DISTRIBUTION
•Diffuse (creeping start of obesity)
•Android (high incidence of DM – type „apple“)
•Gynoid (type „pear“), special type - steatopygia
Madelung collar
Strie
SECONDARY OBESITY
• Hypercorticalism
• Male hypogonadism
• Prolactinom
• Hypothalamic obesity
THERAPY OF OBESITY
1. Restriction of food intake
In men below 11 000 kJ/day, in women – below 8 000 kJ/day
Restriction of saccharides (INZ – antilipophilic hormone), restriction
of lipids (sometimes „lipid“ day). NO – salt, spice, alcohol, caffein.
2. Increase of energy expenditure by physical activity
Activity causing increase of HR up to 140-150/min.
Cyclic, swing movements (basic gymnastics)
Swimming in warm water.
3. Additional methods
Anorectics
Hormones of thyroid gland
Spa
Psychotherapy
Surgical methods – BARIATRIC SURGERY
PREVENTION
STOMACH BANDING
INTRAGASTRIC BALOON
SLEEVE-RESECTION OF STOMACH