TRATAT ROMÂN DE BOLI METABOLICE

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  • Editat de

    Viorel erban

    TRATAT ROMN

    DE

    BOLI METABOLICE

    2

    Brumar

  • Editor: Gabriel TimoceanuPaginare: Gheorghe StanjicTipar: BrumaR

    Editura BrumaR300050 Timioara, str. A. Popovici 6tel./fax: + 40 256 203 934; 293 441e-mail: o#ce@brumar.rowww.brumar.ro

    Descrierea CIP a Bibliotecii Naionale a RomnieiERBAN, VIOREL Tratat romn de boli metabolice / Viorel erban- Timioara: Brumar, 2011ISBN 978-973-602-554-9

    821.135.1-1

    Copyright: Viorel erban

  • Editat de

    Viorel erban

    TRATAT ROMN

    DE

    BOLI METABOLICE

    2

    Brumar

  • Autori

    Alin Albai asistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic specialist diabet, nutriie i boli metabolice, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Oana Albaidoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic specialist diabet, nutriie i boli metabolice, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Katalin Babeconfereniar universitar, Universitatea din Oradea, Facultatea de Medicin i Farmacie, medic primar cardiologie, Spitalul Clinic Judeean de Urgen, Oradea

    Cornelia Baladoctor n medicin, ef de lucrri, Universitatea de Medicin i Farmacie Iuliu Haieganu, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Laura Barnamedic specialist pediatrie, Centrul Medical de Evaluare i Recuperare pentru Copii i Adolesceni Cristian erban, Buzia

    Mihaela Btnean

    doctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar pediatrie, Clinica de Pediatrie III, Timioara

    Veronica Boteamedic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Timioara

    Editor

    Viorel erban

    membru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar diabet, nutriie i boli metabolice, medic primar medicin intern, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Gina Botnariudoctor n medicin, ef de lucrri, Universitatea de Medicin i Farmacie Gr. T. Popa, medic primar diabet, nutriie i boli metabolice, medic primar medicin intern, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Iai

    Anca Cerghizandoctor n medicin, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Elena Cevdoctor n medicin, medic specialist gastroenterologie, Spitalul Municipal Lugoj

    Dan Cheamembru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Carol Davila, medic primar diabet, nutriie i boli metabolice, Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. C. Paulescu, Bucureti

    Mihail Coculescumembru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Carol Davila, medic primar endocrinologie, Institutul Naional de Endocrinologie C. I. Parhon, Bucureti

    Ciprian Constantinmedic specialist diabet, nutriie i boli metabolice, Spitalul Universitar de Urgen Militar Central Carol Davila, Bucureti

    Laura Diaconudoctor n medicin, asistent universitar, Universi- tatea de Medicin i Farmacie Victor Babe, medic specialist diabet, nutriie i boli metabolice, Cli-

  • nica de Diabet, Nutriie i Boli Metabolice, Timi-oara

    Victor Dumitracuprofesor universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar medicin de laborator, competen n imunologie clinic, Spitalul Clinic Judeean de Urgen, Timioara

    Monica Livia Gheorghiudoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Carol Davila, medic primar endocrinologie, Institutul Naional de Endocrinologie C. I. Parhon, Bucureti

    Paula Grigorescu-Sidomembru de onoare al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Iuliu Haieganu, medic primar pediatrie, medic primar endocrinologie, medic primar genetic medical, medic specialist diabet zaharat, nutriie i boli metabolice, Spitalul Clinic de Urgen pentru Copii, Cluj-Napoca

    Nicolae Hncu membru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Iuliu Haieganu, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Corina Hogeamedic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Timioara

    Marinela Holopinmedic primar medicin de laborator, Spitalul Clinic Judeean de Urgen, Timioara

    Alina Lctuudoctor n medicin, medic primar pediatrie, com-peten n diabetologie pediatric, Centrul Medical de Evaluare i Recuperare pentru Copii i Adolesceni Cristian erban, Buzia

    Cristina Mihaela Lctuuasistent universitar, Universitatea de Medicin i Farmacie Gr. T. Popa, medic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Iai

    Cristina Maziluasistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar oftalmologie, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Timioara

    Andrada Mihaiasistent universitar, Universitatea de Medicin i Farmacie Carol Davila, medic specialist diabet, nutriie i boli metabolice, Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. C. Paulescu, Bucureti

    Laura Mihalacheasistent universitar, Universitatea de Medicin i Farmacie Gr. T. Popa, medic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Iai

    Veronica Mocanuconfereniar universitar, Universitatea de Medicin i Farmacie Gr. T. Popa, medic primar endocrinologie, Centrul Medical Medcenter, Iai

    Cristina Nidoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Iuliu Hatieganu, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Camelia Pnudoctor n medicin, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Craiova

    Marusia Popdoctor n medicin, ef de lucrri, Universitatea de Medicin i Farmacie Victor Babe, medic primar pediatrie, Clinica de Pediatrie III, Timioara

    Simona Georgiana Popadoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie, medic primar diabet, nutriie, boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Craiova

    Raluca Maria Popescuasistent universitar, Universitatea de Medicin i Farmacie Gr. T. Popa, medic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Iai

  • Gabriela Radulianprofesor universitar, Universitatea de Medicin i Farmacie Carol Davila, medic primar diabet, nutriie i boli metabolice, Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. C. Paulescu, Bucureti

    Mihaela Roudoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar diabet, nutriie i boli metabolice, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Adriana Rusumedic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Emilia Rusuasistent universitar, Universitatea de Medicin i Farmacie Carol Davila, medic specialist diabet, nutriie i boli metabolice, Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. C. Paulescu, Bucureti

    Cristian Serafinceanuconfereniar universitar, Universitatea de Medicin i Farmacie Carol Davila, medic primar diabet, nutriie i boli metabolice, medic primar nefrologie, Centrul de Dializ, Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. C. Paulescu, Bucureti

    Alexandra Simadoctor n medicin, asistent universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar medicin intern, medic specialist diabet, nutriie i boli metabolice, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Margit erbanmembru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar pediatrie, Clinica de Pediatrie III, Timioara

    Viorel erbanmembru titular al Academiei de tiine Medicale din Romnia, profesor universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar diabet, nutriie i boli metabolice, medic primar medicin intern, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Raluca oimarumedic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Spitalul Judeean Sf. Spiridon, Iai

    Romulus Timarconfereniar universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar diabet, nutriie i boli metabolice, medic primar medicin intern, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Adela Trilescumedic specialist diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Timioara

    Sorin Ursoniuconfereniar universitar, medic primar sntate public i management sanitar, medic primar dermato-venerologie, Universitatea de Medicin i Farmacie Victor Babe, Timioara

    Ioan Andrei Vereiuconfereniar universitar, Universitatea de Medicin i Farmacie Iuliu Haieganu, medic primar diabet, nutriie i boli metabolice, Centrul Clinic de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca

    Adrian Vladconfereniar universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar medicin intern, medic specialist diabet, nutriie i boli metabolice, Clinica de Diabet, Nutriie i Boli Metabolice, Timioara

    Ileana Zologprofesor universitar, Universitatea de Medicin i Farmacie Victor Babe, medic primar oftalmologie, Clinica de Oftalmologie, Spitalul Clinic Municipal, Timioara

  • Tratatul Romn de Boli Metabolice continu, aa cum a fost anunat, cu cel de-al doilea volum al su i ultimul dup aproximativ jumtate de an de la lansarea celui dinti. Acesta cuprinde complicaiile diabetului zaharat, urmate de cele mai frecvente i mai importante boli metabolice: dislipidemiile, obezitatea, hiperuricemiile i sindromul metabolic. n continuare sunt expuse afeciunile cu caracter genetic, porfiriile i hi-poglicemiile endogene.

    O component aparte a acestei pri secunde este constituit din vitamine i din noiuni de alimentaie: principiile alimentaiei sntoase, comportamentul alimentar i tulburrile sale, ancheta alimentar, principii de dietoterapie, de gastrotehnie i de alimentaie parenteral. Iar din Tratat nu putea s lipseasc o tem de mare actualitate, ce se refer la posibila corelaie dintre trio-ul compus din nutriie, diabet zaharat i obezitate, pe de-o parte, i apariia bolii canceroase, pe de alt parte.

    La sfrit, au fost expuse principalele metode epidemiologice, aplicabile studiului bolilor metabolice i au fost introduse un numr consistent de Anexe, cu dou pri: una de biochimie normal i, a doua, cu formule de calcul al unor parametri, cu tabele, curbe i nomograme, utilizate n diagnosticul acestor afeciuni.

    Volumul doi are o extindere mai mare dect primul, deoarece, n timp, am realizat c

    Prefa

    unele capitole au fost omise din planul iniial (de exemplu, vitaminele), iar altele, destul de numeroase, au fost dezvoltate mai mult dect era prevzut; dar, fiindc ni s-a prut c este bine i astfel, nu am mai solicitat reducerea lor.

    De aici a decurs un efort mai mare, dar, ca i n cazul volumului nti, editorul a intervenit numai att ct a fost necesar, pentru ca fiecare capitol s fie, n final, suficient de precis, didactic i actual.

    Pentru munca depus i pentru spiritul de cooperare, coordonatorul rmne ndatorat tuturor autorilor, fr de care cartea nu ar fi putut aprea, ntr-un timp att de scurt, iar pentru contribuia lor profesional i pentru munca de corectare i de redactare, editorul mulumete echipei de colaboratori din Clinica de Diabet, Nutriie i Boli Metabolice din Timioara, i, iari, mai ales colegei Alexandra Sima.

    Toate consideraiile expuse n prefaa la volumul nti rmn valabile, iar interesul cu care acela a fost primit, ne ntrete convingerea c Tratatul este necesar.

    Sperm ca i volumul al doilea al Tratatului s fie la fel de bine apreciat de cititori i s se dovedeasc tot att de util ca i cel anterior, deoarece numai astfel i poate ndeplini me-nirea.

    Viorel erban

  • Foreword

    The Romanian Textbook of Metabolic Diseases continues, as announced, with its second, and final, volume, after almost half-a-year since the first was launched. It contains the complications of diabetes mellitus, followed by the most frequent and important metabolic diseases: lipid disorders, obesity, hyperuricemia, and metabolic syndrome. Subsequent chapters address genetic disorders, porphyrias, and endogenous hypoglycemia.

    A special component of this second volume is represented by chapters dedicated to vitamins and nutrition: principles of a healthy diet, eating behaviour and its disorders, dietary recall, principles of diet therapy and healthy cooking, and parenteral nutrition.

    The textbook could not overlook a very actual and controversial topic regarding the possible relationship between the triad composed by nutrition, diabetes mellitus and obesity, on one hand, and the development of cancer, on the other hand.

    At the end, we exposed the main epide-miological methods used in the study of metabolic disorders and included a significant number of Apendices, with two parts: one for normal biochemistry values and another containing formulas for computing some parameters, as well as tables, curves and nomograms used in the diagnosis of these disorders.

    The second volume is larger than the first as, while working at it, we realized that some chapters were omitted from the first table of contents (such as vitamins), while others, quite a few, were more extensively developed than initially planned. But, as we considered this appropriate, we did not requested the authors to curtail them.

    Hence, the endeavor was more difficult but, as it was the case for the first volume, the editor intervened only when was necessary, so that each chapter to eventually be reasonably accurate, didactic and up-to-date.

    The coordinating editor gratefully acknow-ledges the work and cooperation of all authors, as without them the textbook could not have been published in such a short time. Furthermore, the editor wishes to thank his team from the Clinic for Diabetes, Nutrition and Metabolic Diseases for their scientific contribution as well as for the proofing and editing work, especially to Dr. Alexandra Sima.

    All the considerations exposed in the foreword to the first volume remain valid, and the interest displayed for it strenghtens our belief that this textbook is necessary.

    We hope that the second volume will be as appreciated and as useful as the previous, since this is the only way it can accomplish its goals.

    Viorel erban

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