Lecture 10 - Managing, Preventing Metabolic Syndrome

Question 1

What is Orlistat?

Answer 1

A liase inhibitor.

Causes steatorrhoea if lipids are eaten

Question 2

Outcomes of experiment comparing gastric banding with current medical treatment for obesity

Answer 2

At outset of experiment, both medical and surgical groups had 38% metabolic syndrome prevalence.

After experiment, 24% of medical had MS, only 3% of surgical had MS

Therefore, it is possible to reverse metabolic syndrome with weight loss

Question 3

Why can’t the basis for metabolic syndrome be purely genetic?

Answer 3

Genes don’t mutate fast enough to explain the rapid rise in obesity prevalence

Question 4

Experiment testing ability to keep lost weight off

Answer 4

Mice divided into groups.
One group fed high energy diet (8% corn syrup).
Other group fed low energy Chow diet.
HE diet group split into two groups after a few weeks. One continued on HE diet, the other switched to calorie-controlled chow.
Chow group allowed to eat as much chow as they wanted. Returned to same weight as mice on HE diet.

Question 5

What might be a causative agent for obesity?

Answer 5

Epigenetic

Question 6

Effect of starvation in first trimester

Answer 6

Child develops obesity, metabolic syndrome

Question 7

Very-low energy diet

Answer 7

800 calories per day.
One meal per day, with oil and vitamin supplements.
Mostly protein.

Question 8

Issue with very-low calorie diet

Answer 8

Weight gained back after 5 years

Question 9

Neural weight regulation

Answer 9

In the hypothalamus, arcurate nucleus.
Within arcurate nucleus are two nerve types:
1) Neuropeptide Y nerves. Make glutein-related peptide, neuropeptide Y. These promote hunger.
2) POMC nerves. Release POMC, which is cleaved to MSH. MSH, CART inhibit hunger.

Question 10

How is the arcurate nucleus of the hypothalamus regulated?

Answer 10

Hormones in the blood.
Ten hormones.
One promotes hunger (ghrelin, from empty stomach)

Small intestine releases cholecystokinin, glucagon-like peptide-1, PYY.
Adipose tissue releases leptin.
Pancreas releases amylin, pancreatic polypeptide, insulin.
These suppress hunger

Question 11

Test on hormone levels in blood with dieting

Answer 11

Blood sample taken pre-prandially, then every four hours post-prandially.

After diet, ghrelin levels increased.
PYY, CCK, amylin, leptin levels decreased.
Levels only returned to baseline with weight gain back to obese level.

Question 12

Drug combination that can reduce, and keep off weight

Answer 12

Duromine (15mg), topamax (25mg)

Question 13

Issues with duromine/topamax therapy

Answer 13

Significant side-effects

Question 14

Types of stomach banding
1)
2)
3)

Answer 14

1) Gastric banding
2) Sleeve gastrectomy
3)

Question 15

How does gastric banding reduce hunger?

Answer 15

Bolus of food pushes against band around top of stomach, sends signal via vagus nerve that stomach is full

Question 16

How does sleeve gastrectomy reduce hunger?

Answer 16

Removes part of stomach that produces ghrelin

Question 17

Drug that can slow absorption of carbohydrates

Answer 17

Acarbose

Question 18

Effect of glucagon-like peptide-1

Answer 18

Suppresses glucagon, hunger.

Increases insulin levels

Question 19

Inhibitor of glucagon-like peptide-1

Answer 19

DPP4

Question 20

Drug that increases renal excretion of glucose

Answer 20

SGLT-2

Question 21

SGLT-2 effect

Answer 21

Increases renal excretion of glucose

Question 22

Why are statins not often recommended for people with metabolic syndrome?

Answer 22

Typical dyslipidaemia for MS is high TAGs, low HDL.

Statins would reduce HDL levels

Question 23

Drug that reduces uric acid levels in blood

Answer 23

Allopurinol

Question 24

Gout treatment

Answer 24

Allopurinol