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 and increased 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. ......
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 and increased 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. ......
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