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23 Aug 2018

People who are overweight and wish to lose weight, often do sobecause they are concerned about looking too big. Their increasedsize is attributed to an increased volume of fat.

When people try to lose weight however, they often quantifytheir goals in terms of weight, not volume.

So my question is, is the volume of anadipocyte cell always directly proportional to theweight of the fat stored within the cell?

If not, what factors would increase/decrease the size of theadipocyte cell for a given mass of stored fat?

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Lelia LubowitzLv2

25 Aug 2018

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Based on âMorgan: A case of Diabetesâ by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)

The Patient:

Morgan Water is a 27-year old Native American that lives on a reservation in Oklahoma. Nearly Â¼ of Morganâs tribe has diabetes but she has no direct family history of diabetes, heart disease, or other serious conditions. She is however obese (BMI = 32) and leads a sedentary lifestyle. Morgan has been suffering from an increasing persistence of symptoms including unusual thirst, dizziness, blurred vision, and numbness in her right foot. The symptoms have been developing over several months but as she is planning her wedding she attributed them to nerves. She is finally persuaded to see her family doctor. Her non-fasting blood glucose level was elevated so the doctor has her return the next morning for a fasting blood sample so they could more accurately measure her blood glucose and insulin. Her blood results are below:

Test	Morganâs values	Normal range	Pre-Diabetic range	Diabetic range
Plasma glucose, mg/dl	260	70 -139	140 - 199	â¥ 200
Fasting glucose, mg/dl	140	â¤ 99	100 - 125	â¥ 126
A1C, %	7.6	~ 5	5.7 â 6.4	â¥ 6.5
Fasting Insulin, mIU/ml	34	2 - 10	10 - 20	â¥ 20

The recommendation of Morganâs doctor was to improve her exercise, good nutrition, and weight loss. He recommends meeting with a nutritionist to assist Morgan in her weight loss goals. When Morgan got home and told her family the diagnosis they however had LOTS of suggestions on how she can lose weight. Below is a description of the advice given to her by three family members.

Best friend Savannah:

âYou know how Iâve been losing weight? Well, Iâve been on the Atkinsâ Diet. I heard about it on TV. Itâs great! You get to eat steak, chicken wings, and all the good stuff. All you have to do is limit carbohydrate intake. You should definitely give it a try. This diet has been around for years and it has worked for lots of people, including me.â

*Note: Atkinâs Diet recommends: 10% carbohydrates, 55% fats, 35% protein

Brother Alan:

âI think the best thing for you to do is exercise and stop eating all of that pizza and candy and food filled with fat. Our people never used to eat that junk. I say eat meals that are nutritionally balanced and high in fiber and low in refined sugars and saturated fats. And run a lot. Stop sitting around the house.â

Grandfather:

âMorgan, it is true that it is best to live in harmony and balance â to eat a nutritionally balanced diet that includes carbohydrates, proteins, and âgoodâ fats to meet your bodyâs needs. That is good. But look to your heritage. Our people were never overweight before we started eating âcivilizedâ food. Look to our native diet. I think you should look to traditional herbal remedies for help. What Alan says is true. Exercise is good. But it is sometimes not enough. Our people have always looked to natural medicine for cures. They will lift your spirits and energize you. Then you will lose weight and you will be healthy again. I hear the herbs from the diet shop are safe and good. But you must take them like the medicine label says. It canât hurt to try them.â

*Note: these herbal supplements Morganâs grandfather is recommending contain the herb

ephedra (ephedrine).

Question 5:

Given Morganâs metabolic state, what is the primary fuel source for her cells currently?

A. Carbohydrates (glucose)

B. Fats

C. Proteins

D. It is a balance of all three

Question 6:

Metabolic ketoacidosis is a common problem with diabetics, which is caused by which of the following?

A. Excessive oxidation of fatty acids, leading to an accumulation of ketone bodies in the blood.

B. Excessive oxidation of glucose, leading to an accumulation of ketone bodies in the blood.

C. Excessive oxidation of proteins, leading to an accumulation of ammonia in the blood.

D. Hyperglycemia.

Question 7:

Which weight loss suggestion is designed to achieve some level of ketosis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

Question 8:

One major side effect of the herbal supplement can be hot flashes and increased perspiration due to increased thermogenesis, what is the likely cause of the heat production?

A. Increasing the activity of phosphfructokinase-1.

B. Increasing the activity of the pyruvate dehydrogenase complex.

C. Increasing the activity of citrate synthase.

D. Increasing the activity of uncoupling proteins.

Question 9:

Would substituting fiber and complex carbohydrates (larger % cellulose) for the simple sugars and starches (high sucrose and amylose/amylopectin) help Morgan lose weight, why?

A. Yes, because complex carbohydrates like cellulose are largely indigestible so they pass through

the digestive tract without being absorbed.

B. Yes, cellulose contains less glucose residues than amylose or amylopectin.

C. Yes, because the fructose in sucrose is much more responsible for weight gain than the glucose.

D. No, because cellulose, amylose, and amylopectin are all composed of glucose so it doesnât

matter.

Question 10:

Which weight loss suggestion will lead to an increased need for gluconeogenesis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

Please help me check my answers and correct them if needed.Thank you!

1. Which statement regarding malnutrition is true?

	Malnutrition of one nutrient may directly and indirectly affectonly one system
	All nutrient deficiencies typically manifest in a matter of daysor weeks.
	Most cases of malnutrition in the elderly are directly relatedto a loss of appetite
	Nutritional homeostasis should primarily be achieved bydietary alterations.

2. Movement of the stomach/stomach lining upward into esophagusor diaphragm is termed what?

	Gastric reflux
	Gastric torsion
	Hiatal hernia

3. Which of the following is a function of the liver?

	produce and secrete insulin
	produce and secrete glucagon
	metabolize drugs
	excrete drugs from the body
	store red blood cells

4.
Which of the following regarding malnutrition is true?

	ingestion of supplements will prevent malnutrition
	malnutrition can be avoided if the recommendations of the foodpyramid are followed
	malnutrition in the United States is rare

5. What is protein-carbohydrate malnutrition? A person who:

	doesn't eat enough protein or carbohydrates
	eats to much protein and not enough carbohydrates
	eats to much carbohydrates and not enough protein
	eats to much protein and carbohydrates which interferes withabsorption and digestion of other nutrients

6. Which vitamin is stored in the tissues?

	A
	B
	C

7. The menstrual occurs within 3 or 4 days of which of thefollowing changes in the blood?

	increase in estrogen and decrease in progesterone
	increase in progesterone and decrease in estrogen
	increase in progesterone and estrogen
	decrease in progesterone and estrogen

8. Which statement regarding sperm production and aging istrue?

	Aging increases the amount of sperm produced
	Aging has a variable effect on the amount of spermproduced.
	Aging causes major changes in sperm cell morphology
	Aging causes major changes in sperm cell function

9. Which of the following is a function of the digestivesystem?

	Helping with speech
	Vitamin A production
	Storing blood in the pancreas
	Producing erythropoietin

10. Thinning of the enamel, decrease in nerve cells, recedinggums and loss of muscle of mastication coordination are consideredto be what type of changes in the mouth?

	Abnormal changes
	Age changes

11. A decline in sexual activity with age is primarilyassociated with what age related changes in the physiology of amale?

	Decline in frequency of use
	Deteriorating self-image
	Medication use
	Changes in blood flow

12. Which of the following conditions is not apathological change that effects the stomach?

	Peptic ulcer
	Atrophic Gastritis
	Acute Gastritis
	Stricture

13. Which of the following is an age related cause for fecalincontinence?

	Laxative use
	Ulcerative colitis
	Colorectal cancer
	Disability
	Stool softener

14. A decrease in lactase secretion is an age related changeassociated with the _____________.

	stomach
	small intestine
	large intestine
	pancreas

15. Which of the following statements regarding atrophicgastritis is true?

	causes overproduction of HCL
	causes overproduction of intrinsic factor
	increase absorption of B12
	increase risk for cancer

16. Functional incontinence may be due to a problem withwhat?

	cognitive function
	autonomic system
	urinary bladder
	urethra

17. Which of the following is not a function of nutrients?

	energy for activities
	raw materials for growth
	buffer to maintain pH
	fluid and electrolyte balance

18. Adenosine triphosphate is produced during all of thefollowing processes, except ______.

	Oxidative phosphorylation
	Kreb's cycle
	Electron transport
	Glycation

19. The digestive system helps create nutritional homeostasis,which of the following is one of the four reasons for nutritionalhomeostasis?

	nutrients are formed to supply the energy for vitalfunctions
	nutrients supply raw materials to synthesize body substances
	nutrients counteract against blood so that volume ismaintained
	nutrients tear down worn out substances for later use

20. Women with _____ percent body fat has an increase risk for ashorter life span and weight related diseases.

	18
	22
	27
	31

21. What amount of protein should be consumed daily by an olderadult?

	.25 gram per kilogram of weight
	.5 gram per kilogram of weight
	.75 gram per kilogram of weight
	1 gram per kilogram of weight

22. Stress incontinence is much more common in women than in menbecause women have which of the following?

	longer urethra
	premenopausal thinning
	weakened structures

23. Which of the following is an age related change affectingthe kidneys?

	increase in weight
	increase in width
	decrease in area
	decrease in volume

24. Postmenopausal decrease in estrogen leads to age relatedchanges of the _________.

	Urethra
	Urinary bladder
	Ureter
	Kidney

25. _______ percent of the working capacity of both kidneys isneeded to maintain homeostasis.

	10
	20
	30
	40

26. Which of the following is considered a treatment for urinaryincontinence?

	surgical removal of the sphincter
	medications to modify bladder function
	electric shock therapy

27. Which reproductive hormone provides a decrease risk ofatherosclerosis?

	testosterone
	relaxin
	estrogen
	follicle stimulating hormone

28. Which form of cancer in the female reproductive system rankssecond in occurrence?

	Ovarian
	Cervical
	Endometrial
	Vaginal

29. Which hormone produced in females seems to stimulate thelibido?

	Estrogen
	Progesterone
	Testosterone
	Luteinizing hormone

30. Which of the following regarding prostate cancer istrue?

	it is related to having benign prostatic hypertrophy
	it is more common in white males
	testing for prostatic specific antigen is sensitive andspecific
	it impairs the function of the liver