Appetite, Adiposity and energy Flashcards
Adipose Tissue is an energy store and an endocrine organ
What endocrine hormones does it secrete?
Adiponectin
Corticosteroids
Sex steroids
ADIPOSE
What metabolic associatied products does it produce?
Metabolic::
- Adiponectin -> if you are lean and fit you have lots
- FFA
- Resistin
- Agouti
- PPAR-gamma ligands
- Visfatin
ADIPOSE
What cardiovascular and immune related things does it produce?
CV: PAI-1 and renin-angiotensin
Immune: TNF, IL-6, complements, ASP
What are the properties of adiponectin?
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
Adiponectin is regulated
Increased by
Leanness,
Food restriction
IGF-1
Insuline (acute)
Adiponectin is regulated by:
Decreased b y
Obesity Corticosteroids TNF-alph oxidative stress Insulin (chronic)
Eating is regulated by the brain
Complex interplay between gut, pancreas and brain.
Note stomach produces GHRELIN
Neural mechanisms of Energy balance
Input = output (physical activity, basal metabolic rate, adaptive thermatogenesis
OD and Ob genes
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
Monogenic obesity
Belief that there is a POMC mutation (POMC creates ATCH)
Our obesogenic behaviour leads to susceptability
Relationship between genetics, epigenetics & environment
complex interactions between all of these causing genetic plasticity changes & susceptibility to obesity
Birth Weight
High Birthweight:
increased risk of T2DM
How do we manage obesity?
Diet
Exercise
Behaviour Modification Pharmacotherapy x Bariatric Surgery
Why is weight nearly always regained?
- 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
What is the best diet for weight loss?
Weight Loss with a Mediterranean, or Low-Fat Diet.
*especially in diabetics!
Low-Carbohydrate not as GOOD!
What is the mediterranian diet reccomendations?
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
Meditterranian versus low CHO diet in preventing cardiovascular disease
Significantly lower rate of CV events in M
Very Low Energy Diets
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
What are the contraindications of VLED?
1.
What are the side effects of VLED?
- Constipation
- Diarrhoea
- Halitosis
- Hypotension
- Electrolyte Imbalance
What tests should you perform wrt VLED?
Electrolytes/Creatinine LFT’s Glucose Lipids Uric Acid FBE Before and Half way into diet (6 weeks after starting)
Medical versus surgical therapy- > which is better for weight loss
