1. TPCN VI SC KHE V BNH TTFunctional Foods in Health and DiseasePGS.TS Trn ngCh tch Hip hi TPCN Vit NamNgy 5/10/2014

2. Ni dung:Phn I: Cn thy triu dch bnh mn tnhkhng ly v vaccine d phngPhn II: Nguy c cc bnh mn tnhPhn III: TPCN d phng v h tr iutr cc bnh mn tnhPhn IV: Qun l TPCNPhn V: Nhng chin s tin phong v sckhe cng ng. 3. Phn I:Cn thy triu dch bnh mn tnhkhng ly v Vaccine d phng. 4. 1. Sc khe l g?Theo WHO, sc khe l tnh trng: Khng c bnh tt Thoi mi v th cht Thoi mi v tm thn Thoi mi v x hi. 5. Sc khe v bnh ttSc khe Bnh tt1. Tnh trng lnh ln v cu trc vchc nng ca t bo c th2. Gi vng cn bng ni mi3. Thch nghi vi s thay imi trng1.Tn thng cu trc v chc nngca t bo c th2. Ri lon cn bng ni mi3. Gim kh nng thch nghi vimi trng 6. Sc khe l ti sn qu gi nht:- Ca mi ngi- Ca ton x hiFontenelle: Sc khe l caci qu gi nht trn i m chkhi mt n i ta mi thy tic.iu 10 trong 14 iu rnca Pht:Ti sn ln nht ca i ngil sc khe. 7. 2. Gi tr ca sc khe:Tiu ch cuc sng1 . 0 0 0 . 0 0 0 . 0 0 0 . 0 0 0SK V C T N X CV V M TY DL HV C tin c th n khm bc s nhng khng mua c sc khe tt! C tin c th mua c mu nhng khng mua c cuc sng! C tin c th mua c th xc nhng khng mua c tnh yu! C sc khe, si cng thnh cm! 8. Gi tr tiu dng ca ngi M(Theo GS.TS Mary Schmidl 2009) 1950: Nh + xe + TV 1960: Gio dc i hc 1970: My tnh 1980: Nhiu tin 2000: Sc kho 9. DALE (Disability Adjusted Life - Expectancy)K vng sng iu chnh theo s tn tt l nhng nm k vng sng khe(khe hon ton).+ Nht Bn: 74,5+ Australia: 73,2+ Php : 73,1+ Thy s: 72,5+ Anh: 71,7+ c: 70,4+ M: 70,0+ Trung Quc: 62,3+ Thi Lan: 60,2+ Vit Nam: 58,2+ n : 45,5+ Nigeria: 38,3+ Ethiopia: 33,5+ Zimbabwe: 32,9+ Sierra Leone : 25,9 10. Trng thi sc khe hin nay: Trng thi I (khe hon ton) : 5 10%. Trng thi II (m) : 10 15 %. Trng thi III (na m na khe) : 75%. 11. 3PHNG CHM BO V SC KHEu t, chm sc khi cn ang khe Phng nga cc nguy c bnhtt (Qut rc lau bi). Hiu qu v kinh t nhtDo chnh mnh thc hin Ch n ung Vn ng thn th Gii ta Stress 12. Ngi dt: ch bnhm au mi i khmm au mi i chaNgi ngu: Gy bnh Ht thuc Ung ru qu nhiu n ung v Li vn ngNgi khn: Phng bnh Chm sc bn thn Chm sc sc khe Chm sc cuc sng3 loi ngiTPCN 13. N i kinh hong (Thi Xun-Thu-Chin-Quc):Thnh nhn khng tr bnh ri, m tr bnh cha n, khngtr ci lon n m tr ci lon cha n.Kht mi ung, i mi n, mt mi ngh, m mi khm chabnh Tt c u l mun!Tin bc l ca con, a v l tm thi, V vang l qu kh,Sc khe l ca mnh!. 14. Thit hi do bo ph(Vin nghin cu Brookings - M)1. Chi ph chm sc ngi bo phtrng thnh: 147 t USD/nm2. Chi ph chm sc bo ph tr em:14,3 t USD/nm3. Thit hi kinh t do mt nngsut lao ng do bo ph: 66 tUSD/nm4. Tng thit hi nn kinh t M dobo ph: 227,5 t USD/ nm 15. Chi ph cho bnh tt(TS Edward Choo 2014)Bnh tt Chi ph (VN/nm) Ci gi phi tr thmCao HA 50.000.000 Sng ph thuc vo thuc Lit dng i tho ng + Ngoi tr: 10.000.000+ Ni tr: 72.000.000 Sng ph thuc vo thuc sut i Ch n king sut i Theo di ng huyt Bin chng nguy him: tim, thn, mt, khp Suy thn[Lc thn]72.000.000 Lc sut i Sng ph thuc vo thuc Ph chn tay, d nhim trngSuy thn[Thay thn]+ Singapore: 1.275.000.000+ Vit Nam: 200.000.000 Ch c 50% trng hp sng n 15 nm 30% trng hp b o thi Dng thuc sut iBnh tim[M van tim]80.000.000 Nguy c ti pht Sng ph thuc vo thuc Tip tc phi iu tr sau mUng th ganMt t ha tr liu820.000.00070.000.000 Nguy c ti pht H min dch km, d b nhim trng Tc dng ph cc k nghim trng S sng ko di ti a 5 nmChi ph ngoi iu tr Cht lng cuc sng suy gim nghim trng au n Mt sc lao ng Sng ph thuc vo ngi khc 16. Th lc: cao, nng, sc bn.Pht trin ging ni Tr lc.Kh nng thch nghi.Chiu cao trung bnh ngi trng thnh VN:Nm 1938: 160,0 cmNm 1975: 160,0 cm37 nm 62 nmNm 2000: 162,3 cmNm 2003: 163,7 cm2,3 cm 65 nm3,7 cm( 56,9% so TB). 17. Cc yu t nh hngsc khe 18. CNH + th haThay iphng thclm vicThay ili sng li sinh hotThay i cchtiu dngthc phmThay imi trngHu qu1. t vn ng th lc (70-80%)2. S dng TP ch bin sn3. Tng cn, bo ph4. Stress5. nhim mi trng6. Di truyn1. Tng cc gc t do2. Thiu ht vi cht, vitamin,khong cht, hot cht sinh hc1. Tn thng cu trc, chc nng2. RL cn bng ni mi3. Gim kh nng thch nghiCn thy triudch bnh mn tnh khng lygia tng 19. 10 TN PH SC KHE CA CNG NGH THNG TIN1 Hi chng phng kn2 Hi chng vai gy: au mi do nhn tin3 Bnh GATO: Vng xoy su no: do ng nhp Facebook4 Hi chng ng c tay: au nhc c tay do in thoi + bn phm5 Hi chng mn hnh: nhc mt, mi mt, mt, m mt, kch ng,bong vng mc, song th6 Hi chng ri lon gic ng: do mng x hi dn ti gim min dch, dNhim bnh. AS mn hnh kch thch t bo TKTW gy hi chng mt ng7 Tng cn bo ph: Cuc sng s t vn ng, n thc n CN dn ti tngcn, bo ph, Cholesterol, HA, bo ph 8 Hi chng trm cm: tng tip xc AS nhn to, xem nhiu TV, t tpth dc, tng thi gian cho kt bn c n o, trm cm9 Stress 24/7: ngy v m: my tnh, T, email, nhn tin No khng cthi gian th gin cng thng, mt mi10in thoai di ng = vi trng: T di ng lun m, c s m nhiu,l cho vi khun c tr 20. Tc hi ca sng in t vi SKHiu ng nhit(Nung nng t chc)Hiu ng khngsinh nhit1.Lm dao ng cc vi th: ty lp th, ADN2.Kch thch cc Receptor3.Lm ri lon trao i ion K+ v Na+ mng t boSp xp licc phn t, ionTng dao ngphn t, ionT chc d b nung nngT chc cp t mu: Nhn mt,ng dn tinh, t chc t m.T chc nc bo ha: gan, ty, lch, thn1. Hi chng SNTK: ra m hi tay chn, mt mi,run chi, rng tc, mt ng, nhc u, chng mt,au bng, kh th, nng ny2. c nhn mt3. V sinh, teo tinh hon, gim kh nng tnh dc, RLKN ...4. Bin i chuyn ha: Gim BC, HC, TC; Lot d dy, vim TK, st; RLCN gan, lch, thn,ty5. Gia tng gc t do (FR)6. Suy gim sc khng: gim kh nng thc bo, gim SX Interferon, gim min dch7. RL tim mch: au tim, mch gim hoc tng, HA gim, gin mch 21. Ngi bnh timST lm ri lonsng in tim1188 nnggiikkhhnngg nnnnddnngg iinn tthhooiiddii nngg8866 4433227755Ngi ng kinhST lm RL sng inno. Kch hot cn ng kinh. Cng gip i tho ngST lm RL ni titPh n c thai cho con bST c th gy qui thai RL ni tit - tit saTrn 60 tuiST lm RLCNtrn nn teo v CNc thy tinh thST lm To cThiu nin, nhi ngST nh hng sinhtrng no.Nguy c u no.Suy nhc TK nngLm nng thmtriu chng 22. V SAO CH KHE MT PHN ?CNGTHNGTRONGCUCSNGChi ph N Vic lmGia nhTht nghipTin Cng vicLo sLo lngp lc thi gian Mt ng Bnh tt Cng vic qu tiKit sc 23. www.themegallery.comTHC PHMCung cp cht dinh dngCht dinh dng i th: m ng MCht dinh dng vi th:(vi cht dinh dng) Vitamin Nguyn t vi lng Hot cht sinh hcCu trc c thChc nnghot ngNng lnghot ng 24. www.themegallery.comc im ca vi cht dinh dng1 L nhng cht khng thay th c2Cn thit cho c th: Qu trnh trao i cht Tng trng v pht trin Bo v, chng li bnh tt v yu t bt li Duy tr cc chc nng3C th khng t tng hp v d tr c.Phi tip nhn hng ngy qua con ngn ung 25. NNaann iivvii cchhtt ddiinnhh ddnngg11 tt nnggii tthhiiuu vvii cchhtt ddiinnhh ddnngg22 tt nnggii cc nngguuyy cc tthhiiuu11,,66 tt nnggii ggiimm kkhh nnnngg llaaoo nngg ddoo tthhiiuu mmuu tthhiiuu sstt335500..000000 ttrr eemm bb mm lloo ddoo tthhiiuu VViittaammiinn AA11,,11 ttrriiuu ttrr eemm 30 tui(2) T l: 2-4%(3) Hay gp ngi bo ph bo bng(4) Triu chng m thm, t r rt(5) Tn thng Receptor(6) iu tr bng Insulin l khng cn thit(7) Gan tip tc phn giiGlycogen Glucose cng gy G mu. 96. Bng: phn bit i tho ngtp 1 v tp 2TT Tiu ch phn loi IDDM NIDDM1 T l ton b 0,5 1,0% 2,0 4,0%2 Tui bt u Di30 tui Trn 30 tui3 Trng lngban u BN khngbo ph BN bo ph4 Cch bt u Thnghung tn m 5 i nhiu ung nhiu R rt t r rt6 n nhiu Gy C Khng c 97. TT Tiu ch phn loi IDDM NIDDM7 Tch ceton Bin chng mchThngc nht l bnhmao mchHim c nht lva x ng mch8 S tit Insulin Rt gim Bnh thnghochi gim9 Ph thuc Insulin C Khng10 Hm lngInsulin huyttngRt thp hoc khngcThngbnh thng 98. TT Tiu ch phn loi IDDM NIDDM11 C quan nhn Insulin Him khi b bnh Hay b bnh12 Hm lngGlucagon huyttngTng Bnh thng13 Khng th chng cLangerhansHay gp Khng c14 Mi lin h vi khngnguyn HLAHay gp Khng c15 Yu t bn ngoi (nhimVR, nhim c)C th c Khng c 99. Triu chng DMTng ng huyt: G khng vo c TB li G mu. Gan tng SX G t Glycogen.ng niu:Khi G 10 milimole /l mu.i nhiu:ng niu ko theo nc lm nc tiu.Kht nc: do mt nc nhiu qua nc tiuTch tr Cetonique trong mu gy nhim acid (Acidose)(IDDM) (Gan tng s dng Lipid to nng lng)Ceto niu (IDDM): do CetoseGy (TB khng c G, phi s dng Protein v lipide) 100. Triu chng i tho ngMt: th lcHi th: mi acetonD dy:Bun nnNnauThn:i nhiung niuTrung ng:KhtiL mNg lmC th: GyH hp:Th Kussmaul(su nhanh) 101. Cc bbiinn cchhnngg ccaa tt::1. Bin chng cp tnh: Nhim axit v cht Cetonic ( tp 1). Nhim axit Lactic ( tp 2). Hn m tng p lc thm thu (tp 2). H nghuyt: do dng thuc h nghuythoc nhn n thi qu. Hn m h nghuyt. 102. 2. Bin chng mn tnh:(1) mch mu: Vim ng mch cc chi di. Va x ng mch. Tng huyt p.(2) Bin chng tim: Nhi mu c tim. Tn thng ng mch vnh. Suy tim, au tht ngc. 103. (3) Bin chng mt: Vim vng mc. c thu tinh th. Ri lon khc x, xut huytth knh, Lipid huyt vng mc...(4) Bin chng h thn kinh: Vim nhim dy thn kinh. Tn thng TK TV, ri lon cm gic,gim HA khi ng, tim p nhanh, rilon tiu tin, lit dng... Huyt khi v xut huyt no. 104. (5) Bin chng thn: Suy thn mn tnh. X cng tiu cu thn. Nhim khun ngtit niu.(6) Bin chng da: Nga: m h, quy u, c xu hngLichen ho. Mn nht, nm. Nhim sc vng da gan tay chn. U vng mi mt, phi hp tng cholesterol huyt. Hoi t m: hay , khu tr cng chn (cc nt vng hi xanh llan ra ngoi vi, trong khi trung tm tr nn teo i).u 105. Bin chng ca DM:Mt: Nhn p, c thy tinh thbnh vng mc T, m mtRng: nu, vimTm thn: trm cm, lo uThn kinh:t quSuy gim nhn thcHi th: acetonTai: nghe kmTim mch:Nhi mu c timThiu mu cc bVXM Cholesterol TG HA: tngThn:Lc kmProtein niu D dy: Lit nhSinh dc: bt lcDa:Lon dngNhim trngLotHoi tBnh TKC:au cTeo cNhc cMch mu ngoi vi:NgaTThiu muau 106. III. BO PH 107. TNH HNH V XU TH Bo ph M: ngi trng thnhNam: 20%N: 25% Canada: 15% (c 2 gii) H Lan: 8% Anh : 16% Bo ph tr em: Khng ngng gia tng Vit Nam: + tr em c khu vc 15.20%+ La tui 15 49: 10,7%+ La tui 40 49: 21,9%. 108. QU TRNH HIN I HA TH HA Bo ph l t sng u tin ca mt nhm cc bnh mn tnhkhng ly. Bo ph s dn dt theo i tho ng, tng HA, ri lonchuyn ha lipid, bnh ng mch vnh. Hi chng Th gii miNew World Syndrom! 109. NH NGHA:1. Bo ph: Bo ph l s tngcn nng c th qu mc trungbnh do tng qu mc t l khim ton thn, gy nh hngxu n sc khe.Hoc: S tch ly qu d tha, lanrng nhiu hay t, ca cc m mdn n s tng trn 20% (25%)cn nng c tnh, phi tnh nchiu cao v gii tnh.2. Tha cn: L tnh trng cn nng vtqucn nng nn c so vi chiu cao. 110. Cch tnh cn nng l tng cn nng nn c1. Cng thc Lorentz: PI (Nam) = S - 100 - PI (N) = S - 100 2. x nng: C th tnh: PIPI = (S 100) x 0,9Trong : * PI: Trng lng c th (kg)* S : Chiu cao (cm)S-1504S-1502 111. n v o bo ph:1. Ch s khi c th:kg( )2 2 m( )H W BMI =++ PPhhnn llooii tthhaa ccnn,, bboo pphh tthheeoo BBMMII::i vi ngitrngthnh (WHO 2002)Phn loi BMI (kg/m2)Thiu cn < 18,5Bnh thng18,5 - 24,9Tha cn 25,0Tin bo ph 25, 0 - 29,9Bo ph 1 30,0 - 34,9Bo ph 2 35,0 - 39,9Bo ph 3 40,0 112. thang phn loi bboo pphh cchhoo cchhuu ::Phn loi BMI (kg/m2)Thiu cn < 18,5Bnh thng18,5 - 22,9Tha cn 23,0Tin bo ph 23, 0 - 24,9Bo ph 1 25,0 - 29,9Bo ph 2 30,0 113. Phn loi theo ch ss ccnn nnnngg vv BBMMIIMc bo Phn trm (%) vtcn nngmong munBMI(kg/m2)Tng cn qu mc(Over weigh)> 10% > 25,0Bo ph (Obesity) > 20% > 35,0Bo ph bnh l(Morbid Obesity)> 100% 114. PHN LOI TH BO PHPHN 1. Th ph i: LOI TH BO PH- Bo ph bt u tui trng thnh.- S lng TB m l c nh.- S tng trng lng l do tch m trongmi TB (ph i).- iu tr: gim bt cc cht Glucid l chiu qu.2. Th tng sn ph i:- tui thanh thiu nin- S lng cc TB m tng- ng thi ph i cc TB m.- Kh iu tr hn. 115. 2. Vng tht lng(vng eo, vng bng - WaistCircumference):+ Cch o: Ly thcdy o ngang chu vi quanh rn+ L ch s n gin nh gi khi lngm bng vm ton b c th.+ Nguy c tng ln khi: 90cm i vi nam 80cm i vi n.+ Nguy c chc chn khi: 102cm vi nam 88cm n.i vi chu ngngvng bng l 90cm i vinam v 80cm vi n. 116. 3. T s vng tht lng/vng mng(Waist - Hip Ratio) (W/H):+ Cch o:- o vng tht lng:nhtrn.- o vng mng: Dng thcdy o chu vi ngang hng,ni to nht.+ nh gi: T s ny 1,0 vi nam v 0,85 vi n lcc i tngbo bng.Theo WHO, i vi Chu ngngca t s ny l: 0,9 vi nam v 0,8 vi n. 117. W = 90cmHW =80cmH = 0,90 H W = 0,80 H W 118. C cchh ggyy bboo pphh ::1. Mt cn bng nng lng- Nng lngn vo ln hn nng lngtiu hao- Ch n giu lipid hoc m nng lngcao- Mc thu nhp cng cao, khu phn Protid ng vt, Lipid ng vtcng tng ln2. Hot ng th lc t, li sng tnh ti.3. Yu t di truyn: Theo Mayer J. (1959)- C B v M bnh thng:ch c 7% con ra b bo ph- Nu mt trong hai b bo ph: 40% con ra b bo ph- C B v M bo ph: 80% con ra b bo ph4. Yu t kinh t - x hi:- cc nc ang pht trin, bo phi nh l c im ca s giusang, ch yu tng lp giu, t tng lp ngho (do thiu n)- cc nc pht trin: bo ph ch yu tng lp ngho, t tng lp trn. T x hi thiu n chuyn sang n hay c xuhng n nhiu hn nhu cu. 119. 5. V mt sinh bnh hc, bo ph cn ph thuc vo s phn b mtrong c th:+ Tng khi lngm do:- Tng sn qu mc khi lngt bo m- Ph i t bo m+ S phn b m trong c th:- M tp trung quanh eo lng:bo ph hnh qu to (bo bng, bophn trn, kiu n ng) nguy c cho sc kho nhiu hn choc th v nhiu m trong bng.- M tp trung quanh hng: bo ph hnh qu l ( bo phn thp,bo kiu n b)- Bo ph tr em: m tp trung t chi. T bo m tng sn gp 3-5ln nhngkch thcc th bnh thng. 120. Nguyn nhn bo ph n qu mcL nguyn nhn ch yu (95%)n ung thc n nhiu qu nhu cuc th.n mt lng qu d tha l do:1. Tp qun gia nh2. S tha mn xc cm hay lm du ni lou m mt s ngi cm nhn thy sau khin mt lng ln thc n.3. S gim cc hot ng th lc m khnggim bt khu phn n ung ngi gi,ngi bt ng, t vn ng.4. Tng tit hoc tng hot tnh Insulin, dnti n nhiu, gy tng chuyn Glucidthnh m.5. Kch thch vng di i: Cp nhn bngbn chi phi cm gic thm n, cp nhnbng gia chi phi cm gic chn n. Thct gp: sau chn thng, vim nogyn nhiu 121. Nguyn nhn bo ph Nguyn nhn ni tit(him gp)1. Hi chng Cushin v nhng tn thng di i:- M phn b u mt, c, bng (phn trn c th)- Chn tay mnh khnh.2. Chng tng tit Insulin do u: bo ph do tng sngon ming v to m t Glucid.3. Gim nng tuyn gip: (ph nim)- Gim chuyn ha c bn.- Tch m nhiu ni, cn i, kt hp tch nc.4. Trng thi b hon nh (Hi chng ph sinh dc)- M m tng quanh hng trn i, mng (phn dic th)- Do tn thng vng di i, suy gim tuyn sinhdc. 122. Nguyn nhn bo ph Gim huy ng+ Thc nghim ct thn kinh giao cm bng: gy tch mquanh thn.+ Ct hch giao cm tht lng: tch m vng khung chuv bng.+ Chn thng ct sng gy tn thng giao cm gy tchm vng tn thng.C CH:- H giao cm (Cate cholamin): Lm tng thoi ha m.- H ph giao cm (ph v): Lm tng tch m 123. Nguyn nhn bo ph Gim vn ng th lcNNG LNGN VOVN NG TH LCNNG LNG TIU HAOChuyn ha c bn 70%Sinh nhit 15%Lao ng th lc 15%= 124. Tc hi ca bo ph:1. Mt s thoi mi trong cuc sng:- Kh chu v ma h do lp m dy nh1lp cch nhit- Thngc cm gic mt mi, au u, t bun hai chn.2. Gim hiu sut trong lao ng:- Mt nhiu th gi v ng tc cho mt cng vic do c th qunng n.- D b TNL, TNGT do gim s lanh li, phn ng chm chp.3. Nguy c bnh tt cao: Ngibo ph t l bnh tt cao v tl t vong cng cao. 125. BBoo pphh vv bbnnhh ttiimm mmcchh::+ Bo ph l mt yu t nguy c bnhtim mch vnh (ch ng sau tui vri lon chuyn ha lipid).- Nguy c cao hn khi tui cn tr mb bo bng.- T l t vong do mch vnh cng tnghn khi b tha cn, d ch 10% so vitrung bnh.+ Ngibo ph c nguy c cao HA hnngibnh thng.+ Ngibo ph c t l t qu caohn ngibnh thng. 126. BBoo pphh vv ii tthhoo nngg::+ Khi BMI tng ln th nguy c i ngkhng ph thuc vo insulin (NIDDM) cngtng ln.+ Nguy c i ngtng hn khi:- Bo ph tr em v thiu nin.- Tng cn lin tc.- Bo bng. 127. Bo ph v si mt:+ Bo ph lm tng nguy c si mt gp 3 -4 ln ngibnh thng.+ Ngibo ph, c 1kg m tha lm tngtng hp 20mg cholesterol /ngy. Tnh trng lm tng bi tit mt, tng mc bo hacholesterol trong mt cng vi mc hot ngca ti mt gim dn ti to thnh si mt.Bo ph v cc nguy c sc khe khc:- Gim chc nng h hp.- Ri lon xng: vim xng khp (u gi vhng).- Tng nguy c ung th:i trng, v, tcung.- Tng nguy c bnh Gt. 128. IV. UNG TH 129. c trng ca ung th 130. Ung th l bnh ca TB vi 3 c trng:1. Sinh sn t bo v hn (c th mt kimsot)2. Xm ln ph hoi cct chc xung quanh.3. Di cn n ni khc. 131. HU QU1. Lm t lit mt t chc, c quan,khng hi phc c.2. Gy suy mn, suy nhc v suysp c th.3. Gy nghn ng h hp, chn pcc t chc, c quan khc.4. Lm tc mch mu (no).5. Ri lon ng mu: chy mu bntrong o t.6. Suy gim min dch, khng cnsc khng vi cc tc nhn:VK, virus, KST7. Di cn, xm ln vo c quan quantrng: no, tim, phi, tuyn nitit. 132. UNG THNGUYN PHTTH PHTBt ngun t TB c v trBan u hay v tr gcL ung th do di cn ca TBung th n v tr khc v trban u 133. Phng x C ch gy ung th: Ha cht Virus Gc t dot bin gen Thuc l Vim mn tnhSai hng ADN ..............Phn chia t bo v t chcTB non, khng bit ha, khng thc hin c chc nngT bo qui, d sn, lon snPht trin v hn (Bt t)Xm ln, chn p cc m xung quanhDi cn ti cc m xaTrnh c Apoptosis (cht theo chng trnh)Khng vi cc yu t chng tng sinh 134. QU TRNH PHT TRIN CA UNG TH1.Giai on bt u: TB b t bin2. Giai on khi ng: Tng sinh lnhtnh.3. Giai on tin trin: Tn thng ctnh. Thi k I: Pht trin ti ch. Mt khiu t 10g lm sng c th thy ccn 30 ln nhn i TB, tc: 150-300d. Thi k II: di cn lan trn khi uthng qua ng mch v bch mch.Khi u xm ln xung quanh hnh Concua (t Hy lp :Cancer). 135. NGUYN NHN GY UNG TH1. Sinh hc: nhim VK, virus, KST.2. Vt l: Phng x, tia cc tm, sngradio, sng tn s thp3. Ha hc: Ha cht CN. Ha cht BVTV, thuc th y. Ha cht mi trng. Dc phm, ni tit t.4. n ung: Ru, thuc l c t nm mc TP p mui TP chin, hun khi, nng Tht Nhiu m bo ha5. Li gen di truyn6. Suy gim min dch. 136. Triu chng c bn ca ung th:1. Triu chng ti ch: Ph, n Khi u au Lot Chn p .....2. Triu chng ca di cn:pht trin khi u ni khc Hch bch huyt Gan to, khi u Phi Xng No Rut3. Triu chng ton thn: St cn Chn n Suy mn Ho ra mu, thiu mu ... H.C cn u ..... 137. Nguy c gy ung th. 138. C ch phn t ca thc phm gy ung thThc phmCarcinogenOncogen(Kch thch phn chiat bo)Antioncogen(c ch phn chiat bo)Kch thch phn chiaTB khng ngngBin d gen mt kim sotphn chia TBUng th 139. 24 loi thc phm c nguy c gy ung th1. TP chin rn nng:Tht, c, i g, u ph rn ginSinh amind vng, gyt bin genUng th,c bit K tiu ha+ Cng chin rn gi la cng to nhiu amin d vng, nht l khi ang rn thm du m volm nhit t ngt.+ Amin d vng cn c trong KK, khi bp, khi xe, ng c.+ Nc tht rn cng c amin d vng.2. un nu nhit cao To ra BenzopyrenbencanthraxenUng th nhiuc quan nht ltiu ha3. Khoai ty chin, phng tm, bnh mtrng, bp rang, TP giu carbonhydratx l nhit caoTo raAcrylamideK v,K thn 140. 4. Tht hun khi, c sy kh D toNitrosaminK cc c quankhc nhau.5. Cc loi tht,c p mui,c mui kh, thc n mnCha gc Nitrat, NitritD to thnh NitrosaminK cc c quankhc nhau.6. Tht hp, c hp, xc xch,gim bngCha cht Nitrit boqun d to thnhNitrosamin (Nitrit lmtht c c mu hng,mi v hp dn)K cc c quankhc nhau.7.Ch n giu nng lng,nhiu m, b, trng, sa tht Cung cp nhiu chtt vi K ang phttrin v to nhiu gct do gy h hi genD K cc c quankhc nhau. 141. 8. M NG VT+ M l cht t vi khi u ang pht trin.+ M gy tng axit mt rut gi, cc axit mtlm thay i TB mt cch khng in hnh, cch qu trnh bit ha nim mc rut gy K.+ D tha m ng vt, m thc vt l du ngnhiu -6: lm gim h min dch c th. Chc acid bo -3 ca c c tc dng ngn cn K!+ M l tin cht to ra hormone steroid nhEstrogen, kch thch pht trin cc c quanlin quan nh tuyn v, t cung, tuyn tinlit, d thnh K.+ Du m un nng c nguy c gy K phi (do ccht Carcinogen bc hi ln).+ D b oxy ha to thnh Hyperoxyd lipid: chtny hot ha Procarcinogen thnhCarcinogen, ng thi lm tn thng ADN.+ D gy K rut, i trng, trc trng, v, tcung, tin lit tuyn. 142. 9. THC PHM NHIM NM MC+ Ng, lc, qu hnh, ht c du,qu kh, go, u, gia v b mcc th gy nhim c tAflatoxin (gy K gan).+ Ng cc, nho thi, ru vang, cph, qu kh, mt vi loi thtng vt b nhim c tOchratoxin (gy K thn, gan).+ Ng, go mc c th nhim ct: Fumonisin ca nm mc cth y K gan, thc qun. 143. 10.THC PHM NHIM HA CHT+ Rau qu cn tn d HCBVTV (nhm clo huc)+ Tht gia cm, gia sc, thy sn cn tn d thuctng trng.+ Thc phm b nhim do thi nhim ha chtc t bao b, dng c ch bin, bao gi (Hg,Pb, Cd).+ TP nhim ha cht t mi trng: t, nc,khng kh (Hg, Pb, Cd).+ TP nhim Dioxin (c, tm, cua, s, sa, trng)+ TP nhim PAH, BaP (Benzoapyren): do t rc,than, du, xng nhim vo TP.+ TP nhim BCP (Biphenyl polychlore): ncsng, mc in, my bin th, in, vt liu chngla nhim vo thy sn gy qui thai vK. 144. 11.THT + Tht v tht trngkhc nhau hm lngion st. Tht : c hmlng ion Fe cao.+ Ion st:- Tng xc tc men tnghp N0 t Arginin.- Tng xc tc binNitrat thnh Nitrit.+ Nitrit kt hp axit amintho thnh Nitrosamin,gy K rut, i trng,trc trng. 145. 12. NC UNG KH TRNG BNG CHLOR:Nc c nhiu cht hu c,khi cho chlor vo, c th tothnh:- Chloroacetonitrit: d tch t ng tiu ha v tuyn Giptrng,c th gy K.- Trihalomethan: cng l mtcht gy K. 146. 13. CHT PCB(Polychlorobiphenyl):L cht cch in, cch nhit, rt bn, khng n mn, khngbt la, c dng sn xut bin th in, sn xut dunhn, cn dn, xi nh giy, mc du, thuc tr suPCB thi ra, trn vi Chloruabenzen, di tc dng canhit , s to ra nhiu Dioxin.Dioxin nhim vo TP gy c, K cho ngi. 147. 14. Thuc l gy K1. Nitrosamin: NicotinNitro ha Nitrosamin2. Cc PAHs (Hydrocarbon a vng thm)3. Cc Amin d vng (Hetero cyclic Amines)4. Cc Amin thm (Aromantic Amines)Bin d genUng th 148. 15. RU GY UNG THRu: C2H50HAcetaldehydAcetaldehyd + ADNBin d TBAlcol dehydrogenase (ADH)K(V, gan, trc trng, ming,hng, thc qun) 149. 16. MUI V DA VI NGUY C K n mn: c nguy c K d dy gp hai ln so vi ngikhc. Da mui cn cay v da kh: hm lng Nitrit cncao, vo d dy d to ra Nitrosamin, gy K. 150. 17. Ko, bnh quy,bnh ngt, sclaCha lng ng ln,kt hpph gia, ch bin nng d tohp cht K.K cc c quankhc nhau.18. C fe Ung qu nhiu caf cha lc Caf rang chy to Acrylamide D gy KCha nhiu ng, cht ha hc,gase, cht bo qun kt hp dgy K19. Nc hoa qu pK cc c quankhc nhau. 151. 20. Ht phi khi thuc,khi hngCha nhiu cht gy K nh:Benzen, Naphthylamin PAHs Gy K phi, thcqun, bng quang,gan, thn, i trctrng, d dy rut,kh qun.21. n cc loi c ybin, h, sngD nhim Hg, Cd, Pb, Dioxinv cc c t khct bin gen dgy K cc c quankhc nhau.22. Nc tng Cha 3 MCPD1-3 CPDK cc c quankhc nhau.23.Trng, sa Nhim Sudan, MelaminK thn, c quankhc nhau. 152. 24. Cc cht ph gia TP: c hi v nguyc gy K+ Cc Sulfit bo qun gi mu sc ti tn.+ Hn the (Boax) p tht, c, bnh bt cho do, dai.+ Cht to ngt Cyclamade.+ Formaldehyde bo qun TP lu hng.+ Cht Paradimethyl aminobenzen nhum b vng.+ Ha cht c bo qun tri cy ti lu.+ Ure p c, mc.+ Carbendazim bo qun su ring. 153. CH : i thng ! V cao su: qua qu trnh lu ha cng to ra Nitrosamin. Giong cao su: (ni nu n, l ng TP) khi lo hacng c th to ra Nitrosamin. Dy chun: buc quanh tht quay, dm bng, ch cuncng c kh nng to ra Nitrosamin. 154. nhim khng kh nhim Thc phmThm nhim c t vi lngMConChu nh hng ngay khicn trong bng m 155. nnhh ssnngg BBnngg ttii((nngg))((++)) ((++))MMtt ttrrii NNhhnn ttoo TTuuyynn ttnngg TTuuyynn yynn((++)) ((++))(-)TToo MMeellaattoonniinn TToo GGHH DDaa((--))((++)) ((++))TToo VViitt..DD KKhhnngg ttoo VViitt..DDUUnngg tthh((++))((--)) ((--))((--))VViitt..DD MMeellaattoonniinn((++)) ((++))TTPPCCNNPPhhtt ttrriinn((llnn))((--))wwwwww..tthheemm eeggaalllleerryy..ccoomm CCoommppaannyy LLooggoo 156. EO O NT NGC V K Veo o nt ngc >12 ting/ngymc ung th v cao gp 21 lnnhng ngi khc. eo sut ngy m: cao gphng trm ln. o nt ngc: gy sit cht lngngc v bu v, chn p ccmch bch huyt di da, ngncn lu thng bch mch, cn trthi cc cht c, gy tch t cc t bo m ca v, d K ha. 157. CC YU T GY K HAY GP:1. Ung th khoang ming v hu hng, thc qun: Yu tnguy c chnh l ru v thuc l (chim 75% ung th loi ny).Cc nguyn nhn khc l tiu th ung v thc phm nhit cao, thiu vi cht dinh dng, thc phm p mui.2. Ung th d dy: Hn 20 nm trc, ung th d dy l ung thph bin nht th gii, nhng hin nay, t l t vong do ung th ddy gim xung tt c cc nc cng nghip. Hin nay ungth d dy ph bin nhiu hn cc nc Chu . Nhim vkHelicobacter Pylori l yu t nguy c xc nh. Ch n nhiuthc phm p mui truyn thng (tht mui, da mui), cc loi nhim ha cht (HCBVTV, thuc th y, ha cht thi nhim, c tnm mc, nitrat..) l nhng nguy c ang tng ln. Nguy c nygim i nh khu phn n b sung TPCN, nhiu rau v tri cy 158. 3. Ung th i trc trng: Cc yu t nguy c chyu lin quan n n ung: ch n nhiu tht,nhiu cht bo, t rau qu, trong ch yu l thtbo qun, tht , cht bo bo ha, ung nhiuru, tng cn, d lng ha cht.4. Ung th gan: Gn 75% ung th gan xy ra ccnc ang pht trin. Yu t nguy c chnh lnhim trng mn tnh virus vim gan B, vim ganC, thc phm nhim c t vi nm Aflatoxin. Ungru l yu t nguy c quan trng thng qua xgan v vim gan do ru. 159. 5. Ung th ty: L ung th ph bin cc nc cng nghip hn ccnc ang pht trin. Yu t nguy c chnh l tha cn, bo ph, ch nnhiu tht, t rau qu.6. Ung th phi: L ung th ph bin nht trn th gii. Yu t nguy cch yu l ht thuc. Yu t lin quan khc l khu phn n thiu ht -Caroten, t rau v tri cy.7. Ung th v: L ung th ph bin th hai trn th gii v l ung th phbin nht ph n. Cc yu t nguy c gy ung th v bao gm: Nhngngi khng sinh , c thai ln u mun, mn kinh mun, phi nhim vibc x ion khi di 40 tui, di truyn. i vi nguy c do n ung bao gm:ch n nhiu tht , n nhiu cht bo bo ha, ung nhiu ru, tngcn bo ph, d lng ha cht, trong bo ph v ru l hai yu t quantrng nht. Bo ph lm nguy c ung th v sau mn kinh tng khong 50%,c th do lm tng Estradiol t do trong huyt thanh. i vi ru, nu ungmi ngy mt ln lm tng nguy c ung th v ln 10%, c ch c th do lmtng Estrogen. 160. 88 nngguuyy cc UUnngg tthh vv11..CChh nn:: 2277%% KK vv lliinn qquuaann nn nncchhtt bboo (( 4400%% CCaalloo tt cchhtt bboo)) nn nnhhiiuu tthhtt :: nngguuyy cc llnn 22 llnn22.. BBoo pphh BBoo:: EEssttrrooggeenn mmuu TTBB mm:: cc tthh ssxx EEssttrrooggeennnnhhyy ccmm KK BBoo ssaauu mmnn kkiinnhh:: 5500%% nngguuyy cc BBoo++ccaaoo:: nngguuyy cc 3300%% KK vv:: ddoo bboo pphhMMii ttrrnngg:: nnhhiimm:: HHCC,, VVLLAASS tt nnhhiinn ((kkhhnngg ttoocc VViittaammiinn DD vv MMeellaattoonniinn))77.. RRuu:: nngguuyy ccDDii ttrruuyynn:: MM++DD bb KK,,ccoonn ggii nngguuyy cc 5500%%nngguuyy cc55.. HHCCBBVVTTVV vv tthhuucc tthh yy44.. PPhhii nnhhiimm ttiiaa xxUUnngg tthh vv33.. HHoorrmmoonnee:: NN ttrr vv sspp mmnn kkiinnhh:: nngguuyy cc ccaaoo CChhuu kk KKNN >>4400 nnmm:: nngguuyy cc ccaaoo TThhaaii uu ssaauu 3300:: nngguuyy cc ccaaoo TThhii ggiiaann ggiiaa tthhaaii uu && KKNN uu :: nngguuyy cc ccaaoo KKhhnngg ssiinnhh :: nngguuyy cc 161. Gim st du hiu sm ung th v.11.. CCmm ggiicc:: aauu kkhhii cc nngg aauu cc nnhh aauu kkhhii ss,, nn22.. NNhhnn:: MMuu sscc HHnnhh ddnngg SS ccnn ii DDaa nnhhnn nnhhmm,,ccoo kkoo CChhyy ddcchh,, mmuu33.. SS:: UU,, cccc DDii nngg nn cc cchhyy ddcchh,,mmuuKKhhmm cchhuuyynn kkhhooaa xxcc nnhh 162. 1.Quan st: Hai bn ngc tri vphi c i xng khng; Da vng ngc c bnhn nheo, cng, vim lothay sn si hay khng; u v c lm xung,tit dch l hay khng.2. S ng: Hai bn ngc tri vphi c i xng khng; Da vng ngc c bnhn nheo, cng, vim lothay sn si hay khng; u v c lm xung,tit dch l hay khng.4. S n:Nn kim tra theo hngn, xoay trn, mit trttrn da. Sau dng ngntr, ngn gia, ngn eonhn ca tay cn li kim tra tng t.3. Nm s: Khi nm xung di ukhng k gi. m mt chic gi nh di cng tay tri, bntay tri v tr sau no. Phng thc kim traging nh va m t phn ng kim tra. 163. DU HIU CNH BO K V1. S thy mt cc hay thy dylen vng v hoc nch.2. Thay i kch thc, mu sc,hnh dng.3. Nm v r dch, au, b co ko,sng, 4. Thay i da v: mu da cam,c qung5. So snh hai v thy s khcbit 164. 8. Ung th ni mc t cung: ngibo ph, ung th ni mc t cung caohn ba ln so vi ph n bnh thng,c ch do bo ph tc ng trn cc mchormone. Ch n nhiu cht bo nocng lm tng nguy c hn l ch nnhiu rau qu.9. Ung th tin lit tuyn: Ch nnhiu tht , cc sn phm t sa vcht bo ng vt thng lin quan tis pht trin ung th tin lit tuyn.10. Ung th thn: Tha cn v bo ph lcc yu t nguy c gy ung th thn. 165. 11. Ung th mu (bnh bch cu)+ Nguyn nhn cn cha xc nh r.+ Yu t dch t:- Tip xc phng x- Sng in t thp.- Ha cht- Di truyn- Virus12. Ung th bng quang:- Ha cht- Ht thuc l- Di truyn13. Ung th xng- Ung th xng nguyn pht : Sarcoma- Ung th xng th pht: do di cn n14. Ung th da- nh nng mt tri- Tia cc tm- Ha cht (tip xc, n ung)15. Ung th ming- Ht thuc- Ung ru- Ha cht 166. CC YU T LM TNG NGUY C UNG THTT CC YU T TNG NGUY C UNG TH1 Tha cn v bo ph Thc qun i, trc trng V ph n sau mn kinh Ni mc t cung Thn Ty2 Ru Khoang ming Hu hng Thanh qun Thc qun Gan V3 c t vi nm (Aflatoxin) Gan4 C mui kiu Trung Quc Mi Hu 167. TT CC YU T TNG NGUY C UNG TH5 Tht bo qun i, trc trng6 Thc phm bo qun bng mui D dy7 ung v thc phm rt nng Khoang ming Hu hng Thc qun8 Ch n nhiu tht , cc snphm t sa, cht bo ng vt Tin lit tuyn9 Cc cht bo ng vtCc Amin khc vng (PAHs)Cc Hydrocarbon thm nhiuvngNitrosamin H tiu ha. 168. V. LONG XNG 169. Long xng Long xng l qu trnh gimkhong ca xng do s iu chuynCalci t xng vo mu bi tc dngu th ca thy ct bo (Osteoclast) sovi to ct bo (Osteoblast). Long xng khc vi nhuynxng (Osteomalacia) l dng khcca gim khong do thiu Vitamin D. 170. Phn loi long xngI. Long xng nguyn pht:+ Tup I: Long xng sau mn kinh.+ Tup II: Long xng ngi gi (dolo ha).II. Long xng th pht: do ccnguyn nhn gy thiu Ca. 171. Cc yu t nguy c gylong xng1.Mn kinh sm: s gim Oestrogen l nguynnhn gy long xng.2. N gii.3. Di truyn.4. Cu trc xng mng.5. Ch s khi c th (BMI) thp: th hin cnnng c th thp.6. Ht thuc l: lm gim t trng xng.7. Nghin ru: do nh hng chuyn haprotein, Ca, c vi ct bo.8. Li sng tnh ti: lm gim khi lngxng.9. Ch n: ngho Ca, ngho cc Vitamin,khong cht.10.t tip xc vi nh nng mt tri. 172. 3 yu t c bn lin quankhi lng v t trng xngCh nHormonesinh dcHot ngth lc 173. Vai tr CH N1. Cung c p cc ch t cn thit to xng,duy tr v hi phc xng trong sut cuc i:- Protein- Ca- Vitamin C, D, K- Cht khong: P, Cu, Mn, Mg2. Ch n c vai tr duy tr s cn bng:n vo[ Ca, P]Thi ra[Ca, P]T chc xng l ngun d tr Ca v P,quyt nh sc mnh cah thng c, xng 174. Vai tr ca HormoneCc Hormone c vai trquan trng trong cn bng ngca xng, c tr em v ngiln, bao gm:1. Hormone tuyn gip.2. Hormone tuyn cn gip.3. Hormone sinh dc. 175. Vai tr ca Hormone sinh dc1. c nam v n, hm lng bnh thng caHormone sinh dc cn thit cho sc kheca xng.2. Nhng ngi ph n thi k sinh sn ngn(chm thy kinh v tt kinh sm) c nguyc long xng cao.3. Hormone Ostrogen c vai tr iu ha khilng xng, do giai on mn kinh,do gim Ostrogen nn cng gim khilng xng.4. phu n sau mn kinh, ch n thiu Ca,khi lng xng c th gim ti 15% dothiu Oestrogen v 16% do thiu Ca vVitamin D.Khuyn co: B sung vo ch n hng ngyCa, vitamin D, Hormone sinh dc. 176. Tuyn gip trng: sn xutHormone: Calcitonin1. Tc dng nhanh: lm gim tyct bo, dn ti lm tng lngng Ca xng. Tc dng nyc bit quan trng tr em.2. Tc dng th pht v ko di:lm gim hnh thnh ty ctbo mi.3. Tng ti hp thu Ca ngthn v rut.Kt qu: Calcitonin lm gim Cahuyt. 177. Tuyn cn gip trng: sn xutHormone: Parathormon (PTH)1. PTH tc ng ln xng: lm tnggii phng Ca t xng vo muthng qua:- T t bo xng (Osteocyte)- To ct bo (Osteoblast)- Hy ct bo (Osteoclast)2. Tc dng ln thn:Gim bi xut Ca qua thn.Tng ti hp thu Ca qua thn.Gim ti hp thu P, gy tng thi Pqua nc tiu.3. Tc ng ln rut: tng hp thu Cav P. 178. Vai tr ca Calci1. Ca l nguyn t nhiu nht trong c thchim 1,6% trng lng c th,khong 1000-1500g.+ Ca l thnh phn chnh ca xng, rng,mng: 99%, cn 1% mu, dch ngoibo v t chc phn mm.+ Cng vi P, Mg, Ca c vai tr hn gn ccim xng b t thng, gip xngpht trin v gi c tnh cng chc.2. L thnh phn chnh trong qu trnh ctha ca xng. 179. 3. Do phi chu sc nn ca c th v sma st khi vn ng, cc t bo xng u khp lng b v ra, ri li cti to. Qu trnh ny cn c:- Vitamin kch thch s hp thu Ca.- Mg iu phi Ca vo xng.- Ca cng vi P to ra nhng t bo xngmi.4. Ca gi vai tr truyn dn thng tinth hai trong hot ng ca c th,tham gia vo ton b cc hin tngca c th v cng nng ca t bo. 180. 5. Ca cn lin quan n qu trnh ngmu, hin tng co c, nhp p catim. T l Ca mng t bo, trong tbo v nhn t bo c nh hngquyt nh nh hng ti nhn t bo.6. Tr s sinh, tr em tui ln, ph nmang thai, ph n cho con b, saumn kinh ngi gi,ngi b gyxng do nhu cu cao Ca. Ngitrng thnh, ngi c thi quenung nc c ga, ung cafe hngngy, ung thuc Corticoid u cnc b sung Ca. 181. Before meal: K+channel openedCa2+channel closedTrc ba n:Knh K+ mKnh Ca2+ng 182. After mealSau ba nGlucose send signal to beta cellng gi tn hiu ti t bo betaClosed K+ channelOpened Ca2+channelKnh K+ ngKnh Ca2+ mInsulin produce & secreteTo v bi tit insulinGSX - ATPng(+)ATP/ADP Kh ccBi xutKhi ng Gene Insulin 183. HHnnhh:: QQUU TTRRNNHH DDNN TTRRUUYYNN XXUUNNGG NNGG TTHHNN KKIINNHH QQUUAA SSYYNNAAPP::GGhhii cchh::11,,77.. XXuunngg tthhnn kkiinnhh22.. KKnnhh CCaallccii33.. BBnngg cchhaa cchhtt ddnn ttrruuyynn TTKK44.. CChhtt ddnn ttrruuyynn TTKK55.. RReecceeppttoorr66.. iinn tthh mmnngg ssaauu uuii ggaaii.. 184. DN TRUYN XUNG NG TTHHNN KKIINNHH QQUUAA SSYYNNAAPP::.. SSuunngg TTKK llaann ttii CCcc ttnn ccnngg ssii ttrrcc.... MM kknnhh CCaallccii:: CCaa++++ tt ddcchh mm vvoo ddcchh bboo CChhyy SSyynnaapp ggnn vvoommtt mmnngg bbnngg cchhaa cchhtt ddnn ttrruuyynn TTKK,, ggyy vv cccc bbnngg vv ggiiiipphhnngg cchhtt ddnn ttrruuyynn TTKK vvoo kkhhee SSyynnaapp.... CChhtt ddnn ttrruuyynn TTKK ggnn vvoo cccc RReecceeppttoorr mmnngg ssaauu llmm xxuutthhiinn iinn tthh hhoott nngg vv ddnn ttrruuyynn ii ttiipp.... CC 22 llooii RReecceeppttoorr::((11)) RReecceeppttoorr kkcchh tthhcchh ((mm kknnhh NNaa,, NNaa++ ii vvoo llmm hhiiuu iinn tthh mmnnggttnngg))..((22)) RReecceeppttoorr cc cchh ((MM kknnhh KK,, KK++ ii rraa,, CCll-- ii vvoo hhiiuu iinn tthh mm)).. SS pphhnn cchhtt ddnn ttrruuyynn TTKK:: bb kkhh hhoott 33 cccchh::((11)) TTii hhpp tthhuu ss ddnngg llii((22)) BB mmeenn cc hhiiuu pphhnn ggiiii.. VV dd::- MMeenn AAcceettyyllcchhoolliinneesstteerraassee pphhnn ggiiii AAcceettyyllcchhoolliinn tthhnnhh iioonn AAcceettaatt vvCChhoolliinn..- MMAAOO pphhnn ggiiii CCaatteecchhiinnllaammiinn vv SSeerroottoonniinn..((33)) KKhhuuyycchh ttnn kkhhii kkhhee SSyynnaapp vvoo ddcchh xxuunngg qquuaannhh vv bb mmeenn cc hhiiuupphhnn ggiiii 185. Nhu cu b sung Calci hng ngy :TT LA TUI LNG Ca DNG HNG NGY (mg)1 Tr s sinh 300 - 4002 Tr t 1-3 tui 6003 Tr t 4-9 tui 7004 Tr t 10-12 tui 1.0005 Tr t 13-19 tui 1.2006 Ngi ln 800-9007 Ph n c thai: Thi k u 800 Thi k gia 1.200 Thi k cui v cho con b 1.2008 Ngi gi 1000-12009 Ph n mn kinh 1200-1500 186. VII. CH C NNG GAN V NGUY CTN THNG GAN. 187. I. GAN V CHC NNG CA GAN:GanC quan to nht c thVa c chc nng ngoi titVa c chc nng ni titVa l kho d tr nhiu chtVa l trung tm chuyn ho quan trngChc nng gan gn lin vi sinh mngGan l nh my nng lng ca c th 188. GlycogenCHC NNG CA GAN1. Chuyn ho:Chuyn ho Glucid: Tng hp v thoi hoChuyn ho Lipit:Tng hp acid bo.Oxy ho acid bo.Chuyn ho Cholesterol.Chuyn ho protid:Thoi ho + Tng hpTng hp cc men2. To mtTit mt3. D trLipitProteinVitamin tan trong du: A,D,E,K.Vitamin B12St 189. CHC NNG CA GAN4.To ph hu hng cu mu5.Chng cPhn ng ho hcTo ureLin hp:Vi GlucuroVi SulfatVi GlycolVi MethylOxy ho kh: Ph hu cht cC nh v o thi qua mt: KL, mu 190. S chng c ca cc c quan khcH hp: Thi CO2Tiu ho: o thi mt s cht c qua phnLcTit niu: Cc sn phm cui cng cachuyn ho: ure, acid uric, creatinin ...Cht c ni sinh:Bilirubin kt hpAcidCht c ngoi sinh(vo qua ng tiu ho, mu)Cc sn phm tha:NaH2OMui v cBi titH+NH4+K+: 191. Qu trnh o thi N:ProteinAxitaminNH4+ng vt sng trn cn Chim v b stThu sinh c xng sngng vt bi tit NH4+(Ammoni Otelic)ng vt bi tit Ure(Ure Otelic)ng vt bi tit axit uric(Uric Otelic) 192. Chc nng kh NH4+ ca gan ProteinRutAxitamin(Vk+men)T chcAxit aminNH4+ngoi sinh(4g/24h)NH4+ ni sinh (c)(no, c, t chc)Glutamin + NH4+(khng c)GlutaminThnNH4+Arginin CitrullinOrnithinUr(15-20g Ur/24h) 193. II. NGUYN NHN GY TN THNG GAN1. Sinh hc:- Nhim virus: A, B, C, D,E,G- Nhim vi khun: xon khun,, leptospira- Nhim k sinh trng: sn l gan, amip ....2. Ho hc:- Ho cht cng nghip- Ho cht bo v thc vt.- Thuc- Ni tit t3. L hc:- Phng x- Bc xSn l gan 194. 4. n ung: Thuc l ROH c t nm mc Thc phm p mui TP chin nng Tht M bo ho5. Suy gim min dch - t min6. Li gen di truyn7. Gc t do 195. III. CC TN THNG GAN:1. Ri lon chc nng gan:- RLCN Protid.- RLCN Glucid.- RLCN Lipit.- RLCN nc v in gii.- RLCN to mu.2. Vim gan cp:- Vim gan cp do virut: A,B,C,D,E,G.- Vim gan cp do virut: Brucella, Leptospira, SR ...- Vim gan cp do .- Vim gan cp do nhim c: thuc, ho cht, c t.- Vim gan teo vng cp.3. Vim gan teo nhim m: do suy dinh dng, ROH 196. III. CC TN THNG GAN:5. p xe gan.6. X gan:- Lon dng t bo gan.- Cc hch tng sinh lan trn- TCLK pht trin.- o ln cu trc gan.7. Di truyn: cc bnh Phorphyrie do thiu men sinh tng hpHem, dn ti tch lu Porphyrie.8. Ung th gan 197. Vim gan mn tnhTn thng hoi tTn thng vimHnh thnh t chc xThi gian tn thng 6 thngHoi t TBCht TBXm nhp TB LymphoXm nhp TB PlasmocyteKN...Ti sinh lin tcPht trin si collagenngoi TB 198. Cc loi vim gan mn tnhVim gan mn tnh do virusVim gan B: 10% chuyn MTVim gan D: ng nhim HBVVim gan C: 90% thnh MTVim gan G: do truyn muVim gan mn tnh t minT khng th.ANA: Khng th khng nhnSMA: Khng th chng c trnLKM: KT chng Microsome ca gan v thnSLA: Khng th chng KN gan ho tanLP: Khng th chng gan v tuAMA: Khng th chng MittochondrieVim gan mn tnh do thucMethyldopa, Isoniazid Halothan,Papaverin, Sulfonamid, Aspirin,Clometacin, Benzarone ...Vim gan mn tnh tim tng 199. Nguyn nhnUng th gan:X gan:80% x gan l do ROH (Php)X gan l do Vim gan MT, vim gan virusK ho t x gan: 60-90%12 Vim gan virus: B,C,D,GCc ho cht c:Hp cht v cHp cht hu cHo cht bo v thc vt ....3c t nm mc:AflatoxinOcharatoxin45 K sinh trng: Sn l gan6 Cht phng x. 200. Tin trin v bin chngVim gan mn tnhGiai on u:1. RLCH cht dinh dng: gy, st cn2. C chng3. Tun hon bng h v chy mu tiu ho4. Vng da5. Thiu mu6. Si ti mt7. i ng8. Ni tit: V to Rng tc Gim tnh dc9. Vim lot d dy10. Ri lon ng mu11. St12. H.C gan no (do protein gim, NH3tng13. Da lng bn tay, li , mng tay trng, d gyGiai on sau:1. X gan2. Ung th gan3. T vong 201. Tin trin K gan:Khi pht:1. Mt mi khng r nguyn nhn.2. Km n, y bng, kh tiu.3. Cm gic nng n, au m h sn phi.4. Gy st5. C th st nh.6. au xng khp nhng khng sng.Ton pht:1. Km n, st hn mc d rt c.2. y bng, chng hi (n bt chng)3. Mtmi khng mun hot ng4. Ri lon tiu ho: i ngoi nhiu ln, phn nt5. St: nh hoc cao.6. Gy st nhanh7. au h sn phi: tn dn thuc gim au thng thng khng tc dng8. Gan to, hong n, ph, tun hon bng h, lch to, chy mutiu ho, di cn.Giai on cui:Suy mn, chy mu ng tiu ho bng, tc tnh mch, di cn xaHn mT vong 202. VIII. CHC NNG SINH DC VNGUY C SUY GIM CHC NNG SINHDC 203. 1. Chc nng sinh dc ngi 204. CHC NNG SINH DC NGIChc nng sinh sn: l chc nng c in ca quan h tnh dc,SX ra con ngi 1 duy tr ni gingChc nng khao kht (thm mun): kch thch gi ln cm gic thm mun2 ng c quan hChc nng khoi lc (Orgasmus): - Quan h TD nh cao s khoi lc (hnh phc)- ng c duy tr3Chc nng thng tin: Trao i qua li thng tin, ngh lm su sc thm shiu bit, tin cy, gip v cng tc4Chc nng mong mun thay i tnh dc (chc nng mi, l): Thch mi,l, tr (cn ch ng)5Chc nng kh cng thng: - Kt hng phn tnh dc c ch trung khu khc- Orgasmus: dp tt cc phn x khc6 205. BiN php ch ng chc nng th 5Tun t theo quy trnh 4 giai on:+ Nam t t kh (Ha kh c kh ct kh thn kh)+ N t cu kh (Ph kh- Tm kh T kh Thn kh Ct kh Cn kh - Huyt kh Nhc kh Ty kh)Thay i a im v thi gian: Nhiu a im khc nhau thi gian khc nhauThay i t th:1. Cc t th:(1) Nm c in(2) Nam trn: S-N, S-S(3) N trn: S-N, N-N(4) Nghing(5) Ngi(6) Qu(7) ng(8) Kt hp2. Cc kiu:(1) Rng bay un khc(2) H rnh mi(3) Vn tro cy(4) Ve su bm cnh(5) Ra bay(6) Phng bay ln(7) Th lim lng(8) C giao vy(9) Hc qun c 206. 3. Cc yu t nh hng nchc nng sinh dc 207. nhim mi trng v nhim thc phm nhimsinh hc nhimha hc nhimvt l Gim kh nng thch nghi. Gim sc khng Gim sn xut tinh trng Gim SX HormoneSuy gim tnh dc 208. Kt qu nghin cu ca GS.N.Skakebach(i hc Copenhagen an mch) nhim mi trngThm nhim c t vi lngMt cn bng HormoneSuy gim cht lng tinh trng namUng th t cung nTeo c quan sinh dc 209. Nm 1940: L ng tinh trng nam chu u: TB 113triu/ml Nm 1990: ch cn 66 triu/ml ( 41,6%) lng tinhdch: 25% Theo WHO: Tnh trng di 20 triu/ml v sinh(Tng t 6 n 18%) 210. Qu trnh th tinh Phng tinh: SX: 120 triu TT/d Phng: 2-5 ml x 500 triu TT Thi gian sng: 24 - 72 h Hnh qun: tc 4mm/ pht Ca khu: Mm c m Bung TC: 7x8x5 cm Vi TC Gp g: 1/3 vi ngoi TC. w sng 24 - 48h Di chuyn ngc TC: 3 - 4d Lm t: nim mc TC Pht trin thai: 270 - 290d S thai 211. CH N UNG1. TP ngho Proteine (Acide amin, Arginin )2. TP ngho Vitamin (A,E,B,C ), cht khong (Zn, Ca, Mg )3. Ung nhiu ru, bia4. Nghin, ht thucTAM GIM1. Gim ham mun2. Gim tn sut3. Gim cng 212. nh hng ca lo ha1. Th lc chung: gim st2. Teo hnh th (c quan)3. Teo tuyn ni tit v gim sn xut Hormone4. Gim phn x: tip nhn kch thch, dn truyn, p ng, huy ng5. Hi chng:+ NG GIM: Ti to, phc hi p ng: kch thch, Hormone SX: kch thch, Hormone, dch T l H2O Chuyn ha+ TAM TNG: Tng sinh cht x, TCLK Tch ly cht c dySUY GIM CHC NNG TNH DC 213. STRESS1. Mt iu ha tp trung ca TKTW2. Mt mi lan ta cc c quan3. Suy gim ngun d trYu phn xYu cht lngThiu HormoneYu cng SUY GIM CHC NNG SINH DC 214. BNH TTDch bnh cc bnh mn tnh i tho ng Bnh tim mch Ung th Bnh xng khp Bo ph, tng cn Ri lon chuyn ha Bnh ni tit Bnh thn kinh ..Suy gim chc nng tnh dc 215. CH LM VIC1. Lm vic tr no, vi thit b my tnh.2. Lm vic lin min, thiu ngh ngi.3. t vn ng th lc.4. Lo ngh trin min, cng thng.5. Thu nhp thp.Suy gim chc nng sinh dc 216. T chc cuc sng1. Quan h gia nh2. Quan h x hi3. Cc yu t x hi4. Cc yu t tm l5. Trnh vn ha6. Mi trng7. Quan h tnh yu, tnh dc n iu,nhm chn8. K nng c nhnSuy gim chc nng sinh dc 217. IX. BNH THN KINH 218. CHC NNG H THN KINHGm 100 t t bo vi h thng mng li chng chtcc si TK vi hng ngn t cc xi-np TKTKTWS no Ty sngTK ngoi vi 12 i dy TK s no 31 i dy TK ty sng Phn ngoi vi TKTWCHC NNG4. Hot ng TK cao cp:(1) Tr nh:-Kh nng lu tr thng tin-Kh nng ti hin TT lu gi(2) thc: Dng chy lin tcca thc tnh, nh c thcm ta bit c ang t duy MTxung quanh(3) Cm xc: Thi ch quanvi s kin xung quanh:-Hng cm (khoi cm)-Trm cm(4) Gic ng: Qu trnh c ch vno gy mt thc vi 2 trngthi: gic ng sng chm vgic ng REM1. Cm gic thunhn kch thch 2. X l thng tin: Phn tch Tng hp a ra Q3. Vn ng:p ng KT 219. 5. c im no b:Mng li mch mu phong phTng di: 160.934,4 kmCun 4 vng qu tNo chim 2-5% trng lng c th. Nhng: Chim 20-25% lng mu do tim cung cp Chim 20% lng O2 c th Chim 25% lng Glucose c thNo cha 60% l lipit, nn d b oxy haTB no khng ti sinhNo d b tn thng: Thiu O2 khng qu 5 pht Gc t do tn cng: mi ngy c 10.000 FR v mi ingi c 17 tn FR tn cng12345 220. YU T NGUY C GY TN THNG NO1Thiu nuidng giaion bo thaiv tr nh2TPSLC cu cccht dd3VSV Virus VK KST4Ha cht HCCN HCMT HC trongTP5L hc Phng x Bc x6FR7Livn ng8Bnh mntnh khc: Cushing Addison Suy gip U no Thiu O2 Tn thng noCp tnh Mn tnhThiu mu noCh yu do VXMThiu ht CN thong quaKhng au uKhng nnMng no: (-)Dch no ty: (-)Chy mu noThng do HA caoRL thc, au uHn mDu hiu TK khu trMng no (+)Dch no ty c muau na uSuy gim tr nhSa st tr tu: Alzeilmer Mt tr nh khng hi phc RL ngn ng, vn ng Dn mt kh nng t phc vParkinson(1) Run khi ngh(2) Tng trng lc(3) Nt mt n, v cc(4) Bt ng, mt phi hp 221. Nguyn nhn nhi mu c tim v tai bin mch mu no:X va ng mch Huyt p caoMng va xHuyt pNghn tcM vnhNghn tcM noHoi t c timThiu mu cc b no(RL chc nng thong quakhi cha nhn no)Nhi mu c timChy mu no(RL thc, hn m, du hiukhu tr, mng no, dchno ty)Tai bin mch mu no 222. Thc trng bnh thn kinh(GS L c Hinh 6/2013)I. TH GII:1. TBMMN: Hng nm mc mi: 130.000 140.000ca. C 10 nm li tng gp i.2. Suy gim tr nh: Tui: 50-59: 39% Tui: 60-69: 50% Tui: 70-79: 63% 80 tui: 82%3. Alzheimer: 24.300.000 bnh nhn Mi nm thm: 4.600.000 mc mi C 20 nm tng gp i4. ng kinh: Hin mc: 44,8/100.000 dn Mc mi: 31,6 9,8/100.000 dnII. VIT NAM:1. T l bnh TK: 3,28% (ng th 7)2. TBMMN:+ Hin mc: 415/100.000 dn+ Mc mi: 161/100.000 dn+ T 2000-2010: c 18.195 ca phi nmvin- Nhi mu no: 12.104- Chy mu no: 5.7643. Suy gim tr nh: gia tng4. Alzheimer: 7,9%5. ng kinh: mc mi: 21,67/100.000dn 223. HC THUYT GC T DOFree Radical TheoryPGS.TS Trn ng 224. I. NH NGHA:Gc t do (Free Radical) l cc nguyn t, phn t hocion mang mt in t t do (cha cp i) vng ngoi nnmang in tch m, v th khng n nh, c kh nng oxy hacc nguyn t, phn t v t bo khc.Nguyn t n nh Mt in t Gc t do 225. II. LCH S:+ Moses Gomberg (1866-1947) l ngi u tin phthin ra gc ha hc hu cTriphenylmetyl vo nm 1900ti i hc Michigan USA. 226. + Denham Harman l ngi u tin xut hcthuyt gc t do trong nhng nm 1950 v m rng vonhng nm 1970.- L thuyt gc t do lc u ch cp n cc gc tdo nh Superoxide (O-2).- L thuyt gc t do c m rng bao gm cc tc hioxy ha t cc loi phn ng oxy ha khc (ReactiveOxygen Species ROS) nh Hydrogen Peroxide (H2O2) hocPeroxynitrite (OONO-) + L thuyt ty th ca s lo ha (MitochondrialTheory of Aging) ln u tin c xut nm 1978 vl thuyt gc t do ty th ca s lo ha (MitochondrialFree Radical Theory of Aging) c gii thiu vo nm1980.- Ty lp th l ni sn sinh ra cc ROS.- Cc ROS oxy ha AND, cc Protein v cc thnh phn khcca Ty th.- Cc tn thng li to ra cc ROS.- Mt vng lun hi ca Stress-oxy ha c thnh lp vtheo thi gian dn n s suy thoi ca cc t bo cquan t chc v c th. 227. III. TC NG CA GC T DO:11.. CC cchh ttcc nngg ccaa FFRR::Lm tn thng hoc cht t bo11Oxy ha mng t boOxy ha cc cu trc ni bo22 LLmm hh hhii cccc AADDNN33 GGyy ssnngg vviimm TTCCLLKK44Lin kt ngang (Crosslinks) vi cc phnt Protein, Lipide gy thoi ha, bintnh, mt chc nng t nhin.55 Phn ng dy chuyn oxy-ha gia tngcc ROS 228. 2. 10 tc ng ch yu hay gp do FR(1) Vim nhim, vim khp(2) Suy gim th lc, m la(3) Tn thng v thoi ha t bo thnkinh, to iu kin xut hin ccbnh Alzheimer, Parkinson, tm thnphn lit (4) Thc y qu trnh lo ha.(5) Tng nguy c bnh tim mch, bnhmch vnh.(6) Ung th(7) Ri lon chc nng gan, thn(8) Suy gim h thng min dch(9) Ri lon v tn thng da(10) i tho ng 229. 3. Gc t do c to ra nh th no?1. Qu trnh h h p v chuyn ha trong c th (to ra rcbi FR).2. nhim mi trng.3. nh sng mt tri.4. Bc x5. Thuc6. VSV (VK, virus, KST, nm)7. Thc phm8. Stress9. Cc tn thng. 230. 230Qu trnh oxi ha to ra nng lng v cc gc t doTy thGc t do Gc t do 231. Cc gc t do gy ra mt mi e da ti sc khe231ca chng taNguy hi Gc t doti DNANguy hiti mNguy hi titim mchLo haUng th 232. IV. CC CHT CHNG OXY HA(Antioxydants)1. nh ngha:+ L cc hp cht trung ha,c ch hnh thnh hoctng o thi cc gc tdo. Gc t do nh l RC Cht AO c nhim v nhNGI NHT RC. 233. 2. Cc cht AO bao gm:(1) H thng Ezyme:- SOD (Superoxide Dismutase): Xc Tc phn hy cc Anion Superoxide thnh Oxy v Hydroperoxide. C mt trong hu ht cc t bo hiu kh v dch ngoi bo.- Catalase: l men chuyn i Hydro trong nc v oxy bng cch s dngmt ng yu t l Fe hoc Mn.- Glutathione (GSH): l mt Tripeptid bao gm 3 acid amin: Glutamic,Systeine v Glycine. Glutathion c tc dng chng oxy ha quan trng, tngcng min dch, gii c, chng ung th, cn cho tng hp v phc hiAND, proteine v Postaglandin, h tr lm trng da. 234. (2) Cc vitamin: A, E, C, B (3) Cc cht khong: Zn, Mg, Cu, Fe, Se (4) Cc hot cht sinh hc:+ Phytochemicals:- Polyphenols (Resveratrol, Flavonoids): tr,nho, tri cy, liu, u nnh - Carotenoids (Lycopene, Carotene, Luteine):tri cy, rau trng - Anthocyanins (c tm, nho, du, vitqut )+ Melatonine+ Coenzym Q(5) Cc cht mu thc vt: Flavonids,Chlorophylls 235. 3. n v o lng cht chng oxy ha: ORAC+ ORAC (Oxygen Radical Absorbance Capacity): lmt phng php o lng kh nng chng oxyha ca cc cht chng oxy ha (Antioxxydants).+ Thit b: gm:- Mt my pht hunh quang- Ngun to gc FR Peroxyl khi c nung nng.- Cc FR lm oxy ha cc phn t hunh quang vlm gim cng ca chng.- Cht chng oxy ha bo v phn t hunhquang trnh khi b oxy ha.- Mc bo v c xc nh bng mt quangk- n v tnh l: Micromol Trolox Equivalent TE/100g mu. 236. V. STRESS OXY HA(Cng thng oxy ha)+ nh ngha:- S mt cn bng gia oxy ha (FR) v chngoxy ha (AO), trong cc FR chim u th.- Xy ra khi sn xut ra cc FR vt qu khnng bo v ca h thng phng th chngoxy ha.+ Gc t do (FR) c to ra trong c th hngngy khong 10.000.000 FR.+ Cc FR b phn hy bi cc AO.+ Tc lo ha v nguy c bnh tt phthuc vo s chnh lch gia FR v AO- Nu AO chim u th: Tr lu, th lu t bnh tt- Nu FR chim u th: Gi nhanh, chng cht Nhiu bnh tt 237. Cn bngAO chim u th Tr lu, sng lu t bnh ttFR chim u thGi nhanh, chng chtNhiu bnh tt 238. S HC THUYT GC T DO Free Radical TheoryHHnngg rroo bboo vvKKhh nnnngg ooxxyy hhaa ccaaooTn thngcht TBHH hhii AADDNN Sng vimTCLKLin ktngangPhn ng dychuyn oxyha ROS1. Vim nhim, vim khp2. Suy gim th lc, m la3. Thoi ha TBTK Alzheimer, Parkinson, tm thn phn lit 4. Thc y qu trnh lo ha5. Ung th6. Bnh tim mch, mch vnh7. RLCN gan, thn8. i tho ng9. Suy gim min dch10. Ri lon v tn thng da.1. H thng men (SOD, GSH, Catalase )2. Cc Vitamin: A, E, C, B 3. Cc cht khong: Zn, Mg, Cu, Fe, Se 4. HCSH:- Polyphenol (Resveratrol, Flavonoids- Carotenoids- Melatonin, CoQ ..5. Cht mu thc vt: Flavonoid, Chlorophyll 1. Qu trnh h hp v chuyn ha2. nhim mi trng3. nh sng mt tri4. Bc x5. Thuc6. VSV (VK, virus, KST, nm)7. Thc phm8. Stress9. Cc tn thngPhn t, ng.t,ion mang 1et do 239. NGUN THC PHM CUNG CP CHT CHNG OXY HATT Cht AO Thc phm1234567891011121314151617181920Anthocyaninsb-CaroteneCatechinCryptoxanthinsFlavonoidsIndolesIsoflavonoidLignansLuteinLycopenPolyphenolVitamin AVitamin CVitamin EZoochemicalsHp cht lu hunhCuMnSeZnC tm, nho, duB , xoi, m, c rt, rau bina, mi tyTr, ru vang t , b ng, xoiTr xanh, tri cy, to, ru vang , hnh tyCc loi rau h ci (ci xanh, ci bp, sp l)u nnh, u ph, u lng, u H Lan, saHt m, cm, ng cc, rau quCc loi rau l, ngC chua, bi, hng, da huHng ty, rau Oregano, tr xanhLng trng, gan, c rt, khoai lang, gc, saCam, chanh, qut, qu kiwi, xoi, blackcurrants, bng ci xanh, rau bina, du ty,tDu thc vt (du mm la m), b, cc loi ht, ng cc, gi Tht , ni tng, cTi, hnh ty, ti tyHi sn, tht nc, sa, cc loi htHi sn, tht nc, sa, cc loi htHi sn, ni tng, tht nc, ng ccHi sn, tht nc, sa, cc loi ht 240. HHCC TTHHUUYYTT GGLLYYCCOOSSYYLL HHAACch gi khc: GGllyyccoossyyllaattiioonn SSnn pphhmm GGllyyccaattee hhaa bbnn vvnngg AAddvvaanncceedd GGllyyccaattiioonn EEnndd PPrroodduuccttss GGllyyccoossyyll hhaa PPrrootteeiinnee AAGGEEss GGllyyccoottooxxiinnss..nnhh nngghhaa:: AAGGEEss ll cccc pphhnn tt cc ttoo tthhnnhh ddoo ss kktt hhpp ccaa cccc pphhnn tt nngg dd vvii ccccpphhnn tt PPrrootteeiinnee,, LLiippiiddee,, aacciidd NNuucclleeiicc kkhhnngg ccnn EEnnzzyymmee.. ll ttnnhh ttrrnngg ssiinnhh ll tt nnhhiinn ddnn ttii llmmttnngg cccc bbiinn cchhnngg vv nngguuyy cc bbnnhh tttt,, ttnngg ttcc lloo hhaa ttrroonngg cc tthh.. 241. NNGGUUNN GGCC AAGGEENNggooii ssiinnhh TTPP xx llnnhhiitt ccaaooTTPP tthhmm,, nnggoonn,,mmii vv,, mmuu sscchhpp ddnn++TTnngg xxcc ttccnngg PPrrootteeiinnee AAGGEENNii ssiinnhhQQuu ttrrnnhh ttrraaoo ii cchhtt[[CCaarrbboonnhhyyddrraatt ++ PPrrootteeiinn]]QQuu ttrrnnhh lloo hhaa[[GGlluuccoossee ++ PPrrootteeiinn TTBB ccnngg,, lloo hhaa]] SSttrreessss BBnnhh tttt TThhnngg ttnn TThhiiuu nngg LLii ssnngg kkhhnngg llnnhh mmnnhh((RROOHH,, tthhuucc ll )) nnhh ssnngg mmtt ttrrii GGeennYYuu tt ttnngg ssiinnhh AAGGEEAGEs 242. AAAAGGEE nnggooii ssiinnhhTTPP cchhiinn,, rrnn,, tthhtt nnnngg,, qquuaayy,, gg nnnngg,,qquuaayy BBBBQQ,, kkhhooaaii ttyy rrnn,, tthhtt cc hhuunn kkhhii,,TTPP nn nnggaayyAAddvvaanncceedd GGllyyccaattiioonnEEnndd PPrroodduuccttssPPrrootteeiinnss,, lliippiiddssNNuucclleeiicc aacciiddssGGlluuccoosseeAAGGEE nnii ssiinnhhBBiinn ii cchhuuyynn hhaa GGlluuccoossee((nngg mmuu ccaaoo,, kkhhnngg IInnssuulliinn,,ii tthhoo nngg ))AAllzhheeiimmeerrcc nnhhnn mmttTThhooii hhaa hhoonngg iimm CCaaoo HHAA BBnnhh ttiimm mmcchh BBnnhh mmcchh nnggooii vvii tt qquuTThhiiuu mmuu BBnnhh tthhnn mmnn ttnnhh SSuuyy tthhnn LLoonngg xxnngg GGyy xxnngg ttrrnngg llcc cc ssiinnhh llRREEDDUUCCEEDDLLOONNGGEEVVIITTYY 243. Cc dng Glycosylation(Glycosyl ha Protein)Glycosyl ha Protein v tr N(N-Glycosylation)Glycosyl ha Protein v tr O(O-Glycosylation) 244. Phng php xc nh AGE trong c th1 Xt nghim mu: xc nh ch s A1C, HbA1C2 Xt nghim nc tiu3 Sinh thit da4 My c AGE (AGE-Reader)5 My TruAge (TruAge Scaner) 245. Sugars Proteine Amadori Schiff MaillardAGE + RAGEActivation[Kch hot]NF KBYu t ht nhn Kappa-BGene vimOXY - HA Lipide M, TBCrosslinksChollagenProteineBin tnhKhng cn EnzymeTng theo tui thLp ni mcmch muTB thc boTB n nhn+XUT HIN CC BNH MN TNH Va x ng mch i tho ng Vim khp Bnh thn Nhi mu c tim Hen suyn Bnh thn kinh Bnh vng mc Nha chu vimVIM LDL, ROSTn thngX cngMt chcnng" tnh thmThay i ktdnhc ch NO"sinh TBc trn" Cytokinevim"IL-1b" TNF - C chtc ng ca AGE 246. Tn hiu ha hcReceptorT boPhn chiaChtCho 1 chtvo - raAGE + RAGEVim VXM DM Hen suyn Vim khp Nhi mu c tim Bnh thn Bnh l vng mc Bnh thn kinh Nha chu vim 247. Vngtrm trng hagia AGE v DM[AGE + RAGE]Tng khngInsulinTng phn ng:AGEi tho ngDMng + Proteine 248. Gii hn an ton: 15.000 kU/d/ngi Ti a : 20.000 kU/d/ngi 249. Cch tnh lng AGE n vo:1. Cng thc:Dietary Exposure = (Food Consumption x Food AGE Concentration)S phi nhim ch n ung [Risk][A] [B]Tng cc tch gia tiu th TP vi nng AGE trong TPR = AxBGhi ch: R: Risk (nguy c): lng AGE n vo/ngi/ngy A: Tiu th thc phm/ngi/ngy B: Hm lng AGE trong thc phm (kU/g) : Tng cc AxB2. Cc bc c th:+ Bc 1: iu tra lng tiu th thc phm/d/ngi+ Bc 2: Xc nh hm lng AGE/trong cc TP tiu th+ Bc 3: Xc nh lng AGE n vo tng loi TP:R1 = Tiu th TP x Nng AGE trong TP+ Bc 4: xc nh tng lng AGE n vo:R = R1 + R2 + R3 . 250. A.G.E.s l nguyn nhn hoc tng nng nhiu bnhX ha phiBnh kh ph thngTTHHNNBNH C XNG KHPBBNNHH TTMMCCHHBnh suy timX va ng mchNi mng Ri lonCao huyt p tm thuBnh mch mu ngoi binTng huyt png mch phiBnh mch vnhChng rung tm nhCC BNH KHCSINH DC-TIT NIUBBNNHH NNHHNN KKHHOOAABnh vng mc tiu ngThoi ha im vngGlaucomaChng vin thiESRD/ gcui / Lc phc mcBnh thntiu ngLo ha daBnh tiu ng au thn kinhX cng bHn ch Vn ng chungS tng trng khi u Ri lon cng dng Tc nghn ng niuBBNNHH NNGG HHHHPPVim khp dng thpVim khp mn tnha thot vXng vt gyCc bnh rng mingChng long xngHH TTHHNN KKIINNHH TTWW Stroke/ t qu/Tai bin mch mu no Bnh Alzheimer Amyotrophic/x cng ng vin 251. KKiimm ssoott AAGGEEss11 KKiimm ssoott AAGGEE nnggooii ssiinnhh::cchh nn uunngg hhnn cchh AAGGEE22 KKiimm ssoott AAGGEE nnii ssiinnhh::cchhnngg GGllyyccaatt hhaa11 HHnn cchh ttoo tthhnnhh AAGGEE22 PPhh vv lliinn kktt pphhnn tt33 GGiimm ttcc nngg vv ttnngg oo tthhii11.. TTPPCCNN:: HHoott cchhtt ddcc tthhoo:: IIrriiddooiiddss,, FFllaavvoonnooiiddss,, RReessvveerraattrrooll .. HHoott cchhtt tt hhooaa qquu..22.. VVnn nngg ((ii bb 115500 pphhtt//ttuunn))33.. HHnn cchh TTPP ggiiuu AAGGEE44.. TTnngg TTPP nngghhoo AAGGEE55.. TTrrnnhh SSttrreessss ooxxyy hhaa66.. UUnngg nncc 252. TT Thc phmHm lng AGEAGE kU/100g Khu phn nServing size (g)AGE/Khu phn(Serving)1234567891011121314151617181920Tht ln xng khiB nh kemDu mi g BBQTht b nngTht g chinTht g BBQG Mc DonaldPho mtPizzaXc xchLc rangu chinTrng chinToC rtChuiSa chuaNc p tri cyNc p rau xanh91.57726.48021.68018.52011.2709.9618.8028.6278.4236.8255.4266.4474.1072.7491310943213559090909090301009030904510010010025025025011.9051.3241.08416.66810.1438.9657.9227.7642.5276.8254.8831.9343.6961.237131091085 253. Li khuyn gim tiu th AGE:1. Hn ch, khng dng thng xuyn TPgiu AGE:(1) Sn phm ng vt giu cht bo v Proteine(c bit tht ).(2) Ko, bch quy, bnh ngt, soda giu ng(3) Thc phm ch bin: tht ng gi, pho mt(4) Cht bo, b, m, du(5) Cc thc phm x l nhit kh (nng,chin, rang, rn, quay, hun khi )2. Tng thc phm ngho AGE:(1) Tri cy v ru qu(2) Thy sn(3) Cc loi ng cc(4) Bnh m t bo(5) Pasta, thc phm chay 254. 3. Phng php nu n:(1) S dng mt ni chm(2) Thc phm nu nhit m (luc, hp )(3) p thc phm trong nc st chua(chanh, dm ) hoc nc p tri cychua.4. Li sng lnh mnh:(1) Ng 7-8h mi ngy(2) Tp th dc 150 pht mi tun(3) p dng cc bin php chng bo phv HA cao.(4) Gim Stress oxy ha(5) Khng ht thuc, hn ch ung bia,ru. 255. Phn III:TPCN d phng v h tr iutr cc bnh mn tnhFunctional Food for the Prevention andTreatment of Chronic Diseases 256. I. THC PHM CHC NNGL G? 257. Hnh 1: Thc phm chc nng, thc phm v thucDDDDrrrruuuugggg c cccllalalaaiimimimmFFuunnccttiioonnaall FFooooddFFuunnccttiioonnaall FFooooddDDiieettaarryy ssuupplleemmeenntt NNuuttrraacceeuuttiiccaallDDiieettaarryy ssuupplleemmeenntt NNuuttrraacceeuuttiiccaallFFooooddNNNNoooo c cccllalalaaiimimimmDDrruuggHHHHeeeeaaaalltltlththhh c cccllalalaaiimimimm 258. nh ngha:Thc phm chc nng l sn phm thcphm h tr cc chc nng trong c th, c tcdng hoc khng c tc dng dinh dng, tocho c th tnh trng thoi mi, tng sc khng, gim nguy c v tc hi ca bnh tt.Thc phm chc nng bao gm: Thc phm bsung, Thc phm ch bin t dc tho vThc phm s dng c bit (Thc phm dngcho ph n c thai, thc phm dng cho tr ssinh v tr nh, thc phm dng cho ngi gi,thc phm dng cho mc ch sc khe cbit, thc phm dng cho mc ch y hc cbit). 259. Phn bit TPCN vv TTPP ttrruuyynn tthhnngg::TT Tiu ch TP truyn thng(Conventional Food)TP chc nng(Functional Food)1 Chc nng 1. Cung cp cc cht dinhdng.2. Tha mn v nhu cucm quan.1.Ging chc nng c bn.2.Chc nng th 3: li ch sckhe, gim nguy c v tchi bnh tt.2 Ch bin Ch bin theo cng thcth (khng loi b ccht bt li)Ch bin theo cng thc tinh(b sung thnh phn c li, loib thnh phn bt li) cchng minh khoa hc v chophp ca c quan c thmquyn. 260. TT Tiu ch TP truyn thng TP chc nng3 Tc dngto nnglngTo ra nng lng cao t to ra nng lng4 Liu dng S lng ln (g-kg) S lng rt nh (m, mg).5 i tngs dngMi i tng + Mi i tng;+ C nh hng cho cc itng: ngi gi, tr em, phn c thai, mn kinh, suy yu,ngi m 6 Ngun gcnguyn liuNguyn liu th t thc vt,ng vt (rau, c, qu, tht, c,trng) c ngun gc tnhinHot cht, dch chit t thcvt, ng vt (ngun gc tnhin)7 Thi gian& phngthc dng+ Thng xuyn, sut i.+ Kh s dng cho ngi m,gi, bnh l c bit.+ Thng xuyn, sut i.+ C sn phm cho cc itng c bit. 261. Phn bit TPCN v thucTT Tiu ch TP chc nng(Functional Food)Thuc(Drug)1 nh ngha L sn phm dng h tr (phchi, tng cng v duy tr) cc chcnng ca cc b phn trong c th,c tc dng dinh dng hoc khng,to cho c th tnh trng thoi mi,tng cng khng v gim btnguy c v tc hi bnh tt.L cht hoc hn hp cht dng chongi nhm mc ch phng bnh,cha bnh, chn on bnh hociu chnh chc nng sinh l c th,bao gm thuc thnh phm, nguynliu lm thuc, vaccine, sinh phm yt, tr TPCN.2 Cng b trn nhnv cng ngh snxut L TPCN (sn xut theo lut TP) Cng ngh: chit, nghinTiu chun t nghim ngt hn.Thi gian NC ra SP nhanh hn.L thuc (SX theo lut dc)Cng ngh: chit, tch, tng hpTiu chun nghim ngtThi gian NC ra SP qua nhiu nm.3 Thnh phn, hmlng v hiu quHn hp nhiu cht, hot cht tnhin c trong chui cung cp thcphm.Xp x nhu cu sinh l hng ngyca c th.Hiu ng sinh l n chm nhngbn vngThng l ha cht tng hp tothnh cc phn t.Hm lng cao.Hiu ng mnh m nhanh chngtrong c th4 Ghi nhn + L TPCN+ H tr cc chc nng ca cc bphn c th, tng cng sc khe,gim nguy c v tc hi bnh tt+ L thuc+ C ch nh, liu dng, chng chnh. 262. 5 iu kin sdngNgi tiu dng t mua siu th,hiu thuc, ca hng S dng theo hng dn ca nhsn xut. Phi n khm bnh ti bc s. S dng theo n ca bc s.6 i tngdng+ Ngi khe+ Ngi bnh+ Ngi bnh7 iu kin phnphiBn l, siu th, trc tip, a cp + Ti hiu thuc c dc s+ Cm bn hng a cp8 Cch dng + Thng xuyn, lin tc b sungthm vo khu phn n hng ngy.+ S dng an ton, t tai bin, tcdng ph.+ Tng t (liu trnh).+ Nguy c bin chng, tai bin,tc dng ph.9 Ngun gc,nguyn liuNgun gc t nhin + Ngun gc t nhin,+ Ngun gc tng hp.10 Tc dng + Tc dng lan ta, hiu qu to lan.+ Tc dng chun ha (Khng c tcdng m tnh).+ Tc dng cha 1 chng bnh,bnh c th.+ C tc dng m tnh11 S giao thoa Prohormone Prosteroid Hot cht dc thoGing nhau:(1) Cng thc ha hc(2) C ch tc dng sinh hc(VD: cht c ch COX-2)Khc nhauNm trong ton b cng nhiu hotcht dc tho ca sn phm.L TP duy nht ca sn phm(ha cht tng hp) AT hn Liu dng sinh l t AT hn (tc dng ph) Liu dng cao. 263. CY C1. Ha ch: sao, sy2. Thy ch: ngm, tm3. Thy ha ch: chng, sc 1. Chit2. Tch3. Tng hp1. Chit2. NghinYHCT YH hin i TPCN 264. 10 c im ca Thc phm chc nng:1. L giao thoa gia thc phm v thuc, ging thc phm v bncht nhng khc v hnh thc, ging thuc v hnh thc nhngkhc v bn cht.2. Sn xut ch bin theo cng thc, b sung cc thnh phn mihoc lm tng hn cc thnh phn thng thng vi cc dngSP: vin (nn, nang ), bt, nc, cao, tr3. C th loi b cc cht bt li v b sung cc cht c li, c tcdng tng cng sc khe, d phng v gim thiu nguy c gybnh vi nhng bng chng lm sng v ti liu khoa hc chngminh.4. C tc dng ti mt hay nhiu chc nng ca c th.5. Li ch vi sc khe nhiu hn li ch dinh dng c bn.6. C ngun gc t nhin (thc vt, ng vt, khong vt).7. Tc dng lan ta, hiu qu ta lan, t tai bin v tc dng ph.8. c nh gi y v tnh cht lng, tnh an ton v tnhhiu qu.9. Ghi nhn sn phm theo quy nh ghi nhn TPCN.10.L mt phn ca s lin tc cung cp cc sn phm cho s tiuth ca con ngi nhm duy tr s sng, tng cng sc khe vgim gnh nng bnh tt. 265. Phn loiThc phmThc phm truyn thng (TP thng)[Conventional Food]Thc phm tng cng vi cht[Fortification Food]Thc phm chc nng[Functional Food]Thc phm b sung[Dietary Supplement]Thc phm t dc tho[Botanica/Herbal Dietary Supplement]Thc phm dng cho ch n c bit[Foods for Special Dietary Uses]TP dng cho ph n c thai[Foods for Pregnant Women]TP dng cho tr s sinh, tr nh[Foods for Infants]TP dng cho ngi gi[Foods for the Elderly]TP dng cho mc ch sc khe c bit[Foods for Specified Health Uses]TP dng cho mc ch y hc c bit[Foods for Specified Medical Purposes] 266. CC CNG B (CLAIMS) CA TPCNCng b vdinh dngCng b vSc kheCng b h trcha bnhCng b vchc nngdinh dngCng b vchc nng ctng cngCng b vlm gim nguyc bnh tt(bao gm cgim bo)Cng b vhm lng chtdinh dngCng b vphng bnhCng bh trcha bnhNhng cht ctrong TPChc nngsinh lVt quchc nngthng thngca c thC th lmgim nguy cbnh ttPhng ngabnh ttH triu trCung cp cc cht dinh dng(Vitamin, cht khong) cn thit chotng trng, pht trin v duy trsc khe.Dng cho ngi b thiu ht dd doch , gi ha.T SX, phn phi min l p ngTCQC thit lpCha cc cht nh hng chc nng sinh l v hot tnh sinh hc c thcon ngi.em li li ch c th v sc khe.c nh gi v ph duyt ca c quan c thm quyn. 267. NH NGHA LIN QUAN1. Thc phm: (Food) SP dng chovic n ung ca con ngi dngnguyn liu ti sng hoc quach bin cng cc cht c s dngcho SX CB TP nhm cung cp nnglng, tng trng, pht trin v duytr s sng ca con ngi.2. TPCN: (Functional Food) l SP htr cc chc nng ca cc b phntrong c th, c hoc khng c tcdng dinh dng, to cho c th tnhtrng thoi mi, tng sc khng,gim nguy c v tc hi bnh tt. 268. 3. Cht dinh dng: (Nutrient) l nhng cht c dng nhmt thnh phn ca TP nhm:- Cung cp nng lng, hoc- Cn thit cho tng trng, pht trin v duy tr s sng,hoc- Thiu cht s gy thay i c trng v sinh l.4. Vi cht dinh dng: (Micro Nutrient) bao gm mt lngnh cc phn t hoc ion c trong TP hoc trong c thcn thit cho m bo s hot ng ca h sinh vtsng. Vi cht dinh dng bao gm: cc nguyn t vilng, vitamin, acid amin, acid bo v cc hot cht sinhhc. 269. 5. Th c phm tng cng: [Fortification Food](1) L TP cng thm cht dinh dng vo TP n truyn thng (thng thng).TP n truyn thng l phng tin (vehicle) em thm cc vi cht dinhdng.(2) C th tng cng (cho thm) mt hoc mt nhm cht dinh dng (chttng cng The Fortificant) vo TP mang (TP em Vehicle).(3) Sau khi tng cng thm vo, qu trnh ch bin s lm ng nht ha vcht tng cng tr thnh phn v hnh trong TP.(4) Chin lc tng cng vi cht l iu kin tt nht vi hiu qu cao b sung cc vi cht dinh dng mt cch rng ri trong cng ng.V d: - Tng cng iode vo mui n.- Tng cng st vo bnh m.- Tng cng km vo ng cc, sa.- Tng cng acid Folic vo sn phm bt ng cc.(5) thc hin chng trnh tng cng vi cht cn c 3 iu kin:+ Tng cng cn phi c hiu qu.+ C tnh tin li, d s dng.+ Ph hp vi quy nh php lut v thc tin a phng. 270. 6. TP b sung: (Dietary Supplement, Vitamin andMineral Food Supplements)(1) Ngun gc: dng c c vitamin v cht khong.(2) Thnh phn: 1 loi hoc nhiu loi.(3) Dng SP: vin nn, vin nang, bt, dung dch.(4) SXCB: thnh n v s lng nh tng ng liu sinh l(Physical Forms).(5) Mc ch: B sung vitamin v mui khong cng vi ch n bnh thng hng ngy.(6) Hm lng vitamin v mui khong:+ Gii hn ti thiu (The minimum level):mi vitamin hoccht khong c trong TP b sung cho khu phn n mingy ti thiu phi bng 15%RNI ca WHO/WHO.+ Gii hn ti a (Maximum Amounts): i vi vitamin vcht khong theo khu phn n hng ngy qua khuyn coliu dng ca nh sn xut c thit lp theo cch tnhsau:- Da trn c s nh gi nguy c cn c vo cc dliu khoa hc, c cn nhc ti tnh thc tin, tnh nhy cmca cc nhm tiu dng khc nhau thit lp mc ti acc vitamin v cht khong.- T cc ngun khc quy nh liu vitamin v chtkhong n vo hng ngy. Khi gii hn ti a c thitlp s tnh c liu lng vitamin v cht khong b sungcho dn s. Tuy nhin, s tnh ton ny cng khng phi lduy nht thit lp RNI. 271. 7. Thc phm c bit(Foods for Dietary Uses)(1) C cng thc v qu trnh ch binc bit p ng yu cu dinhdng c bit.(2) p ng iu kin sinh hc, sinhl ca tnh trng ri lon chcnng v bnh tt.(3) Thnh phn khc c bn so vi TPthng thng t nhin.(4) c nh gi v tnh an ton, tnhcht lng, tnh hiu qu v sph chun ca c quan thmquyn. 272. 8. TP dng cho mc ch sc khe c bit.[Foods for Special Health Use](1) Cha cc cht c nh hng ti cu trc sinh l v chcnng sinh hc ca c th con ngi.(2) TP c cng b rng nu c s dng hng ngy c them li li ch sc khe c th: ci thin sc khe vgim thiu tc hi v nguy c bnh tt.+ Khng nh tc dng ci thin sc khe v gim thiucc nguy c cc bnh lin quan ti thiu ht cc chtdinh dng trong c th con ngi, nu c b sung sto nn s cn bng cc cht dinh dng.+ Tc ng vo cu trc sinh l v chc nng sinh hcca cc b phn trong c th, kh nng phc hi, tngcng v duy tr cc chc nng bi cc cht dinhdng v thnh phn xc nh ca TPCN (V d:chc nng tiu ha, tim mch, HA, m mu).+ Cc li ch chung v s dng TPCN.(3) TP phi c nh gi vi s chng minh bng bngchng khoa hc. 273. 9. TP Dng cho mc ch y hc c bit[Foods for Special Medical Purposes]:(1) L cc loi TP s dng cho ch n c bit,dng trong iu tr bnh nhn.(2) C cng thc v qu trnh ch bin c bit nhmmc ch kim sot bnh tt ca ngi bnh.(3) Sn xut ring bit dng nui dng c bit cho:+ Bnh nhn suy gim chc nng n ung, tiu hav hp thu.+ Ri lon qu trnh chuyn ha.+ Thiu ht cht dinh dng no .+ Yu cu bt buc phi b sung cc cht dinhdng m ch n bnh thng khng p ngc, bt buc phi thay i ch n hin ti bimt ch n c bit khc hoc phi hp c hai.(4) S dng di s gim st ca y t. Trn nhn btbuc ghi dng ch Use Under Medical Supervision. 274. 10. Cng b dinh dng(Nutrition claim): B t k mt s miu t no mang tnh cht tuynb rng, d l gi hay hm , mt thc phmc cha ngoi gi tr nng lng, cn c ccprotein, lipid, carbohydrate cng nh cc vitaminv cht khong. Cng b dinh dng s phi ph hp vi chnhsch dinh dng quc gia v khuyn khch chochnh sch , ch nhng cng b dinh dngph hp vi chnh sch dinh dng quc gia mic php thc hin.C 2 loi: 275. 10.1 Cng b v hm l ng ch t dinh d ng (Nutrient content claim):l mt loi cng b dinh dng m t v mc cht dinh dngtrong mt TP no .V d: - Ngun gc canxi- Cao trong x, thp trong m.10.2 Cng b so snh cht dinh dng (Nutrient comparative claim): lcng b so snh mc cht dinh dng hoc gi tr nng lngca hai hay nhiu thc phm tr ln.V d: - Gim hn - Thp hn- t hn - Tng hn- Nhiu hn 276. 11. Cng b v sc khe (Health claim):Bt k mt s miu t no mang tnhcht tuyn b rng, d hm hay ng, v mt s lin quan gia mt thcphm hoc mt thnh phn ca thcphm no vi sc khe.Cng b sc khe bao gm: 277. 11.1. Cng b chc nng dinh dng(Nutrient functional claims):L mt cng b dinh dng m t vaitr sinh l ca cht dinh dng ivi s trng thnh, pht trin vchc nng bnh thng ca c th.V d: cht dinh dng A c vai trsinh l trong bo v, duy tr v h trs pht trin bnh thng ca cth. Thc phm X c hm lng caohoc ngun cung cp cht dinhdng A. 278. 11.2. Cc cng b chc nng khc(Other functional claim): Nhng cng b ny lin quan ti li ch cavic tiu th cc thc phm hoc cc thnhphn ca chng trong tng th ch ni vi cc chc nng bnh thng hoccc tc dng sinh hc trong c th. Nhngcng b ny c lin quan ti tnh tch cc,c tc dng ci thin sc khe v duy trsc khe.V d: Cht A c tc dng h tr chc nngsinh l hoc tc dng sinh hc vi c th.Thc phm Y cha: X gram cht A. 279. 11.3 Cng b gim nguy c bnh tt(Reduction of disease risk claims):Nh ng cng b lin quan t i s tiu th thc phm hoc cc thnh phn cachng trong tng th ch n c tc dng lm gim cc nguy c gy bnhtt hoc cc iu kin nh hng ti sc khe.Gim nguy c bnh tt l c th lm thay i cc yu t ch yu gy nn bnhtt hoc cc iu kin nh hng ti sc khe.Bnh tt c rt nhiu cc yu t nguy c, c th lm thay i mt trong cc yut hoc khng c tc dng. S cng b gim nguy c gy bnh phi chcchn, t ng dng phi d hiu, thch hp ngi tiu dng c th p dng phng trnh.V d:- Ch n ngho trong dinh dng hoc cht A c th lm gim nguy cbnh D. Thc phm chc nng X l TP ngho trong dinh dng v c chacht A.- Ch n giu trong dinh dng v cht A c th lm nguy c bnh D.TPCN X l TP giu trong dinh dng v c cha cht A.Ch : Cng b sc khe (Health laim) phi ph hp vi chnh sch chm sc vbo v sc khe quc gia v khuyn khch cho chnh sch y. Cng b sckhe h tr cho 1 sc khe khe mnh cn c chng minh bng bng chngkhoa hc, chnh xc, gip ngi tiu dng la chn mt ch n ng n,trnh la di khch hng v phi c c quan c thm quyn gim st. 280. 12. Tc dng chm sc sc khe ca TPCN:Mt tc dng c khoa hc chng minh c kh nng cithin sc khe v lm gim thiu nguy c v tc hi bnhtt. N khng phi l tr liu y hc nhm mc ch iu trhay cu cha bnh tt ca con ngi.Tc dng chm sc sc khe ca TPCN th hin:1. Khng nh tc dng ngn nga hoc gim cc bnh tt linquan ti dinh dng khi xy ra s thiu ht trong c thcon ngi nu hp th TPCN c th cung cp y cccht dinh dng ni trn.2. Khng nh tc ng vo cu trc sinh l ca con ngi vcc chc nng bi nhng cht dinh dng c xcnh hoc cc thnh phn nht nh bao gm trong mtTPCN.3. Cung cp cc bng chng khoa hc h tr nhng khngnh rng TPCN c th duy tr hoc tc dng cu trc sinhl v chc nng c th.4. Din t cc li ch chung ca vic s dng TPCN. 281. II. TC DNG CATPCN 282. Tc dngTPCN1 Chng lo ha, ko di tui th.2 To sc khe sung mn3 Tng sc khng, gim nguy c bnh tt4 H tr lm p cho con ngi.5 H tr iu tr bnh tt6 H tr pht trin kinh t - x hi. 283. Sc khe l g ?Tnh trng lnh ln cac th v cu trc vchc nng.iu ha cn bng ni miThch nghi vi s thayi ca hon cnhSC KHE 284. Bnh tt l g?Ri lon cutrc chc nngP t, TB, m,BNH TT (1.000)c quan,c th2Ri lon cnbng ni mi31Gim khnng thch nghivi hon cnh 285. C ch SLB h tr iu tr bnh tt ca TPCN1. Tng cng chc nng chuyn ha(b sung vitamin, cht khong )2. Tng cng cu trc sinh l (b sungcht khong ).3. Tng cng chc nng SL(b sung hotcht sinh hc).4. Chng FR (Vit C,E, b-carotenH tr cu trcchc nng1. iu ha ng mu (cht x,w-3,crome )2. iu ha m mu (Fiber, PUFA, MUFA,Iridoids, Flavonoids ..)3. iu ha cht khong: Ca, Zn 4. iu ha kim toan.KHI BNH = SC KHETng kh nngthch nghi vi hon cnh1. Adaptogen2. Tng sc khng, min dch (c hiuv khng c hiu).3. B sung vitamin, cht khong, hot chtsinh hc.4. Chng vim.Chng RL cn bngni mi 286. Ba li ch c bn ca TPCN trong iu tr1Tng sc khe chungTo sc khe sung mnTng sc khng min dchTng cng cc chc nng c thNhn sm, ng trng h tho, cc loi nm, to, vitamin, cht khong,sn phm t ong Tc ng trc tip nguyn nhn gy bnh:Taxol trong TPCN tinh du thng tc dng chng ung th.Iridoids: td HA, cholesterol, LDL, TG, c ch pht trin TB u.Resveratrol: cholesterol, TG, LDLFlavonoids: chng vim, chng u, thng huyt qunSaponin: khng khun, khng nm 23Tng hiu qu v gim tc dng ph, bin chng ca tn dciu tr ung th bng x tr + ha cht: rng tc, mt mi, chn nS dng TPCN: Trnh rng tc, gim mt mi, tng sc khe, n ngon, sng khoi. 287. 1. TPCN CHNG LO HA KO DI TUI TH:THC PHM CHC NNGLm cho AOvt triChng lo ha T boChng lo ha T chcChng lo ha ko di tui thCung cp cht AOVitamin: A, E, C, BCc cht khongHot cht sinh hcCht mu thc vtCc EnzymB sung Hormone1. Hormone sinh dc2. Hormone pht trin(tuyn yn)3. Hormone tuyn tngNgn nga nguy cbnh tt1. Tng sc khng2. Gim thiu nguy cgy bnh3. H tr iu tr bnhttTng sc khesung mn1. Phc hi, tng cng,Duy tr chc nng tchc, c quan.2. To s khe mnh,khng bnh tt1. Kt gen pht trin,c ch gen lo ha.2. Ko di thi giansinh sn.Gim thiubnh ttTo s khe mnhca TB + c th 288. 2. TPCN TO SC KHE SUNG MN:1. B sung vitamin2. B sung khong cht3. Hot cht4. B sung cht AOTPCN 289. 3. TPCN - TNG SC KHNG,GIM NGUY C BNH TTwww.themegallery.com 290. TPCN TNG CNG H THNG MIN DCHTPCN tng cng h thng min dch (sc khng) khng c hiu:TPCNB sung cc chtdinh dngTuynngoi titC quanto muTng sx:Dch nhyCc menM hiTrung gian ha hcTuynni titTng tng hpProteinTng sxv ti tomuTng sxHormoneTng sc khng 291. TPCNH trcc chc nng c thTngsc khngGim nguy cmc bnhRi lon chuyn haSuy dinh dngLo haBnh mn tnh 292. TPCNCung cp hot chtc chCytokingy vimChng vimc ch menC0X - 2Tng sc khngCc sp TPCN: - Ti- C rt, Sp thc vt.- Probiotics- B sung Zn, vi khong.- B sung Vitamin- B sung Acid amin.- B sung hot cht sinh hc 293. TPCN H TR TNG CNG H THNG MINDCH C HIUKhng nguynC thKhng th Nm linh chi Nm hng To Vitamin A, D, E, C Cht khong: Zn, Ca ++ Sm Hong k ng trng h tho Vision Sa ong cha Acid aminTPCN 294. 4. TPCN h tr lm p con ngip hnh thcBBiiuu hhiinnsscc ppp ni dungKhng cbnh ttC sc bn b,do daiCc chc nngbn vngCn ichiu cao, cn nng- BMI = 18,5 24,9 kg/m2- Ba ch s oBiu hinDaRng, mingu, tcMt, mi, taiNgc, mngDng: i, ng,nm, ngiLi niTPCN 295. 5. TPCN - H TRz PHNG VIU TR BNH TT 296. C ch TPCN h tr iu tr bnh ttTng cng ccchc nng ccb phnCu trc sinh lTng sc khngTng kh nngmin dchBn thn TPCNtc ng trctip tc nhngy bnh:Khng sinhChng FRc ch hockch thch qutrnh chuyn haTng hiu quliu php tn dcGim tc dngph, tai bin liuphp tn dcKhi bnh 297. TThhcc pphhmm cchhcc NNNNGGVitamin Khong cht Axit aminCu to c quan, t chcHot chtsinh hcQu trnh chuyn ho vt cht (ng ho - d ho)Phc hi cu to v chuyn hoPhc hi chc nngPhng v h tr iu tr bnh 298. C CH CHUNG TPCN PHNG CHNG T:Chng h hi TB Langerhans:Tng h thng min dchChng vimChng oxy haTng SX KT, gim tc hi phn ng KN-KTGim ng mu.Gim hp thuGim to thnhSP c ch s ng huyt thpTng nhy cm ca ReceptorGim m muGim bo phTng nui dng cc m, TBChng vim, chng oxy haTPCN tng nhy cm ReceptorTPCN to mi trng kim mu.Hot cht dc thoCht xNg cc nguyn htTo, nm 299. TPCN PHNG CHNG H HI TB LANGERHANS:TPCN tng cng min dch (to xon, linh chi, ng trngh tho, nm hng, ngu chng chi, hong k )TPCN gim nguy c gy bnhTPCN chng FRc ch COX-2 chng vim, tng sc khngB sung ProbioticsKch thch TB Lympho B,TKch thch SX Interferon, Cytokine,B sung Vitamin, cht khong, HCSH: cu trc, chc nng cc tchc sc khng (Zn: tng tng hp Insulin)TPCN chng vim(Curcumin, Iridoids, Flavonoids, Antocyanosids )Hot cht c ch men COX-2Hot cht c ch Cytokin gy vimKch thch SX bch cuTng h thng khng c hiu v khng c hiuTPCN chng oxy ha, bo v TB LangerhansPolyphenolFlavonoidsVitamin (Vitamin E, Vitamin C, b-caroten )ResveratrolAntocyanidineMelatonin, CoQ-10, SODEnzymes, Hormone TPCN kch thch tng SX khng thIridoidsPolyphenolCathechin (EGCG)Falavonoids . 300. TPCN LM GIM NG MU:TPCN b sung cht xLm chm rng d dy no lu n G.To mng keo ph nim mc rut hp thuCn tr rut non trn thc n vi dch tiu ha chm tiu ha v hp thu.TPCN cung cp HCSH c ch men:c ch men -Glucosidase c ch s phn giing i, tinh bt thnh Glucose (u tng ln men,dch chit l du, tinh cht b ng )TPCN l cc sn phm c ch s ng huyt thpTPCN b sung canxi kch thch m knh Canxiqua mng TB KT SX Insulin G. 301. TPCN tng nhy cm caReceptor vi InsulinTPCN b sung cht bo khng no (w-3) tng s nhy cmcc Receptor vi Insulin.TPCN b sung Cr, Mg, Vitamin E:lm cc m s dng G d dng.TPCN kch thch SX Nitric Oxyd (NO) tun hon vi m nui dng TB nhy cm vi Insulin.Cc HCSH: dy tha canh, mp ng, c ch,gio c lam, b ng, ngh, nhu TPCN gim cn chng bo ph:TPCN c ch cm gic thm nTPCN lm chm rng d dy, no lu (cht x)TPCN lm gim hp thu mTPCN lm tng thoi ha m d trTPCN tng o thi.TPCN lm gim m mu (gim TG, cholesterol, LDL, tng HDL) 302. Vai tr ca TTPPCCNN vv NNiittrriicc OOxxiiddeeTTHHCC PPHHMM CCHHCC NNNNGG((DDmm ddnngg hhoocc,, YYoohhiimmbbiinn,, MMaaccccaa,, nnggcc ddnngg,, nngguu ppnn,, llcc nnhhuunngg,, llnn,, hhoo,, cc hhii,, oomm mm,,ccnn ttrrnngg,, ttiimm sseenn,, hhii mm,, ttmm,, ttii,, nngg ttrrnngg hh tthhoo,, nnhhuu ))HHoorrmmoonneeTTeessttoosstteerroonnee KKcchh tthhcchh hhaamm mmuunn LL--AArrggiinniinnTTnngg hhpp CCrreeaattiinneeCChhuu ttrrnnhh UUrrTToo nnnngg llnnggvv pphhtt ttrriinn ccTThhii NNHH33GGiiii pphhnngg NNOO((++))NNOOSSGGiinn cc ttrrnn TThh hhaannggMMuu ttrroo nnCCnngg ddnngg vvttTTnngg nnhhyyccmm cccc mm ddnngg vvttvv mm vvttKKcchh tthhcchhSSXX HHoorrmmoonneeGGHHGGiinn cc ttrrnn tthhnnhh mmcchhTTnngg lluutthhnngg ttuunnhhoonn mmuuGGiimmHHAANNuuii ddnnggttttNNhhaannhh pphhcchhii ttnn tthhnnggpphhnn mmmmTTeessttoosstteerroonnee == hhaamm mmuunnQQHHTTDD NNOO == CCnngg ddnngg 303. Cc khuyn co d phng T:(1) D phng v iu tr tha cn bo ph,c bit cc nhm c nguy c cao.(2) Duy tr BMI tt nht (trong khong 21 23kg/m2).(3) Thc hnh hot ng th lc: trung bnh 20 30pht mi ngy, duy tr t nht 5 ngy trong tun.(Tng tiu hao nng lng,tng tnh nhy cm caInsulin v ci thin tnh trng s dng Glucose cc c). 304. (4) Duy tr ch n v b sung TPCN: n rauqu, u, ng cc ton phn hng ngy, n t ngngt v t cht bo bo ho (khng qu 10% tng nng lngvi nhm c nguy c cao, nn mc < 7% tng nng lng),t khu phn NSP 20g/ngy.+ Nn s d ng cc TP c hm l ng ch t x cao v ch s ng huytthp.+ Ch n phi cung cp c 40-50% lng Calo di dng Hydratcacbon; 15-25% di dng Protein v 25-35% di dng Lipid. Vi ph n vtr em cn tng Protein.+ S dng thng xuyn cc TPCN phng nga T, tim mch, huyt p. 305. (5) - Khng ht thuc l: ngiT c nguy c bnh mchvnh v t qu. Ht thuc l lm tng nguy c .- Khng ung ru v ung c cn.(6) Phng nga cc bnh km theo: v d VXM, tng HA(7) nh k xt nghim, kim tra ng mu 306. Thc phm, li ssnngg vv nngguuyy ccbbnnhh ii nnggttyyppee 22NNIIDDDDMM Xu th gia tngtheo s phttrin x hi -kinh t. Tng gp ivo nm 2025 Tng ln c tng lp trNNIIDDDDMM Xu th gia tngtheo s phttrin x hi -kinh t. Tng gp ivo nm 2025 Tng ln c tng lp tr1. Tha cn, boph2. Bo bng3. Khng hot ngth lc4. i tho ngbm5. Khu phn nhiucht bo no6. Qu nhiu ru7. Tng cht bokhu phn8. Chm pht trintrong t cung1. Tha cn, boph2. Bo bng3. Khng hot ngth lc4. i tho ngbm5. Khu phn nhiucht bo no6. Qu nhiu ru7. Tng cht bokhu phn8. Chm pht trintrong t cungTTnngg1. Gim cn t nguyn ngitha cn v boph (duy tr BMI mctt nht)2. Hot ng th lc3. Thc phm giu NSP4. Thc phm giu acidbo n - 35. Thc phm c ch snghuyt thp (htu)6. m bo khu phncht bo no