Content related to nutrition in SBPMD:
Introduction:
Overall, several areas covered in the SBPMD course are relevant to nutrition. Below is a
summary of the nutrition-related content in these areas as well as links to the respective
lectures. The detailed syllabus content can be viewed from the SBPMD web page (give
web address)
Energy metabolism:
 Overview
 Learning objectives
 Lecture links
Overview:
The lecture series on energy metabolism provides information on metabolic
processes of fundamental importance in human nutrition. Lectures on carbohydrates,
lipids and proteins provide basic structural and metabolic overviews, including
interconversion of fuels and metabolic regulation of nutrients. The interrelationship
between carbohydrate and fat metabolism and the regulation of stored nutrients is
described and an overview of biosynthetic and degradative pathways of macronutrient
metabolism is provided. Basic mechanisms underlying control of blood glucose are
included. For proteins, an overview of the genetic code and protein synthesis is provided,
as well as description of mutation effects on translation.
The lectures summarize how energy provided by nutrients in the food is utilized
in basic metabolism, discusses energy value of different food nutrients, and provides an
overview of energy conversion to heat in uncoupling reactions. The content is relevant in
our understanding of the relation of diet intake and energy expenditure to obesity. Energy
metabolism under aerobic/anaerobic conditions is reviewed, and the section on oxidative
stress and free radicals is relevant to the Nutrition lecture on Atherosclerosis in the
Clinical Practice I course. An overview of the central role of ATP in energy metabolism
is provided. The content provides insight in the fundamental principles for energy
storage, different ways to use energy, and the role of ATP in transport and signal
transduction.
The development of the fat cell, and regulation of fat storage, lipolysis and
transport is described. The differences in function between white and brown fat is
discussed. This content is relevant to the Nutrition lecture on Obesity in the Clinical
Practice I course. In the lecture on lipoprotein metabolism, the composition and
metabolism of the different lipoprotein classes are described as well as key enzymes and
receptors that control their metabolism. The lecture is relevant to the Nutrition lecture on
Atherosclerosis in the Clinical Practice I course. A basic overview of the regulation of
body temperature and how fuels can be converted to heat is given. The content is relevant
to understanding water requirements and how climate and exercise affect requirements.
Learning objectives:
From a nutrition perspective, the students should:
1. Be able to describe the major dietary classes of monosaccharides and their
structural differences.
2. Be able to describe the structural differences between phospholipids, triglycerides
and sterols.
3. Be able to describe the structural difference between different classes of fatty
acids.
4. Be able to describe how nutrition-regulated factors influence translation rate.
5. Be able to describe conditions where energy can be stored or converted to heat.
6. Be able to describe the different functions of ATP in synthetic and transport
functions and in signal transduction.
7. Be able to describe the metabolic interrelationship between carbohydrate and fat
metabolism.
8. Be able to explain (1) how the fed vs. the fasted state affect the metabolism of
glucose, fats and proteins, and (2) the hormonal regulation of the major metabolic
pathways
9. Be able to describe the structure of the different kinds of adipocytes, and how
storage, lipolysis and transport are regulated.
10. Beable to describe (1) the basic structure, synthesis and degradation of the major
lipoproteins, (2) how these pathways are affected by the fed vs. fasted states and
(3) the role of lipid transfer proteins that regulate the various pathways.
Lecture links (give specific web links):
Carbohydrates
Lipids
Protein synthesis
Energy currency
Energy and metabolism
ATP synthesis
Uses of energy
Oxidation of fuels
Synthesis and Storage of Fuels
The Adipocyte
Lipoprotein Metabolism
Regulation of Body Temperature
Endocrinology:
 Overview
 Learning objectives
 Lecture links
Overview:
A number of hormones impact on human nutrition. Hormones affect energy
metabolism, the interrelationship between anabolic and catabolic reactions, the
alternative use of carbohydrates, fat or proteins as energy sources, and endocrinological
diseases have nutritional consequences.
Lectures provide an understanding of the role played by the CNS and pituitary
gland in the regulation of homeostasis, and an overview of the basic structure, regulation
and functions of several key hormones. An overview of Growth Hormone in growth and
regulation of macronutrient metabolism is given, important for the understanding of
nutrient (carbohydrates and protein) consumption as well as exercise effects on growth
hormone levels. The content is relevant to lectures on Lifecycle Nutrition in the Clinical
Practice I course and to SBPM lectures on regulation of blood glucose.
The cell biology of insulin secretion, the histology of the pancreas, and the control
of islet cell secretion are detailed and provide basic understanding of how the
insulin/glucagon ratio regulates blood glucose concentration. Lectures describe the
regulation of insulin secretion, the ensuing changes in the major metabolic pathways, and
how these processes are affected in both normal and diabetic subjects in the fed and
fasted state. This is relevant to macronutrient metabolism and regulation of blood
glucose.
The physiology and hormonal control of calcium, phosphorus and magnesium
homeostasis is presented including a brief description of skeletal remodeling as it relates
to mineral metabolism. The role of thyroid and parathyroid hormones in metabolism and
in the regulation of calcium and phosphate respectively, is addressed. This content is
relevant to lectures on Lifecycle Nutrition in the Clinical Practice I course.
An overview of the individual components of the hypothalamo-pituitary-adrenal
axis and describes the major effects of cortisol on metabolism and on the inflammatory
and immune processes. The reproductive endocrinology lectures provide an extensive
overview of the development of male and female reproductive organs and the hormonal
regulation of reproduction, pregnancy and lactation. Though there are few direct links to
nutrition, an understanding of these lectures is critical to fully appreciating the Lifecycle
Nutrition lectures. The Cytogenetics lecture provides a basis for understanding the impact
of malnutrition on the fetus and also drug teratogenicity.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Describe the (1) impact of growth hormone on macronutrient metabolism, and
(2) the impact of nutritional status on growth hormone secretion.
2. Explain how glucose affects the secretion of insulin and in turn how insulin
and glucagon regulate blood glucose concentration.
3. List the primary functions of the major minerals calcium, phosphorus and
magnesium, and the factors that control their absorption, excretion and serum
concentrations.
4. Describe how insulin and glucagon secretion and action, both in normal and
diabetic subjects, are affected by the fed and fasted state.
5. Explain the basic physiology of male and female sexual development,
including hormonal regulation of the processes. Mastery of these concepts
will enable the student to appreciate how nutritional status can affect fetal
development, growth, sexual development and reproduction.
Lecture links:
Growth Hormone
The Endocrinology of Normal Mineral Homeostasis
Pancreatic Islets
Pancreatic Physiology
Gonadal Function
Male Reproductive System
Testis
Adult Reproduction I & II
Ovarian and Uterine Structure
Fertilization, Pregnancy and Lactation
Structure and Function of the Breast
Placenta
Cytogenetics
Gastroenterology:
 Overview
 Learning objectives
 Lecture links
Overview:
Factors affecting nutrient intake, absorption and excretion are important in
nutrition. These are reviewed in the gastroenterology section of SBPMD, where the
impact of diseases resulting in malabsorption and nutrition deficiencies also are
presented.
Lectures provide an overview of digestion of food and nutrient intake. The
content correlates to malabsorption and undernutrition. The development of the tooth and
its function in mastication as well as age-induced changes in tooth structure are
discussed. An overview of the exocrine and endocrine gastric secretion is provided,
describing mechanisms for digestion of food products and the interaction between food
and local factors.
Lectures on digestion and absorption and biliary secretion provides a basic
understanding of the mechanisms involved in the digestion and absorption of
macronutrients-carbohydrates, protein and fat, biliary secretion, enterohepatic circulation
and the role of bile salts in lipid metabolism. Mechanisms for food and nutrient uptake
and for hydrolysis and absorption of carbohydrates and fat are described. The importance
of ion transport mechanisms is reviewed as well as secretory functions of exocrine glands
involved in food digestion and nutrient uptake. Effect of long-term diet modifications on
digestive enzymes is addressed. These lectures are relevant for the understanding of
nutrient intake and absorption.
A lecture on the complex enteric nervous system is relevant to the understanding
of congenital abnormalities of the ENS and gastro-intestinal diseases in the adult. In
another lecture, an overview of the mechanisms of contractile activity in the fasting and
fed state, including swallowing, gastric emptying, and propulsion and mixing in the small
and large intestines is provided. This is relevant to the understanding of gastro-intestinal
nutrition in health and disease.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Explain the mechanisms in the metabolism of fat and cholesterol.
2. Discuss the rationale for the regimens in the treatment of hyperlipidemia.
3. Describe and explain the anatomical considerations and the various stages of
digestion and absorption of macronutrients and electrolytes in the nutritional
treatment of patients with gastrointestinal disturbances.
Lecture links:
Gut morphology
Structure and biology of the Tooth
Gastric secretion
Digestion and Absorption
Pancreatic and salivary secretion
Biliary Secretion
Enteric Nervous System
Gastrointestinal Motility
Fluid and electrolytes
 Overview
 Learning objectives
 Lecture links
Overview:
The nutrition aspects in this area relates to regulation of water and electrolyte
intake. An introduction to renal structure and function is provided. An overview of a
major function of the kidney and the regulation of extracellular space homeostasis is
given. The distribution of water and ions within a multicellular organism and the different
compositions of the intracellular and extracellular departments are reviewed. The content
is relevant to the understanding of the regulation of sodium intake and relevant to the
understanding of renal nutrition, e.g. dietary sodium intake in congestive heart failure,
renal disease and hypertension.
A lecture provides an understanding of the assessment of potassium balance and
how the kidney handles potassium along the nephron, relevant to the understanding of
dietary intake and excretion of potassium.
Lectures providing an overview of the water content of the body and the reasons
to regulate it and the processes that generate acid or base are given. The content is
relevant to the understanding that metabolism of fuels present in foods results in the
generation of volatile and non-volatile acid as well as base.
Learning objectives:
From a nutrition perspective, the students should be able to:
1. Explain the interrelationships of renal disease and dietary factors such as protein,
electrolytes and water.
2. Describe the impact of dietary factors on acid-base balance
Lecture links:
Volume and Composition of the Body Fluids
Introduction to Renal Structure and Function
Regulation of Extracellular Fluid Volume
Renal Blood Flow and Glomerular Filtration
Regulation of Water Content
Potassium