Appetite, Adiposity and energy

Question 1

Adipose Tissue is an energy store and an endocrine organ

What endocrine hormones does it secrete?

Answer 1

Adiponectin
Corticosteroids
Sex steroids

Question 2

ADIPOSE

What metabolic associatied products does it produce?

Answer 2

Metabolic::

• Adiponectin -> if you are lean and fit you have lots
• FFA
• Resistin
• Agouti
• PPAR-gamma ligands
• Visfatin

Question 3

ADIPOSE

What cardiovascular and immune related things does it produce?

Answer 3

CV: PAI-1 and renin-angiotensin
Immune: TNF, IL-6, complements, ASP

Question 4

What are the properties of adiponectin?

Answer 4

MUSCLE: increases inssulin sensitivity through: increased FFA oxidation, decreased intracellular lipid, increased AMPK activity

LIVER: increases insulin sensitivity:

• increased FFA oxidation & AMPK activity & PPAR-gamma ligand activity.
• Decreased : intracellular lipid and gluconeogenesis

VASCULAR: decreases atherogenesis, decrease inflammation

Question 5

Adiponectin is regulated

Increased by

Answer 5

Leanness,
Food restriction
IGF-1
Insuline (acute)

Question 6

Adiponectin is regulated by:

Decreased b y

Answer 6

Obesity
Corticosteroids
TNF-alph
oxidative stress
Insulin (chronic)

Question 7

Eating is regulated by the brain

Answer 7

Complex interplay between gut, pancreas and brain.

Note stomach produces GHRELIN

Question 8

Neural mechanisms of Energy balance

Answer 8

Input = output (physical activity, basal metabolic rate, adaptive thermatogenesis

Question 9

OD and Ob genes

Answer 9

Ob gene expressed in cells, and Od receptor, produced in the brain
Named LEPTIN
daily injections of LEPTIN reduced body fat in mice BUT
Obesity is NOT associated with leptin deficiency : it is just an important signalling factor

Question 10

Monogenic obesity

Answer 10

Belief that there is a POMC mutation (POMC creates ATCH)

Our obesogenic behaviour leads to susceptability

Question 11

Relationship between genetics, epigenetics & environment

Answer 11

complex interactions between all of these causing genetic plasticity changes & susceptibility to obesity

Question 12

Birth Weight

Answer 12

High Birthweight:

increased risk of T2DM

Question 13

How do we manage obesity?

Answer 13

Diet
Exercise
Behaviour Modification Pharmacotherapy x Bariatric Surgery

Question 14

Why is weight nearly always regained?

Answer 14

• Leptin levels DROP through dieting
• Ghrelin levels increase through dieting (HUNGRY)
• energy expendature DECREASES

*nutrient hormone levels go down, but hunger hormones go up and stay up: lose weight but you’re always hungry

Question 15

What is the best diet for weight loss?

Answer 15

Weight Loss with a Mediterranean, or Low-Fat Diet.
*especially in diabetics!

Low-Carbohydrate not as GOOD!

Question 16

What is the mediterranian diet reccomendations?

Answer 16

Daily: bread, pasta, rice, couscous, polenta, wholegrains, potatoes, fruits, beans, nuts, legumes, veggies & EXERCISE, olive oil, cheese and yoghurt

Weekly: fish, poultry, eggs, sweets
Monthly: Meat

Question 17

Meditterranian versus low CHO diet in preventing cardiovascular disease

Answer 17

Significantly lower rate of CV events in M

Question 18

Very Low Energy Diets

Answer 18

Provide only 400-800 calories /day
Very low in fat and carbohydrate
Low carbohydrate allows ketosis to
occur
Supply all the needed vitamins,
minerals and amino acid
1 sachet or bar tds with plenty of water Vegetables in the evening
Oil on vegetables if gall bladder is present
Daily exercise

Question 19

What are the contraindications of VLED?

Answer 19

1.

Question 20

What are the side effects of VLED?

Answer 20

1. Constipation
2. Diarrhoea
3. Halitosis
4. Hypotension
5. Electrolyte Imbalance

Question 21

What tests should you perform wrt VLED?

Answer 21

Electrolytes/Creatinine 
LFT’s
Glucose
Lipids
Uric Acid
FBE
Before and Half way into diet (6 weeks after starting)

Question 22

Medical versus surgical therapy- > which is better for weight loss