NMDF211 Nutritional Biochemistry
Question:
Task:
Investigate the major metabolic pathways of the given case including elaborate critical discussion on the role of nutrient cofactors, substrates, hormones and enzymes in succeeding/failing to maintain normal metabolic functions within the body. Explain integration of various biochemical pathways and their correlation with client’s symptoms.
Overview:
The assignment should be structured as a report. The purpose of writing a report is to present information which can be described or analysed. Your report can have headings and subheadings, can include tables, graphs and diagrams; and information can be presented in dot point form where appropriate.
Case study
Susan is a 44 year old female who has gained 10 Kg over last two years. She is impressed with ‘detox diet’ that she read on an online blog and wants to try it. She loves perfumes. She watches her favourite web series till late night. Based on her biochemical report (see table below), her Nutritionist has suggested to address Gut dysbiosis and liver detox for her at an initial stage of intervention based on her GP’s diagnosis of non-alcoholic fatty liver disease (NAFLD) Her latest Ultrasound showed evidence of fatty infiltration (steatosis).
She experiences:
Fatigue and frequent urination, stress and anxiety, bloating, abdominal pain after foods.
She doesn’t have time to plan meals or cook and often buys take away foods.
When stressed, she drinks alcohol. She does not like fruits/salads.
Her stressful work does not allow her to have fix meal timings.
History: anxiety, food intolerance- shell fish.
Family history:
Father: Liver cancer, Mother: Diabetes Type II
One day Diet recall
(She likes to eat egg, meat and beef. She is trying to avoid processed foods for past one month)
Breakfast: oats with soy milk, orange juice
Mid-morning: black tea with biscuits
Lunch: beef curry with rice
Evening tea/Dinner: pasta Bolognese
Medications: Extensive anti-biotic use at 1 to 4 years (tonsillitis) and 13 to 15 years (mild acne)
Physical and Biochemical Tests:
|
Test |
Result |
Reference Range |
|
Blood pressure |
145/92 mm of Hg |
Systolic: 110-120 mm/Hg |
|
|
|
Diastolic: 70 – 80 mm/Hg |
|
Heart rate |
76 beats per minute |
72-84 beats per minute |
|
Respiratory rate |
18 per minute |
12-16 per minute |
|
Waist Hip Ratio |
1.4 |
<0.8 |
|
Temperature |
37.8?C |
35.8 – 37.3?C |
|
Body mass index (BMI) |
28 kg/m2 |
Normal 18.5-24.9 kg/m2 |
|
Blood glucose fasting |
7.0 mmol/L |
Below 5.5mmol/L |
|
Fasting insulin |
16mU/L |
Fasting 2 – 12 mU/L |
|
|
|
2hr post prandial 5 – 30 mU/L |
|
Liver tests: |
|
|
|
Albumin |
37 g/L |
34–48 |
|
Protein |
72 g/L |
65–85 |
|
Total bilirubin |
13 µmol/L |
2–24 |
|
GGT |
61 U/L |
<60 |
|
ALP |
112 U/L |
30–110 |
|
ALT |
57 U/L |
<55 |
|
AST |
50U/L |
<45 |
|
Total Cholesterol |
5.7mmol/L |
Below 4.0mmol/L |
Tasks:
- Investigate relevant liver detox pathways in Susan’s case and demonstrate your understanding of the client’s biochemical reports, symptoms and relevant medical/family history. Explain integration/interplay of her gut dysbiosis/microbiome and liver health.
- Based on your research and biochemical analysis, provide two (2) key nutritional/dietary interventions that may benefit this client based on a scientific rationale.
- Suggest one (1) key lifestyle intervention that may benefit this client with a scientific rationale.
Answer:
Introduction
It is a case of a 44 year old women Susan who has gained 10 kg of weight and now wants to try the detox diet in order to reduce the extra weight. Her nutritionist advices her to try gut dysbiosis and liver detox as an initial intervention. This intervention was based on her recent diagnosis that highlighted that she was suffering from non-alcoholic fatty liver disease (NAFLD) (Trovato et al., 2015).
Discussion
As per the case study the physician observed that the patient was experiencing fatigue and frequent urination. This implied that the patient might be suffering from diabetes. It was also noted by the nurse that the stressful job of the patient did not allow her to take meals at the fixed intervals. She also used to feel bloated after meals and experienced abdominal pain and along with this the patient consumes alcohol whenever she is stressed. As it is clear that the patient did not receive proper nutrition and rest that led to such a medical condition which created complications in her system and ultimately resulted in her being overweight (Hodges & Minich, 2015).
Good nutrition is a key part of a healthy lifestyle. The diet can help in achieving and maintaining weight that is healthy in combination with the physical activity that can reduce the risk of chronic diseases such as heart disease and cancer and promote overall health. By observing the biochemical reports for the patient it can be observed that the patient has elevated blood pressure, respiratory rate, Waist Hip Ratio, temperature, Body mass index (BMI), blood glucose fasting, and fasting insulin. All these results highlight the fact that the patient might be suffering from diabetes. The levels of both the fasting glucose and insulin is high that shows that the patient is either diabetic or is on the verge of being detected as diabetic (Carding et al., 2015).
The biochemical tests also highlighted the liver profile of the patient. It showed that the patient might be suffering from liver diseases as well because the patient has elevated levels of GGT (Gamma glutamyl transferase), ALT (Alanine aminotransferase), AST (Aspartate aminotransferase), ALP (Alkaline phosphatase). The high levels of all the four enzymes in the patient indicate that the condition of the liver in the patient is very bad and can even lead to mortality (). The rise in ALT is linked to type 2 diabetes whereas the elevated levels of GGT, AST and ALT are linked to the index of liver damage. The report also show that the total cholesterol level is also very high than the normal range that supports the fact that the patient might be suffering from diabetes.
As the patient was suffering from problems in the liver there has been problem in the liver detoxification pathway. The liver detoxification pathway provides the liver with certain special abilities that allows them to undergo oxidation, hydrolysis and reduction in the first phase and conjugation on the second. The role of diet-based nutrients in the regulation of metabolic pathways involved in detoxification processes has been and continues to be investigated. The existence of these findings generally indicates that specific foods can unregulates or balance metabolic pathways to assist in the biotransformation and subsequent removal of toxins (Trovato et al., 2015).
The lab reports indicate that the patient might be having problem in the phase 1 of the liver detoxification pathway. As the first phase is linked with hydrolysis and oxidation of the toxins that cannot be metabolized easily. There is increasing evidence that gut microbiota dysbiosis is associated with both intestinal and extra-intestinal disorders pathogenesis (Larsen & Dai, 2015). Intestinal disorders include allergy, asthma, metabolic syndrome, cardiovascular disease, and obesity, including inflammatory bowel disease, irritable bowel syndrome (IBS), and coeliac disease.
The microbiota works in conjunction with the defences of the host and the immune system to defend against colonization and invasion of pathogen (Larsen & Dai, 2015). It also conducts an important metabolic role, acting as the source of vital vitamins and nutrients, as well as helping to extract energy and nutrients from food, such as short-chain fatty acids (SCFA) and amino acids (Tilg et al., 2016). Eventually, for a variety of vital functions, the host relies on its intestinal microbiota and thus the intestinal microbiota may contribute to safety.
Dietary Interventions
The diet of chronic liver disease patients is based on a standard diet with appropriate supplements when required. Care management must aim at preserving adequate protein and caloric intake and addressing nutritional deficiencies (Anania et al., 2018). Restriction of proteins can worsen malnutrition and is not recommended, except in cases of hepatic encephalopathy that do not respond to personalized therapy. In view of the increased sensitivity of the patient to infection, food should be well cooked and distributed in 5–7 small daily meals to avoid protein overload and nausea or vomiting (Hernandez-Rodas, Valenzuela & Videla, 2015).
An evening snack seems to have a beneficial effect on the amount of nitrogen, and by reducing sarcopenia increases muscle mass. Thus, the clinician should advice the patient to have an evening snack as the patient usually skips the evening meal (Silva et al., 2015). The intake of evening snack should be taken as the first intervention. The second intervention is the involvement of the Mediterranean diet that includes diet that is constituted of lot of fibres as it is rich with fresh fruits, olives, nuts and cereals.
Lifestyle advice
The lifestyle advice that should be given to Susan is the reduction of the consumption of alcohol and also to perform certain physical exercise. The reduction in the alcohol intake can help Susan to overcome the problems of liver and the physical exercise will help her to keep active and fit. It will also help Susan to reduce the cholesterol level as well the problems of being overweight (Hernandez-Rodas, Valenzuela & Videla, 2015).
Conclusion
Thus, it can be concluded that Susan should follow the diet plan and lifestyle advice as provided by the healthcare professional. As the clinicians advices Susan to take meals at regular interval along with a diet that is rich in fruits, vegetables and cereals it will help the better detoxification of the body toxins. The reduction in the alcohol consumption and regular exercise will also help the patients to solve the problem of extra weight.
References
Anania, C., Perla, F. M., Olivero, F., Pacifico, L., & Chiesa, C. (2018). Mediterranean diet and nonalcoholic fatty liver disease. World journal of gastroenterology, 24(19), 2083–2094. doi:10.3748/wjg.v24.i19.2083
Carding, S., Verbeke, K., Vipond, D. T., Corfe, B. M., & Owen, L. J. (2015). Dysbiosis of the gut microbiota in disease. Microbial ecology in health and disease, 26, 26191. doi:10.3402/mehd.v26.26191
Hernandez-Rodas, M., Valenzuela, R., & Videla, L. (2015). Relevant aspects of nutritional and dietary interventions in non-alcoholic fatty liver disease. International journal of molecular sciences, 16(10), 25168-25198.
Hodges, R. E., & Minich, D. M. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. Journal of nutrition and metabolism, 2015, 760689. doi:10.1155/2015/760689
Larsen, P. E., & Dai, Y. (2015). Metabolome of human gut microbiome is predictive of host dysbiosis. Gigascience, 4(1), 42.
Silva, M., Gomes, S., Peixoto, A., Torres-Ramalho, P., Cardoso, H., Azevedo, R., … Macedo, G. (2015). Nutrition in Chronic Liver Disease. GE Portuguese journal of gastroenterology, 22(6), 268–276. doi:10.1016/j.jpge.2015.06.004
Tilg, H., Cani, P. D., & Mayer, E. A. (2016). Gut microbiome and liver diseases. Gut, 65(12), 2035-2044.
Trovato, F. M., Catalano, D., Martines, G. F., Pace, P., & Trovato, G. M. (2015). Mediterranean diet and non-alcoholic fatty liver disease: the need of extended and comprehensive interventions. Clinical Nutrition, 34(1), 86-88.
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