1, cori.bmp
"Glycolysis can never proceed in the absence of oxygen."
"F"
"As long as NAD is recycled, by reducing pyruvate to lactate, glycolysis can occur under anaerobic conditions."
"Many tumours metabolize glucose by anaerobic glycolysis (and the pentose phosphate pathway)."
"T"
"Many tumours have poor oxidative metabolism. They recycle NAD by reducing pyruvate to lactate, which is exported to the liver for gluconeogenesis." 
2, cori.bmp
"Gluconeogenesis from lactate requires less ATP than is formed during anaerobic glycolysis."
"F"
"Gluconeogenesis requires more ATP than is formed in glycolysis. This is why increased cycling between anaerobic glycolysis and gluconeogenesis leads to hypermetabolism and cachexia."
"There is acidosis as a result of anaerobic glycolysis."
"T"
"This is the result of release from muscle of large amounts of lactate, which is an acid." 
3, cori.bmp
"Oxygen debt is caused by the need to exhale carbon dioxide produced in response to acidosis."
"F"
"Oxygen debt represents the increased metabolic activity to provide the ATP required for gluconeogenesis from lactate after vigorous exercise."
"Oxygen debt reflects the need to replace oxygen that has been used in muscle during vigorous exercise."
"F"
"Oxygen debt represents the increased metabolic activity to provide the ATP required for gluconeogenesis from lactate after vigorous exercise." 
4, cori.bmp
"In anaerobic glycolysis pyruvate is reduced to lactate in muscle."
"T"
"The reduction of pyruvate to lactate permits recycling of NAD under anaerobic conditions, so that glycolysis can continue."
"Most of the lactate released from tumours is used for gluconeogenesis in the liver."
"T"
"A proportion will be oxidized carbon dioxide and water, to provide the ATP required for gluconeogenesis." 
5, fast.bmp
"In the fasting state there is increased secretion of glucagon in response to decreased glucose in the portal blood."
"T"
"As the concentration of glucose in the hepatic portal vein falls, so insulin secretion falls, and glucagon secretion increases."
"In the fasting state there is decreased secretion of glucagon in response to decreased glucose in the portal blood."
"F"
"As the concentration of glucose in the hepatic portal vein falls, so insulin secretion falls, and glucagon secretion increases."
6, fast.bmp
"In the fasting state there is increased secretion of insulin in response to decreased glucose in the portal blood."
"F"
"Insulin is the hormone of the fed state. It is secreted in response to an increased concentration of glucose in the hepatic portal vein, coming from the gastro-intestinal tract. In the fasting state, as the concentration of glucose in the hepatic portal vein falls, so insulin secretion falls and glucagon secretion increases."
"In the fasting state there is decreased secretion of insulin in response to decreased glucose in the portal blood."
"T"
"Insulin is the hormone of the fed state. It is secreted in response to an increased concentration of glucose in the hepatic portal vein, coming from the gastro-intestinal tract. In the fasting state, as the concentration of glucose in the hepatic portal vein falls, so insulin secretion falls and glucagon secretion increases." 
7, fast.bmp.
"In the fasting state, insulin acts to increase the synthesis of glycogen from glucose."
"F"
"Insulin is the hormone of the fed state; its main actions are to increase the synthesis of tissue reserves of glycogen, triacylglycerol and protein when there is an abundant supply of metabolic fuels coming from a meal. It is glucagon, secreted in the fasting state, that acts to increase the breakdown of glycogen."
"In the fasting state, glucagon acts to increase the synthesis of glycogen from glucose."
"F"
"Glucagon is secreted in the fasting state and acts to increase the breakdown of glycogen." 
8, fast.bmp
"In the fasting state insulin acts to increase the breakdown of glycogen to maintain blood glucose."
"F"
"Insulin acts to increase the synthesis of glycogen, and decrease its breakdown; it is glucagon, secreted in the fasting state, that acts to increase the breakdown of glycogen."
"In the fasting state glucagon acts to increase the breakdown of glycogen to maintain blood glucose."
"T"
"Glucagon is secreted in the fasting state and acts to increase the breakdown of glycogen." 
9, fuels.bmp
"In the fasting state the main metabolic fuel for most tissues comes from fatty acids released from adipose tissue."
"T"
"Apart from tissues that are more or less completely reliant on glucose as their fuel, most tissues use fatty acids from adipose tissue reserves in the fasting state."
"In the fed state the main metabolic fuel for most tissues is glucose."
"T"
"When there is an abundant supply of glucose it is the main fuel for most tissues." 
10, fuels.bmp
"In the fed state muscle can take up glucose for use as a metabolic fuel because glucose transport in muscle is stimulated in response to insulin."
"T"
"Insulin acts to recruit glucose transporters to the cell surface in muscle and adipose tissue, so that in the presence of insulin they can take up and metabolize glucose."
"In the fed state muscle can take up glucose for use as a metabolic fuel because glucose transport in muscle is stimulated in response to glucagon."
"F"
"Glucagon is secreted in the fasting state. Insulin is secreted in the fed state and acts to recruit glucose transporters to the cell surface in muscle and adipose tissue, so that in the presence of insulin they can take up and metabolize glucose." 
11, fuels.bmp
"In the fed state adipose tissue can take up glucose for synthesis of triacylglycerol because glucose transport in adipose tissue is stimulated in response to insulin."
"T"
"Insulin acts to recruit glucose transporters to the cell surface in muscle and adipose tissue, so that in the presence of insulin they can take up and metabolize glucose."
"In the fed state adipose can take up glucose for synthesis of triacylglycerol because glucose transport in adipose tissue is stimulated in response to glucagon."
"T"
"Glucagon is secreted in the fasting state. Insulin is secreted in the fed state and acts to recruit glucose transporters to the cell surface in muscle and adipose tissue, so that in the presence of insulin they can take up and metabolize glucose." 
12, fuels.bmp
"Ketone bodies are synthesized in muscle in the fasting state, and the amount synthesized increases as fasting extends into starvation."
"F"
"Ketone bodies are synthesized in the liver, and are exported to muscle and other tissues in the fasting state."
"Ketone bodies are synthesized in liver in the fasting state, and the amount synthesized increases as fasting extends into starvation."
"T"
"Ketone bodies are synthesized in the liver, and are exported to muscle and other tissues in the fasting state for use as a metabolic fuel, so as to spare glucose for tissues that are more or less completely reliant on glucose. Ketogenesis increases as fasting is prolonged." 
13, fuels.bmp
"Plasma glucose is maintained in starvation and prolonged fasting by breakdown of liver glycogen reserves."
"F"
"Liver and muscle glycogen together would only meet glucose needs in fasting for about 18 hours. As fasting is prolonged, so increasingly glucose is synthesized by gluconeogenesis from amino acids and the glycerol of triacylglycerols."
"Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis from amino acids."
"T"
"Liver and muscle glycogen together would only meet glucose needs in fasting for about 18 hours. As fasting is prolonged, so increasingly glucose is synthesized by gluconeogenesis from amino acids and the glycerol of triacylglycerols." 
14, fuels.bmp
"Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis from fatty acids."
 "F"
"Fatty acids can never be a substrate for gluconeogenesis."
"Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis from ketone bodies."
"F"
"Ketone bodies can never be a substrate for gluconeogenesis." 
15, fuels.bmp
"Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis from the glycerol released from adipose tissue triacylglycerol."
"T"
"Glycerol is substrate for gluconeogenesis. However, the fatty acids from triacylglycerol can never be a substrate for gluconeogenesis."
 "Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis from the amino acids released by the breakdown of muscle protein."
"T"
"Liver and muscle glycogen together would only meet glucose needs in fasting for about 18 hours. As fasting is prolonged, so increasingly glucose is synthesized by gluconeogenesis from amino acids and the glycerol of triacylglycerols." 
16, fuels.bmp
"Fatty acids and triacylglycerol are synthesized in adipose tissue in the fasting state."
"F"
"In the fasting state triacylglycerol is hydrolysed to release fatty acids for use as a metabolic fuel, and fatty acid synthesis is inhibited."
"Fatty acids and triacylglycerol are synthesized in adipose tissue in the fed state."
"T"
"Insulin is the hormone of the fed state; its main actions are to increase the synthesis of tissue reserves of glycogen, triacylglycerol and protein when there is an abundant supply of metabolic fuels coming from a meal." 
17, fuels.bmp
"Fatty acids and triacylglycerol are synthesized in the liver in the fasting state."
"F"
"In the fasting state triacylglycerol and fatty acid synthesis are inhibited."
"Fatty acids and triacylglycerol are synthesized in the liver in the fed state."
"T"
"Insulin is the hormone of the fed state; its main actions are to increase the synthesis of tissue reserves of glycogen, triacylglycerol and protein when there is an abundant supply of metabolic fuels coming from a meal." 
18, fuels.bmp
"Ketone bodies provide the main fuel for the central nervous system in the fasting state."
"F"
"Although the central nervous system can use ketone bodies as a metabolic fuel, they cannot account for more than a small percentage of total nervous system energy requirements."
"Ketone bodies provide the main fuel for red blood cells in the fasting state."
"F"
"Red blood cells lack mitochondria, and therefore can never metabolize fatty acids or ketone bodies; they are completely reliant on glucose as their metabolic fuel at all times." 
19, fast.bmp
"In the fasting state the kidneys synthesize glucose from amino acids."
"T"
"Liver and muscle glycogen together would only meet glucose needs in fasting for about 18 hours. As fasting is prolonged, so increasingly glucose is synthesized by gluconeogenesis from amino acids in the liver, kidneys and intestinal mucosal cells."
"In the fasting state muscle synthesizes glucose from amino acids."
"F"
"Muscle does not have the enzymes required for gluconeogenesis. It releases amino acids from the breakdown of muscle protein; these are used by the liver, kidneys and intestinal mucosal cells as substrates for gluconeogenesis." 
20, fuels.bmp
"In the fasting state adipose tissue synthesizes ketone bodies." 
"F"
"Adipose tissue releases fatty acids in the fasting state; these are used in the liver for synthesis of ketone bodies."
"In the fasting state adipose tissue synthesizes glucose from the glycerol released by the breakdown of triacylglycerol."
"F"
"Adipose tissue lacks the enzymes required for gluconeogenesis; it exports the glycerol released by the breakdown of triacylglycerol to the liver, where it is a substrate for gluconeogenesis." 
21, fuels.bmp
"In the fasting state the main fuel for the central nervous system is fatty acids released from adipose tissue."
"F"
"The central nervous system has a very limited capacity for the oxidation of fatty acids, and they can never provide more than a small proportion of energy needs. The main fuel of the central nervous system is glucose under all conditions."
"In the fasting state the main fuel for red blood cells is fatty acids released from adipose tissue."
"F"
"Red blood cells lack mitochondria, and therefore can never metabolize fatty acids or ketone bodies; they are completely reliant on glucose as their metabolic fuel at all times." 
22, wtloss.bmp
"The blue line shows the theoretical weight loss for a subject who is consuming less energy from food than his/her energy expenditure. The red line shows the observed weight loss over several weeks. Part of the explanation for the difference is that as body weight decreases the Basal Metabolic Rate (BMR) falls."
"T"
"BMR decreases with decreasing body weight, and therefore a person with a lighter body will have a lower energy requirement, not only for maintenance, but also because the energy cost of physical activity decreases with decreasing BMR." 
"The blue line shows the theoretical weight loss for a subject who is consuming less energy from food than his/her energy expenditure. The red line shows the observed weight loss over several weeks. Part of the explanation for the difference is that as body weight decreases the Basal Metabolic Rate (BMR) increases."
"F"
"BMR decreases with decreasing body weight, and therefore a person with a lighter body will have a lower energy requirement, not only for maintenance, but also because the energy cost of physical activity decreases with decreasing BMR." 
23, cori2.bmp
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. There is no increase in total glucose oxidation, therefore there must be an increase in fatty acid oxidation in the hypermetabolic patients."
"T"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP. If glucose oxidation is not increased, the ATP must be coming from fatty acid oxidation. This will result in considerably reduced adipose tissue reserves, leading to significant wasting."
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. There is no increase in total glucose oxidation, and fatty acid oxidation will be normal in the hypermetabolic patients."
"F"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP. If glucose oxidation is not increased, the ATP must be coming from fatty acid oxidation. This will result in considerably reduced adipose tissue reserves, leading to significant wasting."
24, cori2.bmp
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. The hypermetabolic patients will have a lower body temperature than those whose weight is stable."
"F"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP, and therefore there must be an increased metabolic rate. This will result in an elevated body temperature."
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. The hypermetabolic patients will have a higher body temperature than those whose weight is stable."
"T"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP, and therefore there must be an increased metabolic rate. This will result in an elevated body temperature."
25, cori2.bmp
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. The hypermetabolic patients will have a lower oxygen consumption than those whose weight is stable."
"F"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP, and therefore there must be an increased metabolic rate. This will result in an increased rate of oxygen consumption."
"The diagram shows glucose oxidation and cycling between glycolysis and gluconeogenesis in three groups of patients with advanced cancer. The hypermetabolic patients will have a higher oxygen consumption than those whose weight is stable."
"T"
"There is a very considerable increase in cycling between glycolysis and gluconeogenesis in the hypermetabolic patients. This requires a significant amount of ATP, and therefore there must be an increased metabolic rate. This will result in an increased rate of oxygen consumption."
26, blank.bmp
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in a decrease in metabolic rate."
"F"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate."
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in an increase in metabolic rate."
"T"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate."
27, blank.bmp
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in a decrease in oxygen consumption."
"F"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate, and hence increased oxygen consumption."
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in an increase in oxygen consumption."
"T"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate, and hence increased oxygen consumption."
28, blank.bmp
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in a decrease in body temperature."
"F"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate, and hence increased body temperature."
"Stimulation of adipose tissue hormone-sensitive lipase by tumour proteoglycan in patients with cachexia will result in an increase in body temperature."
"T"
"Stimulation of adipose tissue hormone-sensitive lipase will result in release of fatty acids into the circulation. If these are not required for muscle metabolism, they will be taken up by the liver, re-esterified to triacylglycerol and exported in very low density lipoprotein. There is a cost of 6 x ATP for each mol of triacylglycerol formed from fatty acids and glycerol phosphate, so this cycling of lipids will result in an increased metabolic rate, and hence increased body temperature."
29, blank.bmp
"An increase in metabolic rate of approximately 13% in a hypermetabolic patient will result in a 1 degree Celsius rise in body temperature."
"T"
"Each degree Celsius increase in body temperature, in fever or hypermetabolism, requires an increase of about 13% in metabolic rate."
"An increase in metabolic rate of approximately 13% in a hypermetabolic patient will result in a 1 degree Celsius fall in body temperature."
"F"
"Hypermetabolism means an increase in metabolic rate, and hence increased heat production. There will therefore be a rise in body temperature. Each degree Celsius increase in body temperature, in fever or hypermetabolism, implies an increase of about 13% in metabolic rate."
30, blank.bmp
"A hypermetabolic patient will consume about 2 - 2.7 L additional oxygen per hour for each degree Celsius increase in body temperature."
"T"
"Each degree Celsius increase in body temperature requires a 13% increase in metabolic rate. Assuming an initial energy expenditure of 8 - 10 MJ / day, 1 degree Celsius increase in temperature will require an additional 1 - 1.3 MJ energy expenditure. Each L of oxygen consumed is equivalent to 20 kJ; therefore 1 MJ additional energy expenditure will require an additional 50 L oxygen, and 1.3 MJ an additional 65 L per day. This gives an increase in oxygen consumption of between 50/24 = 2.1 and 65/24 = 2.7 L per hour."
"A hypermetabolic patient will consume about 2 - 2.7 L less oxygen per hour for each degree Celsius increase in body temperature."
"F"
"Hypermetabolism means an increase in metabolic rate, and therefore an increase in oxygen consumption."
31, blank.bmp
"Part of the emaciation and wasting of patients with cachexia is due to reduced protein synthesis. There is decreased protein synthesis because of the high ATP cost of protein synthesis."
"T"
"Protein synthesis requires 4 x ATP per amino acid incorporated, plus additional ATP for amino acid transport and RNA synthesis; in an undernourished person (and this will include a patient with cachexia) the rate of protein synthesis falls because there is a lack of metabolic fuel to provide this ATP."
"Part of the increased metabolic rate in patients with cachexia is due to an increase in protein synthesis."
"F"
"Although protein synthesis is indeed energy expensive, and an increased rate of protein synthesis would result in increased metabolic activity to provide the ATP required, in patients with cachexia there is a reduction in protein synthesis, partly because of a lack of metabolic fuels to provide the necessary ATP."
32, blank.bmp
"Part of the emaciation and wasting of patients with cachexia is due to reduced protein synthesis. There is decreased protein synthesis because of depletion of tissue pools of amino acids by the tumour."
"T"
"Many tumours have high requirements for glutamate and leucine, and interferon-gamma induces indoleamine dioxygenase, which depletes tissue pools of tryptophan. This shortage of amino acids impairs protein synthesis."
"Part of the emaciation and wasting of patients with cachexia is due to reduced protein synthesis. There is decreased protein synthesis because of insulin resistance."
"T"
"Tumour necrosis factor, secreted in response to many tumours, impairs the function of the insulin receptor; insulin stimulates amino acid uptake and protein synthesis, therefore in the presence of tumour necrosis factor there will be decreased protein synthesis."
33, blank.bmp
"Part of the emaciation and wasting of patients with cachexia is due to increased protein catabolism. "
"T"
"In cachexia there is an increase in tissue protein catabolism, as well as a decrease in protein synthesis, and this adds to the emaciation and wasting."
"Part of the emaciation and wasting in patients with marasmus is due to increased protein catabolism."
"F"
"In marasmus there is no increase in protein catabolism. The nett loss of tissue protein is the result of decreased replacement synthesis."
34, blank.bmp
"Part of the emaciation and wasting of patients with marasmus is due to reduced protein synthesis. There is decreased protein synthesis because of the high ATP cost of protein synthesis."
"T"
"Protein synthesis requires 4 x ATP per amino acid incorporated, plus additional ATP for amino acid transport and RNA synthesis; in an undernourished person the rate of protein synthesis falls because there is a lack of metabolic fuel to provide this ATP."
"Part of the emaciation and wasting in patients with marasmus is due to increased protein catabolism."
"F"
"In marasmus there is no increase in protein catabolism. The nett loss of tissue protein is the result of decreased replacement synthesis."
35, blank.bmp
"Marasmus is the predictable result of prolonged inadequate food intake."
"T"
"If you extrapolate from the normal fasting state into prolonged starvation you can explain the loss of adipose tissue and muscle protein which lead to the wasting and emaciation of marasmus."
"Kwashiorkor is the predictable result of prolonged inadequate food intake."
"F"
"If you extrapolate from the normal fasting state into prolonged starvation you can explain the loss of adipose tissue and muscle protein which lead to the wasting and emaciation of marasmus. However, there are additional factors involved in the development of kwashiorkor."
36, blank.bmp
"People with marasmus may show clinical signs of vitamin A deficiency that does not respond to vitamin A supplements."
"T"
"Transport of vitamin A from the liver requires a plasma retinol binding protein, and synthesis of this protein is severely impaired in protein-energy malnutrition, so that there may well be functional vitamin A deficiency despite adequate liver reserves."
"People with marasmus may show clinical signs of vitamin A deficiency yet a liver biopsy would reveal adequate liver reserves of the vitamin."
"T"
"Transport of vitamin A from the liver requires a plasma retinol binding protein, and synthesis of this protein is severely impaired in protein-energy malnutrition, so that there may well be functional vitamin A deficiency despite adequate liver reserves."
37, blank.bmp
"Children with kwashiorkor may show clinical signs of vitamin A deficiency that does not respond to vitamin A supplements."
"T"
"Transport of vitamin A from the liver requires a plasma retinol binding protein, and synthesis of this protein is severely impaired in protein-energy malnutrition, so that there may well be functional vitamin A deficiency despite adequate liver reserves, and this will not respond to supplements of the vitamin."
"Children with kwashiorkor may show clinical signs of vitamin A deficiency yet a liver biopsy would reveal adequate liver reserves of the vitamin."
"T"
"Transport of vitamin A from the liver requires a plasma retinol binding protein, and synthesis of this protein is severely impaired in protein-energy malnutrition, so that there may well be functional vitamin A deficiency despite adequate liver reserves, and this will not respond to supplements of the vitamin."
38, blank.bmp
"People with marasmus are no more susceptible to infections than adequately fed people."
"F"
"Protein-energy malnutrition leads to severely impaired synthesis of immunoglobulins (because of the high energy cost of protein synthesis). This means that they are more susceptible to infections. Indeed, what are considered to be mild infections in adequately nourished people may prove fatal to those who are severely under-nourished."
"Children with kwashiorkor are more susceptible to infections than adequately fed children."
"T"
"Protein-energy malnutrition leads to severely impaired synthesis of immunoglobulins (because of the high energy cost of protein synthesis). This means that children with kwashiorkor are more susceptible to infections. Indeed, what are considered to be mild infections in adequately nourished children may prove fatal to those who are severely under-nourished."
39, blank.bmp
"Protein-energy malnutrition can be a cause of malabsorption."
"T"
"There is considerable loss of the intestinal mucosa in protein-energy malnutrition, with flattening of the villi. This is because intestinal mucosal cells normally turn over within about 48 hours, and this is a very energy expensive process. The flattening of the villi leads to a very considerable reduction in the absorptive surface of the small intestine, and hence malabsorption of such food as is available."
"Protein-energy malnutrition can be a cause of diarrhoea."
"T"
"There is considerable loss of the intestinal mucosa in protein-energy malnutrition, with flattening of the villi. This is because intestinal mucosal cells normally turn over within about 48 hours, and this is a very energy expensive process. The flattening of the villi leads to a very considerable reduction in the absorptive surface of the small intestine, and hence malabsorption of such food as is available. This malabsorption results in diarrhoea."
40, blank.bmp
"In patients with cachexia part of the problem is due to impaired food intake."
"T"
"There is impairment of appetite in many serious diseases, and many of the drugs used to treat cancer cause distortion of the sense of taste."
"Chemotherapy for cancer can cause malabsorption."
"T"
"Chemotherapy is designed to prevent cell proliferation in the tumour, but will have a similar effect on all rapidly dividing tissues. Intestinal mucosal cells normally turn over within about 48 hours; inhibition of cell proliferation leads to loss of the mucosa and flattening of the villi, resulting in a very considerable reduction in the absorptive surface of the small intestine, and hence malabsorption of such food as is available."
41, stunting.bmp
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. Marasmus is defined as weight < 60% of that expected, with oedema."
"F"
"This would be marasmic kwashiorkor, the most serious form of malnutrition. Marasmus is defined as weight < 60% of that expected, with no oedema."
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. Marasmus is defined as weight < 60% of that expected, with no oedema."
"T"
"Marasmus is defined as weight < 60% of that expected, with no oedema. Weight between 60 - 80% of that expected, without oedema, is classified as undernutrition."
42, stunting.bmp
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. Kwashiorkor is defined as weight < 60% of that expected, with oedema."
"F"
"This would be marasmic kwashiorkor, the most serious form of malnutrition. Kwashiorkor is defined as weight 60 - 80% of that expected, with oedema."
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. Kwashiorkor is defined as weight 60 - 80% of that expected, with oedema."
"T"
"Kwashiorkor is defined as weight 60 - 80% of that expected, with oedema. Weight < 60% of that expected, with oedema, is marasmic kwashiorkor."
43, stunting.bmp
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. There is stunting of growth in kwashiorkor, showing that there is a deficiency of protein."
"F"
"The diagram shows that children with kwashiorkor are not significantly stunted, achieving > 90% of expected height for age; children with marasmus and marasmic kwashiorkor are more significantly stunted."
"Malnourished children may suffer from marasmus, kwashiorkor or marasmic kwashiorkor. There is little or no stunting of growth in kwashiorkor, showing that the problem is not a simple deficiency of protein."
"T"
"The diagram shows that children with kwashiorkor are not significantly stunted, achieving > 90% of expected height for age; children with marasmus and marasmic kwashiorkor are more significantly stunted."
44, blank.bmp
"Protein deficiency is a major problem in developing countries."
"F"
"What we call protein-energy malnutrition is really a lack of metabolic fuels, with protein being used for energy-yielding metabolism. Increasing energy intake (eg with carbohydrate) can result in increased protein synthesis and positive nitrogen balance in undernourished children."
Increasing energy intake (eg with carbohydrate) can result in increased protein synthesis and positive nitrogen balance in undernourished children."
"T"
"What we call protein-energy malnutrition is really a lack of metabolic fuels, with protein being used for energy-yielding metabolism. Providing additional metabolic fuel both spares dietary protein for tissue protein synthesis and also permits protein synthesis (which is an energy expensive process) to proceed."
45, blank.bmp
"Kwashiorkor may be precipitated in malnourished children by a mild infection."
"T"
"It is a common observation that a few months after an outbreak of disease such as measles there is an increase in cases of kwashiorkor in developing countries. It is likely that the increased radical production as a result of activation of macrophages is what precipitates the development of kwashiorkor in undernourished children."
"Kwashiorkor may be precipitated in malnourished children by oxygen radical damage to cell membranes."
"T"
"It is a common observation that a few months after an outbreak of disease such as measles there is an increase in cases of kwashiorkor in developing countries. It is likely that the increased radical production as a result of activation of macrophages is what precipitates the development of kwashiorkor in undernourished children."
46, blank.bmp
"The oedema of kwashiorkor does not resolve unless the child is fed a high protein diet."
"F"
"The oedema of kwashiorkor resolves rapidly once the child is provided an adequate intake of energy; protein is not essential."
"The oedema of kwashiorkor begins to resolve when the child is fed a high carbohydrate diet."
"T"
"The oedema of kwashiorkor resolves rapidly once the child is provided an adequate intake of energy; protein is not essential."
47, blank.bmp
"Kwashiorkor is caused by feeding a diet that provides adequate energy by is deficient in protein."
"F"
"This was the belief at one time, but it is now known that  the cause of kwashiorkor is a lack of metabolic fuels (ie energy) and not protein deficiency with an adequate energy intake."
"Kwashiorkor is caused by feeding a diet that provides adequate energy by is deficient in protein."
"F"
"This was the belief at one time, but it is now known that  the cause of kwashiorkor is a lack of metabolic fuels (ie energy) and not protein deficiency with an adequate energy intake."
48, blank.bmp
"Marasmus is characterized by fatty infiltration of the liver."
"F"
"It is kwashiorkor that is characterized by fatty infiltration of the liver."
"Kwashiorkor is characterized by fatty infiltration of the liver."
"T"
"One of the features that distinguishes kwashiorkor from marasmus is fatty infiltration of the liver."
49, blank.bmp
"Marasmus is characterized by sparse, whispy, under-pigmented hair."
"F"
"It is kwashiorkor that is characterized by sparse, whispy, under-pigmented hair."
"Kwashiorkor is characterized by sparse, whispy, under-pigmented hair."
"T"
"One of the features that distinguishes kwashiorkor from marasmus is sparse, whispy, under-pigmented hair."
50, blank.bmp
"Marasmus is characterized by sooty dermatitis."
"F"
"It is kwashiorkor that is characterized by sooty dermatitis."
"Kwashiorkor is characterized by sooty dermatitis."
"T"
"One of the features that distinguishes kwashiorkor from marasmus is sooty dermatitis."
51, blank.bmp
"Marasmus is characterized by oedema."
"F"
"It is kwashiorkor that is characterized by oedema."
"Kwashiorkor is characterized by oedema."
"T"
"The key feature that distinguishes kwashiorkor from marasmus is oedema."
-999
Copyright David A Bender 2002

