E2 Obesity & Metabolic Syndrome Flashcards
Obesity is most prevalent in
non-hispanic black population followed by hispanics and non-hispanic whites
Obesity has the lowest prevalence in
Asians
What age range is obesity highest in?
Age 40-60
Adipose tissue
-Provides insulation and mechanical support for the body
-Secretes hormone-like molecules: Adipokines
Adipokines
immune cell function & bodys main energy reserve
Adipocytes
Fat-storing cells
-store fat as triglycerides
-can increase in number and hypertrophy to increase fat mass
Major areas for fat storage:
- Subcutaneous or peripheral adipose tissue (subdermal tissue)
- Visceral adipose tissue (Gets btwn organs)
What is a healthier type of fat storage that causes less inflammation?
Peripheral fat
Android vs gynoid obesity
Android: Apple, Men, greater risk of heart disease, hypertension, diabetes, and stroke
Gynoid: Pear, Women
What waist circumference causes greater risk of coronary artery disease
Women > 35in
Men >40 in
Adipose tissue is an ___ organ
Endocrine
Secrete Adipokines
What are the 5 adipokines?
- Leptin
- Angiopoietin-related protein
- Angiotensinogen
- Retinol-binding protein
- IL-6, TNF-alpha
Angiopoietin-related protein
Insulin resistance & inflammation
Angiotensinogen
-Precursor to A2
-Secreted from fat cells to help regulate BP
-Inflammation
-Insulin resistance in lipogenesis
Retinol-binding protein
insulin resistance in muscle
IL-6, TNF-alpha
Biomarkers related to inflammation
-CRP & inflammatory markers
Adipokines are cell signaling proteins that are necessary for life and good i general but too many or too much we associate with
obesity and causes problems
Adiponectin
“Good” Adipokines
-Inverse relationship with the fat content in the body
Increased fat content in body = _____ adiponectin produced
decreased
What does adiponectin do?
- Enhances cell sensitivity to insulin
- Anti-inflammatory effects
- Protects against arteriosclerosis
Leptin
“Good” adipokine
-Tells body it is fulls (Satiety)
-Works with adiponectin to increase sensitivity to insulin, reduce triglycerides, and inhibit fat accumulation
Increased fat = _____ leptin
increased
Obese individuals becomes
Leptin resistant
-Overeat
-Excessive weight gain
-Hyperglycemia
-Hyperinsulinemia
A person is considered Obese if there BMI is
> 30kg/m2
Obesity is the _____ leading cause of death
5th
Genetics and obesity
-Polygenic condition
-Several genetic mutations associated (leptin gene)
-Obesogens
What is obesogens?
Chemicals that can contribute to the development of obesity (must have a combination of lifestyle and environment factors involved)
Risk factors for obesity
-Excess caloric intake
-Sedentary lifestyle
-Low socioeconomic status (poverty)
-Cultural aspects of eating
-Age (40-60)
-Smoking cessation
-Genetics
-Secondary disorders (Cushings, genetic disorders)
BMI =
Weight (kgs) / height (m)^2
[Weight (pounds)/ height (inches) ^2 ] x 703
What BMI is considered severe (morbidly) obese
> 40
Ghrelin Action
-Stimulates hunger
-Controls gastric motility & acid secretion
-Stimulates growth hormone
Ghrelin is ____ when obese
decreased
Glucagon-like peptide (GLP-1)
-Stimulates insulin secretion
-Inhibits glucagon release
-Slows gastric emptying
-Increase satiety
Glucagon-like peptide is _____ when obese
decreased
Peptide YY Action
-reduce appetite
-inhibit gastric motility
-Increase energy expenditure
Peptide YY is _____ when obese
decreased
Cholecystokinin (CCK) Action
-Increase satiety
-Decrease food intake
-Stimulate gallbladder contraction
-Pancreatic enzyme release
-Slow gastric emtying
Cholecystokinin (CCK) is ____ when obese
decreased (some say increased)
Obese patients are often in chronic, _______
low-grade inflammatory state
Macrophages, lymphocytes, neutrophils, and mast cells infiltrate adipocytes which cause release of ______. The systemic effects of these, coupled with other endocrine responses in obesity, results in _______
Cytokines
insulin resistance, metabolic syndrome, and health issues associated with obesity
MOA of orlistat
binds to gastric and pancreatic enzymes and blocks these enzymes, reduces fat absorption by 30%
Side effects of Orlistat
-Black box: Liver injury
-GI symptoms: oily spotting, flatulence, fecal incontinence (reduce by reducing fat intake to less than 30%)
-Decrease vitamin conentrations (MUST take multi-vitamin)
Teaching point for orlistat
Must take for 3 months to start seeing effects
OTC
Obesity drug therapy considerations for all
- Must use with diet & exercise
- Beset for people with a high health risk (BMI >30 04 BMI >27 w/ other risk factors)
- Most doctors will not prescribe unless patients have tried diet and exercise alone for 6 months
- Limited effectiveness
- Long-term treatment
- Rebound effect
What are the 3 types of bariatric surgeries?
Liposuction
Gastric Bypass
Gastric Banding
Metabolic syndrome is characterized by
atleast 3 risk factors
- Waist circumference (>40 men or >35 female)
- Triglycerides (>150)
- HDL cholesterol (<40 men or >50 female)
- BP (>120 Systolic or >85 diastolic)
- Fasting blood sugar (>110)
What do we do for metabolic syndrome?
Treat the conditions individually
-High BP -> BP meds
-High triglycerides (anti-lipemic agents)
-High Blood glucose (diabetes management)
Most important:
-Weight loss
-Exercise
-Healthy diet
-Smoking cessation
