9. environmental and nutritious disease

8/16/2019 9. Environmental and Nutritious Disease

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dr. Yuliet sinanu

ENVIRONMENTAL andNUTRITIONAL DISEASE


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“The Global Burden Of Disease”

Efe !erubahan I li" #erhada$ %eseha#an To sisi#as a&en fisi dan a&en i"ia'i !olusi lin& un&an Resi o !en(a i# a iba# !e er)aan Efe Te"ba au Efe Al ohol *edera a iba# Oba# Tera$eu#i dan

!en(alah&unaan oba# *edera a iba# A&en +isi !en(a i# Gan&&uan Nu#risi


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The GBD

Sis#e" s#andar# $ela$oran $en(a i# sehin&&a da$a#di e#ahui )u"lah $en(a i# den&an an& a e"a#ian#erban(a

%esi"$ulan GBD9%e uran&an &i:i ; undernu#ri#ion<Is=he"i= hear# disease > =erbro,as=ular disease!en(a i# infe si%e"a#ian ana ? @ #hn sudah "enurun

E"er&in& infe=#ious disease


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+i&ure 4 3 orld'ide "or#ali#( of =hildren under @ (ears of a&e/ No#e #he "ore #han @6 fold differen=e be#'een areas 'i#h #he lo'es# and hi&hes# "or#ali#(/ Malnu#ri#ion

and infe=#ions are "a)or =auses of #he hi&h "or#ali#( in Eas#. *en#ral. and es# Afri=a/Downloaded from: StudentConsult (on 6 February 2010 10:48 AM)

200! "lse#$er


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Efek Perubahan Iklim terhadapKesehatan GLOBAL ARMING CCC %enai an suhu 6.5 * #hn. se)a 3456 %enai an $er"u aan lau# 3 1 8 "" #hn !en(ebab 0

*O8Me#hanO:oneUa$ air

Ber#inda se$er#i selubun& seli"u# (an& "enahan "en(era$ener&i (an& di eluar an dari $er"u aan bu"i sehin&&a #idada$a# di e"bali an e a#"osfer/

GREEN HOUSE EFFECT


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+i&ure 4 8 Sour=es and =onse uen=es of in=reased &reenhouse &ases/ A. !redi=#ed #e"$era#ure in=reases durin& #he #'en#( firs# =en#ur(/ Differen# =o"$u#er "odels $lo#an#i=i$a#ed rises in #e"$era#ure of 8>F3 59 #o @>F3 59* b( #he (ear 8366/ B. Release of =arbon dioHide ;*O8< fro" =o"bus#ion sour=es in *hina. 34 6 #o 866@/ *hina

has no' sur$assed #he Uni#ed S#a#es as #he 'orld s lar&es# $rodu=er of *O8/ *. Re&ions of #he Uni#ed S#a#es in 'hi=h o:one l e,els are abo,e eHis#in& a==e$#eds#andards ;76 $$b durin& an 7 hour $eriod


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Bebera$a $en(a i# (& "un& in #i"bul9!en(/ %ardio,as ular. =erebro,as ular dansal/$erna$asanGas#roen#eri#is dan $en(a i# infe si (& e$ide"iVe=#or borne infe=#ious diseaseMalnu#risi


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+i&ure 4 J Ku"an eH$osure #o $ollu#an#s/ !ollu#an#s =on#ained in air. 'a#er. and soilare absorbed #hrou&h #he lun&s. &as#roin#es#inal #ra=#. and s in/ In #he bod( #he( "a(a=# a# #he si#e of absor$#ion bu# are &enerall( #rans$or#ed #hrou&h #he bloods#rea" #o,arious or&ans 'here #he( "a( be s#ored or "e#aboli:ed/ Me#abolis" of Henobio#i=s

"a( resul# in #he for"a#ion of 'a#er soluble =o"$ounds #ha# are eH=re#ed. or ina=#i,a#ion of #he a&en#. =rea#in& a #oHi= "e#aboli#e/

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enobio#i 0 bahan i"ia e so&en(an& ada di udara. air. "a anan dan#anah

Masu e dala" #ubuh "anusia"elalui inhalasi. #er#elan a#au on#auli#/

enobio#i 0 bahan i"ia e so&en(an& ada di udara. air. "a anan dan#anah

Masu e dala" #ubuh "anusia"elalui inhalasi. #er#elan a#au on#auli#/


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+i&ure 4 enobio#i= "e#abolis"/ A. enobio#i=s =an be "e#aboli:ed #o non#oHi= "e#aboli#es and eli "ina#ed fro" #he bod( ;de#oHifi=a#ion


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*O 0

Tida berbau. #ida ber'arna. #ida berasa. #ida"en&iri#asiO sidasi arbon (an& #ida se"$urnaSu"ber 0 asa$ endaraan. "esin 1 "esin den&an

bahan ba ar a(u a#au ba#ubara Asfi sia de$resi SS! e"a#ianMen&i a# Kb 866H O 8*O Kb 86 1 J6P hi$o sia sis#e"i

*O Kb 56 1 6P esadaran > e"a#ian


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O:one ;OJ<

UV Q O8Di la$ s#ra#osfer ; 86 1 J6 "il<+ "elindun&i bu"i dari radiasi UV (&berbaha(a

Dala" J6 #hn #era hir "eni$is dan berluban&

Ground le,el o:oneNi#ro&en o sida Q bahan or&aniSu"ber 0 e"isi &as indus#ri . endaraanRadi al bebasMerusa e$i#el saluran $erna$asan > al,eolar #($e 3


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Sulfur dio sidaSu"ber 0 $e"ba aran ba#ubara dan "in(a #/u$ada $abri $eleburan #e"ba&a dan $abri er#asDile$as e udara asa" sulfur dan sulfur #rio sidaRasa #erba ar $ada #en&&oro an. suli# berna$as.dan seran&an as"a

!ar#i el 1 $ar#i el halusSu"ber 0 indus#ri (& "e"a ai ba#ubara dan "in(a? 36 " al,eolus infla"asi "edia#or radan&

36 " di eluar an di#an& a$ o / E$i#el res$


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Polusi udara…….

Dala" ruan& ;indoor<

o/ ,en#ilasi ruan& uran&Su"ber 0

asa$ #e"ba au ;ro o


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Pencemaran o . !ogam berat

Su"ber 0 udara. air dan#anah (an& #er on#a"inasi

!d *a# ru"ah . bensin dan"ainan ana 1 ana /

Ana > or& de'asa 76 1 7@ P disera$ oleh

#ulan& dan &i&i. VS alsiu"

Kalf life dala" #ulan& 86 1J6 #hn Ana e=il "en(era$ @6P

ban(a dari or& de'asa/

TIMBAL (Pb)


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+i&ure 4 5 !a#holo&i= fea#ures oflead $oisonin& in adul#s/

+i&ure 4 Lead $oisonin&/ I"$aired re"odelin& of =al=ified =ar#ila&e in #hee$i$h(ses ;arro's< of #he 'ris# has =aused a "ar ed in=rease in #heir

radiodensi#(. so #ha# #he( are as radio$a ue as #he =or#i=al bone/ ;*our#es(of Dr/ G/ / Die#:. De$ar#"en# of Radiolo&(. Uni,ersi#( of TeHas

Sou#h'es#ern Medi=al S=hool. Dallas. T /<


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Mer=ur( Ada dala" =a#. os"e#i . $en&oba#an sifilis.

o"$onen diure#i=In#o si asi "er=ur( #re"or. &in&&i,i#is. $erila u aneh/Su"ber in#o si asi0

I an (& #er=e"ar

A"al&a" &i&i!e er)a #a"ban& e"as

!en(a i# MINAMATA ; Mina"a#a ba( 1 2e$an&<

=erebral $als( Tuli. bu#a/ Re#ardasi "en#al Defe SS!

!en(a i# MINAMATA ; Mina"a#a ba( 1 2e$an&<

=erebral $als( Tuli. bu#a/ Re#ardasi "en#al Defe SS!


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ArsenS=r na#ural ada dala" #anah dan air/2& dala" herbisida ; ra=un #i us


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"esiko Kesehatan # EksposurIndustri dan Pertanian Lebih dari 36 )u#a lu a lu a dan se i#ar

366/666 e"a#ian #er)adi se#ia$ #ahun di A"eri a Seri a# seba&ai onse uensi

dari e=ela aan er)a dan $en(a i#/ %e=ela aan er)a "eru$a an "asalah

#erbesar di ne&ara ne&ara ber e"ban&.

sedan& an $en(a i# (an& berhubun&anden&an er)a lebih serin& #er)adi dine&ara ne&ara indus#ri/


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+ra si $en(a i# &lobal di ai# an den&an$a$aran er)a "en=a u$ 3JP darise"ua asus $en(a i# $aru obs#ru #if

roni . 4P dari an er $aru $aru. dan8P dari leu e"ia/


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!elaru# or&ani ban(a di&una an dala" )u"lah besar di seluruh dunia/

Bebera$a dian#aran(a %&loroform dan 'arbontetra'lor$da . di#e"u an dala" $e"bersih dan$en&erin& dan $en&hilan& =a#/

!e"a$aran a u# #in& a# #in&&i dari a&en# ini"en(ebab an $usin& dan ebin&un&an.

de$resi sis#e" saraf $usa#. bah an o"a/ !ada #in& a# (an& lebih rendah "en(ebab an

#o si $ada ha#i dan &in)al/


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Kidro arbon $olisi li da$a# dile$as an sela"a $e"ba aranbahan ba ar fosil. #eru#a"a e#i a ba#u baradan &as diba ar $ada suhu #in&&i ;se$er#idala" $eleburan ba)a


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Or&ano lorin . ; dan halo&enasi sen(a'aor&ani se=ara u"u" < adalah $roduli$ofili sin#e#is (an& #ahan de&radasi/

Di&una an seba&ai $es#isida #er"asu DDT.

Lindane. Aldrin dan Dieldrin/Or&ano lorin non $e$#isida #er"asu$ol(=hlorina#ed bi$hen(ls ;!*Bs< dan dioHin /DDT dilaran& di A"eri a Seri a# $ada #ahun

34 J. #e#a$i lebih dari se#en&ah $endudu AS#erde#e si $.$ DDE. "e#aboli# DDT (an& $an)an&/


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Ben=ana lin& un&an di 2e$an& dan *hina $ada

a hir #ahun 3456. disebab an oleh onsu"si"in(a beras #er on#a"inasi den&an !*B sela"a$rodu si "era=uni se i#ar 8666 oran&/Manifes#asi u#a"a dari $en(a i# ini adalah

=hlora=ne dan hi$er$i&"en#asi $ada uli# dan u u/Sebuah asus aneh era=unan dioHin (an&disen&a)a. (an& "e"bua# beri#a u#a"ain#ernasional dan "eru$a an hala"an de$anilus#rasi =hlora=ne "eliba# an $residen "asade$an U raina/


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Men&hiru$ debu "ineral $en(a i# $aru roninon neo$las#i di enal seba&ai non$neu"o=oniosis/

Is#ilah ini )u&a #er"asu $en(a i# $en(a i# (an&disebab an oleh $ar#i el or&ani dan anor&ani .

dan asa$ i"ia "en&indu si #er)adin(a$en(a i# $aru non neo$las#i=/

an& $alin& u"u" $neu"o=oniosis disebab anoleh e s$osur #erhada$ debu ba#ubara. sili a.

asbes. dan beriliu"/


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!a$aran ,inil lorida (an& di&una an dala" sin#esaresin $ol(,in(l "en&arah e $en&e"ban&an

an&iosar=o"a ha#i. #i$e )aran& dari #u"or ha#i/

!a$aran dari $h#hala#es $ada he'an labora#oriu""en(ebab an &an&&uan endo rin dan sindro"

dis&enesis #es#is "eliba# an hi$os$adia.ri$#or is"us. dan elainan sel #es#is (an& "iri$den&an ondisi (an& #ida di e#ahui asaln(a/

!h#hala#es ban(a di#e"u an dala" $las#i fle sibel ;

se$er#i an#un& $e"bun& us "a anan< dan dala"'adah "edis se$er#i an#on& darah dan seru"/


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EFEK A$AP TE%&AKAU


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an& a e)adian an er$aru se"a in"enin& a#

$ero o $asif sa"abaha(an(a den&an$ero o a #if


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'E(E"A AKI&AT A)E*FI$IK TRAUMA ME%ANIS

abrasi on#usio laserasi lu a insisi

lu a #usu

TRAUMA TERMAL lu a ba ar Ki$er#er"ia

hea# =ra"$s hea#eHhaus#ion hea# s#ro e

Ki$o#er"ia


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+i&ure 4 35 A. *on#usion resul#in& fro" blun# #rau"a/ The s in is in#a=#. bu# #here is he"orrha&e of sub=u#aneous ,essels. $rodu=in& eH#ensi,e dis=olora#ion/ B.La=era#ion of #he s=al$9 #he brid&in& s#rands of fibrous #issues are e,iden#/ ;+ro" #he De$ar#"en# of !a#holo&(. Sou#h'es#ern Medi=al S=hool. Dallas. T /<



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e / Arus lis#ri #e&an&an rendah ; "is.ru"ah < > #e&an&an #in&&i ; "is. abel#e&an&an #in&&i > $e#ir <

#er)adi 8 )enis =edera 0 lu a ba ar 1 e,aluasi lu a ba ar fibrilasi ,en#ri el e"a#ian

'E(E"A !I$T"IK


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Malnu#risi ener&i 1 $ro#ein9 Maras"us %'ashior or

Anore sia ner,osa > Buli"ia 9 dila u an

den&an sen&a)a Defisiensi ,i#a"in 9 A.B.*.D.E.% Obesitas 9 $enin& a#an BB a iba#

$eni"bunan )arin&an le"a (& da$a#"en(ebab an &an&&uan eseha#an. ; 86 P<

PE*+AKIT )I,I


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+i&ure 4 8J *hildhood "alnu#ri#ion/ A. Maras"us/ No#e #he loss of "us=le "ass and sub=u#aneous fa#9 #he head a$$ears #o be #oo lar&e f or #he e"a=ia#ed bod(/ B.%'ashior or/ The infan# sho's &enerali:ed ede"a. seen as as=i#es and $uffiness of #he fa=e. hands. and le&s/ ;A. +ro" *lini= Bara . Reiseberi=h# %en(a/<



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+i&ure 4 8@ Vi#a"in A "e#abolis"/



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+i&ure 4 85 Vi#a"in A defi=ien=(0 i#s "a)or =onse uen=es in #he e(e and in #he $rodu=#ion of era#ini:in& "e#a$lasia of s$e=iali:ed e$i#helial surfa=es. and i#s $ossiblerole in e$i#helial "e#a$lasia/ No# de$i=#ed are ni&h# blindness and i""une defi=ien=(/



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+i&ure 4 84 Vi#a"in D defi=ien=(/ There is inade ua#e subs#ra#e for #he renal 3>al$ha9 h(droH(lase ;3


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+i&ure 4 J6 An#i "i=robial effe=# of ,i#a"in D/ !a#ho&ens and li$o$ol(sa==harides ;L!S< s#i"ula#e Toll li e re=e$#ors ;TLRs< in "a=ro$ha&es. =ausin& #he #rans=ri$#ion of,i#a"in D re=e$#or ;VDR< and an in=rease in * !8 B a=#i,i#( in "i#o=hondria/ This =auses #he $rodu=#ion of 3.8@;OK


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+i&ure 4 J3 Ma)or =onse uen=es of ,i#a"in * defi=ien=( =aused b( i"$aired for"a#ion of =olla&en/



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+i&ure 4 38 Me#abolis" of e#hanol0 oHida#ion of e#hanol #o a=e#aldeh(de b( #hree differen# rou#es. and #he &enera#ion of a=e#i= a=id/ No#e #ha# oHida#ion b( ADK ;al=oholdeh(dro&enase< #a es $la=e in #he =(#osol9 #he =(#o=hro"e ! @6 s(s#e" and i#s * !8E3 i sofor" are lo=a#ed in #he endo$las"i= re#i=ulu" ;"i=roso"es


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+i&ure 4 3J Ad,erse dru& rea=#ion/ S in $i&"en#a#ion =aused b( "ino=(=line. a lon& a=#in& #e#ra=(=line deri,a#i,e/ A. Diffuse blue &ra( $i&"en#a#ion of #he forear"9 B.De$osi#ion of dru& "e#aboli#e iron "elanin $i&"en# $ar#i=les in #he der"is/ ;*our#es( of Dr/ Xsol# Ar&en(i. De$ar#"en# of !a#holo&(. Uni,ersi#( of ashinon. Sea##le.

A/<



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+i&ure 4 3 A=e#a"ino$hen "e#abolis" and #oHi=i#(/ ;See #eH# for de#ails/< ;*our#es( of Dr/ a,ier Va uero. De$ar#"en# of !a#holo&(. Uni,ersi#( of ashinon. Sea##le.A/<



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+i&ure 4 3@ The effe=# of =o=aine on neuro#rans"ission/ The dru& inhibi#s reu$#a eof #he neuro#rans"i##ers do$a"ine and nore$ine$hrine in #he =en#ral and $eri$heral

ner,ous s(s#e"s/


d


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+i&ure 4 3 Effe=#s of ioni:in& radia#ion on DNA and i#s =onse uen=es/ The effe=#s on DNA =an be dire=#. or "os# i"$or#an#l(. indire=#. #hrou&h free radi=al for"a#ion/


"adiation in-ur


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+i&ure 4 86 +ibrosis and ,as=ular =han&es in sali,ar( &lands $rodu=ed b( radia#ion #hera$( of #he ne= re&ion/ A. Nor"al sali,ar( &land9 B. fibrosis =aused b( radia#ion9*. fibrosis and ,as=ular =han&es =onsis#in& of fibroin#i"al #hi= enin& and ar#eriolar s=lerosis/ V. ,essel lu"en9 I. #hi= ened in#i"a/ ;*our#es( of Dr/ Melissa U$#on.

De$ar#"en# of !a#holo&(. Uni,ersi#( of ashinon. Sea##le. A/<



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+i&ure 4 83 *hroni= radia#ion der"a#i#is 'i#h a#ro$h( of e$ider"is. der"al fibrosis. and #elan&ie=#asia of #he sub=u#aneous blood ,essels/ ;A"eri=an Re&is#r( of!a#holo&( >F3549 3446/<



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+i&ure 4 88 EH#ensi,e "edias#inal fibrosis af#er radio#hera$( for =ar=ino"a of #he lun&/ No#e #he "ar edl( #hi= ened =ardiu"/ ;+ro" #he #ea=hin& =olle=#ion of #heDe$ar#"en# !a#holo&(. Sou#h'es#ern Medi=al S=hool. Dallas. T /<



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+i&ure 4 8 Me=hanis"s of =an=er =a=heHia/ The fi&ure illus#ra#es #hree "e=hanis"s #ha# =ause "us=le a#ro$h( and "us=le de&rada#ion leadin& #o =a=heHia/ ;3<!ro#eol(sis indu=in& fa=#or ;!I+< $rodu=ed b( #u"ors de&rades "(osin hea,( =hain #hrou&h #he $ro#easo"e. =ausin& "us=le a#ro$h(9 ;8< TN+ and o#her =(#o ines

$rodu=ed b( #u"ors and #he hos# a=#i,a#e N+ >F4@ 9B and ini#ia#e #he #rans=ri$#ion of #he ubi ui#in li&ases MA+BH and MuR+3. =on#ribu#in& #o $ro#ein brea do'n9 ;J<al#era#ions in #he d(s#ro$hin &l(=o$ro#ein =o"$leH leadin& #o d(s#ro$hin de&rada#ion b( #he $ro#easo"e also $ar#i=i$a#e in #he "us=le a#ro$h( of =a=heHia/



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+i&ure 4 J8 Re&ula#ion of ener&( balan=e/ Adi$ose #issues &enera#e afferen# si&nals #ha# influen=e #he a=#i,i#( of #he h($o#hala"us. 'hi=h is #he =en#ral re&ula#or ofa$$e#i#e and sa#ie#(/ These si&nals de=rease food in#a e b( inhibi# in& anaboli= =ir=ui#s. and enhan=e ener&( eH$endi#ure #hrou&h #he a=#i,a#ion of =a#aboli= =ir=ui#s/ ! .

$e$#ide / See #eH# for de#ails/



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+i&ure 4 JJ Neurohu"oral =ir=ui#s in #he h($o#hala"us #ha# re&ula#e ener&( balan=e/ Sho'n are !OM* *ART anoreHi&eni= neurons and N! A&R! oreHi&eni= neuronsin #he ar=ua#e nu=leus of #he h($o#hala"us. and #heir $a#h'a(s/ See #eH# for de#ails/



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9. environmental and nutritious disease

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