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 Levels of food intake regulation 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 !!! Peripheral regulators of apetite Adipose tissue hormons Leptin Adiponectin Resistin GIT hormones Peptide YY Pancreatic polypeptide Ghrelin GLP-1 Oxyntomodulin Cholecystokinin BombesinPancreatic hormones Insulin Pancreatic polypeptide Amylin Peripheral regulators of apetite 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) Hypothalamic Structure and Neuronal Pathways Regulating Appetite Arcuate nucleus Paraventricular nucleus Lateral hypothalamic area and perifornical area Ventromedial nucleus Hypothalamic Regulators of Appetite • NPY • Melanocortin system • CART Reward and Regulation of Appetite • Opioids • Endocannabinoids • Dopaminergic systém • Serotonin Brain stem regulators of apetite • GLT-1 • NPY • nucleus of the solitary tract! Model for energy homeostasis 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