Protein Malnutrition Essay Discussion: Alterations in Cellular Processes

Protein Malnutrition Essay Discussion: Alterations in Cellular Processes

Genetics is what makes us unique from one individual to another. It plays a major role in the structural make-up of a person.  It also gives us a bigger picture on how our genes are a major factor in disease processes. According to CDC, understanding genetic factors and genetic disorders is important in learning more about promoting health and preventing disease (CDC, 2021).

The scenario assigned to me is Scenario 3, which tackles Protein Malnutrition. Basing on the given case, the age 83 years old and genetics correlates given by the articles below Protein Malnutrition Essay Discussion: Alterations in Cellular Processes.

Cells are constantly exposed to a harmful environment throughout life. Increasing cell damage contributes to the dysfunction that characterizes the aging body. The best example of DNA damage as a cause of aging are the progeroid syndromes, which are caused by a deficiency in the mechanisms involved in DNA repair and whose symptoms begin early in life (Li, Jog, Candelario, Reddy, & Comai, 2009; Agherbi, Gaussman-Wenger, Vrthuy, Chasson, Serrano & Diabali, 2009).

Further reading says several genetic factors are implicated in aging. Specific gene combinations (genotypes) determine lifespan: remarkable changes in duration are observed as a result of alteration in a single gene, as in human progeroid syndromes (Navarro, Cau, & Levy, 2006). In addition, mutations in genomic and mitochondrial DNA are a consequence of reduced repair efficiency, and lead in part to deterioration of somatic stem cell function (Sharpless & DePinho, 2007).

With the above readings, aging with the decline function in the cellular level that resulted to age-associated changes in gene function is one of contributing factors of how the patient developed the disease Protein Malnutrition Essay Discussion: Alterations in Cellular Processes.

Another reading suggests that non-protein coding RNAs or better known as ncRNAs that nevertheless have a key role in development, health, and disease (Dauncey, 2013 & Bicknell, 1999). They act as regulators of transcription, epigenetic processes and gene silencing, and individual variation at non-coding regulatory sequences adds a further level of complexity. Dramatic advances in RNA biology over recent years is of particular significance to an understanding of the brain because neurons are highly transcriptionally active and demonstrate strong expression of ncRNAs. Many ncRNAs have a vital role in normal brain function and are involved in neural development, plasticity, memory, and cognition (Dauncey, 2009). Epigenetic processes are often involved, suggesting key interactions between ncRNAs and environmental factors such as nutrition (Dauncey, 2013).

In the scenario given, the patient is an elderly. As we age, our teeth are lost because of bone changes. Sensation of taste and smell also are diminished which makes the elderly eating as a less enjoyable which results to fair to poor appetite.  Effects of aging on the perceptions of smell and taste have been observed, which may alter or decrease food intake. This is a common perceived problem among elderly individuals who complain of a loss of both taste and smell (Busse, 1980). Food may not be chewed properly which makes swallowing challenging.  Also reduced appetite in older people has been linked to medication related reductions in saliva production, reduced taste ability and poor oral health (Pilgrim, Robinson, Sayer & Roberts, 2015).

Small intestine is the part of the gastrointestinal tract where much of the absorption takes place due to its large surface area provided by the numerous microvilli covering intestinal villi and the digestive enzymes on its surface actively secreted to optimize uptake of dietary substances. Adequate absorption takes place when there are mechanically intact digestive organs to produce the necessary enzymes as well as an adequate blood supply, motility, and microflora. Malabsorption develops when malfunction in any of these components leads to failure of absorption of nutrients resulting from a wide variety of causes (Babbin, Crawford, Sitaraman, 2006) Protein Malnutrition Essay Discussion: Alterations in Cellular Processes.

With inadequate food intake being mentioned an increase of required protein and energy are needed by our body.  As World Health Organization, used the term malnutrition which refers to deficiencies (‘undernutrition’), excesses or imbalances in a person’s intake of energy and/or nutrients (World Health Organization, 2016).

Other symptom presented is the, venous edema which correctly defined as a swelling caused by an increase in protein-poor interstitial fluid, which is a consequence of increased capillary filtration, is the most frequent type of leg edema (Blankfield, Finkelhor, Alexander, et al, 1998)

In the cellular level aspect, studies show protein digestion and absorption begin as proteolysis in the stomach with proenzymes that become automatically activated at low pH levels (i.e., an acidic environment). The extent of proteolysis depends on pH levels, gastric motility for mixing, and other dietary constituents presents during the process. For example, the duodenal and jejunal release of cholecystokinin (CCK) depends on the release of amino acids in the stomach. Amino acids stimulate the release of CCK, and CCK stimulates the release of pancreatic enzymes. Additional release of amino acids occurs in the duodenum through the action of other proteases. After various levels of protein digestion by pancreatic enzymes, amino acids, dipeptides, and tripeptides are ready for absorption via brush border sodium-dependent amino acid co-transporters. These sodium-dependent amino acid co-transporters transport the products of proteolysis both passively and secondarily through their indirect use of energy from a sodium-potassium ATPase pump. Different classes of amino acid transporters exist and select out amino acids based on being neutral, basic, or acidic. Further selectivity exists for the specific transport of dipeptides and tripeptides (Goodman, 2010)

Malabsorption affects millions of people worldwide. The fact that malabsorption syndromes have multiple etiologies obscures the prevalence and incidence. However, some malabsorption syndromes can be estimated by discussing the epidemiology of subgroups. Gluten-sensitive enteropathy (GSE) is present at its highest rates in Europeans and North Americans. GSE can be found in parts of India and is rarest in those of Asian, Caribbean, and African descent. Tropical sprue is known for affecting residents and visitors to Puerto Rico, the Caribbean, West Africa, northern South America, south-east Asia, and India (Owens & Greenson, 2007) Protein Malnutrition Essay Discussion: Alterations in Cellular Processes.

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References

https://www.cdc.gov/genomics/about/basics.htm

Accessed September 1, 2021

Li B, Jog S, Candelario J, Reddy S, Comai L. Altered Nuclear Functions In Progeroid Syndromes: a Paradigm For Aging Research. Scientific World Journal. 2009; 9:1449–1462.

Agherbi H, Gaussmann-Wenger A, Verthuy C, Chasson L, Serrano M, Djabali M. Polycomb Mediated Epigenetic Silencing and Replication Timing at the INK4a/ARF Locus During Senescence. PLoS One. 2009;4: e5622 Protein Malnutrition Essay Discussion: Alterations in Cellular Processes.

Navarro CL, Cau P, Levy N. Molecular Bases of Progeroid Syndromes. Hum Mol Genet. 2006;15(Spec No 2): R151–161.

Sharpless NE, DePinho RA. How Stem Cells Age and Why This Makes Us Grow Old. Nat Rev Mol Cell Biol. 2007; 8:703–713.

Dauncey MJ Genomic and Epigenomic Insights Into Nutrition and Brain disorders. Nutrients 2013; 5: 887–914.

Dauncey MJ, Bicknell RJ Nutrition and Neurodevelopment: Mechanisms of Developmental dysfunction and disease in later life. Nutrition Res Rev 1999; 12: 231–253.

Dauncey MJ New Insights Into Nutrition and Cognitive Neuroscience. Proc Nutr Soc 2009; 68: 408–415.

Pilgrim AL, Robinson SM, Sayer AA, Roberts HC. An Overview of Appetite Decline In Older People. Nursing Older People. 2015;27(5):29–35.

Babbin B.A., Crawford K., Sitaraman S.V. Malabsorption work-up: utility of small bowel biopsy. Clin. Gastroenterol. Hepatol. 2006;4:1193–1198.

http://www.who.int/features/qa/malnutrition/en/ (Last accessed 1 September 2021)

Busse, E. W. Eating In Late Life: Physiological and Psychological Factors. Am Phaemacol 20 (1980), pp. 36-38

Pilgrim AL, Robinson SM, Sayer AA, Roberts HC. An Overview of Appetite Decline In Older People. Nursing Older People. 2015;27(5):29–35.

 

Blankfield, R. P., Finkelhor, R. S., Alexander, J. J., et al. Etiology and Diagnosis Of Bilateral Leg Edema in primary care. Am J Med, 105 (3) (1998), pp. 192-197

 

Goodman, B.E. Insights into digestion and absorption of major nutrients in humans. Adv Physiol Educ. 2010 Jun;34(2):44-53.

Owens S.R, Greenson J.K. The Pathology Of Malabsorption: Current Concepts. Histopathology. 2007 Jan;50(1):64-82.

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In my scenario, an 83 year-old resident of a nursing facility is experiencing edema in their extremities and abdomen. Their medical history shows malabsorption syndrome and trouble eating due to not having dentures. The diagnosis is protein malnutrition. Protein-energy undernutrition, known as PEU, is actually common among institutionalized older people with edema being one of the symptoms (Morley, 2018). Genetics do not typically play a role in the cause of PEU, as the cause is typically malnutrition. Malnutrition is common among this population, with “up to 55% of elderly people admitted to hospital[s] [having] pre-existing evidence of malnutrition, [while in] the geriatric rehabilitation setting, the incidence of protein undernutrition…is estimated at 57%” (Wells & Dumbrell, 2006). This patient was at such a high risk, being institutionalized and having trouble eating (an obvious factor that would lead to malnutrition), this outcome was almost an inevitability. The physiologic response here was the edema. Edema is a swelling, typically of the lower extremities, which occurs when protein levels in the blood become too low. I believe this happened because proteins “help to hold salt and water inside the blood vessels so fluid does not leak out into the tissues” (Harvard Health Publishing, 2018) and their deficiency causes fluid to leak out and be retained in the tissues, usually the ones in the legs, ankles, and feet. In cases of cellular edema, it is the cells within these tissue that retain the extra fluids (Scallan et al., 2010). This type of malnutrition-based edema is common in children as well as the elderly, so had there been different characteristics, such as an age range in the twenties and thirties, I would have made a diagnosis of edema based off of factors like side effects of new medication, pregnancy, kidney disease, or emphysema (National Center for Biotechnology Information, 2016).

References
Harvard Health Publishing. (2018, December 18). Edema. Harvard Health; Harvard Health. https://www.health.harvard.edu/a_to_z/edema-a-to-z

Morley, J. (2018). Protein-Energy Undernutrition (PEU). Merck Manuals Professional Edition; Merck Manuals. https://www.merckmanuals.com/professional/nutritional-disorders/undernutrition/protein-energy-undernutrition-peu

National Center for Biotechnology Information. (2016, December 30). Causes and signs of edema. Nih.gov; Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK279409/

Scallan, J., Huxley, V. H., & Korthuis, R. J. (2010). Pathophysiology of Edema Formation. Nih.gov; Morgan & Claypool Life Sciences. https://www.ncbi.nlm.nih.gov/books/NBK53445/

Wells, J. L., & Dumbrell, A. C. (2006). Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clinical Interventions in Aging, 1(1), 67–79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682454/

Protein Malnutrition Essay Discussion: Alterations in Cellular Processes