Chapter Notes for Lecture: E.N.

Marieb, HUMAN ANATOMY & PHYSIOLOGY,5TH Edition, , Benjamine Cummings Publisher, 2001 Prepare from : V.A. Austin’s PowerPpoint
Presentation (ISBN: 0-8053-5469-7), CD ROM: Pearson Education, Inc. , 2003.
 
Chapter 25
Nutrition, Metabolism, and Body Temperature Regulation
Nutrition
•      Nutrient – a substance that promotes normal growth, maintenance, and repair
•      Major nutrients – carbohydrates, lipids, and proteins
•      Other nutrients – vitamins and minerals (and technically speaking, water)
•      Grains, fruits, vegetables, meats and fish, and milk products
Carbohydrates
•      Complex carbohydrates (starches) are found in bread, cereal, flour, pasta, nuts, and potatoes
•      Simple carbohydrates (sugars) are found in soft drinks, candy, fruit, and ice cream
•      Glucose is the molecule ultimately used by body cells to make ATP
•      Neurons and RBCs rely almost entirely upon glucose to supply their energy needs
•      Excess glucose is converted to glycogen or fat and stored
•      The minimum amount of carbohydrates needed to maintain adequate blood glucose levels is
100 grams per day
•      Starchy foods and milk have nutrients such as vitamins and minerals in addition to complex
carbohydrates
•      Refined carbohydrate foods (candy and soft drinks) provide energy sources only and are
referred to as “empty calories”
Lipids
•      The most abundant dietary lipids, triglycerides, are found in both animal and plant foods
•      Essential fatty acids – linoleic and linolenic acid, found in most vegetables, must be ingested
•      Dietary fats:
•    Help the body to absorb vitamins
•    Are a major energy fuel of hepatocytes and skeletal muscle
•    Are a component of myelin sheaths and all cell membranes
•      Fatty deposits in adipose tissue provide:
•    A protective cushion around body organs
•    An insulating layer beneath the skin
•    An easy-to-store concentrated source of energy
•      Prostaglandins function in:
•    Smooth muscle contraction
•    Control of blood pressure
•    Inflammation
•      Cholesterol stabilizes membranes and is a precursor of bile salts and steroid hormones
Lipids: Dietary Requirements
•      Higher for infants and children than for adults
•      The American Heart Association suggests that:
•    Fats should represent less than 30% of one’s total caloric intake
•    Saturated fats should be limited to 10% or less of one’s total fat intake
•    Daily cholesterol intake should not exceed 200 mg
Proteins
•      Complete proteins that meet all the body’s amino acid needs are found in eggs, milk, milk
products, meat, and fish
•      Incomplete proteins are found in legumes, nuts, seeds, grains, and vegetables
•      Proteins supply:
•    Essential amino acids, the building blocks for nonessential amino acids
•    Nitrogen for nonprotein nitrogen-containing substances
•      Daily intake should be approximately 0.8g/kg of body weight
Proteins: Synthesis and Hydrolysis
•      All-or-none rule
•    All amino acids needed must be present at the same time for protein synthesis to occur
•      Adequacy of caloric intake
•    Protein will be used as fuel if there is insufficient carbohydrate or fat available
•      Nitrogen balance
•    The rate of protein synthesis equals the rate of breakdown and loss
•    Positive – synthesis exceeds breakdown (normal in children and tissue repair)
•    Negative – breakdown exceeds synthesis (e.g., stress, burns, infection, or injury)
•      Hormonal control
•    Anabolic hormones accelerate protein synthesis
Vitamins
•      Organic compounds needed for growth and good health
•      They are crucial in helping the body use nutrients and often function as coenzymes
•      Only vitamins D, K, and B are synthesized in the body; all others must be ingested
•      Water-soluble vitamins (B-complex and C) are absorbed in the gastrointestinal tract
•    B12 additionally requires gastric intrinsic factor to be absorbed
•      Fat-soluble vitamins (A, D, E, and K) bind to ingested lipids and are absorbed with their
digestion products
•      Vitamins A, C, and E also act in an antioxidant cascade
Minerals
•      Seven minerals are required in moderate amounts
•    Calcium, phosphorus, potassium, sulfur, sodium, chloride, and magnesium
•      Dozens are required in trace amounts
•      Minerals work with nutrients to ensure proper body functioning
•      Calcium, phosphorus, and magnesium salts harden bone
•      Sodium and chloride help maintain normal osmolarity, water balance, and are essential in
nerve and muscle function
•      Uptake and excretion must be balanced to prevent toxic overload
Metabolism
•      Metabolism – all chemical reactions necessary to maintain life
•      Cellular respiration – food fuels are broken down within cells and some of the energy is
captured to produce ATP
•    Anabolic reactions – synthesis of larger molecules from smaller ones
•    Catabolic reactions – hydrolysis of complex structures into simpler ones
•      Enzymes shift the high-energy phosphate groups of ATP to other molecules
•      These phosphorylated molecules are activated to perform cellular functions
Stages of Metabolism
•      Energy-containing nutrients are processed in three major stages
•    Digestion – breakdown of food; nutrients are transported to tissues
•    Anabolism and formation of catabolic intermediates where nutrients are:
•   Built into lipids, proteins, and glycogen
•   Broken down by catabolic pathways to pyruvic acid and acetyl CoA
•    Oxidative breakdown – nutrients are catabolized to carbon dioxide, water, and ATP
Oxidation-Reduction Reaction
•      Oxidation occurs via the gain of oxygen or the loss of hydrogen
•      Whenever one substance is oxidized, another substance is reduced
•      Oxidized substances lose energy
•      Reduced substances gain energy
•      Coenzymes act as hydrogen (or electron) acceptors
•      Two important coenzymes are nicotinamide adenine dinucleotide (NAD+) and flavin adenine
dinucleotide (FAD)
Mechanisms of ATP Synthesis: Substrate-Level Phosphorylation
•      High-energy phosphate groups are transferred directly from phosphorylated substrates to ADP
•      ATP is synthesized via substrate level phosphorylation in glycolysis and the Krebs cycle
Mechanisms of ATP Synthesis: Oxidative Phosphorylation
•      Uses the chemiosmotic process whereby the movement of substances across a membrane is
coupled to chemical reactions
•      Is carried out by the electron transport proteins in the cristae of the mitochondria
•    Nutrient energy is used to pump hydrogen ions into the intermembrane space
•    A steep diffusion gradient across the membrane results
•    When hydrogen ions flow back across the membrane through ATP synthase, energy is captured
and attaches phosphate groups to ADP (to make ATP)
Carbohydrate Metabolism
•      Since all carbohydrates are transformed into glucose, it is essentially glucose metabolism
•      Oxidation of glucose is shown by the overall reaction:
 
C6H12O6 + 6O2 à 6H2O + 6CO2 + 36ATP + heat
 
•      Occurs in three pathways
•    Glycolysis
•    Krebs cycle
•    The electron transport chain and oxidative phosphorylation
Glycolysis
•      A three-phase pathway in which:
•    Glucose is oxidized into pyruvic acid
•    NAD+ is reduced to NADH + H+
•    ATP is synthesized by substrate-level phosphorylation
•      Pyruvic acid:
•    Moves on to the Krebs cycle in an aerobic pathway
•    Is reduced to lactic acid in an anaerobic environment
Glycolysis: Phase 1 and 2
•      Sugar activation
•    Two ATP molecules activate glucose into
fructose-1,6-diphosphate
•      Sugar cleavage 
•    Fructose-1,6-diphosphate is cleaved into two 3-carbon isomers
•   Dihydroxyacetone phosphate
•   Glyceraldehyde 3-phosphate
Glycolysis: Phase 3
•      Oxidation and ATP formation
•    The 3-carbon sugars are oxidized (reducing NAD+)
•    Inorganic phosphate groups (Pi) are attached to each oxidized fragment
•    The terminal phosphates are cleaved and captured by ADP to form four ATP molecules    
•      The final products are: 
•    Two pyruvic acid molecules
•    Two reduced NAD+ (NADH + H+) molecules
•    A net gain of two ATP molecules
Krebs Cycle: Preparatory Step
Occurs in mitochondrial matrix and is fueled by pyruvic acid and fatty
•      Pyruvic acid is converted to acetyl CoA in three main steps:
•    Decarboxylation
•   Carbon is removed from pyruvic acid
•   Carbon dioxide  is released
•    Oxidation
•   Hydrogen atoms are removed from pyruvic acid
•   NAD+ is reduced to NADH + H+
•    Formation of acetyl CoA – the resultant acetic acid is combined with coenzyme        A, a sulfur-
containing coenzyme, to form acetyl CoA
Krebs Cycle
•      An eight-step cycle in which acetic acid is decarboxylated and oxidized, generating: 
•    Three molecules of NADH + H+
•    One molecule of FADH2
•    Two molecules of CO2
•    One molecule of ATP
•      For each molecule of glucose entering glycolysis, two molecules of acetyl CoA enter the Krebs
cycle
Electron Transport Chain
•      Food (glucose) is oxidized and the hydrogen:
•    Are transported by coenzymes NADH and FADH2
•    Enter a chain of proteins bound to metal atoms (cofactors)
•    Combine with molecular oxygen to form water
•    Release energy
•      The energy released is harnessed to attach inorganic phosphate groups (Pi) to ADP, making ATP
by oxidative phosphorylation
Hypothetical Mechanism of Oxidative Phosphorylation
•      The hydrogens delivered to the chain are split into protons (H+) and electrons
•    The protons are pumped across the inner mitochondrial membrane by:
•   NADH dehydrogenase (FMN, Fe-S)
•   Cytochrome b-c1
•   Cytochrome oxidase (a-a3)
•    The electrons are shuttled from one acceptor to the next
•      Electrons are delivered to oxygen, forming oxygen ions
•      Oxygen ions attract H+ to form water
•      H+ pumped to the intermembrane space:
•    Diffuses back to the matrix via ATP synthase
•    Releases energy to make ATP
Electronic Energy Gradient
•      The transfer of energy from NADH + H+ and FADH2 to oxygen releases large amounts of energy
•      This energy is released in a stepwise manner through the electron transport chain
•      The electrochemical proton gradient across the inner membrane:
•    Creates a pH gradient 
•    Generates a voltage gradient
•      These gradients cause H+ to flow back into the matrix via ATP synthase
Summary of ATP Production
Glycogenesis and Glycogenolysis
•      Glycogenesis – formation of glycogen when glucose supplies exceed cellular need for ATP
synthesis
•      Glycogenolysis – breakdown of glycogen in response to low blood glucose
Gluconeogenesis
•      The process of forming sugar from noncarbohydrate molecules
•      Takes place mainly in the liver
•      Protects the body, especially the brain, from the damaging effects of hypoglycemia by ensuring
ATP synthesis can continue
Lipid Metabolism
•      Most products of fat metabolism are transported in lymph as chylomicrons
•      Lipids in chylomicrons are hydrolyzed by plasma enzymes and absorbed by cells
•      Only neutral fats are routinely oxidized for energy
•      Catabolism of fats involves two separate pathways
•    Glycerol pathway
•    Fatty acids pathway
•      Glycerol is converted to glyceraldehyde phosphate
•    Glyceraldehyde is ultimately converted into acetyl CoA
•    Acetyl CoA enters the Krebs cycle
•      Fatty acids undergo beta oxidation which produces:
•    Two-carbon acetic acid fragments, which enter the Krebs cycle
•    Reduced coenzymes, which enter the electron transport chain
Lipogenesis and Lipolysis
•      Excess dietary glycerol and fatty acids undergo lipogenesis to form triglycerides
•      Glucose is easily converted into fat since acetyl CoA is:
•    An intermediate in glucose catabolism
•    The starting molecule for the synthesis of fatty acids
•      Lipolysis, the breakdown of stored fat, is essentially lipogenesis in reverse
•      Oxaloacetic acid is necessary for the complete oxidation of fat
•    Without it, acetyl CoA is converted into ketones (ketogenesis)
Lipid Metabolism: Synthesis of Structural Materials
•      Phospholipids are important components of myelin and cell membranes
•      The liver:
•    Synthesizes lipoproteins for transport of cholesterol and fats
•    Makes tissue factor, a clotting factor
•    Synthesizes cholesterol for acetyl CoA
•    Uses cholesterol for forming bile salts
•      Certain endocrine organs use cholesterol for synthesizing steroid hormones
Protein Metabolism
•      Excess dietary protein results in amino acids being:
•    Oxidized for energy
•    Converted into fat for storage
•      Amino acids must be deaminated prior to oxidation for energy
•      Deaminated amino acids are converted into:
•    Pyruvic acid
•    One of the keto acid intermediates of the Krebs cycle
•      These events occur as transamination, oxidative deamination, and keto acid modification
Oxidation of Amino Acids
•      Transamination – switching of an amine group from an amino acid to a keto acid (usually a-
ketoglutaric acid of the Krebs cycle)
•    Typically, glutamic acid is formed in this process
•      Oxidative deamination – the amine group of glutamic acid is:
•    Released as ammonia
•    Combined with carbon dioxide in the liver
•    Excreted as urea by the kidneys
•      Keto acid modification – keto acids from transamination are altered to produce metabolites that
can enter the Krebs cycle
Synthesis of Proteins
•      Amino acids are the most important anabolic nutrients, which form:
•    All protein structures
•    The bulk of the body’s functional molecules
•      Amounts and types of proteins:
•    Are hormonally controlled
•    Reflect each life cycle stage
•      A complete set of amino acids is necessary for protein synthesis
•    All essential amino acids must be provided in the diet
State of the Body
•      The body exists in a dynamic catabolic-anabolic state
•      Organic molecules (except DNA) are continuously broken down and rebuilt
•      The body’s total supply of nutrients constitutes its nutrient pool
•      Amino acid pool – body’s total supply of free amino acids is the source for:
•    Resynthesizing body proteins
•    Forming amino acid derivatives
•    Gluconeogenesis
Interconversion Pathways of Nutrients
•      Carbohydrates are easily and frequently converted into fats
•      Their pools are linked by key intermediates
•      They differ from the amino acid pool in that:
•    Fats and carbohydrates are oxidized directly to produce energy
•    Excess carbohydrate and fat can be stored
Absorptive and Postabsorptive States
•      Metabolic controls equalize blood concentrations of nutrients between two states
•      Absorptive
•    The time during and shortly after nutrient intake
•      Postabsorptive
•    The time when the GI tract is empty
•    Energy sources are supplied by the breakdown of body reserves
Absorptive State
•      The major metabolic thrust is anabolism and energy storage
•    Amino acids become proteins
•    Glycerol and fatty acids are converted to triglycerides
•    Glucose is stored as glycogen
•      Dietary glucose is the major energy fuel
•      Excess amino acids are deaminated and used for energy or stored as fat in the liver
Principal Pathways of the Absorptive State
•      In muscle
•    Amino acids become protein
•    Glucose is converted to glycogen
•      In the liver
•    Amino acids become protein or are deaminated to keto acids
•    Glucose is stored as glycogen or converted to fat
•      In adipose tissue
•    Glucose and fats are converted and stored as fat
•      All tissues use glucose to synthesize ATP
Insulin Effects on Metabolism
•      Insulin controls the absorptive state and its secretion is stimulated by:
•    Increased blood glucose
 •    Elevated amino acid levels in the blood
•    Gastrin, CCK, and secretin
•      Insulin enhances:
•    Active transport of amino acids into tissue cells
•    Facilitated diffusion of glucose into tissue
Diabetes Mellitus
•      A consequence of inadequate insulin production or abnormal insulin receptors
•      Glucose becomes unavailable to most body cells
•      Metabolic acidosis, protein wasting, and weight loss results as fats and tissue proteins are used
for energy
Postabsorptive State
•      The major metabolic thrust is catabolism and replacement of fuels in the blood
•    Proteins are broken down to amino acids
•    Triglycerides are turned into glycerol and fatty acids
•    Glycogen becomes glucose
•      Glucose is provided by glycogenolysis and gluconeogenesis
•      Fatty acids and ketones are the major energy fuels
•      Amino acids are converted to glucose in the liver
Principle Pathways in the Postabsorptive State
•      In muscle:
•    Protein is broken down to amino acids
•    Glycogen is converted to ATP and pyruvic acid (lactic acid in anaerobic states)
•      In the liver:
•    Amino acids, pyruvic acid, stored glycogen, and fat are converted into glucose
•    Fat is converted into keto acids that are used to make ATP
•      Fatty acids (from adipose tissue) and ketone bodies (from the liver) are used in most tissue to
make ATP
•      Glucose from the liver is used by the nervous system to generate ATP
Hormonal and Neural Controls of the Postabsorptive State
•      Decreased plasma glucose concentration and rising amino acid levels stimulate alpha cells of
the pancreas to secrete glucagon (the antagonist of insulin)
•      Glucagon stimulates:
•    Glycogenolysis and gluconeogenesis
•    Fat breakdown in adipose tissue
•    Glucose sparing
•      In response to low plasma glucose, the sympathetic nervous system releases epinephrine, which
acts on the liver, skeletal muscle, and adipose tissue to mobilize fat and promote glycogenolysis
Liver Metabolism
•      Hepatocytes carry out over 500 intricate metabolic functions
•      A brief summary of liver functions
•    Packages fatty acids to be stored and transported
•    Synthesizes plasma proteins
•    Forms nonessential amino acids
•    Converts ammonia from deamination to urea
•    Stores glucose as glycogen, and regulates blood glucose homeostasis
•    Stores vitamins, conserves iron, degrades hormones, and detoxifies substances
Cholesterol
•      Is the structural basis of bile salts, steroid hormones, and vitamin D
•      Makes up part of the hedgehog (Hh) molecule that directs embryonic development
•      Is transported to and from tissues via lipoproteins
•      Lipoproteins are classified as:
•    HDLs –
high-density lipoproteins have more protein content
 •    LDLs –
low-density lipoproteins have a considerable cholesterol component
•    VLDLs –
very low density lipoproteins are mostly triglycerides
Lipoproteins
•      The liver is the main source of VLDLs, which transport triglycerides to peripheral tissues
(especially adipose)
•      LDLs transport cholesterol to the peripheral tissues and regulate cholesterol synthesis
•      HDLs transport excess cholesterol from peripheral tissues to the liver
•    Also serve the needs of steroid-producing organs (ovaries and adrenal glands)
•      High levels of HDL are thought to protect against heart attack
•      High levels of LDL, especially lipoprotein (a), increase the risk of heart attack
Plasma Cholesterol Levels
•      The liver produces cholesterol:
•    At a basal level of cholesterol regardless of dietary intake
•    Via a negative feedback loop involving serum cholesterol levels
•    In response to saturated fatty acids
•      Fatty acids regulate excretion of cholesterol
•    Unsaturated fatty acids enhance excretion
•    Saturated fatty acids inhibit excretion
•      Certain unsaturated fatty acids (omega-3 fatty acids, found in cold-water fish) lower the
proportions of saturated fats and cholesterol
Non-Dietary Factors Effecting Cholesterol
•      Stress, cigarette smoking, and coffee drinking increase LDL levels
•      Aerobic exercise increases HDL levels
•      Body shape is correlated with cholesterol levels
•    Fat carried on the upper body is correlated with high cholesterol levels
•    Fat carried on the hips and thighs is correlated with lower levels
Body Energy Balance
•      Bond energy released from catabolized food must equal the total energy output
•      Energy intake – equal to the energy liberated during the oxidation of food
•      Energy output includes the energy:
•    Immediately lost as heat (about 60% of the total)
•    Used to do work (driven by ATP)
•    Stored in the form of fat and glycogen
•      Nearly all energy derived from food is eventually converted to heat
•      Cells cannot use this energy to do work, but the heat:
•    Warms the tissues and blood
•    Helps maintain the homeostatic body temperature
•    Allows metabolic reactions to occur efficiently
Regulation of Food Intake
•      When energy intake and energy outflow are balanced, body weight remains stable
•      The hypothalamus releases peptides that influence feeding behavior
•    Orexins are powerful appetite enhancers
•    Neuropeptide Y causes a craving for carbohydrates
•    Galanin produces a craving for fats
•    GLP-1 and serotonin make us feel full and satisfied
Feeding Behaviors
•      Feeding behavior and hunger depends on one or more of five factors
•    Neural signals from the digestive tract
•    Bloodborne signals related to the body energy stores
•    Hormones, body temperature, and psychological factors
Nutrient Signals Related to Energy Stores
•      High plasma levels of nutrients that signal depressed eating
•    Plasma glucose levels
•    Amino acids in the plasma
•    Fatty acids and leptin
Hormones, Temperature, and Psychological Factors
•      Glucagon and epinephrine stimulate hunger
•      Insulin and cholecystokinin depress hunger
•      Increased body temperature may inhibit eating behavior
•      Psychological factors that have little to do with caloric balance can also influence eating
behaviors
Control of Feeding Behavior and Satiety
•      Leptin, secreted by fat tissue, appears to be the overall satiety signal
•    Acts on the ventromedial hypothalamus
•    Controls appetite and energy output
•    Suppresses the secretion of neuropeptide Y, a potent appetite stimulant
•      Blood levels of insulin and glucocorticoids play a role in regulating leptin release
Metabolic Rate
•      Rate of energy output (expressed per hour) equal to the total heat produced by:
•    All the chemical reactions in the body
•    The mechanical work of the body
•      Measured directly with a calorimeter or indirectly with a respirometer
•      Basal metabolic rate (BMR)
•    Reflects the energy the body needs to perform its most essential activities
•      Total metabolic rate (TMR)
•    Total rate of kilocalorie consumption to fuel all ongoing activities
Factors that Influence BMR
•      Surface area, age, gender, stress, and hormones
•      As the ratio of surface area to volume increases, BMR increases
•      Males have a disproportionately high BMR
•      Stress increases BMR
•      Thyroxine increases oxygen consumption, cellular respiration, and BMR
Regulation of Body Temperature
•      Body temperature – balance between heat production and heat loss
•      At rest, the liver, heart, brain, and endocrine organs account for most heat production
•      During vigorous exercise, heat production from skeletal muscles can increase 30–40 times
•      Normal body temperature is 36.2°C (98.2°F); optimal enzyme activity occurs at this temperature
•      Temperature spikes above this range denature proteins and depress neurons
Core and Shell Temperature
•      Organs in the core (within the skull, thoracic, and abdominal cavities) have the highest
temperature
•      The shell, essentially the skin, has the lowest temperature
•      Blood serves as the major agent of heat transfer between the core and shell
•      Core temperature remains relatively constant, while shell temperature fluctuates substantially
(20°C–40°C)
Mechanisms of Heat Exchange
•      The body uses four mechanisms of heat exchange
•    Radiation – loss of heat in the form of infrared rays
•    Conduction – transfer of heat by direct contact
•    Convection – transfer of heat to the surrounding air
•    Evaporation – heat loss due to the evaporation of water from the lungs, mouth mucosa, and skin
(insensible heat loss)
•      Evaporative heat loss becomes sensible when body temperature rises and sweating produces
increased water for vaporization
Role of the Hypothalamus
•      The main thermoregulation center is the preoptic region of the hypothalamus
•      The heat-loss and heat-promoting centers comprise the thermoregulatory centers
•      The hypothalamus:
•    Receives input from thermoreceptors in the skin and core
•    Responds by initiating appropriate heat-loss and heat-promoting activities
Heat-Promoting Mechanisms
•      Low external temperature or low temperature of circulating blood activates heat-promoting
centers of the hypothalamus to cause:
•    Vasoconstriction of cutaneous blood vessels
•    Increased metabolic rate
•    Shivering
•    Enhanced thyroxine release
Heat-Loss Mechanisms
•      When the core temperature rises, the heat-loss center is activated to cause:
•    Vasodilation of cutaneous blood vessels
•    Enhanced sweating
•      Voluntary measures commonly taken to reduce body heat include:
•    Reducing activity and seeking a cooler environment
•    Wearing light-colored and loose-fitting clothing
Mechanisms of Body Temperature Regulation
Hyperthermia
•      Normal heat loss processes become ineffective and elevated body temperatures depress the
hypothalamus
•      This sets up a positive-feedback mechanism, sharply increasing body temperature and
metabolic rate
•      This condition, called heat stroke, can be fatal if not corrected
Heat Exhaustion
•      Heat-associated collapse after vigorous exercise, evidenced by elevated body temperature,
mental confusion, and fainting
•      Due to dehydration and low blood pressure
•      Heat-loss mechanisms are fully functional
•      Can progress to heat stroke if the body is not cooled and rehydrated
Fever
•      Controlled hyperthermia, often a result of infection, cancer, allergic reactions, or central
nervous system injuries
•      White blood cells, injured tissue cells, and macrophages release pyrogens that act on the
hypothalamus, causing the release of prostaglandins
•      Prostaglandins reset the hypothalamic thermostat
•      The higher set point is maintained until the natural body defenses reverse the disease process
Developmental Aspects
•      Good nutrition is essential in utero as well as throughout life
•      Lack of proteins needed for fetal growth and in the first three years of life can lead to mental
deficits and learning disorders
•      With the exception of insulin-dependent diabetes mellitus, children free of genetic disorders
rarely exhibit metabolic problems
•      In later years, non-insulin-dependent diabetes mellitus becomes a major problem
•      Many agents prescribed for age-related medical problems influence nutrition
•    Diuretics can cause hypokalemia by promoting potassium loss
•    Antibiotics can interfere with food absorption
 •    Mineral oil interferes with absorption of fat-soluble vitamins
•    Excessive alcohol consumption leads to malabsorption problems, certain vitamin and mineral
deficiencies, deranged metabolism, and damage to the liver and pancreas