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Baltimore,\tMD.)\nHigh\tnutrition\trisk\tindividuals\tmust\tbe\tidentified\tand\tassessed\tmonthly\tby\tthe\tdietitian.\tHigh\trisk\nis\tdefined\tas:\n•\t\nSignificant\tweight\tloss\tdefined\tas\t5%\tof\tbody\tweight\tin\t1\tmonth\tor\t10%\tof\tbody\tweight\tin\t6\nmonths\n•\t\nNutrition\tsupport\t(tube\tfeedings\tor\n\tparenteral\tnutrition)\n•\t\nDialysis\tpatients\n•\t\nWounds\tor\tpressure\tinjuries
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Medicare,\tMedicaid,\tor\tprivate\tinsurances.\tThough\tthe\tpalliative\tcare\tapproach\tis\tbest\tto\tinitiate\tat\nthe\tdiagnosis\tof\ta\tdisease,\tthere\tare\tmany\tbenefits\tto\tstarting\tcare\tat\tany\tpoint\tduring\tthe\nprogression\tof\ta\tparticular\tdisease.\nHospice\tcare\n\tis\ta\tservice\twhich\tprovides\textra\tsupport\tto\ta\tterminally\till\tindividual\n\tand\tto\tthe
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] |
and\tto\tthe\nfamily.\tHospice\tcare\tis\tcovered\tunder\tMedicaid,\tMedicare,\tand\tmost\tprivate\tinsurance\tplans\tand
|
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] |
Introduction\nThe\tchapters\tin\tthis\tsection\treflect\tthe\tevolution\tof\tnutritional\tscience,\tfrom\tthe\tidentification\tof\nnutrient\trequirements\tand\tthe\tpractical\tapplication\tof\tthis\tknowledge\tto\tthe\tconcepts\tthat\trelate\nnutrition\tto\tthe\tprevention\tof\tchronic\tand\tdegenerative\tdiseases\tand\tto\toptimization\tof\thealth\tand\nperformance.
|
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performance.\nThe\trelationship\tbetween\tnutrition\tand\tdental\tdisease\thas\tlong\tbeen\trecognized.\n\tIn\tmore\trecent\ndecades\tthe\tpossibility\tof\tnutrition\ttherapy\tto\tprevent\tand\ttreat\tbone\tdisease\thas\tbecome\tan\tactive\narea\tof\tresearch\tand\twe\tare\tnow\taware\tthat\tthe\tinflammatory\tprocess\tis\ta\tfactor\tthat\tnutrition\tcan\nmodulate.
|
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0.03550894185900688,
0.06628622859716415,
0.02934543415904045
] |
modulate.\nHealthy\tlifestyles,\tgood\tnutrition,\tand\tphysical\tactivity\tare\tfoundations\tof\thealth,\tfitness,\tand\ndisease\tprevention.\tUnderstanding\tthe\trole\tof\tnutrition\tin\tsports\tand\tin\n\toptimizing\tperformance\thas\nled\tto\tdietary\tand\texercise\tpractices\tgenerally\tapplicable\tto\ta\trewarding,\thealthy\tlifestyle.
|
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Increased\taccess\tto\thighly\tprocessed\tand\tcalorically\tdense\tfoods\thas\tled\tto\tan\toverabundant\tintake\nof\tenergy\tfor\tmany\tindividuals.\tEfforts\tto\treduce\tbody\tweight,\twidely\tpursued\twith\tvarying\tdegrees\nof\tenthusiasm\tand\tdiligence,\tare\toften\tdisheartening,\tmaking\tthe\tknowledge\tpresented\n\there\tso
|
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20\nNutrition\tin\tweight\tmanagement\nLucinda\tK.\tLysen,\tRDN,\tRN,\tBSN,\tDorene\tRobinson,\tRDN,\tCDN,\tRebecca\tRudel,\tMPH,\tRDN,\tCNSC\nKEY\tTERMS\nabdominal\tfat\nactivity\tthermogenesis\t(AT)\nadipocyte\nadiposity\trebound\nandroid\tfat\tdistribution\nbariatric\tsurgery\nbody\tmass\tindex\t(BMI)\nbrown\tadipose\ttissue\t(BAT)\ncarbohydrate-insulin\ttheory\tof\tobesity
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brown\tadipose\ttissue\t(BAT)\ncarbohydrate-insulin\ttheory\tof\tobesity\ncommercial\tweight\tloss\tcenters\ncomorbidities\nessential\tfat\nfat\tmass\nfat-free\tmass\t(FFM)\ngastric\tbanding\ngastric\tbypass\nghrelin\ngynoid\tfat\tdistribution\nHealth\tat\tEvery\tSize;\tHAES®\nhormone-sensitive\tlipase\t(HSL)\nhyperphagia\nhyperplasia\nhypertrophy\nhypophagia\nincretin\ninsulin
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hyperphagia\nhyperplasia\nhypertrophy\nhypophagia\nincretin\ninsulin\nintermittent\tfasting\t(IF)\nintragastric\tballoon\t(IGB)\nketogenic\tdiet\nketones\nketosis\nlaparoscopic\tsleeve\tgastrectomy\t(LSG)\nlean\tbody\tmass\t(LBM)\nleptin\nlipogenesis\nlipoprotein\tlipase\t(LPL)\nmeal\treplacements\nmedically\tsupervised\tweight\tloss\tprograms\nmetabolic\tsyndrome\t(MetS)
|
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medically\tsupervised\tweight\tloss\tprograms\nmetabolic\tsyndrome\t(MetS)\nmorbid\tobesity\nnight-eating\tsyndrome\t(NES)
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nonalcoholic\tfatty\tliver\tdisease\t(NAFLD)\nnonexercise\tactivity\tthermogenesis\t(NEAT)\nnutritional\tgenomics\nobesity\nobesogen\noverweight\nresting\tmetabolic\trate\t(RMR)\nself-help\tprograms\nsensory-specific\tsatiety\nset\tpoint\n\ttheory\nstorage\tfat\nsemivolatile\torganic\tcompounds\t(SVOCs)\ntelehealth\nunderweight\nvagus\tnerve\nvery\tlow-calorie\tdiets\t(VLCDs)
|
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mechanisms\tcan\tresult\tin\tweight\tfluctuations.\nOn\tone\tend\tof\tthe\tweight\tspectrum\tis\tunderweight.\tAlthough\n\tthe\tinability\tto\tgain\tweight\tcan\tbe\ta\nprimary\tproblem,\tlow\tbody\tweight\tis\tusually\tsecondary\tto\ta\tdisease\tstate,\tan\teating\tdisorder,\tor\ta\npsychiatric\tdisorder.\tIn\tthe\telderly\tor\tin\tchildren,\tunintentional\tweight\tloss\tcan\tbe\tespecially
|
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] |
detrimental\tand\tshould\tbe\taddressed\tearly\tto\tprevent\tmalnutrition\tor\tother\tundesirable\nconsequences\tincluding\tpoor\tgrowth,\tdepressed\timmune\tfunction,\thormone\timbalance,\n\tdelayed\nhealing,\tand\tloss\tof\tbone\tdensity.\tMost\tcrucial\tis\tthe\tin\tutero\tdevelopment\tof\tthe\tfetus.\tBabies
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|
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] |
forefront—beginning\tin\tthe\t1970s—was\tGeorge\tL.\tBlackburn,\tMD,\tPhD,\twho,\talong\twith\tBruce\nBistrian,\tMD,\tPhD,\tat\tHarvard\tMedical\tSchool,\tand\ta\tnumber\tof\tother\thighly\trespected\tcolleagues,\nprovided\tthe\tfoundation\tfor\twhat\teventually\tbecame\tthe\tfield\tof\tnutritional\tmedicine.\tPublications\nhighlighting\tthe\tinadequate\tnutrition
|
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0.07310175150632858
] |
highlighting\tthe\tinadequate\tnutrition\n\tmanagement\tof\thospitalized\tpatients\tput\tthis\ttopic\tand\nnutritional\tmedicine\ton\tthe\t“world\tmap.”\tDespite\tthe\tfact\tthat\tDr.\tBlackburn\tand\this\tgroup\tfound\nthat\tmany\tof\tthe\thospitalized\tpatients\twere\tshockingly\tmalnourished\t(\nBlackburn\tet\tal,\t1977\n),\tthey
|
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] |
Blackburn\tet\tal,\t1977\n),\tthey\nalso\tdiscovered\tthat\tthe\tpatients\twere\toften\tnot\tunderweight\tbut\tinstead,\twere\toverweight\tor\teven\nobese.\tThis\tled\tto\tDr.\tBlackburn’s\tdevelopment\tof\n\tnutritional\tliquid\tand\tsolid\tdiets,\tsupplementing\npatients\twith\tprotein\tto\tencourage\tloss\tof\tbody\tfat\twhile\tsaving\tmuscle\tand\timproving\tnutritional
|
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] |
the\ttitle\t“\tFather\tof\tObesity”\t(\nTable\t20.1\n:\tThe\tStory\tof\n\tGeorge\tL.\tBlackburn,\tMD,\tPhD).\tThe\tgrowing\npopulation\tof\tobese\tindividuals\tand\tthe\tplethora\tof\tevidence\tthat\tit\tis\tassociated\twith\tchronic\tdisease\nhas\tmotivated\tintense\tresearch\ton\tthe\tsubject\tand\tresulted\tin\tobesity\tas\ta\tspecialty\tin\tnutritional
|
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] |
medicine.\tObesity\tmeets\tthe\tcriteria\tto\tbe\tclassified\tas\ta\t“disease,”\twhich\thas\tmade\tit\treimbursable\nby\tinsurance\tcompanies\tfor\tmedical\ttreatment,\tand\n\tin\tmany\tcases,\tfor\tnutritional\tmanagement\tby\nRegistered\tDietitian\tNutritionists.\nTABLE\t20.1\nThe\tStory\tof\tGeorge\tL.\tBlackburn,\tMD,\tPhD
|
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] |
model\tthat\tinfluenced\tphysicians\n\tand\tadministrators\tand\tother\thealth\tcare\tprofessionals\tto\tfollow\nsuit,\topening\tdoors\tfor\tdietitians\teverywhere.\nShortly\tafter\tDr.\tBlackburn’s\tdeath\tin\t2017,\tCaroline\tApovian,\tMD,\tProfessor\tof\tMedicine\tand\nPediatrics,\tBoston\tUniversity\tSchool\tof\tMedicine,\tand\t2018\tpresident\tof\tthe\tObesity\tSociety,
|
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] |
reflected\ton\tDr.\tBlackburn’s\ttremendous\taccomplishments\tduring\tan\tinterview.\tShe\tsaid,\t“George\nBlackburn\n\twas\ttruly\tthe\tfather\tof\tnutrition\tand\tobesity\tmedicine.\tHis\tenergy\tand\tenthusiasm\twere\nincredible.\tHe\tis\tsomeone\twho\tnot\tonly\tencouraged\tme\tto\tdo\tmy\tbest\twork,\tbut\talso\tcountless\tother
|
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] |
Body\tweight\n\toften\tis\tdescribed\tin\tterms\tof\tits\tcomposition,\n\tand\tdifferent\tmodels\thave\tbeen\tadvanced\nto\testimate\tbody\tfat.\tAssessment\tof\tbody\tcomposition\tis\tdiscussed\tin\tdetail\tin\t\nChapter\t5\n.\nTraditionally,\ta\ttwo-compartment\tmodel\tdivides\tthe\tbody\tinto\t\nfat\tmass\n,\tthe\tfat\tfrom\tall\tbody\tsources
|
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fat\tmass\n,\tthe\tfat\tfrom\tall\tbody\tsources\nincluding\tthe\tbrain,\tskeleton,\tintramuscular\tfat,\tand\tadipose\ttissue,\tand\t\nfat-free\tmass\t(FFM)\n,\nwhich\tincludes\twater,\tprotein,\tand\tmineral\tcomponents\t(\nFig.\t20.1\n).\tThe\n\tproportions\tof\tFFM\tare\nrelatively\tconstant\tfrom\tperson\tto\tperson.\nFIG.\t20.1\nThe\tcomponents\tof\tfat-free\tmass\tin\tthe\tbody.\nAlthough\t\nFFM
|
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] |
FIG.\t20.1\nThe\tcomponents\tof\tfat-free\tmass\tin\tthe\tbody.\nAlthough\t\nFFM\n\toften\tis\tused\tinterchangeably\twith\tthe\tterm\tlean\tbody\tmass,\tit\tis\tnot\texactly\tthe\nsame.\t\nLean\tbody\tmass\t(LBM)\n\tincludes\twater,\tbones,\torgans\tand\tskeletal\tmuscle.\tLBM\tis\thigher\tin\nmen\tthan\tin\twomen\tand\trepresents\tthe\tlargest\tcomponent\tof\t\nresting\tmetabolic\trate\t(RMR)\n.
|
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resting\tmetabolic\trate\t(RMR)\n.\nMinimizing\tthe\tloss\tof\tLBM\tis\tdesirable\tduring\tthe\tweight\n\tloss\tprocess.\tWater,\twhich\tmakes\tup\t60%\nto\t65%\tof\tbody\tweight,\tis\tthe\tmost\tvariable\tcomponent\tof\tLBM,\tand\tthe\tstate\tof\thydration\tcan\tinduce\nfluctuations\tof\tseveral\tpounds.\nBody\tfat
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] |
to\tsupport\tthe\tburden\tof\texcess\tadipose\ttissue.\nEssential\tfat\n,\tnecessary\tfor\tnormal\tphysiologic\tfunctioning,\tis\tstored\tin\tsmall\tamounts\tin\tthe\tbone\nmarrow,\theart,\tlung,\tliver,\tspleen,\tkidneys,\tmuscles,\tand\tthe\tnervous\tsystem.\tIn\tmen,\tapproximately
|
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between\t18%\tand\t24%\tfor\tmen\tand\t25%\tand\t31%\tfor\twomen.\tOn\tthe\tother\textreme,\t“elite\tfit”\tmen\nare\tas\tlow\tas\t2%\tto\t5%\tbody\tfat\tand\twomen\t10%\tto\t13%.\nAdipose\ttissue\tcomposition\nAdipose\n\ttissue\texerts\ta\tprofound\tinfluence\ton\twhole-body\thomeostasis.\tAdipose\ttissue\tis\tlocated
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primarily\tunder\tthe\tskin,\tin\tthe\tmesenteries\tand\tomentum,\tand\tbehind\tthe\tperitoneum.\tThis\tis\toften\nreferred\tto\tas\t\nvisceral\tadipose\ttissue\t(VAT)\n.\tAlthough\tit\tis\tprimarily\tfat,\tadipose\ttissue\talso\ncontains\tsmall\tamounts\tof\tprotein\tand\twater.\t\nWhite\tadipose\ttissue\t(WAT)\n\tstores\tenergy\tas\ta\nrepository\tfor\tTGs,\tcushions
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many\tmore\tiron\tcontaining\tmitochondria,\twhich\tmakes\tit\tbrown.\tIn\tadults\tBAT\tis\tactivated\tvia\tcold\nexposure\thelping\tto\tregulate\tbody\n\ttemperature,\thowever\tBAT\tis\tnot\tactivated\tin\tthermoneutral\nconditions.\tA\tgeneral\tactivation\tof\tBAT\tcontinues\tto\tinterest\tdrug\tmanufactures\tas\ta\tpotential
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obesity\ttherapy,\tbut\tfor\tthe\tpresent\tBAT\tplays\tonly\ta\tminor\tpart\tin\thuman\tenergy\tmetabolism\t(\nTam\net\tal,\t2012\n).\nAdipocyte\tsize\tand\tnumber\nThe\tmature\tfat\tcell\t(\nadipocyte\n)\tconsists\tof\ta\tlarge\tcentral\tlipid\tdroplet\tsurrounded\tby\ta\tthin\trim\tof\ncytoplasm,\twhich\tcontains\tthe\tnucleus\tand\tthe\tmitochondria.\tThese\tcells\tcan\tstore\tfat\tequal\tto\t80%
|
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0.11298275738954544,
0.11451306939125061,
0.08291130512952805,
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] |
to\t95%\tof\ttheir\tvolume.\tGains\tin\tweight\tand\tadipose\ttissue\toccur\tby\tincreasing\tthe\tnumber\tof\tcells,\nadding\tthe\tsize\tof\tcells\tas\tlipid,\tor\ta\tcombination\tof\tthe\ttwo.\nHyperplasia\n\t(increased\tnumber\tof\tcells)\toccurs\tas\ta\tnormal\tgrowth\tprocess\tduring\tinfancy\tand\nadolescence.\tCell\tnumber\tincreases\tin\tlean
|
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] |
adolescence.\tCell\tnumber\tincreases\tin\tlean\n\tand\tobese\tchildren\tinto\tadolescence,\tbut\tthe\tnumber\nincreases\tfaster\tin\tobese\tchildren.\tIn\tteens\tand\tadults,\tincreases\tin\tfat\tcell\tsize\tare\tmore\tcommon,\nbut\thyperplasia\talso\tcan\toccur\tafter\tthe\tfat\tcontent\tof\texisting\tcells\thas\treached\tcapacity.
|
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During\tnormal\tgrowth,\tthe\tgreatest\tpercentage\tof\tbody\tfat\t(approximately\t25%)\tis\tset\tby\t6\tmonths\nof\tage.\tIn\tlean\tchildren,\tfat\tcell\tsize\tthen\tdecreases;\n\tthis\tdecrease\tdoes\tnot\toccur\tin\tobese\tchildren.\nAt\tthe\tage\tof\t6\tyears\tin\tlean\tchildren,\t\nadiposity\trebound\n\toccurs,\tespecially\tin\tgirls,\twith\tan
|
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] |
adiposity\trebound\n\toccurs,\tespecially\tin\tgirls,\twith\tan\nincrease\tin\tbody\tfat.\tAn\tearly\tadiposity\trebound\toccurring\tbefore\t5\t½\tyears\told\tis\tpredictive\tof\ta\nhigher\tlevel\tof\tadiposity\tat\t16\tyears\tof\tage\tand\tin\tadulthood;\ta\tperiod\tof\tlater\trebound\tis\tcorrelated\nwith\thealthy\tadult\tweight\t(\nHughes\tet\tal,\t2014\n).\nWith\n\t\nhypertrophy
|
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] |
with\thealthy\tadult\tweight\t(\nHughes\tet\tal,\t2014\n).\nWith\n\t\nhypertrophy\n\t(increased\tcell\tsize),\tfat\tdepots\tcan\texpand\tas\tmuch\tas\t1000\ttimes\tat\tany\tage,\nas\tlong\tas\tspace\tis\tavailable.\tIn\ta\tclassic\tstudy,\tBjörntorp\tand\tSjöström\t(1971)\tdemonstrated,\tusing
|
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weight\tloss\tas\ta\tresult\tof\ttrauma,\tillness,\tor\tstarvation,\tthat\tfat\tcell\tsize\tdecreases\tbut\tcell\tnumbers\nremain\tthe\tsame.\nFat\tstorage\nMost\tstored\tfat\tcomes\tdirectly\tfrom\tdietary\tTGs.\tThe\tfatty\tacid\tcomposition\n\tof\tadipose\ttissue\tmirrors\nthe\tfatty\tacid\tcomposition\tof\tthe\tdiet.\tEven\texcess\tdietary\tcarbohydrate\tand\tprotein\tare\tconverted\tto
|
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fatty\tacids\tin\tthe\tliver\tby\tthe\tcomparatively\tinefficient\tprocess\tof\t\nlipogenesis\n.\tUnder\tconditions\tof\nrelative\tenergy\tbalance,\tlittle\tdietary\tcarbohydrate\tis\tconverted\tto\tfat\tfor\tstorage.\tIn\tconditions\tof\npositive\tenergy\tbalance,\tcarbohydrate\toxidation\tincreases\twhile\n\tTGs\tare\tpreferentially\tstored\tand\tde
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TGs\tare\tpreferentially\tstored\tand\tde\nnovo-lipogenesis\tfrom\tcarbohydrate\toccurs\twhen\tmore\tcarbohydrate\tis\tpresent\tthan\tcan\tbe\teither\noxidized\tor\tstored\tas\t(liver\tor\tmuscle)\tglycogen\t(\nSong\tet\tal,\t2018\n).\nSemivolatile\torganic\tcompounds\t(SVOCs)\n\taccumulate\tin\tadipose\ttissues\tfrom\texposure\tto
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0.015048151835799217,
0.0625559538602829,
0.04231948032975197,
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0.04437130689620972,
0.0788898840546608,
0.10951482504606247,
-0.05735757574439049
] |
accumulate\tin\tadipose\ttissues\tfrom\texposure\tto\ntoxins,\tchemicals,\tand\tpesticides.\tWhen\tadipose\ttissue\tis\tmobilized\tduring\tweight\tloss,\tSVOCs\tare\nreleased\t(see\n\t\nClinical\tInsight:\n\tWhat’s\tin\tThat\tFat\tWhen\tYou\tLose\tIt?\n).\tThe\teffect\tof\tSVOCs\ton\tthe\ndeveloping\tfetal\tbrain\tis\tnot\tyet\tknown\t(see\t\nChapter\t14\n),\twhich\tadds\tto\tthe\thealth\tconcern\tabout
|
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] |
Chapter\t14\n),\twhich\tadds\tto\tthe\thealth\tconcern\tabout\nobese\tpregnant\twomen\twho\tlose\tweight.\nCLINICAL\tINSIGHT\nWhat’s\tin\tThat\tFat\tWhen\tYou\tLose\tIt?\nThe\trole\tof\ttoxins\tin\tobesity\tdevelopment\tand\tlater\tfat\tloss\tis\tbecoming\tincreasingly\tconcerning\nas\tthe\temerging\tevidence\n\tforms\ta\tplausible\tlink\tbetween\ttoxins\tand\tobesity.\tExposure\tto\ttoxins
|
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] |
comes\tfrom\ttwo\tmain\tsources:\tthe\tenvironment\t(external\tor\texogenous\ttoxins),\twhich\tincludes\nenvironmental\tpollutants\tsuch\tas\tpesticides,\tindustrial\tcompounds,\tsolvents,\tdetergents,\nplasticizers,\tcosmetic\tadditives,\tchemical\tadditives,\tcolorings,\tpreservatives,\tflavorings,\tmicrobial\ntoxins\tsuch\tas\taflatoxins\tfrom\tpeanuts,\tmycotoxins
|
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] |
toxins\tsuch\tas\taflatoxins\tfrom\tpeanuts,\tmycotoxins\n\tfrom\tmolds,\tand\tbisphenol-A\tfound\tin\tplastic\nbaby\tbottles,\ttoys,\tand\tespecially\tdental\tsealants;\tand\t“lifestyle\tchemicals,”\tsuch\tas\talcohol,\tover-\nthe-counter\t(OTC)\tdrugs,\tand\tprescription\tdrugs.\tIt\tcan\tbe\tbyproducts\tfrom\tfood\tpreparation\tsuch
|
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high\ttemperatures.\tToxins\tcan\talso\toriginate\tfrom\tthe\tgut\t(i.e.,\tbreakdown\tproducts\tof\nmetabolism,\tincluding\thormones,\tinternal\ttoxins\tsuch\tas\tmetabolites\tof\tyeast\t[d-arabinitol],\tor\tgut
|
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bacteria).\nStudies\tshow\tthat\tthese\ttoxins,\twhich\tare\toften\tfat\tsoluble\tand\n\thave\tan\taffinity\tfor\tadipose\ntissue,\tare\toften\tstored\tin\tthe\tbody’s\tdepot\tfat.\tTheir\tpresence\tis\tlinked\tto\tinflammation,\ndevelopment\tof\ttype\t2\tdiabetes,\tand\ta\tsuppressed\tresting\tmetabolic\trate\t(post-weight\tloss).\tIn\tthe
|
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] |
case\tof\tweight\tor\tfat\tloss,\tthe\trelease\tof\tthese\ttoxins\tcan\tinterfere\twith\tthe\tbody’s\tfunctioning,\nplacing\ta\tburden\ton\tthe\tliver\tand\teven\tits\tability\tto\tcontinue\tto\tlose\tmore\tfat\n\t(\nLa\tMerrill\tet\tal,\n2013\n;\t\nLee\tet\tal,\t2018\n;\t\nTremblay\tet\tal,\t2004\n).\nWith\tincreasing\texposure,\ttoxins\tmay\talter\tmetabolism,\tdisrupt\tendocrine\tfunction,\tdamage\tthe
|
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] |
mitochondria,\tincrease\tinflammation\tand\toxidative\tstress,\tlower\tthyroid\thormones,\tand\talter\ncircadian\trhythms\tand\tthe\tautonomic\tnervous\tsystem.\tThese\tall\tinterfere\twith\tkey\tweight\tcontrol\nmechanisms\tin\tthe\tbody.\tUsing\ta\tcomprehensive\tapproach\n\tto\tobesity,\tincluding\tthe\tassessment
|
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] |
to\tobesity,\tincluding\tthe\tassessment\nand\ttreatment\tof\ttoxin-mediated\teffects,\tmay\tresult\tin\tmore\teffective\tbody\tfat\tand\tweight\nmanagement.\tLifestyle\tmodifications\tmay\tbe\thelpful,\tincluding\treducing\texposure\tto\ttoxins\tand\nsupporting\tmobilization\tand\telimination\tof\tstored\tand\texternal\ttoxins;\thowever,\tthe\tspecific
|
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] |
mechanisms\tof\tsupport,\tincluding\tpromoting\tnormoglycemia\tand\tingestion\tof\tcruciferous\nvegetables\tand\tfibrous\tfoods,\tare\tstill\tunder\tinvestigation\t(\nLee\tet\tal,\t2017\n).\nSheila\tDean,\tDSc,\tRDN,\tLDN,\tCCN,\tIFMCP\nLipoprotein\tlipase\nDietary\tTG\tis\ttransported\tto\tthe\tliver\tby\tchylomicrons.\tEndogenous\tTGs\tsynthesized\tin\tthe\tliver\tfrom
|
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] |
free\tfatty\tacids\t(FFA)\ttravel\tas\tpart\tof\tvery-low-density\tlipoprotein\tparticles.\tThe\tenzyme\nlipoprotein\tlipase\t(LPL)\n\tmoves\tlipid\tfrom\tthe\tblood\tinto\n\tthe\tadipose\tcell\tby\thydrolyzing\tTGs\tinto\nFFA\tand\tglycerol.\tGlycerol\tproceeds\tto\tthe\tliver;\tfatty\tacids\tenter\tthe\tadipocyte\tand\tare\treesterified
|
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into\tTGs.\tWhen\tneeded\tby\tother\tcells,\tTGs\tare\thydrolyzed\tonce\tagain\tto\tfatty\tacids\tand\tglycerol\tby\nhormone-sensitive\tlipase\t(HSL)\n\twithin\tthe\tadipose\tcell;\tthey\tthen\tare\treleased\tinto\tthe\ncirculation.\nHormones\taffect\tLPL\tactivity\tin\tdifferent\tadipose\ttissue\n\tregions.\tEstrogens\tstimulate\tLPL\tactivity
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regions.\tEstrogens\tstimulate\tLPL\tactivity\nin\tthe\tgluteofemoral\tadipocytes,\tand\tthus\tpromote\tfat\tstorage\tin\tthis\tarea\tfor\tchildbearing\tand\nlactation.\tIn\tthe\tpresence\tof\tsex\tsteroid\thormones,\ta\tnormal\tdistribution\tof\tbody\tfat\texists.\tWith\ta\ndecrease\tin\tsex\tsteroid\thormones—as\toccurs\twith\tmenopause\tor\tgonadectomy—central\tobesity\ttends\nto\tdevelop.
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to\tdevelop.\nRegulation\tof\tbody\tweight\nBody\tweight\tis\tthe\n\tproduct\tof\tgenetic\teffects\t(DNA),\tepigenetic\teffects\t(heritable\ttraits\tthat\tdo\tnot\ninvolve\tchanges\tin\tDNA),\tand\tthe\tenvironment\t(\nKaplan,\t2018\n).\tBody\tweight\tregulation\tis\tusually\ndescribed\tin\tterms\tof\ta\thomeostatic\tbiological\tfeedback\tsystem\tacting\ton\tenergy\tintake\tand\tenergy
|
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] |
variable\tand\tless\tunderstood.\nBecause\tthe\tprecision\tof\tappetite\tcontrol\tis\tundermined\tin\tthe\tprevailing\tobesogenic\tenvironment\nthat\tincludes\tpsychosocial,\n\tbehavioral,\tand\tenvironmental\tfactors\tthat\taffect\teating\tbehavior\t(and\ntherefore\tenergy\tintake),\tnew\tmodels\tof\tbody\tweight\tregulation\twhich\talso\taddress\tthese\tmissing
|
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] |
factors\thave\tbeen\tcalled\tfor\t(\nBelfort-DeAguiar\tand\tSeo,\t2018\n;\t\nHall\tet\tal,\t2014\n).\nHunger,\tappetite,\tand\tsatiety\nSatiety\tis\tassociated\twith\tthe\tpostprandial\tstate\twhen\texcess\tfood\tis\tbeing\tstored.\tHunger\tis\nassociated\twith\tthe\tpostabsorptive\n\tstate\twhen\tthose\tstores\tare\tbeing\tmobilized.\tPhysical\ttriggers\tfor
|
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state\twhen\tthose\tstores\tare\tbeing\tmobilized.\tPhysical\ttriggers\tfor\nhunger\tare\tmuch\tstronger\tthan\tthose\tfor\tsatiety,\twhich\texternal\tcues\tfor\teating\tcan\toverride.\nWhen\teither\toverfeeding\tor\tunderfeeding\toccurs\tin\tchildren\tthey\texhibit\tspontaneous\t\nhypophagia\n(undereating)\tor\t\nhyperphagia
|
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hypophagia\n(undereating)\tor\t\nhyperphagia\n\t(overeating)\taccordingly.\tAdults,\thowever,\tare\tless\tconsistent\tin\nnaturally\tcompensating\tfor\tovereating,\twhich\n\tcan\tresult\tin\tbody\tweights\tslowly\tcreeping\tup\tover\ntime.\tUnexplained\tweight\tloss\tin\tadults\tis\toften\ta\tsymptom\tof\tother\tfactors\tincluding\tstress\tor\nunderlying\tdisease.\tSee\t\nFocus\tOn
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underlying\tdisease.\tSee\t\nFocus\tOn\n:\tSignals\tfrom\ta\tHost\tof\tHormones\n\tand\t\nTable\t20.2\n\tfor\tfurther\ninformation\tand\tdetail\ton\tthe\tneurochemicals\tand\thormones\tinvolved\tin\tappetite\tand\tsatiety.\nTABLE\t20.2\nRegulatory\tFactors\tInvolved\tin\tEating\tand\tWeight\n\tManagement\nBrain\nNeurotransmitters\nCharacteristics\tand\tFunction\nNorepinephrine\tand\ndopamine
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] |
Characteristics\tand\tFunction\nNorepinephrine\tand\ndopamine\nReleased\tby\tthe\tsympathetic\tnervous\tsystem\t(SNS)\tin\tresponse\tto\tdietary\tintake;\nmediates\tthe\tactivity\tof\tareas\tin\tthe\thypothalamus\tthat\tgovern\tfeeding\tbehavior.\nFasting\tand\tsemistarvation\tlead\tto\tdecreased\tSNS\tactivity\tand\tincreased\tadrenal
|
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reinforcement\tproperties\tof\tfood.\nSerotonin,\nneuropeptide\tY,\nand\tendorphins\nDecreases\tin\tserotonin\tand\tincreases\tin\tneuropeptide\tY\thave\tbeen\tassociated\twith\tan\nincrease\tin\tcarbohydrate\tappetite.\tNeuropeptide\tY\tincreases\tduring\tfood\ndeprivation;\tit\tmay\tbe\ta\tfactor\tleading\tto\tan\tincrease\tin\tappetite\tafter\n\tdieting.
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dieting.\nPreferences\tand\tcravings\tfor\tsweet,\thigh-fat\tfoods\tobserved\tamong\tobese\tand\nbulimic\tpatients\tinvolve\tthe\tendorphin\tsystem.\nCRF\nOrexin\n(hypocretin)\nInvolved\tin\tcontrolling\tadrenocorticotropic\thormone\trelease\tfrom\tthe\tpituitary\tgland;\nCRF\tis\ta\tpotent\tanorexic\tagent\tand\tweakens\tthe\tfeeding\tresponse\tproduced\tby
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norepinephrine\tand\tneuropeptide\tY.\tCRF\tis\treleased\tduring\texercise.\nOrexin\n\tis\ta\tneurotransmitter\tproduced\tby\tthe\thypothalamus\tthat\thas\ta\tweak\nresemblance\tto\tsecretin\tproduced\tin\tthe\tgut\tand\tis\tan\tappetite\tstimulant\tand\ncentral\tregulator\tof\tglucose\tand\tenergy\thomeostasis.\nGut\tHormones\nCharacteristics\tand\tFunction\nIncretins
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Gut\tHormones\nCharacteristics\tand\tFunction\nIncretins\nGastrointestinal\tpeptides\tincrease\tthe\tamount\tof\tinsulin\treleased\tfrom\tthe\tbeta\tcells\nof\tthe\tpancreas\tafter\teating,\teven\tbefore\tblood\tglucose\n\tlevels\tbecome\televated.\nThey\talso\tslow\tthe\trate\tof\tabsorption\tby\treducing\tgastric\temptying\tand\tmay
|
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] |
directly\treduce\tfood\tintake.\tIncretins\talso\tinhibit\tglucagon\trelease\tfrom\tthe\talpha\ncells\tof\tthe\tpancreas.\t(See\tGLP-1\tand\tGIP.)\nCCK\nReleased\tby\tthe\tintestinal\ttract\twhen\tfats\tand\tproteins\treach\tthe\tsmall\tintestine,\nreceptors\tfor\tCCK\thave\tbeen\tfound\tin\tthe\tgastrointestinal\ttract\tand\tthe\tbrain.\nCCK
|
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] |
CCK\n\tcauses\tthe\tgallbladder\tto\tcontract\tand\tstimulates\tthe\tpancreas\tto\trelease\nenzymes.\tAt\tthe\tbrain\tlevel,\tCCK\tinhibits\tfood\tintake.\nBombesin\nReleased\tby\tenteric\tneurons;\treduces\tfood\tintake\tand\tenhances\tthe\trelease\tof\tCCK.\nEnterostatin\nA\tportion\tof\tpancreatic\tlipase\tinvolved\tspecifically\twith\tsatiety\tafter\tthe\tconsumption\nof\tfat.\nAdiponectin
|
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of\tfat.\nAdiponectin\nAn\tadipocytokine\tsecreted\tby\tthe\tadipose\ttissue\tthat\n\tmodulates\tglucose\tregulation\nand\tfatty\tacid\tcatabolism.\tLevels\tof\tthis\thormone\tare\tinversely\tcorrelated\twith\nBMI.\tThe\thormone\tplays\ta\trole\tin\tmetabolic\tdisorders\tsuch\tas\ttype\t2\tdiabetes,\nobesity,\tand\tatherosclerosis.\tLevels\tdrop\tafter\tgastric\tbypass\tsurgery\tfor\tup\tto\t6
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0.012866954319179058,
0.1177755743265152,
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0.010879897512495518,
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0.10377674549818039,
0.059725794941186905,
0.12122878432273865,
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] |
months.\nGlucagon\nIncreased\tsecretion\tof\tglucagon\tis\tcaused\tby\thypoglycemia,\tincreased\tlevels\tof\nnorepinephrine\tand\tepinephrine,\n\tincreased\tplasma\tamino\tacids,\tand\ncholecystokinin.\tDecreased\tsecretion\tof\tglucagon\toccurs\twhen\tinsulin\tor\nsomatostatin\tis\treleased.\nApolipoprotein\tA-IV
|
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] |
somatostatin\tis\treleased.\nApolipoprotein\tA-IV\nSynthesized\tand\tsecreted\tby\tthe\tintestine\tduring\tlymphatic\tsecretion\tof\nchylomicrons.\tAfter\tentering\tthe\tcirculation,\ta\tsmall\tportion\tof\tapolipoprotein\tA-IV\nenters\tthe\tCNS\tand\tsuppresses\tfood\tconsumption.\nFatty\tacids\nFree\tfatty\tacids,\ttriglycerides,\n\tand\tglycerol\tare\tfactors\tthat\talso\taffect\tuptake\tof
|
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] |
and\tglycerol\tare\tfactors\tthat\talso\taffect\tuptake\tof\nglucose\tby\tperipheral\ttissues.\nGLP-1\tand\tGIP\nReleased\tby\tintestinal\tmucosa\tin\tthe\tpresence\tof\tmeals\trich\tin\tglucose\tand\tfat;\nstimulate\tinsulin\tsynthesis\tand\trelease;\tGLP-1\tdecreases\tglucagon\tsecretion,\ndelays\tgastric\temptying\ttime,\tand\tmay\tpromote\tsatiety;\texamples\tof\tincretin\nhormones.\nInsulin
|
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] |
hormones.\nInsulin\nActs\tin\tthe\tCNS\tand\tthe\tperipheral\tnervous\tsystem\n\tto\tregulate\tfood\tintake\tand\tis\ninvolved\tin\tthe\tsynthesis\tand\tstorage\tof\tfat.\tIt\tis\tpossible\tthat\tobese\tpersons\twith\ninsulin\tresistance\tor\tdeficiency\thave\ta\tdefective\tglucose\tdisposal\tsystem\tand\ta\ndepressed\tlevel\tof\tthermogenesis.\tThe\tgreater\tthe\tinsulin\tresistance,\tthe\tlower
|
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the\tthermic\teffect\tof\tfood.\tFasting\tinsulin\tlevels\tincrease\tproportionately\twith\tthe\ndegree\tof\tobesity;\thowever,\tmany\n\tobese\tpersons\thave\tinsulin\tresistance\tbecause\nof\ta\tlack\tof\tresponse\tby\tinsulin\treceptors,\timpaired\tglucose\ttolerance,\tand\nassociated\thyperlipidemia.\tThese\tsequelae\tcan\tusually\tbe\tcorrected\twith\tweight\nloss.\nLeptin
|
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] |
loss.\nLeptin\nAn\tadipocytokine\tsecreted\tby\tthe\tadipose\ttissue,\tcorrelated\twith\tpercent\tof\tbody\tfat.\nPrimary\tsignal\tfrom\tenergy\tstores;\tin\tobesity\tloses\tthe\tability\tto\tinhibit\tenergy\nintake\tor\tto\n\tincrease\tenergy\texpenditure.\tCompared\twith\tmen,\twomen\thave\nsignificantly\thigher\tconcentrations\tof\tserum\tleptin.\nResistin
|
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] |
significantly\thigher\tconcentrations\tof\tserum\tleptin.\nResistin\nAn\tadipocytokine\texpressed\tprimarily\tin\tadipocytes;\tantagonizes\tinsulin\taction.\nGhrelin\nProduced\tprimarily\tby\tthe\tstomach;\tacts\ton\tthe\thypothalamus\tto\tstimulate\thunger\nand\tfeeding.\tGhrelin\tlevels\tare\thighest\tin\tlean\tindividuals\tand\tlowest\tin\tthe\tobese.\nIncreased\tlevels\tare
|
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Increased\tlevels\tare\n\tseen\tin\tpeople\twho\tare\tdieting,\tand\tsuppressed\tlevels\tare\nnoted\tafter\tgastric\tbypass,\tpossibly\tcounteracted\tby\tadiponectin.\nPYY\n3-36\nSecreted\tby\tendocrine\tcells\tlining\tthe\tsmall\tbowel\tand\tcolon\tin\tresponse\tto\tfood;\ta\n“middle\tman”\tin\tappetite\tmanagement.\tPYY\tseems\tto\twork\topposite\tfrom\tghrelin;\nit\tinduces\tsatiety.
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0.09138032793998718,
0.04392038285732269,
0.02708519995212555,
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] |
it\tinduces\tsatiety.\nIL-6\tand\tTNF-α\nBoth\tare\tgut\thormones.\tCytokines\tsecreted\tby\tadipose\ttissue\tand\n\tparticipate\tin\nmetabolic\tevents.\tImpair\tinsulin\tsignals\tin\tmuscle\tand\tliver.\tLevels\tare\nproportional\tto\tbody\tfat\tmass\t(Thomas\tand\tSchauer,\t2010).\nOxyntomodulin\nSecreted\tfrom\tL-cells\tin\tsmall\tintestine\tin\tresponse\tto\ta\tmeal.\tExerts\tits\tbiologic
|
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] |
effects\tthrough\tactivation\tof\tGLP-1\tand\tglicentin-related\tpancreatic\tpeptide\n(GRPP)\t(Bray\tand\tBouchard,\t2014).
|
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] |
GLP-2\nProduced\tin\tthe\tL-cells\tof\tsmall\n\tintestines\tand\tin\tneurons\tof\tCNS.\tIs\tan\tintestinal\ngrowth\tfactor.\tInhibits\tgastric\temptying\tand\tacid\tsecretion\twhile\tstimulating\nintestinal\tblood\tflow.\tDecreases\tgastric\tacid\tsecretion\tand\tgastric\temptying\tand\nincreases\tmucosal\tgrowth\t(\nBray\tand\tBouchard,\t2014\n).\nFGF-21
|
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0.0067755659110844135
] |
increases\tmucosal\tgrowth\t(\nBray\tand\tBouchard,\t2014\n).\nFGF-21\nExpressed\tin\tthe\tliver\tand\tsecreted\tmainly\tduring\tfasting\tand\tafter\tfeeding\ta\nketogenic\tdiet.\tCan\tdecrease\tbody\tweight\twithout\n\taffecting\tfood\tintake.\tIncreases\ninsulin\tsensitivity,\tdecreases\tgluconeogenesis,\tand\tincreases\tglucose\tuptake\tin\nadipocytes\t(\nBray\tand\tBouchard,\t2014\n).
|
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