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1. OBESITY It is the condition where excess fat has accumulated in the body due to overnutrition . It is due to increased energy intake and decreased energy expenditure. Obesity index or body mass index is used to assess obesity: BMI= Weight in kg/(height)² in meters. Central obesity is of 2 types: Android Gynecoid

2. DISEASES RELATED TO OBESITY Hypertension Coronary artery disease Diabetes mellitus Metabolic syndrome

3. Treatment of obesity Lifestyle modification Controlled exercises Medications Surgery

4. Regulators of Appetite Hypothalamus Polypeptides that increase appetite: Neuropeptide Y Ghrelin Melanin concentrating hormone Orexin Endocnnabinoid Cholecystokinin Polypeptide YY Insulin Cortisol

5. Regulators of Appetite Polypeptides that decrease appetite: Leptin Melanocyte stimulating hormone Glucagon related peptide Cocain amphetamine related transcript Serotonin

6. Adipose tissue talks to brain through factors Leptin Neuropeptide Y Ghrelin Galanin Adiponectin Visfatin Omentin Tumour necrosis factorresisitin Retinol binding protein 4 Non esterified fatty acids Sleep

7. Prescription of diet General principals: The ideal body weight Protein requirement Calorie requirement Specific dynamic action Ratio of calories from proximate principals.

8. First step: calorie requirement DIET FOR A 60 KG SEDENTARY MAN Energy required + SDA := 2000 kcal Protein :=60g Calcium := 400mg Iron := 25mg

9. Second step: proximate principals

10. Third step: General composition of food

11. Fourth step: Determine the items of food Food exchange system Mutual supplementation of cereals and pulses Prescribing a normal diet

12. Fifth step:- three meals per day The total quantities of proximate principles are divided into breakfast, lunch and dinner.

13. Diets for Patients with diabetes A Diet having a low glycemic index should be given so that elevation in blood glucose is minimal. The total calories should be given in small divided doses, so that small quantity of food is taken at frequent intervals between 6AM and 8AM

14. GLYCEMIC INDEX incremental area under glucose tolerance curve after 50g test meal G. I= ×100 incremental area under glucose tolerance curve after 50g glucose meal

15. General principals for a diebetic diet Sugar, sweet and refined carbohydrates to be avoided Increased leafy vegetables and restriction of tubers. Frequent small meals with distribution of calories in such a way that:- Breakfast- 15% Mid-morning snack-5% Lunch-30% Evening tea- 10% Dinner-35% Bedtime snack-5%

16. Nutrition in the elderly

17. Total Parenteral Nutrition (TPN) Composition is mainly as follows Glucose-10-30% Protein- 1-1.5g/ kg body weight Fat- 1-4g/ kg body weight Multivitamins Trace elements Sodium Potassium Calcium magnesium

18. Nutraceuticals Commonly approved Nutraceuticals;- Potassium- high blood pressure and stroke Plant sterols- coronary heart disease Soy protein- coronary heart disease Calcium- osteoporosis Fruits and vegetables- cancer Grain products containing soluble fiber- coronary heart disease Folic acid- neural tube defects Resveratrol from grapes – antioxidant Flavonoids from citrus-antioxidant Omega -3 fatty acid – cardiovascular disease

19. Dietary supplement Vitamins Minerals Herbs Amino acids metabolites

20. Functional foods Vitamin D Carbohydrates Vitamin C Vitamin E Carotenes Creatine Caffeine

21. Clinical case study 2 An 8 month old girl was brought to the clinic in an irritable state. Weight was much lower than expected, mid arm circumference and triceps thickness were very low for age. Creatinine – height index was low and serum albumin was normal. The mother had stopped breast feeding at the age of 6 months and was now giving only formula milk which was diluted. What is your probable diagnosis.

22. Clinical case study 1 A 2yr old boy was brought to the OPD. He was eating poorly for the last 1month, had intermittent diarrhea, and had become irritable and apathetic. On examinaton , he was underweight for height and small for age. He was pale, weak, skin was flaky, hair was brittle, abdomen was distended, liver was enlarged and generalized edema was present. Laboratory test shows: Hemoglobin-6.5g/dl Total protein-4.0g/dl Albuminn - 1.8g/dl What is your probable diagnosis?