Nutrition 445

Case Study 4
Due May 1, 2015
Alyssa Kiscaden
Obesity:
A 19-year-old woman sought medical help because she was 30 kg overweight. Most of her
excess weight was in the form of adipose tissue. A medical history revealed that her diet was
extremely poor. Much of her caloric intake was carbohydrate candy, cookies, cake, soft drinks,
and beer; her dietary fat intake was actually quite moderate.
Questions:
1. How is it possible to form excess amounts of triglyceride in the body if a diet contains
predominately carbohydrate?
a. The body can form excess amounts of triacylglycerides from endogenous sources.
VLDL, IDL, LDL, and HDL are synthesized in the liver from endogenous lipids.
When there is excess carbohydrate intake the body will use acetyl-CoA to go
through lipogenesis, instead of the TCA cycle, to create fatty acids and then
esterification to form triacylglycerides. The excess carbohydrates are stored as
triacylglycerides in the adipose tissues. Studies have shown a diet rich in simple
sugars increases the synthesis of linoleic and palmitic acid into VLDL
triaclyglycerides.
2. How does acetyl CoA generated inside the mitochondria reach the cytoplasm for use by
the fatty acid biosynthetic pathway?
a. Acetyl CoA is generated inside the mitochondria through beta oxidation of fatty
acids or the oxidation of pyruvate to acetyl-CoA. Acetyl-CoA cannot be directly
transported out of the mitochondria. Citrate synthase combines oxaloacetate with
acetyl-CoA to form citrate. Citrate can then be transported into the cytoplasm to
undergo de novo lipogenesis.
3. How might the carbohydrate ingested by this patient supply the NADPH needed for fatty
acid biosynthesis?
a. Ingested carbohydrates can go through the pentose phosphate pathway. In this
pathway, glucose is oxidized into a 5 carbon sugar (pentose) used to make
nucleotides. During this catabolic reaction, an anabolic process occurs by
generating NADPH.
4. Devise a test that would indicate whether this patient could mobilize the triglyceride that
is stored in her adipose tissue.
a. Hormone sensitive lipase is the enzyme that hydrolyzes triacylglycerides in
adipose tissue. It is stimulated by epinephrine, norepinephrine,
adrenocorticotropic hormone (ACTH) and glucagon. Insulin suppresses levels of
HSL. A test could be done to indicate if there were proper levels of hormone

sensitive lipase circulating in a fasting state. Because of her high carbohydrate

diet, she most likely has high levels of insulin circulating causing a decrease in
HSL.
5. What kind of unsaturated fatty acid can be synthesized from glucose? What metabolic
reactions would be involved in this process?
a. Any unsaturated fatty acid that is not essential can be synthesized from glucose.
Essential fatty acids must be consumed in the diet. Glucose would first enter
glycolysis. Glucose is the precursor for the glycerol of a fatty acid. It is formed
from glycolysis intermediates glyceraldehyde-3-phosphate and dihydroxyacetone
phosphate. Glucose can also be used to form acetyl-CoA which is formed into
citrate and then used to form malonyl-CoA, the first step of fatty acid synthesis.