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Obesity - Faults of Nutrition

fat, albumin, body, food, amount, especially and rich

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The following section of the etiology is the most important in the disease now under consideration. Not only do the preceding etio logical factors materially depend upon the influence of a faulty nutri tion, but the latter by itself is capable of causing an overproduction of fat, corpulence, and obesity, in persons in whom the former etio logical factors are absent. In order to study the injurious effect of defects of nutrition we must distinguish : a. Those clue to the ingestion of excessive and improper food; and b. Those resulting from an insufficient assimilation.

Both faults of nutrition may be and generally are present at the same time; but the latter process may suffice to produce an abnor mal accumulation of fat, especially when the preceding etiological factors act in combination with it.

a. Faulty Nutrition.—The animal body consumes for the mainte nance of the absolutely necessary vital functions, when at rest, a certain quantity of albumin, fat, carbohydrates, and water; and this amount is increased according to the labor performed by the body, especially muscular labor. If the ingestion is restricted to the amount of albumin, fat-forming substances, and water required under these circumstances the body maintains its equilibrium. If the in gestion of these substances exceeds the requirements, then with the rapid decomposition of albumin the non-nitrogenous constituents separated from it and the excessively ingested fat-forming sub stances are changed into fat and deposited in the tissues. The ex cess of water consumed is under normal conditions rapidly excreted with the utilized materials in the urine, sweat, and insensible per spiration. The temporary requirement of our body in the way of nutritive material therefore will vary according to its resting or ac tive condition, regard being had also to the age. As this requirement is of decisive importance in the treatment of obesity a more detailed consideration of it becomes absolutely necessary.

In the following tables the temporary requirement of nutritive material is noted according to agd, rest, and muscular activity : The ingestion of food beyond these quantities will necessarily be followed by an accumulation of fat in the body. The extent of the over-production in that event is dependent upon the amount of the in gested food, upon the existence of an individual, especially an heredi tary, disposition to fat hyperplasia, and furthermore upon the laws governing nutrition. A nutrition which is effected with an overpro

duction of fat coincides absolutely with the fattening of animals, and the rational principles underlying the latter apply exactly to the former. Therefore, wherever increased fat-formation comes under consideration, as in forced feeding, the quality of the nutrient mate rial will always be of paramount importance, and in the etiology of corpulence such foods as are easily changed into fat and substances which serve to economize fat will deserve special attention.

a. Foods Favoring the Formation of Fat.—It was Liebig who, basing his belief on the experience that domestic animals are best fat tened by being supplied with food rich in carbohydrates, taught that the chief and preferable fat-formers are the carbohydrates, by the side of which the fat in the food plays only an inferior role, especially since the animal fats are altogether different from those contained in the food.

Later, when Virchow demonstrated a fatty metamorphosis of the albuminous protoplasm in the pus, epithelial, and glandular cells, these observations of course could find no application to the physio logical processes of nutrition so as to lead to the assumption of a de velopment of fat from albumin. It was Pettenkofer and Voit who showed, by experiments on dogs, that it was probable that from the decomposing albumin fat is formed, or at least a substance rich in carbon from which fat develops by synthesis. On feeding a large dog experimentally with 400 gm. albumin daily, all the nitrogen of the albumin had reappeared in the urine, but not all the carbon in the expired air and the urine ; hence a decomposition product, rich in carbon, of the albumin had remained in the body, and this they be lieved to be fat. Moreover, it was observed by Subottin, Voit, and Kemmerich that a suckling bitch exclusively and plentifully fed with meat furnished the greatest amount of milk rich in fat. By these experiments the proof of the formation of fat from albumin was thought to be established.

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