Contributors/epidemiology Flashcards
% Americans with obesity
adults 42%, children 19%
Diagnostic critera MetS
Men/women (canadian)
- Abd Circumference > 88/102 cm
- TG> 150 ( 1.7)
- HDL < 50/40 ( 1.3/1.0)
- Elevated fasting glucose 100 (5.6) or medicated
- BP 130/85 or medicated
Melanocortin 4 Receptor deficiency presentation 4
, genetic abnormality 3
Hyperphagia obesity early on
“big boned” ( increased BMD)
Accelerated linear growth
reduced sympathetic nervous activity
Auto dominant or recessive
Most common genetic defect causing obesity
Chromosome 18
Prader-Willi Syndrome presentation 6, genetic facts 3
Hyperphagia Short stature Weak muscle tone Insatiable appetite Developmentally delayed ,intellectually impaired Fair skin/light hair
Not inherited
chromosome 15
most common obesity syndrome
AlBRIGHT’s Hereditary OsteoDystrophy presentation 5, genetic abnormality 2
Short Dysmorphic extremities (ie/short 4/5 MCs) dental hypoplasia pseudohypoPTH Intellectual disability
Auto dominant
defect in GNAS on chr 20
Cohen Syndrome
little blind Leonard with a beer belly
Small head, intellectual and developmental disability Joint hypermobility Central obesity Retinal dystrophy Thick hair/eyebrows/eyelashes Friendly
X-linked recessive, girls can carry
Mutation of Zinc finger gene
Lipodystrophy is limitation in proliferation and differentiation of fat cells. Presentation, clinical/lab findings
Muscular appearance
Prominent peripheral veins from birth
Possible hyperphagia
Congential or acquierd (ie HIV related)
Reduced Leptin relative to body fat
Insulin resistance
High TGs
Hepatic steatosis- can have big belly
Setmelanotide is a melanocortin-4 receptor agonist. Max dose 3 mg/day, can titrate down if needed.
What conditions is it indicated for?
skips leptin receptor and POMC system at level of arcuate nucleus, goes straight to Mc4r. Usually this is triggered by alphaMSH
6 years of age or older with obesity due to :
POMC deficiency
PCSK1 prohormone convertase mutation
Leptin receptor deficiency
Lipidema is symetrical enlargement of legs due to increased subcutaneous fat deposits, may cause lymphedema. Treatments?
painful. Positive cuff sign
Nutrition Physical activity Psychological support Manual lympatic drainage, compression hose. Lymph sparing liposuction
AACE definition of obesity
Obesity= BMI> 30 with no complications
Obesity Stage 1= BMI>25 with mild-moderate complications
Obesity Stage II= BMI > 25 with severe obesity related complications
Abdominal obesity on S. Asians, Chinese, Japanese
men >90, women> 80 cm
Environmental factors contributing to obesity 5
Stress Sleep Prenatal influences Heavy metal pollutants Chemical exposures-arsenic, cadmium, BPA, POPs
What gene, on which chromosome, is associated with adiposity?
FTO gene ( FaT mass Obesity) Chromosome 16
How does PCOS cause obesity?
check
Increased levels of insulin cause energy to be converted to fat, and increase androgen production by the ovaries
Also estrogen converted to androgen
How does insomnia and sleep disorder contribute to obesity?
Decreased sleep cause increase in ghrelin/cortisol and decreased leptin
