Module 8: Stress and Nutritional Status Alteration

Stress

A state caused by the activation of the neuroendocrine and immune systems in response to a stressor.

General Adaptation Syndrome (GAS)

The body's overall response to stress, describing both short-term and long-term physiological responses.

Stage 1: Alarm Reaction

Immediate response to a stressor, activating the sympathetic nervous system.

Stage 2: Resistance

Occurs when the stressor continues; body adapts and conserves energy.

Stage 3: Exhaustion

Prolonged stress leads to the failure of the body's adaptation, resulting in weakened immune function.

Epinephrine and Norepinephrine

Hormones released during the alarm stage that increase heart rate, blood pressure, and redirect blood away from the GI tract.

Cortisol

A stress hormone released during resistance and exhaustion stages, breaking down fats and proteins and increasing glucose production.

Post-Traumatic Stress Disorder (PTSD)

Chronic activation of the stress response after one or more traumatic events.

Nutritional Status

Assessment of the balance between energy intake and energy expenditure.

Overnutrition

When excess energy is stored as triglycerides in adipose tissue.

Marasmus

Severe calorie deficiency resulting in loss of fat and muscle.

Kwashiorkor

Severe protein deficiency commonly resulting in swelling and stunted growth.

Anorexia Nervosa

An eating disorder characterized by self-starvation and fear of weight gain.

Bulimia Nervosa

An eating disorder involving binge eating followed by purging.

Binge Eating Disorder

Consuming large amounts of food in a short period without purging.

Body Mass Index (BMI)

A measurement to assess body weight relative to height; does not distinguish muscle from fat.

Waist Circumference

A measurement used to assess obesity, with indicators being ≥ 35 inches for women and ≥ 40 inches for men.

Waist-to-Hip Ratio

A measurement indicating obesity status, where men > 1.0 and women > 0.8 are considered at risk.

Upper Body Obesity

Associated with higher risk for cardiovascular disease, type 2 diabetes, and other health issues.

Lower Body Obesity

Associated with lower metabolic disease risk but can still pose health challenges.

Persons with PTSD demonstrate

decreased cortisol levels, increased sensitivity of cortisol receptors, and  an enhanced negative feedback inhibition of cortisol release with the dexamethasone suppression test. All the other options occur in patients with major depression.

Which result in response to dexamethasone suppression test is considered a specific marker for PTSD?

increased sensitivity of cortisol receptors

Which of the following is associated with a protein deficiency and impaired brain development as a result?

kwashiorkor

Stress-induced tachycardia is a result of which of the following?

increases in the secretion of catecholaminesand the activation of the sympathetic nervous system.

Stress

does result in an increase in catecholamine release resulting in increased heart rate. Norepinephrine, a catecholamine, secretion is increased in stressful situations. ADH is also increased and results in vasoconstriction of  blood vessels.

Jane does not cope with stress well.  She started a new job several months ago shortly after experiencing divorce, and has been experiencing gastrointestinal upset and frequent colds.  Jane recently had blood work drawn and her blood glucose levels were elevated.  Jane's GI symptoms, frequent colds, and elevated blood glucose levels are more than likely due to stress and the hormone/neurotransmitter ____________

cortisol

The alarm phase of the general adaptation syndrome is also referred to as:

the fight or flight response

The General Adaptation Syndrome (GAS)

is often used interchangeably with the fight or flight response.  The fight or flight response is the body's physiologic response to a threat and a means of survival.  This is a negative feedback loop in that hormones and neurotransmitters are mobilized in the event of a stressor, and resolve as the stressor resolves

Stress

is what triggers the fight or flight response (GAS).  Selye's hypothesis was the general adaptation syndrome

A diagnosis of post traumatic stress disorder (PTSD) would be based on which of the following criteria for symptoms?

At least a month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life.

BMI

doesn't distinguish between muscle, fat, and bone density.

State Seyle’s definition of stress.

as a state manifested by symptoms resulting from the coordinated activation of the neuroendocrine and immune systems. Stress occurs when a stressor disrupts homeostasis and causes the body to activate physiological responses in an attempt to adapt. This response is known as the General Adaptation Syndrome (GAS).

The General Adaptation Syndrome (GAS)

is the body's predictable response to stress and consists of three stages: alarm reaction, adaptation, and exhaustion.

Stage 1: Alarm Reaction

• Immediate response to a stressor.

• Activates the "fight-or-flight" response.

• Epinephrine and norepinephrine are released.

• Heart rate, blood pressure, and breathing increase.

• Blood is redirected to skeletal muscles.

• The immune system may temporarily weaken.

Stage 2: Adaptation

• The body attempts to adjust to the ongoing stressor.

• Cortisol levels remain elevated.

• The body conserves energy and adapts to maintain function.

• Normal body functions continue despite the stress.

Stage 3: Exhaustion

• Occurs when stress is prolonged and the body's resources become depleted.

• Resistance decreases and immunity becomes severely suppressed.

• Increased risk of infection, illness, heart attack, and other diseases.

• The body can no longer effectively cope with the stressor.

Autonomic Nervous System

• Activates the sympathetic nervous system.

• Produces the fight-or-flight response.

• Increases heart rate, blood pressure, and respiratory rate.

• Diverts blood away from the digestive tract and toward the heart and muscles.

Endocrine System

• Releases stress hormones including epinephrine, norepinephrine, and cortisol.

• Increases blood glucose levels for energy.

• Stimulates breakdown of fats and proteins.

• Maintains energy supplies during stress.

Immune System

• Initially may become activated.

• Long-term cortisol release suppresses immune function.

• Increases susceptibility to infections and disease.

• Reduces inflammatory responses.

Musculoskeletal System

• Muscles tense in response to stress.

• Can cause muscle pain, tension headaches, and migraines.

• Chronic tension may contribute to musculoskeletal disorders.

What are some of the results of acute stress?

• Increased heart rate

• Increased blood pressure

• Increased respiratory rate

• Increased blood glucose levels

• Increased alertness

• Muscle tension

• Dilated pupils and bronchioles

 What are some of the results of chronic stress?

• Suppressed immune system

• Increased risk of infection

• Hypertension

• Coronary artery inflammation

• Heart attack (myocardial infarction)

• Type 2 diabetes

• Digestive problems

• Anxiety and depression

• Substance abuse

• Diseases of adaptation such as cardiovascular, inflammatory, and mental disorders

Post-traumatic stress disorder (PTSD)

is a condition that results from chronic activation of the stress response after experiencing one or more traumatic events.

PTSD symptoms

• Flashbacks

• Nightmares

• Depression

• Panic attacks

• Mood disorders

• Anxiety

PTSD potential causes

• Military combat

• Physical abuse

• Sexual assault

• Natural disasters

• Serious accidents

• Violent crime

• Witnessing traumatic events

• Childhood trauma

Individuals with PTSD are

also at increased risk for substance abuse, hypertension, cardiovascular disease, Type 2 diabetes, asthma, and chronic pain disorders.

Body Mass Index (BMI)

• Uses height and weight to estimate body fat.

• Formula: weight (kg) ÷ height (m²).

• Categories:

  • Underweight: ≤18.5

  • Overweight: 25–29.9

  • Obese: ≥30

• Limitation: Cannot distinguish muscle from fat.

Body Circumference Measurements

• Measure body fat distribution.

• Includes waist circumference, waist-to-hip ratio, and skinfold measurements.

• Better indicator of health risks associated with abdominal obesity.

High Risk Measurements

• Waist circumference ≥35 inches in women.

• Waist circumference ≥40 inches in men.

• Waist-to-hip ratio >0.8 in women.

• Waist-to-hip ratio >1.0 in men.

Upper Body Obesity (Central/Abdominal Obesity)

• Excess fat stored around the abdomen and internal organs (visceral fat).

• More dangerous form of obesity.

• Strongly associated with metabolic syndrome.

obesity risk

• Cardiovascular disease

• Type 2 diabetes

• Hypertension

• Liver dysfunction

• Cancer

• Osteoarthritis

Lower Body Obesity (Peripheral Obesity)

• Excess fat stored around the hips, buttocks, and thighs.

• Less associated with metabolic disease.

• More commonly linked to varicose veins and mobility issues.

What are the health risks associated with obesity?

• Cardiovascular disease

• Hypertension

• Type 2 diabetes

• Liver dysfunction

• Osteoarthritis

• Certain cancers

• Metabolic syndrome

• Chronic inflammation

• Respiratory problems

• Increased mortality

Excess adipose tissue also acts as an endocrine organ and contributes to systemic inflammation.

Marasmus

• Severe calorie and protein deficiency caused by starvation.

• Characterized by loss of muscle mass and body fat.

• Person appears extremely thin with visible bones.

Marasums signs and symptoms

• Severe weight loss

• Stunted growth

• Sparse hair

• Dry skin

• Diarrhea

• Low body temperature

• Low heart rate

• Low blood pressure

• Increased infections

Kwashiorkor

• Severe protein deficiency with inadequate calories.

• Most common in children after being weaned from breast milk and given low-protein diets.

Kwashiorkor signs and symptoms

• Edema (swelling)

• Ascites (swollen abdomen)

• Enlarged liver

• Thin hair

• Skin depigmentation

• Dry skin

• Stunted growth

• Increased infections

• Hypoalbuminemia

Marasmus

severe wasting and weight loss.

Kwashiorkor

edema and swollen abdomen caused by protein deficiency.

Anorexia Nervosa

• Eating disorder characterized by self-starvation.

• Distorted body image and intense fear of gaining weight.

• Severe calorie restriction despite being underweight.

• Physical effects resemble starvation.

Bulimia Nervosa

• Eating disorder involving repeated episodes of binge eating followed by purging.

• Purging may include vomiting, laxative use, fasting, or excessive exercise.

Binge Eating Disorder

• Consuming large amounts of food in a short period of time.

• Individual feels unable to control eating.

• No purging behaviors occur afterward.

• Often associated with obesity and emotional distress.