Students Guidebook 2013 Blok5

Students Guidebook

Students Guidebook

Block V: Metabolism & Energy

6th edition 2013

Contributors:

Seto Priyambodo

Ardiana Ekawanti Dewi Suryani

Dian Puspita sari

Ida Ayu Eka Widiastuti

Monalisa

Putu Aditya

Marie Yuni Andani

Siti Farida

Wahyu Sulistya AffarahYunita Sabrina

Fakultas Kedokteran

Universitas MataramMetabolism and energy

Students Guidebook

6th Edition 2013Block coordinator:

dr. Seto Priyambodo , M.Sc

Contributor:Ardiana Ekawanti

Dewi SuryaniDian Puspita sari

Ida Ayu Eka Widiastuti

Monalisa

Putu Aditya

Marie Yuni Andani

Siti Farida

Wahyu Sulistya Affarah

Yunita Sabrina

Preface

Sufficient amount of nutrients are required by an individual to stay healthy. Human body cannot synthesize all of the required nutrients; therefore individuals always need to consume an adequate and appropriate food. The process in which nutrient from food could be utilized by cells and tissues requires several process: digestion, absorption, metabolism and utilization. Students are expected to learn these concepts in the nutrition and metabolism block.

Within this block, various learning strategies will be applied to provide students with a better understanding of nutrition and metabolism concepts. A problem based approach is the core of the learning strategies. This method requires active participation of students within the whole learning process in which, therefore, students are at the centre of the learning process.

Since students participation is necessary, the acquisition of new knowledge and skills is largely depended on students activities. This guidebook is developed to assist students during their study in this block. We realize that this guidebook has some limitations. Therefore, suggestions and comments would be well appreciated.

Mataram, March 2013

Vice Dean I

Dr. Doddy Ario Kumboyo, Sp.OG (K)

NIP. 195204091980031010

Table of Contents

Introduction _______________________________________________________________1

Expected Outcomes ________________________________________________________3

Learning Strategies ________________________________________________________6

Evaluation ________________________________________________________________9

Referrence _______________________________________________________________11

Annex 1: Scenario _________________________________________________________12

Annex 2: Time Table _______________________________________________________

Introduction

Block Name: Metabolism and Energy

A human adult eat tons of food each year. Metabolism and Energy block attempts to answer the question why by emphasizing on the concept of digestion, metabolism and utilization of nutrients to fulfill human body requirement. As seen in figure 1, mass flows of nutrient undergo several processes: digestion, metabolism and utilization. Digestion processes consist of mechanical digestion, chemical transformation and nutrient absorption in gastrointestinal tract. After being absorbed, nutrients are converted into energy, heat and specific body component by several chemical transformation processes. These products are then used for growth and development, repair of tissue damage, basal metabolism and activities. The remaining nutrients are put as deposit in certain part of the body. In individual with certain health status, the nutrient requirement will be different. More energy may be required to fulfill high metabolism processes while some other products are required to repair tissue damage.

Figure 1. Conceptual basis for understanding nutrition and metabolism

During this block, students need to understand the concept illustrated above in depth and link it with several clinical settings, i.e. nutritional, organ and metabolic disorders. To facilitate this understanding, two major themes are applied in this block, including 1) nutrition for normal individual well-being, and 2) nutrition in certain clinical settings, i.e. nutritional, organ, and metabolic disorders.

The first theme, nutrition for normal individual well-being, is addressed to answer the following question:

Where can people get required nutrients from?

What will happen when food enters the gastrointestinal tract?

What are the roles of nutrients for normal individual?

Will the requirement differs in various stages of life?

Studies have shown that nutrition is essential in maintaining human well-being, particularly nutrients that cannot be synthesized by the body such as essential amino acids, water-soluble and fat-soluble vitamins, minerals, and the essential fatty acids. The body also requires an adequate energy substrate, metabolizable carbohydrate, indigestible carbohydrate (fiber), additional nitrogen, and water.

The requirement of nutrients varies in different stages of life, i.e. newborn, infant, childhood, adolescence, adult, the elderly, and pregnancy. In general, nutrients are required for producing energy for work, basal metabolism, growth and tissues repair, and regulation of the body function. The balance between intake and utilization of nutrients will then determine the well-being of individuals.

In order to fulfill an adequate amount of nutrients, a person needs to consume various source of food in a considerable amount. Different dietary products provide a variety of essential nutrients. Furthermore, when foods enter the body, they undergo a range of digestive process in the human gastrointestinal tract, which include physical and chemical processes. Some nutrients are absorbed loosely while others are absorbed in very small amount. Therefore, ones need to know the function of gastrointestinal tract in providing nutrients for the body. After being absorbed, what will happen to those nutrients? Will it be utilized directly?

A range of metabolism process is required to transform circulated nutrients into substrates that can be used directly by human tissues. The nutrients may be used for different purposes in the body. Once there is an excessive amount of nutrients, they will be stored as nutrient deposit or being excreted. The balance between intake and utilization is necessary to ascertain normal functioning of the body.

Clinically, imbalance nutritional intake and requirement may result in several disorders, e.g. deficiency syndrome (vitamin A deficiencies, stunting, wasting, etc) and over nutrition (obese, vitamin toxicity, etc). Disorders of organ and metabolism, e.g. diabetes, renal failure, heart disease, liver abnormalities, hypertension, and diabetes, may influence nutritional stability. These disorders may lead to a decrease or increase of excretion, detainment of nutrients in the blood vessels, etc. The second theme will provide the basis of understanding the clinical consequences of under- and over nutrition, as well as the nutritional adjustment in certain organ and metabolic disorders.

Duration of the block: 7 effective weeks

Eligibility for this block:

Have completed block 1, 2, 3 and 4

Did not fail in more than 2 previous blocks

Expected Outcome

After completing this block, students are expected to be able 1) to construct dietary plan for normal individual, 2) to construct dietary plan for patient with nutritional disorder (malnourished individual), and 3) to construct dietary plan for patient with organ disorders (kidney, heart and liver) and metabolic disorders (diabetes and hypertension), 4) to practice a long life learning, and 5) to communicate effectively with colleagues and other professionals. In order to achieve this outcome, students should master the following constructs:

1. Nutrition for normal individual wellbeing

1.1. Explaining the anatomy, physiology and histology of digestive system in providing nutrients and maintaining energy stability.

1.2. Explaining the principles of human diet (source and metabolism of nutrient).

1.3. Explaining the nutritional requirement in different lifecycle.

1.4. Explaining the concept of energy stability, energy production and expenditure.

1.5. Able to collect and apply basic interpretation skills in a given data regarding diet (secondary data) to validate scientific information systematically.

1.6. Able to use data and scientific evidence in approaching individual dietary plan.

1.7. Performing anthropometric measurements to assess nutritional status.

1.8. Identifying, deciding, and determining appropriate laboratory measurement to assess nutritional status.

2. Nutritional disorders

2.1. Explaining the pathogenesis and pathophysiology of nutritional disorders (nutrient deficiencies and excessive syndromes).

2.2. Explaining the effect of non biological factors related to nutritional disorders.

2.3. Explaining the principles of drug and food interaction on gastrointestinal tract.

2.4. Interpreting and explaining clinical and laboratory data to determine the diagnosis of nutritional disorders.

2.5. Explaining common health promotion and preventive approaches related to community nutrition.

3. Organ disorders

3.1 Explaining the principles of dietary treatment for patient with organ and metabolic disorders.

3.2 Exploring and recording clearly dietary plans for patients with organ and metabolic disorders.

3.3 Explaining and deciding when to give parenteral and enteral dietary route4. Long live learning

4.1 Developing capability to be updated with scientific and technological advancement.

4.2 Critically analyze medical literature and appropriately applied to students patient.

5. Ethics, moral and profesionalism

5.1 Appreciating others without preferences in certain personal status.

5.2 Presenting a case clearly and efficiently.

5.3 Constructively responding other people opinions

5.4 Providing sufficient time and paying attention to when other professionals (dieticians) expressed their idea or consideration.

The following objectives are required in developing understanding related to the constructs above:

1. Explaining the anatomy of gastrointestinal tract and its related apparatus and glands

2. Explaining the histology of gastrointestinal tract

3. Explaining the basic principle of gastrointestinal tract function, including a) the motility, b) the neurological and hormonal control, and c) blood flow regulation of gastrointestinal tract

4. Explaining the secretory function of gastrointestinal tract, including a) gastrointestinal secretion, b) types and characteristics of gastrointestinal glands, c) factors determining gastrointestinal secretion, and d) bile composition and function.

5. Explaining the transport and absorption mechanism nutrition in gastrointestinal tract, including a) digestion process (mechanic and chemical process), b) the role and function of esophagus, gaster, intestinum tenue and intestinum crassum in the transport mechanism of nutrients and food blending process, c) the digestion of carbohydrate, protein and fat, and d) basic principles of water, electrolytes and nutrient absorption.

6. Explaining the physiology of hungry behavior

7. Explaining and calculating the requirement of energy in different life cycle, i.e. newborn (premature and aterm), infant, childhood, adolescence, adulthood (including pregnant and lactating mother) and geriatric

8. Explaining and calculating the requirement of nutrients (macro- and micronutrients) in different life cycle, including a) pregnancy and breastfeeding, b) neonates (premature and aterm), infant and child, c) adolescence, d) adult, and e) geriatric

9. Formatting daily human diet based on recommended dietary allowance (RDA)

10. Applying knowledge on nutrition and metabolism to explain certain popular diet, e.g. blood type diet, herbal diet, etc

11. Explaining different sources of nutrients from daily diet, including a) macronutrients (lipid, carbohydrate and protein) and b) micronutrients (vitamins [water- and fat-soluble vitamins) and trace element [calcium, iron and iodium])

12. Explaining the process of distribution, metabolism and excretion of macro- and micronutrients in the human body

13. Explaining the body control (neuronal and hormonal) in maintaining energy stability

14. Explaining the role of macronutrients in maintaining energy stability

15. Explaining the role of micronutrients in the normal function of the body

16. Explaining the composition of energy-source nutrients in various types of dietary products

17. Explaining the concept of energy expenditure, including expenditures for basal metabolism, activities and sickness

18. Explaining the association between nutritional intake and social environment

19. Explaining the pathophysiology of macro- and micronutrients deficiencies and excesses

20. Explaining the pathogenesis of macro- and micronutrients deficiencies and excesses

21. Explaining the risk factor for acquiring nutritional disorders (deficiencies and excesses)

22. Explaining the impact of acquiring nutritional disorders (biological and non biological impact)

23. Measuring body weight, height, waist, arm circumference, and head circumference

24. Explaining various laboratory measurement required to assess nutritional status (lipid profile, hemoglobin, serum protein, etc)

25. Explaining the route of nutritional intake (enteral and parenteral) in clinical settings

26. Explaining the basic principles of oral drug administration, including a) types, and b) the mechanism of food and drug interaction

27. Providing examples of drugs that interact in the gastrointestinal tract

28. Explaining the principle that underlies the needs to perform dietary adjustment (macro- and micronutrients) in organ and metabolic disorders

29. Explaining the dietary composition (macro- and micronutrients) for individual with organ and metabolic disorders

Learning Strategies

Strategies used to deliver educational materials in this block consist of tutorials, lecturers, laboratory works, and students assignments. Tutorial with problem based approach is the heart of the learning strategy. Other strategies are required to complete student understanding on a given problem/topic.

A. Tutorials

The tutorial approach is developed based on the problem-based learning (PBL) principle in which students are at the center. Therefore, students themselves are responsible for their own learning process. Students decide for themselves what they want to learn and have considerable control over the choice of literature. During the tutorials, they are divided into group of 10-12 students to discuss a given problem using a procedure called the seven jump approach. This approach is conducted in the following consecutive phases, including:

Step 1: Clarifying unfamiliar terms

Step 2: Problems definition

Step 3: Brainstorm

Step 4: Analyzing the problems

Step 5: Formulating learning objectives

Step 6: Self-study

Step 7: Reporting

In general, the tutorial process for each case is conducted in two group work. During the first group work, students will work in a group for a given case until they come out with learning objectives (step 5). After the first session, student will conduct a self-study and report their finding in the second session. These processes are repeated for the whole tutorials. During each week, students are given sufficient time to consult with expert their difficulties in understanding certain topics.

The problems discuss in the tutorial groups consist of 1) vacation to Bali, 2) my second pregnancy, 3)old baby, 4) diet oh diet, and 5) Mama Mias problem. These problems are addressed to cover all of the given objectives/outcome, except for medical and certain other skills.

During the process, students have a number of roles to take, i.e. one student acts as a chair, another as a scriber and the whole process is supervised by a tutor. The chair and scriber are chosen randomly and every student will get their turn to be the chair and scriber. Both of them have important roles in maintaining the learning atmosphere of the group.

B. Lecturers

Lecturer provides fundamental knowledge on certain aspect in metabolism and energy and enhances students understanding on difficult topics further. Overall, lecture represents 12% of all educational processes. The following topics are given during lecturers:

The anatomy of gastrointestinal tract

The histology of gastrointestinal tract and its accessory glands

Neurological and hormonal control of gastrointestinal tract

Transport mechanism of nutrient, water and electrolytes in gastrointestinal tract

Overview of nutrients metabolism

Basic principles of human dietary intake

Laboratory tests for nutritional disorders (syndrome deficiency or excessive of nutrients)

Food supplementation and fortification

Drug and food interaction

Beside the above topics, there are four other lectures on medical research and statistics, i.e. 1) probability, 2) research subject, unit analysis and sampling, 3) research variables, and 4) sample size measurement.

C. Laboratory works

In order to prove a better understanding regarding to metabolism and energy, students will be provided with four laboratory works in this block. These laboratories include histology, anatomy, and medical skill laboratories.

The anatomy laboratory is required to enhance students understanding on gastrointestinal anatomy. Students will be divided into three groups and undergo two sessions of laboratory work.

The histology laboratory is required to enhance students understanding on gastrointestinal histology and accessory glands. Students will be divided into three groups.

Skills laboratory will provide students with skills in performing anthropometric measurements and vein puncture. The following methods will be used during students laboratory work, including lecture, demonstration, structured and self exercise on anthropometric measurement, vein and arterial puncture.

D. Student assignment

Overall, there are two assignments in this block, writing essay and case-study. Students will work in a group of 10-12 persons for both assignments.

Writing essayIn this assignment, certain theme will be provided for each group of students. The students will write and analyze based on theme according to scientific writing procedure. Analysis should be made from the medical nutrition perspective. The theme will be provided during the third week of the block.

The essay is written in A4 paper, with arial font, 11 points, and 1.5 cm space. The essay should have been completed and handed to the following email address:

[email protected] study: individual nutrition in certain clinical conditions

Each group will conduct a visit to instalasi gizi of NTB Province General Hospital. During the visit, student should collect relevant information on a given case. Students will be guided for nutritional visit to the patients by a dietician and attend nutritional outpatient polyclinic. The cases consist of 1) nutrition in pregnancy, 2) nutrition for children under five, 3) nutrition for patient with metabolic disorders, 4) nutrition for patient with organ disorder, and 5) nutrition for the elderly. This assignment is addressed to provide students capabilities in 1) collecting, analyzing, and interpreting information related to nutrition in clinical setting, 2) applying knowledge on nutrition in certain clinical setting, and 3) performing appropriate case presentation skill.

Following the visit, student will then analyze the case from the medical nutrition perspective. The result of the study will be presented in mini seminar attended by relevant expertise. Written report shall be provided and collected on line to the following email address

[email protected] following experts shall attend the seminar, including dietician, pediatrician, obstetrician, and internist. They will provide feedback on students presentation and assess the presentation using a given assessment tool. Final mark of this case study will be determined based on the presentation (40%) and written report (60%).

Evaluation

The evaluation of student achievement during the metabolism and energy block consist of three components: 1) overall block achievement, 2) medical skill performance, and 3) medical research capability. The following table summarizes the contribution of these components in students final mark as well as categories assessed in each component.

Component of assessmentScore percentage

Tutorial assessment

Laboratory work

Student assignment

Jurnal reading

Case study

Final examination

Oral examination

Written examination

CBT

5 %

7.5%

7.5%

40%

60%

80%

20%

70%

10%

Students that attend all session on time (maximum tolerance time 15 minute) will be granted with 2.5% of overall block achievement score. This attendance is also one of the pre-requisite of following final examination, both oral and written examinations.

Practical examination will be provided for anatomy and histology laboratory. The assessment consists of a set of questions pointed on specific part of human gastrointestinal tract. The aim is to explore students knowledge on gastrointestinal tract anatomy and histolgy.

In this blok, medical skill performance, particularly anthropometric measurement skills, will be assessed. Scenarios will be given and students are asked to perform appropriate anthropometric examination and vein puncture procedure. Standardized checklist is used to assess students performance along with OSCE to assess students skill.

Both students assignments will be assessed using standardized checklist. Tutors of the block shall act as the assessor. Specifically for case study, students final mark comes from both presentation and written report. Standardized checklists will be developed to include students presentation and scientific written skill, as well as understanding on a given topic.

Oral examination will be conducted for 15 minutes for each student. Tutors will act as the assessor. Each assessor will be equipped with a list of questions and expected answers in a checklist format as part of the assessment tool. The aim is to assess students understanding regarding the concept applied in this block. Each student will be given a case related to the expected outcome of the block. After reading the scenario, students will be asked to provide general overview on the topic and followed with discussion session with assessor.

Written examination constitutes as the largest proportion in the overall block achievement. This examination will provide information regarding students general understanding of the concept applied in this block.. Multiple choice questions (MCQ) with vignette are at the heart of it

Computer Based Test (CBT) will be conducted for preparing the students to UKDI. It consist of 10% of final examination proportion. The examination will be held in computer laboratory. Multiple choice questions (MCQ) with vignette are also at the heart of it.Reference

American Dietetic Association, 2000. Manual of Clinical Dietetics, 6th edition. American Dietetic Association, Chicago Illinois.

Baynes and Dominickzak, 2003. Medical Biochemistry. Mosby Co, Singapore.

Bowman, BA & Russell, RM, 2001. Present Knowledge in Nutrition, 8th edition. ILSI Press, Washington, DC.

Brody, T, 1999. Nutritional Biochemistry, 2nd edition. Academic Press, California.

Guyton, AC and Hall, JE, 2006. Textbook of Medical Physiology, 11th edition. Elsevier Saunders, Philadelphia.

Harkness, R, 1984. Interaksi Obat. Penerbit ITB Bandung, Bandung.

Hoffer, LJ, 2001. Clinical Nutrition: Protein-energy malnutrition in the in patient. CMAJ, 165:10.

Jones, JP, 2002. Clinical Nutrition: Functional Food. CMAJ, 166:12.

Melmon and Morrelis, 2000. Clinical Pharmacology, 4th edition. McGraw Hill, New York.

Montgomery, et al, 1993. Biochemistry. Mosby Co, Singapore

Moore, KL & Dalle, AF, 2006. Clinically Oriented Anatomy, 5th edition. Lippincott Williams & Wilkins, Philadelphia.

Murray, et al, 2003. Biokimia Harper, ed 25. EGC, Jakarta.

Pi-Sunyer,FX, 2000. Over nutrition and Under nutrition as Modifiers of Metabolic Processes in Disease States. Am J Clin Nutr; 72 (suppl): 533S-7S.

Saladin, 2007. Anatomy & Physiology: The Unity of Form and Function, 4th edition. McGraw Hill Co, New York.

Sediaoetama, AD, 1993. Ilmu Gizi I. Dian Rakyat, Jakarta.

Setiawati, A, 2005. Farmakologi Dasar dan Klinik. Balai Penerbit FK UI, Jakarta.

UNICEF, 1991. Strategy for improved nutrition of children and women in developing countries. UNICEF policy review, New York.

WHO, 1999. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health workers.

Wilson, et al, 1991. Harrisons Principles of Internal Medicine. Mc-Graw Hill Co, New York

Wiryo, H, 2004. Malnutrisi Berat: Patofisiologi, Penilaian, Pengobatan, Rehabilitasi dan Follow up. UPT Mataram University Press, Mataram.

Annex 1. Scenario 1THE UPSET STOMACHOn the last weekend, July (17 years old) stayed over at Saris house. They had planned to work on their essay together. On her first day there, Sari prepared milk and cereal for their breakfast. Actually shes not used to have breakfast especially something with milk, but she didnt want to upset Sari, so she ate it anyway.A few hours passed, she felt her stomach bloating and urgency to defecate. She thought there might be something wrong, because usually she only has bowel movement once a day, early in the morning. She was right; the whole day became a torture for July because she was having diarrhoea and frequent release of gas (flatulence).July remembered she had the same symptoms a couple of times when she took ice creams.

That day was definitely not Julys day; although the smell of Saris moms cooking made her salivating, she didnt want to take any chances of upsetting her stomach even more. Fortunately, the diarrhoea and excessive gas in her stomach had gone the next day. July promised herself not to take milk anymore.References:

Roy, PK. (2013) Lactose intolerance. [ONLINE] Available from http://emedicine.medscape.com/article/187249-overview#a0104Last Updated Mar 15, 2013.Accessed on April 11, 2013.

NDDIC (n.d) [ONLINE] Available from http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/ Last updated April 23, 2012. Accessed on April 11, 2013.

NDDIC (n.d) [ONLINE] Available from http://digestive.niddk.nih.gov/ddiseases/pubs/gas/ Last updated January 2, 2013. Accessed on April 11, 2013

Greenberger, NJ. (n.d) Diarrhoea in adults. [ONLINE] http://www.merckmanuals.com/home/digestive_disorders/symptoms_of_digestive_disorders/diarrhea_in_adults.html#v5612761 Last updated October, 2012. Accessed on April 11, 2013.

Scenario 2

IDEAL BODY WEIGHT

Dr. Ridwan is a family doctor. He has some patients which have problems in their weight body.

First patient is an obese boy (BMI: 34 kg/m2). He is 10 years old which doesnt like any physical activities except playing playstation only along his day.

The second is a pregnant women (37 weeks of gestation) which her ultrasonography result showed fetal low weight estimation. She is very worry about it and ask some suggestions to prevent low birth weight of her baby.

The last is a 55 years old farmer. He is very afraid of getting skinny day by day. He was tried to not eat much meat and rice in his daily meals, because he dont want to get any disease such as diabetic mellitus, hypertension, and other old disease.

As a family doctor, dr. Ridwan must give education and suggestions to his patients. And it is very important to know first the daily nutrition and energy requirement of each patient. Can you help dr. Ridwan?

Bottom of Form

Reference

Bowman, BA & Russell, RM, 2001. Present Knowledge in Nutrition, 8th edition. ILSI Press, Washington DC. Part 6: Nutrition and the Life Cycle, p403-46.

American Dietetic Association, 2000. Manual of Clinical Dietetics, 6th edition. American Dietetic Association, Chicago, Illinois. Part 2: Lifecycle Nutrition, p69-158.

UNICEF, 1991. Strategy for improved nutrition of children and women in developing countries. UNICEF policy review, New York.

Scenario 3:

Meraih impian menjadi model runway Indonesia

Melihat model runway dengan tampilan menawan membawakan busana indah hasil rancangan para fashion designer kondang membuat nyaris seluruh gadis bercita-cita menjadi salah satu dari mereka. Wajah yang sempurna, figur tubuh yang menawan, ditambah dengan gaya hidup yang terkesan sangat glamour menempatkan para model runway ini sebagai pusat perhatian dimana pun mereka berada. Namun semua itu mereka peroleh tentunya bukan dalam satu malam. Banyak proses dan jalan panjang yang melelahkan untuk menjadi model runway professional. Butuh perencanaan, perjuangan dan tekad yang kuat.

Tidak perlu diragukan lagi keindahan tubuh para model runway adalah yang menjadi poin penting dalam karier mereka. Maka tidak sedikit model runway yang sukses di dunia fashion adalah mereka yang usianya masih sangat muda, 14 atau 15 tahun, karena di masa ini mereka paling mudah mendapatkan tubuh yang sangat langsing. Tak jarang untuk mendapatkan badan yang super langsing itu para model menghalalkan segala cara untuk menurunkan atau mempertahankan berat badan mereka. Mulai dari work-out yang berlebihan hingga diet ekstrem yang mereka jalankan. Bahkan beberapa dari model yang menjalankan diet tersebut harus mengakhiri hidupnya dengan tragis, karena anorexia dan malnutrisi. Beberapa dari mereka masih lebih beruntung karena masih bisa direhabilitasi untuk memperbaiki kondisi kesehatan mereka.

Semenjak maraknya kasus anoreksia dan malnutrisi di kalangan model, pihak pelaku fashion industry lebih jeli dalam memilih model yang akan mereka gunakan dalam fashion event-nya. Mulai dari diberlakukan aturan batas minimal berat badan model, hingga tes kesehatan untuk mendapatkan model super langsing yang sehat. Semakin hari, kesadaran untuk menjadi dan menggunakan model yang sehat ini semakin berkembang ke arah yang positif. Karena bagaimana pun juga, model-model runway yang cantik ini menjadi role-model jutaan pasang mata yang melihat. Campaign menjadi model yang sehat terus digencarkan lewat media massa agar masyarakat (terutama wanita) semakin paham bahwa untuk berpenampilan bak seorang model tidak perlu sampai mengorbankan kesehatan atau bahkan nyawa. Dengan hidup yang teratur, pola makan yang sehat, dan hati yang positif, tentunya tidaklah sulit bagi perempuan Indonesia untuk mendapatkan postur tubuh ideal sebagai seorang runway model.

References:

http://thesevenagency.com/ind/blog/read/1059/SCENARIO 4

The challenge

Iron deficiency is the most common and widespread nutritional disorder in the world. As well as affecting a large number of children and women in developing countries, it is the only nutrient deficiency which is also significantly prevalent in industralized countries. The numbers are staggering: 2 billion people over 30% of the worlds population are anaemic, many due to iron deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases. Malaria, HIV/AIDS, hookworm infestation, schistosomiasis, and other infections such as tuberculosis are particularly important factors contributing to the high prevalence of anaemia in some areas.

Iron deficiency affects more people than any other condition, constituting a public health condition of epidemic proportions. More subtle in its manifestations than, for example, protein-energy malnutrition, iron deficiency exacts its heaviest overall toll in terms of ill-health, premature death and lost earnings.

Source: WHO, 2010

Try to find out the other micronutrient problems!

Scenario 5: BRING OUT THE GARBAGE OUT OF THE BODY

A group of 3rd year students were discussing a case of a 37 year old male who was admitted to the hospital due to chronic liver disease. One student pointed out that having this condition the patient could be prone to drug toxicity as a result of impaired detoxification function of the liver. Another student further associated impaired funtion of the liver in this case was possibily due to signficant decrease of cytochrome P450.

Regarding detoxification function, the supervisor mentioned that the mechanism of detoxification is a complex process involvng many enzymatic mechanisms. Further more, detoxification exhibit significant individual variability, and are affected by many factors. REFERENCES

Liska, D.J. 1998. The Detoxifiction Enzyme System. Aleternative Medicine Review. Vol 3. No. 3

Masson L.F, Sharp L, Cotton S.C, Little J, 2005. Cytochrome P-450 1A1 Gene Polymorphisms and Risk of Breast Cancer: A HuGE Review. Human Gnome Epidemiology. Vol 161. No. 10

Fakultas Kedokteran

Universitas Mataram

Food composition

Requirement

Meal size

Food origin

Nutritional input

Mechanical digestion

Chemical transformation

Nutrient absorption

Digestion

Interconversions of absorbed monomers

Anabolic reactions (Synthesis of body specific components)

Catabolic reactions (Energy / ATP or Heat)

Formation of excretion products (waste)

Metabolism

Inside human body

Basal metabolism

Growth and development

Tissue repair

Nutrient deposit

Activity

Health status

Physiological output

Almatsier, S, 2002. Prinsip dasar ilmu gizi. Jakarta: PT Gramedia Pustaka Utama.