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203 theme 1 > 11. Appetite and Weight > Flashcards

11. Appetite and Weight Flashcards

1
Q

obesity health risks

A 
6% UK deaths 
metabolic syndrome/type 2 diabetes 
CV disease
liver disease
cancer
reproductive dysfunction
joint problems 
psychological morbidity
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2
Q

metabolic syndrome

A

constellation of closely associated CV risk factors:
visceral obesity
dyslipidaemia
hyperglycaemia
hypertension
underlying mechanism = insulin resistance

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3
Q

pathophysiology of metabolic syndrome

A

increased free fatty acids (lipolysis of visceral fat, gluconeogenesis, dyslipidaemia)
pro-inflammatory cytokines - TNF alpha, IL-6
insulin resistance
decreased GLUT-4 expression
decreased tyrosine kinase activity

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4
Q

type 2 diabetes risks

A

age
obesity
family history
ethnicity

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5
Q

why is type 2 diabetes prevalence increasing?

A

ageing population
increased obesity prevalence (+diagnosed younger)
better detection /diagnosis

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6
Q

obesity and cardiovascular disease

A 
metabolic disease + increased:
blood volume and viscosity 
vascular resistance 
hypertension 
left ventricular hypertrophy 
coronary artery disease 
stroke
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7
Q

obesity and respiratory system

A

obstructive sleep apnoea
hypoxia/hypercapnia
pulmonary hypertension - right heart failure
accidents

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8
Q

obesity and GI/liver

A

non-alcoholic fatty liver
non-alcoholic steatohepatitis - may progress to cirrhosis, portal hypertension, hepatocellular cancer
gallstones
reflux

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9
Q

obesity and cancer

A

~10% cancer deaths in non smokers

breast, endometrial, oesophagus, colon, renal, thyroid

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10
Q

obesity - mechanisms of increased cancer

A

increased insulin
increased free IFG-1
increased oestrogen
adipocytokines

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11
Q

obesity and reproductive system

A

PCOS - oligonmenorrhoea, hirsutism, sub fertility, insulin resistance
male hypogonadism
adverse pregnancy outcomes

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12
Q

obesity and joints

A

osteoarthritis

gout

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13
Q

aetiology of obesity

A

genetic factors
environmental factors
programming
gut microbiome

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14
Q

genetic causes of obesity

A

rare - obesity associated syndromes, Prader-Willi, Bardet-Biedl
common - polygenic, susceptibility genes

+ hypothyroidism, Cushing’s

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15
Q

diet and obesity

A

high fat, high sugar
coca-colanisation of developing world
socio-economic factors

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16
Q

obesity and physical activity

A

20-50% total energy expenditure
obesity prevalence related to proxy measures: car ownership, TV viewing
socioeconomic factors

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17
Q

foetal programming

A

‘programming’: stimuli at critical periods have persistent biological effects

stressors: undernutrition, trace elements
mechanism: epigenetic modification

18
Q

life course model

A

factors operating at every stage of life affect health outcomes later in life
pathway of risk between events and health outcomes
worst outcome: low birth weight, excessive weight gain in infancy, adult obesity

19
Q

gut microbiome

A

integral to host homeostasis - absorption, reabsorption
influenced by diet: high fat high fibre
influence disease risk: obesity, type 2 diabetes

20
Q

regulation of appetite and weight

A

slow acting hormones that regulate weight

rapid acting peptides that regulate meal sizes

21
Q

slow acting hormones

A

regulate body weight
leptin insulin
signal body fat % to hypothalamus - decrease food intake and increase energy expenditure

22
Q

rapid acting peptides

A 
regulate meal sizes 
cholecystokinin (CCK) - reduce eating 
ghrelin - increase eating 
PYY - reduce eating 
act via hypothalamus
23
Q

arcuate nucleus in hypothalamus

A 
accelerator neurons
neuropeptide Y: increases eating 
agouti-related peptide (ArRP): blocks melanocortin receptor 
brake neutrons: POMC neurone 
melanocortin peptides: decrease eating
24
Q

leptin in mice

A

deficiency - mouse models of obesity

leptin treatment reduces obesity in leptin-deficient mice

25
Q

leptin in humans

A

starvation single: permissive effect ion puberty/reproduction
deficiency/mutation of receptors = rare
usually: increased leptin concentration with increased fat, ?leptin resistant, ?decreased leptin CNS transport

26
Q

treatment

A

lifestyle modification
pharmacological
surgical
public health/social

27
Q

lifestyle modification - diet

A

500-1000kcal energy deficiency
low energy density: decreased saturated fat and sugar, increased fruit and veg
decrease portion sizes and snacking
structured meals/meal replacement

28
Q

lifestyle modification - physical activity

A

exercise 7 days a week

regardless of weight loss, exercise increases health

29
Q

VLCD and type 2 diabetes

A

primary care programme
patients with type 2 diabetes
initial total diet replacement with formula
stepped food reintroduction
long term maintenance with structured support
46% induced remission if type 2 diabetes

30
Q

lifestyle modification usual targets and problems

A

10% weight loss, 1-2lb per week
‘yo-yo’ dieting - regain weight loss
obesogenic environment
weight loss: results in increased hunger and decreased satiety

31
Q

pharmacological therapy

A

orlistat

metformin

32
Q

orlistat mechanism

A

binds and inhibits lipases in lumen of gut
prevents hydrolysis of dietary fat into absorbalblke free fatty acids/glycerol
excrete ~1/3 dietary fat

33
Q

orlistat adverse effects

A

flatulence, oily faecal leakage, diarrhoea
reduced absorption of fat soluble vitamins
(supplement)

34
Q

metformin

A

best first line for obese patients with type 2 diabetes (all other oral hypoglycaemic agents and insulin cause weight gain)
recommended by NICE for prevention of type 2 diabetes in high risk adults

35
Q

problems with pharmacological treatment

A

can only increase 3-4 fold proportion of patients who achieve 5% weight loss
weight regained after treatment stops

36
Q

surgical treatments

A

laparoscopic adjustable banding

roux-en-Y gastric bypass

37
Q

laparoscopic adjustable banding

A

restrictive only

inject/withdraw saline to adjust band diameter

38
Q

roux-en-Y gastric bypass

A

restrictive
malabsorptive
alterations in but hormones and bile acid flow contribute to weight loss
micronutrient deficiencies - supplemented with iron, B12, folate, calcium, vitamin D
dumping syndrome - GI/vasomotor symptoms
endocrine factors important in effects
increased satiety is key

39
Q

advantages of weight loss surgery

A

weight loss: 25-30%
resolves/improves comorbidities
saves costs

40
Q

disadvantages of weight loss surgery

A

preoperative mortality/morbidity
long term follow up
some weight regain
expense

203 theme 1 (16 decks)

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