Environmental and Nutritional Diseases Dan Lodge-Rigal, M.D. Reading: Big Robbins: Chapter 9, Basic Robbins: 7 Laboratory tests (Bakerman): review tests for nutrition, particularly albumin, transthyretin Online module on Nutrition, Module 25

Part 1: Injury from Physical Agents A. Health Effects from Climate Change Global warming: What is the evidence? What is projected? Effects Ozone and Human disease What is ozone? Beneficial effects and consequences of ozone depletion Ozone as air pollutant

B. Mechanical Injury Blunt force trauma: Abrasion Contusion Laceration Injury from sharp instrument: Penetrating and perforating (stab) wound Incised wound Gunshot wounds Entrance wound Exit wound

C. Thermal Injury: Hyperthermia Localized hyperthermia: thermal burns Local tissue effects of thermal injury Systemic effects of extensive burns 1) 2) 3) 4) Generalized hyperthermia: At risk: Terms: Heat stress Heat exhaustion Heat stroke and Multi-organ dysfunction syndrome D. Hypothermia Localized hypothermia: Frostbite Trenchfoot

Generalized hypothermia: At risk: Pathophysiology E. Radiation General: Sources of radiation: background radiation and excessive exposure Exposure, Absorption, and Dose Curie Gray (Gy) and Centigray (cGy) Sievert (Sv) Factors influencing physical effects of radiation: Source factors 1) 2) Target factors 1) 2) 3) 4) Radiation effects: Direct versus Indirect Acute versus Chronic

Cellular injury: Nucleus and DNA Cytoplasm Tissue/Organ injury: Radiation and Neoplasia Cancers with strong associations with radiation exposure: 1) 2) 3)

Environmental and Nutritional Diseases Dan Lodge-Rigal, M.D.

Part 2: Nutritional Diseases Reading: Robbins Chapter 9 Laboratory tests (Bakerman): review tests for nutrition, particularly albumin, transthyretin Online module on Nutrition, Module 25 A. Generalized Nutritional Disorders Overnutrition and Obesity Epidemic of obesity Current estimate of incidence of obesity in US: Current estimate of incidence of obesity in children: Definition of overweight and obesity: Body Mass Index (BMI) BMI equation: Healthy: Overweight: Obese: Extreme obesity: Limitations of BMI Fat distribution and health risk: Android vs Gynoid Peripheral versus Central (visceral) Pathogenesis: Obesity as a disorder of energy balance Afferent signals 1) 2) 3) Central processing 1)

Efferent signals 1) 2)

Reasons for energy “imbalance” Biochemical and Genetic Societal and Behavioral Complications of Obesity 1) 2)

3) 4) 5) Protein Energy Malnutrition Primary versus Secondary Malnutrition Causes of secondary malnutrition 1) 2) 3) 4) Effects of generalized malnutrition on protein “compartments” Visceral: Somatic: Marasmus definition: pathogenesis: features: 1) 2) 3) 4)

Kwashiorkor definition: pathogenesis: features: 1) 2) 3) 4) 5) Cachexia: B. Disorders of Specific Nutrients: Vitamins What is a vitamin(e)? Fat Soluble Vitamins General aspects of fat soluble vitamins: Vitamin A Sources of Vitamin A pre-formed vs pro-vitamin A Functions: 1) 2) 3) Consequences of Deficiency:

1) 2) 3) Vitamin A Toxicity Signs/Symptoms: 1) 2) 3) 4) Pregnancy and Vitamin A: How do you assess Vitamin A status?

Vitamin D Sources of Vitamin D 1) 2) D2 + D3 = Total Vitamin D Action of Vitamin D: Vitamin D Receptor Vitamin D Responsive Elements (VDRE) and gene products: 1) 2) 3) 4) Vitamin D Deficiency: Children: Rickets Adults: Osteomalacia

Other potential roles of Vitamin D and consequences of deficiency: 1) 2) 3) Assessing Vitamin D status: What test to order? Challenges: Controversies over Vitamin D sufficiency and recommended daily intake Vitamin D Toxicity: Vitamin E Classes: tocopherol (alpha-tocopherol) and tocotrienols Food sources: 1) 2) 3) Functions: Antioxidant: Vitamin E deficiency: Rare. Associated conditions: Effects: 1) 2) Vitamin E toxicity Vitamin K Major forms: Plants: phylloquinone Bacteria: menaquinone Sources: Diet: Gut bacteria:

Functions of Vitamin K: Vitamin K carboxylase and coagulation Other potential effects of Vitamin K: 1) 2) Vitamin K deficiency: True deficiency state: uncommon in adults Iatrogenic: Warfarin therapy Newborns Vitamin K toxicity: relatively non-toxic Water Soluble Vitamins General aspects of water soluble vitamins: Vitamin C (ascorbic acid) Derived from glucose (humans lack necessary enzyme) Physico-chemical property: donates/accepts H+, anti-oxidant Heat labile, destroyed by sun exposure Sources of Vitamin C 1) 2) 3) 4) Functions of Vitamin C: 1) 2)

3) Vitamin C deficiency (scurvy) Vitamin C toxicity and Megadose Vitamin C ? Curative or Preventative properties B Vitamins: What are they? 1) 2) 3) 4) 5) 6) 7) 8) Thiamin (Thiamine) (B1) Thiamin and Thiamin pyrophosphate (TPP) rice and grain processing and thiamin deficiency Sources of thiamin 1) 2) 3) 4) Alcohol and thiamin absorption Thiamin and major metabolic pathways: Other:

Thiamin deficiency: Beri Beri Central nervous system effects: Wernicke encephalopathy Korsakoff psychosis Niacin (B3) Forms: Nicotinic acid, Nicotinamide Sources of Niacin: 1) 2) 3) 4) Functions: > 200 enzymatic reactions as NAD or NADP (redox potential) Deficiency state: Pellagra 4 “D’s” of Pellagra: 1) 2) 3) 4) High dose Niacin as cholesterol-lowering drug