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Obesity Medicine > ABOM Review > Flashcards

ABOM Review Flashcards

1
Q

3 afferent pathways in energy balance

A
  1. Environmental sensing (GI , sensory organs)
  2. Metabolic needs (liver, muscle, bone)
  3. Energy stores (adipose, liver, muscle)
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2
Q 
Leptin:
what is the primary problem in obesity?
are levels high or low?
binds to ?
anorexigenic or orexigenic?
A

leptin resistance
high
leptin receptor in hypothalamus
anorexigenic

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3
Q

Adiponectin:
low or high in obesity?
anorexigenic or orexigenic?
what induces expression of adiponectin?

A

low
anorexigenic
PPAR-Y agonizts - TZDs

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4
Q

effects of adiponectin on skeletal muscle, liver, cardiac muscle

A

skeletal muscle: increases glucose uptake, increases fatty acid uptake, increases mitochondrial mass and oxidative capacity
liver: insulin-like and insulin sensitizing effects
cardiac muscle: remodeling, vasodilation, anti-inflammatory, anti-atherosclerotic

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5
Q

low adiponectin is independently associated with

A

t2DM, MetS, fatty liver, cad, endothelial dysfunction, MI, chf, htn

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6
Q

3 adipokines are

secreted by

A

leptin adiponectin resistin

adipokines

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7
Q

5 incretins are

secreted by

A 
GLP-1
PYY
ghrelin
GIP
oxyntomodulin
intestinal L cells, stomach fundus
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8
Q

GLP-1 (glucagon like peptide 1) :
anorexigenic or orexigenic
high or low in obesity
sites of action/ function

A 
anorexigenic
low (post prandial)
pancreas - increases insulin release
gut delays carb absorption and decreases gastric secretion/ motility
brain increases satiety
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9
Q

how does GLP-1 increase satiety in brain?

A

inhibits NPY

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10
Q

Peptide YY (PYY):
anorexigenic or orexigenic
high or low in obesity
sites of action/ function

A

anorexigenic
low (post prandial)
afferent vagus and hypothalamus
increases satiety and stimulates glucose-mediated insulin secretion

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11
Q

what is the only circulating orexigenic hormone

A

ghrelin

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12
Q 
ghrelin:
stands for
secreted by
peaks when
function
high or low in obesity before meals, post prandially
suppressed longest by
A 
growth hormone release inducing peptide
fundus
before meals
stimulate food intake
low before meals (appropriate) , post prandially less suppression
protein
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13
Q

DPP4 degrades what

A

GLP-1 and PYY

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14
Q

pharmacologic GLP-1 agonists are

A

exenatide, liraglutide

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15
Q

pharmacologic DPP4 inhibitors are

A

sitagliptin

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16
Q

satiety factor secreted by pancreas

A

amylin, or islet amyloid polypeptide

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17
Q

pharmocologic actor on amylin

A

pramlintide

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18
Q

what is the first myokine?
action?
what stimulates it

A

irisin
stimulates browning of white fat, induces insulin secretion, leads to weight loss and improved glucose control
exercise and cold

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19
Q

what are the anorexigenic neurotransmitters released from first order neurons?
where are they located?

A

POMC (proopiomelanocortin) and CART (cocaine and amphetamine related transcript)
arcuate nucleus of hypothalamus

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20
Q

what are the orexigenic neurotransmitters released from first order neurons?
where are they located?

A

AgRP (agouti related peptide) and NPY (neuropeptide Y)

arcuate nucleus of hypothalamus

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21
Q

what stimulates POMC/ CART

A

insulin, leptin

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22
Q

what stimulates AgRP/ NPY

A

ghrelin

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23
Q

what do POMC/ CART stimulate?

effect?

A

MC4R receptors of paraventrcular nucleus (PVN) and lateral hypothalamus
decreased food intake, increased energy expenditure

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24
Q

what do AgRP / NPY stimulate?
inhibit?
effect?

A

Y1R receptor on neurons in paraventricular nucleus (PVN) and lateral hypothalamus
MC4R receptors in PVN and LH
MC3R receptors in first order neurons in arcuate nucleus
increased food intake, decreased energy expenditure

25
Q

how does activation of melanocortin receptor (MC4R) cause increased energy expenditure

A

increased brown adipose tissue thermogenesis
increased white adipose tissue lipolysis
increased locomotor and myocardial activity
increased muscle glycogenolysis, glucose and fatty acid oxidation, and protein synthesis

26
Q

noradrenergic neurons originate in

A

locus coeruleus, lateral tegmental field of hypothalamus

27
Q

what causes vagal efferent activation?
anatomy?
effect?

A

low leptin signaling, persistent orexigenic signaling (ghrelin)
lateral hypothalamus and paraventricular nucleus 2nd order neurons stimulate medial longitudinal fasiculus and dorsal motor nucleus of the vagus
increased energy storage

28
Q

mechanisms of vagally mediated increased energy storage?

A

reduced HR and o2 consumption
increased peristalsis and pyloric opening
increased post prandial insulin secretion and fat deposition
increased glucose and FFA uptake into adipose tissue and increased insulin sensitivity

29
Q

adult DRI for fat

A

20-35%

30
Q

adult DRI for carbs

A

45-65%

31
Q

adult DRI for protein

A

10-39%

0.8 g/kg/d

32
Q

diet to lower TG

A

atkins

33
Q

diet to decreased cvd, dm

A

ornish, vegan

34
Q

diet to decrease BP

A

dash (high carb, <25%fat, 2-3 low fat dairy, high in ca, mg, k fiber, low in meats, sweets, snacks

35
Q

diet to decrease cvd

A

mediterranean

36
Q

diet to decrease seizures

A

ketogenic

37
Q

diet to treat short gut and malabsorption

A

medium chain triglycerides

38
Q

which is more important , diet type or adherence?

A

adherence

39
Q

does macronutrient mix predict weight loss

A

no

40
Q

dietary strongest evidence of treatment benefit (wt loss)

A

meal replacements

41
Q

what is more important than caloric intake

A

energy density

42
Q

very low calorie diets require how much protein?

A

1.5 g/kg/d

43
Q

contraindications to very low calorie diet

A

renal insufficiency, type I dm, esld, pregnancy, pancreatitis

44
Q

side effects of very low calorie diet

A

gallstones, constipation, fatigue, coldness, hair loss, irregular menses

45
Q

weight regain following VLCD

A

40-50% within 1-2 years

46
Q

B1 thiamine (function, findings, deficiency)

A

pyruvate dehydrogenase, neuropathy,cardiomegaly, beri beri, wernicke korsakoff

47
Q

B2 riboflavin (function, findings, deficency)

A

FAD, mouth/tongue pain, chelitis

48
Q

B3 niacin (FFD)

A

NAD, desquamative dermatitis sun exposed, dementia, diarrhea, death, pellagra

49
Q

B6 pyridoxine

A

transamination, polyneuropathy, anemia

50
Q

B12 cobalmin

A

methyltransfer, neuropathy periph/central, pernicious anemia

51
Q

folate

A

dna synthesis, glossitis, stomatitis, megaloblastic anemia

52
Q

vitamin C

A

collagen synthesis, perifollicular petechiae, poor wound healing, scurvy

53
Q

calcium, phos, mg affected area, deficency

A

bones, enzymes, conduction, osteopenia, arrhythmia, sz

54
Q

zinc

A

metalloenzymes, growth, acrodermatitis enteropathica

55
Q

copper

A

metalloenzymes, menkes kinky hair

56
Q

selenium

A

glutathione peroxidase, kershan disease, cardiomyopathy

57
Q

chromium

A

glucose tolerance, glucose intolerance

58
Q

what is refeeding syndrome?

who is at risk?

A

depletion phos, mg, K with feeding causing heart failure

alcoholics, NPO 7 days, bariatric surgery postop, elderly, esld, anorexia

59
Q

most common nutrient problems after bariatric surgery

less common

A

ca, vitamin D, iron, b12

thiamine, zinc , copper

Obesity Medicine (1 decks)

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