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Although human need for various nutrients is well-established, the exact requirements for the different nutrients are not well-known. Nutrient requirements are affected by genetics; environment; nature of the diet; and hemeostatic demands under changing physiological conditions expressed as growth, reproduction and response to the stress of injury or disease. Pregnant and lactating women should be properly nourished if well-nourished infants are desired. Nutrient and energy needs are considerably increased during pregnancy and lactation. The most rapid growth of infants occurs during the 1st 4 to 6 months of life. Because of the many advantages of breast milk over artificial milk, full-term newborn infants should be breastfed, unless there are specific contraindications or breastfeeding is unsuccessful. The American Medical Association (AMA) urges that better efforts be made to educate the public and the medical profession as to the advantages of breastfeeding. The 4th to the 6th months of life constitute the transitional period in infant feeding. The baby should be introduced to single-ingredient foods in small quantities, one at a time, to isolate food sensitivities. Good eating habits can be formed early in life through the proper and gradual introduction of varied and nutritional meal patterns. Energy balance is a nutritional problem in late childhood and once maturity is achieved, while calorically and nutritionally inadequate diets are a growing concern for the elderly. Immoderate eating habits (e.g., overeating) may aggravate or contribute to the development of degenerative diseases and should be discouraged. The AMA recommends that the American public focus on the achievement and maintenance of the most desirable body weight through a proper combination of dietary control and exercise. Specific dietary modifications (sodium restriction, weight control) are necessary in the management of hypertension, diabetes, coronary heart diseases and other medical problems. The medical profession should assume a more active role in teaching people how to achieve and maintain good health habits through behavioral modification.
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PMID:American Medical Association concepts of nutrition and health. Council on Scientific Affairs. 49 Aug 37

Obesity is the most prevalent nutritional problem in North America and is associated with multiple chronic diseases. A sample, stratified by age and sex (N = 193), was taken from all the patients that visited Dr. Pila Hospital's Family Practice Center during a two month period. From the medical records, data was obtained about age, sex, body mass index, and the presence of diabetes mellitus, arterial hypertension, hypercholesterolemia or hyperlipidemia. The mean age was 44.8 years. The prevalence rates for obesity, hyperlipidemia, arterial hypertension, and diabetes were 53.4%, 69.5%, 26.0% and 17.2% respectively. The prevalence rates for hypertension and diabetes were twice in obese subjects than in non obese subjects. No statistical association was found between obesity and hyperlipidemia. Although this sample is not representative of the general population, this study sheds light on the impact of obesity and associated conditions among users of health services.
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PMID:[Prevalence of obesity and associated conditions in a center for family medicine]. 144 69

Obesity is considered to be a major nutritional disorder in the U.S. and in many parts of the industrialized world. The physiology of the obese and their propensity for chronic disease has been of growing interest over the past few years, and an extensive literature has begun to accumulate. Obesity is a heterogeneous disorder. When viewed in the broadest sense, it has been considered a disorder of energy balance. The development of obesity in humans is of complex etiology, involving genetic and environmental components that affect regulatory and metabolic events. The prevalence of overweight and obesity in a population depends on the particular reference or standard of desirable weight selected for use. A trend toward increasing height and weight has been evident among adults for several centuries, and among children as early as the 7th year of life in developed countries. Overweight persons are at increased risk for coronary artery disease, high blood pressure, diabetes mellitus, and cancer. The degree of overweight that carries additional risk without affecting mortality needs to be defined. Overweight most likely contributes in varying degrees to morbidity in different societies, because the risk for most common chronic diseases is multifactorial. In defining overweight and obesity, morbidity, in addition to mortality, ought to be taken into consideration. The multidisciplinary approach to the study of obesity--borrowing concepts and techniques from endocrinology, neurobiology, genetics, and nutrition--should yield new insights into how environmental factors such as diet and physical expenditure interact to influence energy metabolism and body composition.
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PMID:Characteristics of obesity: an overview. 330 Apr 91

Studies on diabetes mellitus in tropical zones indicate that its traditional link with overnutrition depends not only on the economic level, but also on some ethnic, social and cultural factors. At present, we insist on the unexpected relationship between diabetes mellitus and undernutrition either in some major infantile forms (described in India and Nigeria) with calcareous pancreatitis, or some less severe forms observed in Africa. This tropical diabetes mellitus occurs in some patients with normal weight or inferior to normal; it is not very ketogenic, responding to glucagon stimulation, and seems more frequent in the chronic malnutrition areas. So, it is tempting to utilize diabetes mellitus as an indicator of nutritional disorder or of dietary toxic factors. However, we ought to consider it within a multifactor surroundings associating genetic determinism and the other factors of tropical aggressiveness.
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PMID:[Tropical diabetes mellitus, a new nutritional indicator?]. 392 7

Reviewed here are the major nutritional problems of older females, stressing where older female nutrition differs from that of older males. Older females have a higher body mass index and lower waist-to-hip ratio than do older males. Older females reduce their food intake compared to younger females much less than do older males compared to younger males. Total energy expenditure is minimally reduced in older females compared to young females. Resting metabolic rate is reduced by 13% in older females. The major nutritional problem faced by older females, protein energy malnutrition, and its reversible causes are addressed. Inability to recognize the need for fluids is a common problem leading to dehydration in older persons. Older persons are at major risk for ingesting less than two-thirds of the recommended dietary allowance for vitamins. Older women are more likely than men to take vitamin or mineral supplements. Osteopenia is a common problem leading to fractures in older women, and decreased calcium intake and vitamin D deficiency, as well as estrogen deficiency, play a role in the pathogenesis of osteopenia. Total cholesterol levels increase with age in older women, while high-density lipoprotein cholesterol levels decline. However, cholesterol levels that are optimum for survival are higher in older women than in older men. At < 65 years of age, diabetes mellitus (DM) is more common in females, and at > 65 years of age it is more common in males. Over one-half of older persons with DM are undiagnosed. Management of DM in older persons requires a judicious approach to balance the potential problems of hypo- and hyperglycemia.
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PMID:Nutrition and the older female: a review. 840 92

1. Obesity is the most common nutritional disorder in the US and is a major cause of human essential hypertension. Although the precise mechanisms by which obesity raises blood pressure (BP) are not fully understood, there is clear evidence that abnormal kidney function plays a key role in obesity hypertension. 2. Obesity increases tubular reabsorption and this shifts pressure natriuresis towards higher BP. The increased tubular reabsorption is not directly related to hyperinsulinaemia, but is closely linked to activation of the sympathetic and renin-angiotensin systems, and possible changes in intrarenal physical forces caused by medullary compression due to accumulation of adipose tissue around the kidney and increased extracellular matrix within the kidney. 3. Obesity is also associated with marked renal vasodilation and increased glomerular filtration rate, which are compensatory responses that help overcome the increased tubular reabsorption and maintain sodium balance. However, chronic renal vasodilation causes increased hydrostatic pressure and wall stress in the glomeruli which, along with increased lipids and glucose intolerance, may cause glomerulosclerosis and loss of nephron function in obese subjects. Because obesity is a primary cause of essential hypertension as well as type II diabetes, there is good reason to believe that obesity may also be the most frequent cause of end-stage renal disease. 4. Future research is needed to determine the mechanisms by which excess weight gain activates the neurohumoral systems and alters renal structure and function. Because of the high prevalence of obesity in most industrialized countries, unravelling these mechanisms will likely provide a better understanding of the pathophysiology of human essential hypertension and chronic renal failure.
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PMID:Abnormal kidney function as a cause and a consequence of obesity hypertension. 949 61

Obesity is a very common and an increasing nutritional problem in Finland and in other western countries and also in circumpolar areas. Dietary factors like high intakes of fat and alcohol, and physical inactivity predispose to obesity. Childhood obesity increases the risk of obesity in adulthood. Obesity is associated with cardiovascular diseases, non-insulin-dependent diabetes mellitus and musculoskeletal disorders which cause work disability. Prevention of obesity should be more focused because treatment of obesity is difficult and the long-term result generally poor. Multidisciplinary co-work is needed to find out how the factors of childhood are related to obesity in adulthood.
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PMID:Obesity is a health problem. 975 77

Diabetes mellitus has become one of the most prevalent causes of renal disease, and approximately 30% of all insulin-dependent diabetic patients die of renal failure. Renal transplantation is generally the preferred treatment for diabetic patients with end-stage renal disease because it leads to a better quality of life than any other form of dialysis. Because fluid retention, electrolyte and acid-base disturbances are present in diabetics at a higher glomerular filtration rate than in non-diabetics, dialysis is initiated when the creatinine clearance is 10-20 ml/min, levels slightly higher than the recommended 5 ml/min for non-diabetics. Since 1978 continuous ambulatory peritoneal dialysis (CAPD) has become the preferred mode of therapy for diabetics. This method of dialysis offers several medical advantages: slow and sustained ultrafiltration, stable cardiovascular status, easier control of hypertension, preservation of residual renal function for a period longer than haemodialysis, steady state biochemical parameters. An additional advantage is a good, tight control of blood sugar achieved by intraperitoneal administration of insulin, which eliminates the need for multiple subcutaneous insulin injections. Intraperitoneally administered insulin closely mimics physiological events, though this route usually requires higher daily insulin doses. Heparinisation and access-related complications, which are the major cause of morbidity while on haemodialysis, are avoided. The social advantages include the possibility of home dialysis, long distance travel, uninterrupted job-related activity. Peritonitis remains the main complication of CAPD in diabetics. The pathogenesis, spectrum of organisms and treatment of peritonitis in diabetics do not differ from those seen in non-diabetics. The technique of catheter insertion, postoperative catheter care and common catheter complications are similar in diabetics to that in nondiabetic patients. Nutritional problems during CAPD may be aggravated by the loss of proteins, amino-acids, polypeptides and vitamins in the dialysate. They are especially important in those diabetics who are wasted and malnourished because of poor food intake, vomiting, and intercurrent illnesses. Foot problems are very important in diabetics on CAPD, and a multidisciplinary approach is absolutely crucial. The major contributory factors in the development of foot ulceration are neuropathy, peripheral vascular disease and abnormal stress. With proper selection of patients, diabetics can survive for a long period of time on CAPD. The morbidity and mortality observed during this therapy are primarily related to associated risk factors such as cardiovascular disease, atherosclerotic complications and infections. Certain features of CAPD make it a suitable therapy for diabetics.
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PMID:[Continuous ambulatory peritoneal dialysis in diabetic patients]. 986 95

Obesity is a common nutritional problem often associated with diabetes, insulin resistance, and fatty liver (excess fat deposition in liver). Leptin-deficient Lep(ob)/Lep(ob) mice develop obesity and those obesity-related syndromes. Increased lipogenesis in both liver and adipose tissue of these mice has been suggested. We have previously shown that the transcription factor sterol regulatory element-binding protein-1 (SREBP-1) plays a crucial role in the regulation of lipogenesis in vivo. To explore the possible involvement of SREBP-1 in the pathogenesis of obesity and its related syndromes, we generated mice deficient in both leptin and SREBP-1. In doubly mutant Lep(ob/ob) x Srebp-1(-/-) mice, fatty livers were markedly attenuated, but obesity and insulin resistance remained persistent. The mRNA levels of lipogenic enzymes such as fatty acid synthase were proportional to triglyceride accumulation in liver. In contrast, the mRNA abundance of SREBP-1 and lipogenic enzymes in the adipose tissue of Lep(ob)/Lep(ob) mice was profoundly decreased despite sustained fat, which could explain why the SREBP-1 disruption had little effect on obesity. In conclusion, SREBP-1 regulation of lipogenesis is highly involved in the development of fatty livers but does not seem to be a determinant of obesity in Lep(ob)/Lep(ob) mice.
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PMID:Absence of sterol regulatory element-binding protein-1 (SREBP-1) ameliorates fatty livers but not obesity or insulin resistance in Lep(ob)/Lep(ob) mice. 1192 8

Obesity is the most common nutritional disorder in the United States. Growing evidence suggests that obesity initiates a cascade of disorders including hypertension, diabetes, atherosclerosis, and chronic renal disease, many of which are interdependent. Abnormal kidney function, caused by increased renal tubular reabsorption, initiates volume expansion and increased blood pressure during excess weight gain, and the hypertension and metabolic abnormalities associated with obesity, in turn, contribute to chronic renal disease. Obesity causes cardiac and vascular disease through well-known mediators such as hypertension, type II diabetes, and dyslipidemia, but there is evidence for less well-characterized mediators such as chronic inflammation and hypercoagulation. Although obesity is increasingly recognized as a serious health problem, there are still many unanswered questions about how the multiple disorders associated with excess weight gain interact to cause cardiovascular and renal disease. Also, there are few studies that have examined whether sustained weight loss in obese subjects can reverse these changes. In view of the "epidemic" of obesity in our country and the excess burden of cardiovascular and renal disease in minority populations, addressing these issues is of paramount importance for the Jackson Heart Study, as well as for other national health initiatives.
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PMID:Mechanisms of obesity-associated cardiovascular and renal disease. 1224 Jul 10


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