ERN3120 - Molecular, cellular and clinical nutrition
Course content
This course gives basic and evidence based knowledge on the uptake and turnover of minerals and vitamins and clinical nutrition related to nutritional screening and treatment of several different dietary disorders.
Learning outcome
The course is organised as blocks of (mainly) one or two weeks on a particular topic:
Weeks 1, 2: Water-soluble vitamins
This group of vitamins comprise thiamin, riboflavin, niacin, folate, pyridoxin, vitamin B12, pantothenic acid, biotin and vitamin C. They have a wide variety of actions in the body, acting as co-factors for enzymes in a great many metabolic reactions. In addition, vitamin C acts as a general antioxidant. As they are water-soluble these vitamins are generally not stored but need to be frequently replenished. The uptake, metabolism and role of each will be discussed, together the dietary sources, recommended daily intakes, and the consequences of very low or very high intake.
Learning goals
- Knowledge of the biochemisty and function of each of the
vitamins in the body. - Consideration of uptake, metabolism and
excretion. - Sources in food, daily intake recommendations.
- Consequences of deficiency or excess
- • Influences of methods of storage and preparation of
food on vitamin content.
Week 3: Vitamin A
Vitamin A, a lipid-soluble vitamin, is formed by cleavage of certain carotenoids, and is therefore obtained from a range of green and orange fruits and vegetables. It is important as a chromophore in the retina, and also acts as a regulator of transcription of genes encoding proteins involved in embryogenesis, differentiation, reproduction, hematopoiesis and the immune response.
Learning goals:
- Absorption, transportation, metabolism, storage and
degradation of vitamin A - Role of vitamin A in the visual process
- Regulation of gene expression by vitamin A
- Sources of vitamin A in the diet; recommended
intake - Effects of deficiency; pracitcal measures to correct
deficiency - Vitamin A toxicity.
Week 4: Vitamin E and antioxidants
During respiration in the mitochondria, a small proportion of the oxygen is released as a particularly reactive form – superoxide – which, after conversion to the hydroxyl free radical, can oxidise biological molecules including lipids, proteins and nucleic acids. This damage may contribute to cardiovascular disease, cancer and other serious diseases, and it is also thought to be a factor in aging. Cells have potent antioxidant defences, augmented by micronutrients from the diet, particularly vitamin E (α-tocopherol). Vitamin E is lipid-soluble, is transported in plasma lipoproteins, is an integral part of cell membranes, and accumulates in fat-stores.
Learning goals:
- Oxidative damage and protection by antioxidants
- Biochemistry of vitamin E
- Uptake, transport and storage of vitamin E
- Vitamin E and gene expression
- Role of vitamin E in maintaining health
Weeks 5, 6: Vitamin D, vitamin K, calcium
Vitamin D has a crucial role in calcium uptake and homeostasis. Vitamin K is involved in regulation of clotting protein synthesis (part of the coagulation cascade) and also plays a part in preventing osteoporosis. Deficiency of vitamin D causes rickets (bone deformation in children) – a disease of urban populations in industrialised northern Europe, cured by exposure to sunlight or by cod liver oil. Bone metabolism is central to this block of lectures.
Learning goals:
- Vitamin D and vitamin K: sources, uptake,
metabolism - Calcium homeostasis
- Bone growth and remodelling; rickets and
osteoporosis
Week 7: Iron
The role of iron in oxygen transport is well understood. The absorption, transport, storage and excretion of iron need to be taken into account when considering the development of iron deficiency and iron overload. Iron requirements vary widely at different stages of life.
Learning goals:
- Uptake and metabolism of iron
- Lifecycle of erythrocytes
- Iron-containing proteins
- Sources in food: requirements
- Reasons for and results of iron deficiency and iron
overload
Week 8: Essential minerals and trace elements
Minerals and trace elements play an essential role in human health, although some may be required in very small amounts. Iron and calcium are dealt with elsewhere in the course. In this block, we will cover magnesium, zinc, selenium, copper, chromium and iodine; their sources in foods, bioavailability, metabolism, and mechanisms of action. The effects of deficiency and of excess, and the recommendations on levels of intake, will be discussed.
Learning goals:
- Essential minerals and trace elements
- Absorption, metabolism and turnover
- Normal mechanisms of action
- Methods used to determine recommendations on
intake - Potential toxic effects
Week 9: Other micronutrients
Many components of food are not essential for life or normal development, but are regarded as beneficial in terms of promoting health or preventing disease. They include antioxidants (carotenoids, flavonoids etc.), probiotics, salicylates, coenzyme Q and glucosinolates. The literature on effects of these compounds is confused and contradictory. A main aim of this block of lectures is to increase critical awareness, for example in assessing whether reported effects are biologically significant. The mechanisms by which micronutrients (and non-nutrients) can act will be dealt with in detail.
Learning goals:
- Different types of micronutrients and their
sources - Possible modes of action of micronutrients
- The balance between beneficial and possible harmful effects
of micronutrients - Critical examination of evidence from laboratory and animal
experiments and human studies on the effects of micronutrients
Weeks 10, 11: Immunity and nutrition
The immune system, and thus our resistance to disease, is affected by nutrition in various ways. Nutritional deficiencies are known to impair the immune response, and increase the incidence and severity of infectious diseases including tuberculosis and HIV. Food is responsible for many allergies, especially in children. The process of atherosclerosis is exacerbated by inflammatory cytokines, which can be produced in response to nutritional factors.
Learning goals:
- The immune system; innate immunity; cell-mediated and
humoral immunity - Nutrient-immune reactions
- Allergies
- Roles of nutrition and immune response in specific
diseases
Week 13: Undernourishment and enteral nutrition
(Clinical)
The emphasis is on malnutrition and undernourishment in industrialised countries, in at-risk groups and in the hospital setting. Lectures will cover the reasons for malnourishment and its consequences, ways of recognising and quantifying it, and strategies for treatment and prevention. There will be practical experience making anthropometric measurements, and detailed instruction in the theory and practice of enteral nutrition.
Learning goals:
- Causes and consequences of
malnutrition/undernourishment - Vulnerable groups, in the community and among
patients - Identification and assessment of
undernourishment - Prevention and treatment. Enteral nutrition
Week 14: Physical activity and nutrition
Exercise in connection with competitive sports makes nutritional demands, not just for macronutrients to supply energy, but also for micronutrients, fluid intake and electrolytes. Appropriate nutrition is important before, during and after heavy exercise and competition, to ensure performance as well as restitution. Specialist foods and supplements designed to improve sports performance are available commercially. Exercise can significantly alter nutrient metabolism, for example of protein and fats.
Learning goals:
- Factors affecting requirements for various nutrients
associated with exercise - Nutritional recommendations applicable to people engaging in
sports - Nutrients to meet increased energy-requirements
- Requirements for micronutrients, minerals,
fluids - The process of restitution
Week 15: Cystic fibrosis, celiac disease, lactose intolerance
(Clinical)
The etiology and pathogenesis of celiac disease (gluten intolerance) lead naturally to consideration of dietary control of the disease. Lactose intolerance is dealt with similarly. Preparing and consuming a gluten- and lactose-free menu provides practical experience. Cystic fibrosis is not a nutritional disorder, but nutritional counselling contributes to successful control of the disease, and to retarding its progression and morbidity. Lectures explaining the background to the disease, and its complications, in children, adolescents and adults, are given at the Norsk senter for Cystisk fibrose (NSCF).
Learning goals:
- Celiac disease; etiology, incidence, pathogenesis,
diagnosis - Control of celiac disease by diet
- Lactose intolerance; etiology, incidence, pathogenesis,
diagnosis - Control of celiac disease by diet
- Etiology, incidence and pathogenesis of cystic
fibrosis - Medical multidisciplinary treatment of cystic fibrosis,
including use of pancreatic enzymes - Nutritional recommendations and dietary treatment of cystic
fibrosis
Week 16: Gastrointestinal diseases (Clinical)
The range of gastrointestinal diseases includes dyspepsia, constipation, irritable bowel syndrome, inflammatory bowel disease, diverticulitis, Chrone’s disease and ulcerative colitis. It also encompasses the short bowel condition following surgery. For all of these, there are specific dietary needs or recommendations. Enteral nutrition (see week 13) is necessary in some cases.
Learning goals:
- Etiology, incidence and pathogenesis of the various
gastrointestinal diseases - Short bowel condition
- Treatment of gastrointestinal disorders/relief of symptoms
by dietary means - Medical and surgical treatment of gastrointestinal
disease
Week 17: Food toxicology
Food is a source of toxins as well as nutrients. Pesticide residues, food additives and environmental contaminants are a common source of concern, but there are also natural toxins (generally elements of plant protection against pests) and mycotoxins produced by contaminating fungi. Cooking and processing of food can also introduce toxins.
Learning goals:
- Principles of toxicology, dose-effect
relationships - Natural toxins, mycotoxins and food mutagens; acute and
long-term effects - Environmental contaminants including heavy
metals - Risk assessment; hazard identification, risk management and
communication
Weeks 18, 19: Cancer and nutrition
It is estimated that one in three cancers has a dietary cause – whether because of something present in food that induces or promotes carcinogenesis, or because of a lack of preventive agents. The common advice to eat 5 portions of fruits or vegetables per day to avoid cancer is based on epidemiological evidence, but the reasons for the protective effect remain obscure. This set of lectures ranges from molecular mechanisms to population studies, and includes laboratory practice and a literature survey.
Learning goals:
- Molecular and cellular mechanisms underlying the process of
carcinogenesis - DNA damage, DNA repair, mutation, chromosome damage:
biomarkers on the road to cancer - Nutrition and cancer: the evidence from
epidemiology - Laboratory-based project – assessing DNA damage in
humans - Recent advances in cancer research: critical reading of the
literature
Week 20: Nutrition of different groups
Nutritional needs are not constant. They vary with life-stage, and also can be affected by lifestyle, cultural and ethnic characteristics of different population groups.
Learning goals:
- Nutrition in pregnancy and for nursing mothers; babies and
infants - Nutrition for children and young people
- Special nutritional needs of immigrants
- Vegetarianism
- Nutritional problems associated with alcoholism
Weeks 21: Nutrition in the elderly (Clinical)
While nutrition in the elderly can be justified as a distinct topic, it is important to recognise that they are an extremely heterogeneous group, ranging from fit and active to geriatric, and their nutritional needs vary accordingly. Under- and malnutrition are not uncommon, and can be the result of physical and psychological factors. Practice as a nutritionist in nursing homes and home care services has particular challenges; the provision of adequate nutrition is rooted in Norwegian law.
Learning goals:
- The heterogeneous group known as
‘elderly’ - Importance of food and meals for the elderly
- Factors affecting diet and nutritional status
- Strategies to prevent under- and malnutrition
- Nutrition in nursing homes and home care
services
Week 22: Topical issues in nutrition
Many issues in nutrition are controversial, either because the science underlying them is equivocal, because they raise ethical questions, because commercial rather than nutritional interests are paramount, or because the public receive unbalanced or deliberately misleading information. Obvious examples include ‘organic’ or ‘ecological’ foods, genetically modified organisms in food, commercial promotion of foods as healthy, and diets for slimming and health. In the future, we should be concerned about issues such as matching optimal nutrition to individual genotypes. The week will include discussion on a selection of topical issues. (Since they are meant to be topical, they will not be announced in advance, and may include topics suggested by students.) Individual research on these topics will culminate in a half-day seminar during which opposing views will be presented.
Learning goals:
- Awareness of various ethical and practical questions and
problems in nutrition - Critical appraisal of common nutritional beliefs –
are they simply myths? - Ability to present and debate nutritional
issues
Admission
Id does not exist in shared textLimited only to students enrolled on the bachelor program.
Id does not exist in shared textPrerequisites
Formal prerequisite knowledge
Id does not exist in shared text ERN2110 - Kosthold, samfunn og ernæringsepidemiologi
ERN3110 - Energigivende næringsstoffer og klinisk ernæring
If you have been absent from the study program for two consecutive years or more, you may be required by the Faculty to redo previously approved mandatory activities and/or exams.
Teaching
Teaching will take the form of lectures, PBL-assignments, literature searches and reporting, practical experience in the clinic and the laboratory, group work and seminar presentations. Certain elements of the course are obligatory, and must be completed before proceeding to the examination.
Access to teaching
Id does not exist in shared textExamination
The first 11 weeks (up until calendar around week 12) will cover topics in nutrition biology, and will be followed by a 4-hour exam at the beginning of April. The rest of the semester will deal with aspects of clinical nutrition, and will be tested with 4-hour exam in early June. Each exam will contribute 40%. Futhermore, an individual assignment will be written during the first half of the semester. It will be graded (A-E) and a pass will be necessary to be allowed to take part 2 of the exam