Endocrine and Metabolic Conditions Flashcards
Normal BMI
18.5 to <25 kg/m2
Overweight BMI
25 to <30 kg/m2
Class 1 Obesity
30 to <35 kg/m2
Class 2 Obesity
35 to <40 kg/m2
Class 3 Obesity
≥40 kg/m2
BMI parameters
Set based on measured adiposity and the levels at which risk of adverse outcomes increase
Elevated BMI linked with
Greater risk of fatal and combined fatal and nonfatal CHD
Greater risk of fatal stroke, ischemic stroke, and hemorrhagic stroke
Greater risk of combined fatal and nonfatal CAD
Greater risk for T2DM
Greater risk of all-cause mortality
Risk of hypertension and dyslipidemia, musculoskeletal and functional limitations
Pear shape
Wider hips, smaller top half
Common in women
Apple shape
Smaller hips, wider top half
Common in men
Makes it more difficult to breath due to the organs being pressed together
Lower limb stress (bad knees)
CVD risk due to abdominal fat
Lower back pain
Overweight and obesity
Risk of abdominal adiposity
Excessive abdominal adiposity is associated with greater health risk
Adults with a BMI of 18.5 to <25 kg/m2 or with a BMI of 25 to <30 kg/m2 without indicators of increased health risk
Should be counseled to engage in behaviors that will avoid weight gain
Adults with a BMI of 25 to <30 kg/m2 with indicators of increased health risk or a BMI ≥30 kg/m2
Should be counseled to engage in behaviors to lose weight
Adults with a BMI of 27 to <30 kg/m2 with a comorbidity or a BMI ≥30 kg/m2 who have been unsuccessful with weight loss
May require pharmacotherapy as an adjunct to a comprehensive lifestyle weight loss program
Adults with a BMI of 35 to <40 kg/m2 with a comorbidity or a BMI ≥40 kg/m2 who have been unsuccessful with weight loss
Should be referred to a bariatric surgery specialist to consider this treatment option as an adjunct to a comprehensive lifestyle weight loss program
Creating goals
Don’t center goals that are regarding weight
Instead, make goals that pertain to promoting health
Dietary approaches for weight loss
Achieved when a diet resulted in a sufficient energy deficit regardless of the specific composition of the diet
CEPs DON’T PRESCRIBE DIETS
High glycemic-load and low glycemic-load diets
Research is mixed for support of either diet
High protein diets
Have shown more promise but the evidence is still unsure
More concerned about adequate protein diet before high protein diets
Need about 1.2-2.0 grams of protein/day; minimum is 0.8 grams
Mediterranean diet
Ideal cardiovascular diet
Less red meat, poultry, butter, and sugar
Increased fish, olive oil, grains, fruits, vegetables, cheese, and yogurt
Heart disease and cancer prevention
Meal replacements
Shakes
Nutrition bars
Frozen food
We know the calories and nutritional values making it easier to track calories
Very-low calorie diets (VLCDs)
Highly engineered powdered supplements that are rich in protein and average in the range of 600-800 kcal/day
Administered under medical supervision out-patient or in-patient
The problem is there is no good transition time to get out of the VLCDs diet
Designed to achieve weight loss goal in a short time frame
Physical activity (exercise training) for weight loss
Not a great way to lose weight due to the time it takes
There was no significant change in weight in studies in which physical activity was <150 minutes per week
150+ minutes/week there is significant weight loss
Only a modest weight loss occurs with physical activity
RT for weight loss
Not a lot of studies have done
RT can increase a person’s overall physical function which increases total daily energy expenditure
Physical activity (lifestyle changes)
Increasing someone’s physical activity can aid in weight loss
Short term adherence to physical activity
2-6 lbs improvement over time in weight reduction
No improvement in other areas like cardiac health, etc
Long-term adherence to physical activity
Lifestyle behavior changes is the main goal
200-300 minutes/week of moderate to vigorous PA to increase total energy expenditure overall
Wearable monitors will aid in tracking activity
LIFESTYLE MODIFICATION IS A CRITICAL FACTOR IN WEIGHT MANAGEMENT AND RISK FACTOR REDUCTION
Prevention of weight gain
2.2-4.4 lbs of annual weight gain
Inverse relationship between adiposity and PA
Modest increases in energy expenditure of 50-100 kcal/day may be sufficient to prevent or reduce average weight gain
Diabetes
Screening recommended in asymptomatic people at any age who are overweight or obese or have one additional risk factor for diabetes
45+ and at least every 3 years after that age
Diabetes risk factors
Lack of physical activity
First-degree relative with diabetes
High risk because of race or ethnicity (African American, Latino, Native American)
Hypertension
History of CVD
Diabetes screening tests
Fasting plasma glucose
65-gram oral glucose tolerance test
Hemoglobin A1C
Fasting plasma glucose
Measures glucose levels in a person who has been fasting for at least eight hours
75 gram oral glucose tolerance test
OGTT requires fasting before drinking a glucose solution. Following a two-hour waiting period, blood is drawn
When sugar is consumed, insulin is released causing the levels to go up then right back down
Someone who’s glucose tolerant won’t have the level go back down and will stay elevated
Hemoglobin A1C test
Does not require fasting, and measures the blood level of glycosylated hemoglobin over the past two to three months (90 days)
Type 1 diabetes mellitus (T1DM)
Destruction of beta cells in the pancreas causes the production of insulin to be damaged=insulin deficiency
5-10% of all diabetic cases
More commonly diagnosed in children and adolescents
Genetic and environmental factors (viral infections)
Increased risk for other autoimmune disorders
Type 2 diabetes mellituse (T2DM)
Insulin resistance with relative insulin deficiency
Can progress to an insulin secretory defect with insulin resistance
90-95% of all diabetic cases
Obesity and abdominal adiposity
Hyperglycemic develops gradually with no classic symptoms
Type 2 diabetes mellitus obesity risk factors
Visceral fat accumulation (fat around the organs)
Central adiposity
Type 2 diabetes mellitus risk factors👀👀👀👀
Age ≥ 45 years
BMI ≥ 25 kg/m2 or central adiposity (defined by waist circumference)
Habitual physical inactivity
Having a first-degree relative with DM
African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity
If a female, delivering a baby weighing > nine pounds or having a past diagnosis of GDM
Having polycystic ovary syndrome
Presence of HTN
Presence of a low level of HDL cholesterol
Presence of a high TG level
Previous diagnosis of IGT or IFG
A history of vascular disease
Diabetes complications
Affects all normal metabolic actions of insulin, including glucose transport, hexokinase activity, glycogen synthesis, and glucose oxidation
Have multiple comorbidities
The increase of the production of glucose by hepatocytes and portal adipocytes are key factors in the development of the complications
Macrovascular complications of diabetes
Coronary artery disease
Stroke
Peripheral artery disease
Microvascular complications of diabetes
Renal disease
Diabetic retinopathy
Diabetic neuropathy
Treatment of T2DM lifestyle approaches
Implementation of an intensive lifestyle modification of increased PA and adoption of heart-healthy diet
Similar to weight management approaches
Reduce body weight by 5-10%
Prevention of T2DM lifestyle approaches
Weight loss
Lifestyle group
Compare medication or lifestyle approach focused on weight loss to reduce onset of developing T2DM
Pharmacotherapy in diabetes
Insulin
Glucosidase, Metformen, etc.
Exercise and PA in patients with T1DM
Benefits of physical activity on endothelial function
Favorable changes in lipid, lipoprotein, and apolipoprotein levels
Improvements in HbA1c levels and reduced insulin requirements
Exercise and PA in patients with T2DM
RT can improve insulin activity
Higher rates in Westernized environments than other environments
Metabolic syndrome
A disorder characterized by IGT, dyslipidemia, and HTN, which together were associated with an increased risk of T2DM and CVD
Primary underlying mechanism for the syndrome was attributed to insulin resistance at the level of the skeletal muscle
Criteria for metabolic syndrome (WHO)
Risk factors and comorbidities of metabolic syndrome
Puts individual at risk for other diseases like CHD
Metabolic syndrome physical activity
PA individuals with metabolic syndrome had a lower CVD risk than inactive individuals with metabolic syndrome
