Content related to nutrition in SBPMD:
Introduction:
Overall, several areas covered in the SBPMD course are relevant to nutrition. Below is a summary of the nutrition-related content in these areas as well as links to the respective lectures. The detailed syllabus content can be viewed from the SBPMD web page (give web address)
Energy metabolism:
· Overview
· Learning objectives
· Lecture links
Overview:
The lecture series on energy metabolism provides information on metabolic processes of fundamental importance in human nutrition. Lectures on carbohydrates, lipids and proteins provide basic structural and metabolic overviews, including interconversion of fuels and metabolic regulation of nutrients. The interrelationship between carbohydrate and fat metabolism and the regulation of stored nutrients is described and an overview of biosynthetic and degradative pathways of macronutrient metabolism is provided. Basic mechanisms underlying control of blood glucose are included. For proteins, an overview of the genetic code and protein synthesis is provided, as well as description of mutation effects on translation.
The lectures summarize how energy provided by nutrients in the food is utilized in basic metabolism, discusses energy value of different food nutrients, and provides an overview of energy conversion to heat in uncoupling reactions. The content is relevant in our understanding of the relation of diet intake and energy expenditure to obesity. Energy metabolism under aerobic/anaerobic conditions is reviewed, and the section on oxidative stress and free radicals is relevant to the Nutrition lecture on Atherosclerosis in the Clinical Practice I course. An overview of the central role of ATP in energy metabolism is provided. The content provides insight in the fundamental principles for energy storage, different ways to use energy, and the role of ATP in transport and signal transduction.
The development of the fat cell, and regulation of fat storage, lipolysis and transport is described. The differences in function between white and brown fat is discussed. This content is relevant to the Nutrition lecture on Obesity in the Clinical Practice I course. In the lecture on lipoprotein metabolism, the composition and metabolism of the different lipoprotein classes are described as well as key enzymes and receptors that control their metabolism. The lecture is relevant to the Nutrition lecture on Atherosclerosis in the Clinical Practice I course. A basic overview of the regulation of body temperature and how fuels can be converted to heat is given. The content is relevant to understanding water requirements and how climate and exercise affect requirements.
Learning objectives:
From a nutrition perspective, the students should:
1. Be able to describe the major dietary classes of monosaccharides and their structural differences.
2. Be able to describe the structural differences between phospholipids, triglycerides and sterols.
3. Be able to describe the structural difference between different classes of fatty acids.
4. Be able to describe how nutrition-regulated factors influence translation rate.
5. Be able to describe conditions where energy can be stored or converted to heat.
6. Be able to describe the different functions of ATP in synthetic and transport functions and in signal transduction.
7. Be able to describe the metabolic interrelationship between carbohydrate and fat metabolism.
8. Be able to explain (1) how the fed vs. the fasted state affect the metabolism of glucose, fats and proteins, and (2) the hormonal regulation of the major metabolic pathways
9. Be able to describe the structure of the different kinds of adipocytes, and how storage, lipolysis and transport are regulated.
10. Beable to describe (1) the basic structure, synthesis and degradation of the major lipoproteins, (2) how these pathways are affected by the fed vs. fasted states and (3) the role of lipid transfer proteins that regulate the various pathways.
Lecture links (give specific web links):
Carbohydrates
Lipids
Protein synthesis
Energy currency
Energy and metabolism
ATP synthesis
Uses of energy
Oxidation of fuels
Synthesis and Storage of Fuels
The Adipocyte
Lipoprotein Metabolism
Regulation of Body Temperature
Endocrinology:
· Overview
· Learning objectives
· Lecture links
Overview:
A number of hormones impact on human nutrition. Hormones affect energy metabolism, the interrelationship between anabolic and catabolic reactions, the alternative use of carbohydrates, fat or proteins as energy sources, and endocrinological diseases have nutritional consequences.
Lectures provide an understanding of the role played by the CNS and pituitary gland in the regulation of homeostasis, and an overview of the basic structure, regulation and functions of several key hormones. An overview of Growth Hormone in growth and regulation of macronutrient metabolism is given, important for the understanding of nutrient (carbohydrates and protein) consumption as well as exercise effects on growth hormone levels. The content is relevant to lectures on Lifecycle Nutrition in the Clinical Practice I course and to SBPM lectures on regulation of blood glucose.
The cell biology of insulin secretion, the histology of the pancreas, and the control of islet cell secretion are detailed and provide basic understanding of how the insulin/glucagon ratio regulates blood glucose concentration. Lectures describe the regulation of insulin secretion, the ensuing changes in the major metabolic pathways, and how these processes are affected in both normal and diabetic subjects in the fed and fasted state. This is relevant to macronutrient metabolism and regulation of blood glucose.
The physiology and hormonal control of calcium, phosphorus and magnesium homeostasis is presented including a brief description of skeletal remodeling as it relates to mineral metabolism. The role of thyroid and parathyroid hormones in metabolism and in the regulation of calcium and phosphate respectively, is addressed. This content is relevant to lectures on Lifecycle Nutrition in the Clinical Practice I course.
An overview of the individual components of the hypothalamo-pituitary-adrenal axis and describes the major effects of cortisol on metabolism and on the inflammatory and immune processes. The reproductive endocrinology lectures provide an extensive overview of the development of male and female reproductive organs and the hormonal regulation of reproduction, pregnancy and lactation. Though there are few direct links to nutrition, an understanding of these lectures is critical to fully appreciating the Lifecycle Nutrition lectures. The Cytogenetics lecture provides a basis for understanding the impact of malnutrition on the fetus and also drug teratogenicity.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Describe the (1) impact of growth hormone on macronutrient metabolism, and (2) the impact of nutritional status on growth hormone secretion.
2. Explain how glucose affects the secretion of insulin and in turn how insulin and glucagon regulate blood glucose concentration.
3. List the primary functions of the major minerals calcium, phosphorus and magnesium, and the factors that control their absorption, excretion and serum concentrations.
4. Describe how insulin and glucagon secretion and action, both in normal and diabetic subjects, are affected by the fed and fasted state.
5. Explain the basic physiology of male and female sexual development, including hormonal regulation of the processes. Mastery of these concepts will enable the student to appreciate how nutritional status can affect fetal development, growth, sexual development and reproduction.
Lecture links:
Growth Hormone
The Endocrinology of Normal Mineral Homeostasis
Pancreatic Islets
Pancreatic Physiology
Gonadal Function
Male Reproductive System
Testis
Adult Reproduction I & II
Ovarian and Uterine Structure
Fertilization, Pregnancy and Lactation
Structure and Function of the Breast
Placenta
Cytogenetics
Gastroenterology:
· Overview
· Learning objectives
· Lecture links
Overview:
Factors affecting nutrient intake, absorption and excretion are important in nutrition. These are reviewed in the gastroenterology section of SBPMD, where the impact of diseases resulting in malabsorption and nutrition deficiencies also are presented.
Lectures provide an overview of digestion of food and nutrient intake. The content correlates to malabsorption and undernutrition. The development of the tooth and its function in mastication as well as age-induced changes in tooth structure are discussed. An overview of the exocrine and endocrine gastric secretion is provided, describing mechanisms for digestion of food products and the interaction between food and local factors.
Lectures on digestion and absorption and biliary secretion provides a basic understanding of the mechanisms involved in the digestion and absorption of macronutrients-carbohydrates, protein and fat, biliary secretion, enterohepatic circulation and the role of bile salts in lipid metabolism. Mechanisms for food and nutrient uptake and for hydrolysis and absorption of carbohydrates and fat are described. The importance of ion transport mechanisms is reviewed as well as secretory functions of exocrine glands involved in food digestion and nutrient uptake. Effect of long-term diet modifications on digestive enzymes is addressed. These lectures are relevant for the understanding of nutrient intake and absorption.
A lecture on the complex enteric nervous system is relevant to the understanding of congenital abnormalities of the ENS and gastro-intestinal diseases in the adult. In another lecture, an overview of the mechanisms of contractile activity in the fasting and fed state, including swallowing, gastric emptying, and propulsion and mixing in the small and large intestines is provided. This is relevant to the understanding of gastro-intestinal nutrition in health and disease.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Explain the mechanisms in the metabolism of fat and cholesterol.
2. Discuss the rationale for the regimens in the treatment of hyperlipidemia.
3. Describe and explain the anatomical considerations and the various stages of digestion and absorption of macronutrients and electrolytes in the nutritional treatment of patients with gastrointestinal disturbances.
Lecture links:
Gut morphology
Structure and biology of the Tooth
Gastric secretion
Digestion and Absorption
Pancreatic and salivary secretion
Biliary Secretion
Enteric Nervous System
Gastrointestinal Motility
Fluid and electrolytes
· Overview
· Learning objectives
· Lecture links
Overview:
The nutrition aspects in this area relates to regulation of water and electrolyte intake. An introduction to renal structure and function is provided. An overview of a major function of the kidney and the regulation of extracellular space homeostasis is given. The distribution of water and ions within a multicellular organism and the different compositions of the intracellular and extracellular departments are reviewed. The content is relevant to the understanding of the regulation of sodium intake and relevant to the understanding of renal nutrition, e.g. dietary sodium intake in congestive heart failure, renal disease and hypertension.
A lecture provides an understanding of the assessment of potassium balance and how the kidney handles potassium along the nephron, relevant to the understanding of dietary intake and excretion of potassium.
Lectures providing an overview of the water content of the body and the reasons to regulate it and the processes that generate acid or base are given. The content is relevant to the understanding that metabolism of fuels present in foods results in the generation of volatile and non-volatile acid as well as base.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Explain the interrelationships of renal disease and dietary factors such as protein, electrolytes and water.
2. Describe the impact of dietary factors on acid-base balance
Lecture links:
Volume and Composition of the Body Fluids
Introduction to Renal Structure and Function
Regulation of Extracellular Fluid Volume
Renal Blood Flow and Glomerular Filtration
Regulation of Water Content