MIA syndrome.ppt
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The relationship between diet and MIA syndrome in ESRD.
Rebecca Chiang
2006/3/24
Introduction
* Malnutrition ,defined as insufficient Protein-calorie intake ,is highly prevalent in HD and PD patients.
* There may be at least two different types of malnutrition in the patients.
* The first type (type1) is associated with the uraemia (such as physical inactivity , underdialysis, dietary restrictions and psychosocial factors)
Introduction
* It is characterized by a modest reduction in serum albumin levels ,became of lower protein and energy intake due to uraemia toxicity.
* Second, Type 2 malnutrition is characterized by hypoalbuminaemia, higher REE (resting energy expenditure ), increased oxidative stress and increased protein catabolism.
Introduction
* In this type of malnutrition is usually an inflammatory response, higher levels of CRP and pro-inflammatory cytokines.
* The type2 malnutrition is associated with MIA syndrome.
Type2 malnutrition and atherosclerotic
MIA( malnutrition ,inflammation , atherosclerotic) syndrome
MIA syndrome
may be in connect with............
* Malnourished
* Inflammation
* Atherosclerotic
* Diet (appetite)
* Oxidative stress
* Volume overload
Malnutrition and inflammation
* Chronic inflammation may cause muscle wasting, hypoalbuminaemia and anorexia.
* Elevated levels of pro-inflammatory cytokines may cause malnutrition by acting directly on the gastrointestinal system or indirectly through affecting appetite and resting energy expenditure andincreased protein hydrolysis and muscle protein breakdown .
Malnutrition and inflammation
* During inflammation,interleukin1 and tumor necrosis factor cause protein-energy malnutrition by inducing anorexia ,reducing voluntary motor activity, decreasing muscle protein synthesis ,and increasing muscle catabolism.
Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15: 953-960
Malnutrition and inflammation
* Chronic inflammation can lead to hypoalbuminemia and loss of appetite.
* Albumin is also an important antioxidant, and patients with malnutrition and low serum albumin levels have a decreased antioxidative capacity.
Inflammation and Atherosclerotic
* Inflammation and accelerated atherosclerosis may also be indirectly associated via oxidative stress, which has recently been recognized as an important factor in the development of both endothelial dysfunction and atherogenesis. Indeed, recent studies suggest that ESRD patients are subject to increased oxidative stress, which appears to be closely associated with inflammation .
Nguyen-Khoa T, Massy ZA, De Bandt JP et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. Nephrol Dial Transplant 2001; 16: 335-340 24.
Handelman GJ, Walter MF, Adhikarla R et al. Elevated plasmaF2-isoprostanes in patients on long-term hemodialysis. Kidney Int 2001; 59: 1960-1966
Malnutrition and Atherosclerotic
* Increase oxidative stress
* Fluid overload
* Increase free fatty acid
* Increase homocysteine
Diet and oxidative stress
Diet restriction or poor appetite
* Antioxidant vitamin
(such as Vit E, VitC, β-carotene...)
* Antioxidant mineral
(such as Zn, Mn ,Se......)
* Protein intake
* Inappropriate carbohydrate and fat intake
Diet and oxidative stress
Antioxidant function
Serum albumin
Antioxidant enzymes function
(eg. SOD,GSH,catalase...)
Diet intake and Volume overload
* Salt intake
* Water intake
* Protein intake(hypoalbuminaemia)
Volume overload and Oxidative stress
* In uremia ,there is an imbalance between oxidant production and antioxidant defense mechanisms.
* Chronic volume expansion ,anemia ,disturbances of calcium-phosphatemetabolism,hyperhomocysteinaemia and a microinflammatory state associated with increased oxidative stress.
Volume overload and Oxidative stress
* In a volume-overload dog model, the depressed cardiac function and contractility were shown to be due to increased levels of ROS , possibly due to an increase in the generation of ROS by the activated polymorphnuclear leukocytes in blood. Similar results were reported in dogs with heart failure induced by aortic stenosis.
Prasad K, Gupta JB, Kalra J, Mantha SV, Lee P, Bharadwaj B. Effects of vitamin E on the cardiac function and contractility in chronic volume-overload heart failure. In: Dhalla NS, Beamish RE, Takeda N, Nagano M (editors): The failing heart. New York: Lippincott-Raven; 1995. pp. 413-420.
Prasad K, Gupta JB, Kalra J, Bharadwaj B. Oxygen free radicals in volume overload heart failure. Mol Cell Biochem 1992; 111:55-59.
Prasad K, Kalra J, Massey KL, Bharadwaj B. Increased production of oxygen free radicals by polymorphonuclear leukocytes in heart failure due to aortic stenosis. Angiology 1989; 40:472-478.
Volume overload and Oxidative stress
Oxidative stress and inflammation
* Oxidative stress may also stimulate an inflammatory response. Interestingly, several recent clinical studies suggest that oxidative stress and inflammation may be linked in ESRD patients
Nguyen-Khoa T, Massy ZA, De Bandt JP et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. Nephrol Dial Transplant 2001; 16: 335-340
Handelman GJ, Walter MF, Adhikarla R et al. Elevated plasma F2-isoprostanes in patients on long-term hemodialysis. Kidney Int 2001; 59: 1960-1966
Mezzano D, Pais EO, Aranda E et al. Inflammation, not homocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int 2001 60: 1844-1850......（后略) ......
The relationship between diet and MIA syndrome in ESRD.
Rebecca Chiang
2006/3/24
Introduction
* Malnutrition ,defined as insufficient Protein-calorie intake ,is highly prevalent in HD and PD patients.
* There may be at least two different types of malnutrition in the patients.
* The first type (type1) is associated with the uraemia (such as physical inactivity , underdialysis, dietary restrictions and psychosocial factors)
Introduction
* It is characterized by a modest reduction in serum albumin levels ,became of lower protein and energy intake due to uraemia toxicity.
* Second, Type 2 malnutrition is characterized by hypoalbuminaemia, higher REE (resting energy expenditure ), increased oxidative stress and increased protein catabolism.
Introduction
* In this type of malnutrition is usually an inflammatory response, higher levels of CRP and pro-inflammatory cytokines.
* The type2 malnutrition is associated with MIA syndrome.
Type2 malnutrition and atherosclerotic
MIA( malnutrition ,inflammation , atherosclerotic) syndrome
MIA syndrome
may be in connect with............
* Malnourished
* Inflammation
* Atherosclerotic
* Diet (appetite)
* Oxidative stress
* Volume overload
Malnutrition and inflammation
* Chronic inflammation may cause muscle wasting, hypoalbuminaemia and anorexia.
* Elevated levels of pro-inflammatory cytokines may cause malnutrition by acting directly on the gastrointestinal system or indirectly through affecting appetite and resting energy expenditure andincreased protein hydrolysis and muscle protein breakdown .
Malnutrition and inflammation
* During inflammation,interleukin1 and tumor necrosis factor cause protein-energy malnutrition by inducing anorexia ,reducing voluntary motor activity, decreasing muscle protein synthesis ,and increasing muscle catabolism.
Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15: 953-960
Malnutrition and inflammation
* Chronic inflammation can lead to hypoalbuminemia and loss of appetite.
* Albumin is also an important antioxidant, and patients with malnutrition and low serum albumin levels have a decreased antioxidative capacity.
Inflammation and Atherosclerotic
* Inflammation and accelerated atherosclerosis may also be indirectly associated via oxidative stress, which has recently been recognized as an important factor in the development of both endothelial dysfunction and atherogenesis. Indeed, recent studies suggest that ESRD patients are subject to increased oxidative stress, which appears to be closely associated with inflammation .
Nguyen-Khoa T, Massy ZA, De Bandt JP et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. Nephrol Dial Transplant 2001; 16: 335-340 24.
Handelman GJ, Walter MF, Adhikarla R et al. Elevated plasmaF2-isoprostanes in patients on long-term hemodialysis. Kidney Int 2001; 59: 1960-1966
Malnutrition and Atherosclerotic
* Increase oxidative stress
* Fluid overload
* Increase free fatty acid
* Increase homocysteine
Diet and oxidative stress
Diet restriction or poor appetite
* Antioxidant vitamin
(such as Vit E, VitC, β-carotene...)
* Antioxidant mineral
(such as Zn, Mn ,Se......)
* Protein intake
* Inappropriate carbohydrate and fat intake
Diet and oxidative stress
Antioxidant function
Serum albumin
Antioxidant enzymes function
(eg. SOD,GSH,catalase...)
Diet intake and Volume overload
* Salt intake
* Water intake
* Protein intake(hypoalbuminaemia)
Volume overload and Oxidative stress
* In uremia ,there is an imbalance between oxidant production and antioxidant defense mechanisms.
* Chronic volume expansion ,anemia ,disturbances of calcium-phosphatemetabolism,hyperhomocysteinaemia and a microinflammatory state associated with increased oxidative stress.
Volume overload and Oxidative stress
* In a volume-overload dog model, the depressed cardiac function and contractility were shown to be due to increased levels of ROS , possibly due to an increase in the generation of ROS by the activated polymorphnuclear leukocytes in blood. Similar results were reported in dogs with heart failure induced by aortic stenosis.
Prasad K, Gupta JB, Kalra J, Mantha SV, Lee P, Bharadwaj B. Effects of vitamin E on the cardiac function and contractility in chronic volume-overload heart failure. In: Dhalla NS, Beamish RE, Takeda N, Nagano M (editors): The failing heart. New York: Lippincott-Raven; 1995. pp. 413-420.
Prasad K, Gupta JB, Kalra J, Bharadwaj B. Oxygen free radicals in volume overload heart failure. Mol Cell Biochem 1992; 111:55-59.
Prasad K, Kalra J, Massey KL, Bharadwaj B. Increased production of oxygen free radicals by polymorphonuclear leukocytes in heart failure due to aortic stenosis. Angiology 1989; 40:472-478.
Volume overload and Oxidative stress
Oxidative stress and inflammation
* Oxidative stress may also stimulate an inflammatory response. Interestingly, several recent clinical studies suggest that oxidative stress and inflammation may be linked in ESRD patients
Nguyen-Khoa T, Massy ZA, De Bandt JP et al. Oxidative stress and haemodialysis: role of inflammation and duration of dialysis treatment. Nephrol Dial Transplant 2001; 16: 335-340
Handelman GJ, Walter MF, Adhikarla R et al. Elevated plasma F2-isoprostanes in patients on long-term hemodialysis. Kidney Int 2001; 59: 1960-1966
Mezzano D, Pais EO, Aranda E et al. Inflammation, not homocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int 2001 60: 1844-1850......（后略) ......
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