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CVDM > Metabolic Disease, Obesity and COVID-19 > Flashcards

Metabolic Disease, Obesity and COVID-19 Flashcards

1
Q

What is obesity?

A

Abnormal or excessive fat accumulation that may impair health

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2
Q

What waist circumferences for men and women show an increased rate of obesity related morbidity?

A

Men ≥202cm
Women ≥88cm

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3
Q

Name some factors influencing obesity

A

Genetics
Environment
Energy balance
Fetal nutrition

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4
Q

How does fetal nutrition affect obesity?

A

Under-nutrition of the fetus during intrauterine development may lead to later onset of metabolic disease, and an adverse nutritional environment in utero can lead to programmed susceptibility to disease

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5
Q

Why in the UK do we live in an obesogenic environment?

A

Availability of energy dense foods
Large portion sizes
Cheap food outside of home
Altered eating patterns (snacks instead of meals)
More sedentary lifestyles
Car travel

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6
Q

Name some chronic illnesses that can arise from obesity

A

T2DM
Heart disease
Obstructive sleep apnoea
Cancer
Osteoarthritis
Hypertension

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7
Q

How does obesity cause T2DM?

A

Higher plasma FFA causes increased glucose production with reduced hepatic glucose utilisation, leading to hyperinsulinaemia and hyperglycaemia

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8
Q

How does obesity cause heart disease?

A

Larger body mass causes higher oxygen consumption and cardiac output, leading to myocardial hypertrophy, congestive heart failure or coronary heart disease and sudden death

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9
Q

How does obesity cause obstructive sleep apnoea?

A

Increased chest and abdominal fat causes alterations in breathing which is exaggerated when lying flat

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10
Q

What types of cancer does a BMI ≥30 increase your risk of?

A

Prostate
Breast
Endometrial
Cervical
Colorectal
Gallbladder

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11
Q

How does obesity cause osteoarthritis?

A

Increased weight puts increased pressure on the joints and wears away cartilage

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12
Q

What joints are mostly affected by arthritis in obese individuals?

A

Lower back, knees, hips

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13
Q

What metabolic diseases can increased fructose intake cause?

A

Dyslipidaemia - NASH
Hypertension via increased uric acid
Obesity and insulin resistance
Accelerated ageing process

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14
Q

What is metabolic syndrome?

A

At least 1 of:
- T2DM
- Insulin resistance
- Impaired glucose tolerance
Plus at least 2 of:
- Hypertension
- Obesity
- Hypertriglyceridaemia
- Microalbuminuria

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15
Q

What is the link between T2DM and Alzheimer’s disease?

A

T2DM patients are at a 1.5-2.5% increased risk of dementia
AD patients are more prone to T2DM

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16
Q

Apart from T2DM, what metabolic features increase the risk of Alzheimer’s disease?

A

Body weight extremes and hypercholesterolaemia

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17
Q

AD is associated with increased/reduced glucose metabolism and insulin signalling in the brain

A

Reduced

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18
Q

How can we fix the problem of obesity?

A

Societal engagement
Inform
Motivate - individual sets personal goals
Incentive
Influence - changes in advertising and pricing to alter societal attitudes

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19
Q

Describe the structure of SARS-CoV-2

A

Contains glycoprotein spikes
Has a membrane layer which is alcohol/detergent sensitive
Inside is the virus genome which is RNA and encodes ~27 proteins

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20
Q

How does SARS-CoV-2 enter cells?

A

The spike proteins allow it to bind and enter healthy cells

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21
Q

How is SARS-CoV-2 detected by the immune system?

A

By the spike proteins

22
Q

What are the functions of S1 and S2 of the spike protein of SARS-CoV-2?

A

S1 - recognition site. Allows the recognition and binding to the cell receptor
S2 - facilitates fusion of viral membrane with the cell

23
Q

What cleaves the viral S glycoprotein in SARS-CoV-2?

A

Transmembrane serine protease 2 (TMPRSS2)

24
Q

ACE2:
What is it?
What is its function?

A

Zinc metalloprotease involved in BP control
Catalyses the hydrolysis of angiotensin II to angiotensin 1-7

25
Q

What is the primary receptor for SARS-CoV-2?

A

ACE2 receptor

26
Q

How many cleavage sites are on SARS-CoV-2?

A

3, cleavage occurs after binding to ACE2

27
Q

Symptoms of mild-moderate SARS-CoV-2 infection

A

Headache
Loss of smell
Cough
Nasal obstruction
Lack of energy
Myalgia
Runny nose
Sore throat
Fever

28
Q

Symptoms of severe SARS-CoV-2 infection

A

Fever
Joint pain
Abdominal pain
SOB
Pneumonia
Cough
Vomiting
Fatigue/malaise
Confusion

29
Q

Symptoms that patients in ICU with SARS-CoV-2 had

A

ARDS
Acute respiratory failure
Dyspnoea
Myocardial injury
Arrhythmias
Heart failure
Kidney failure
Encephalopathy

30
Q

Co-morbidities for SARS-CoV-2

A

Hypertension
CKD
Liver disease
Immunocompromised
COPD
CVD
Cancer

31
Q

True or false:
Diabetes is a risk factor for SARS-CoV-2 infection

A

False
Not a risk factor for infection but major risk factors for progression to critical illness
Increased risk of hospitalisation, intensive care, ARDS, mechanical ventilation and death

32
Q

In what groups is obesity associated with increased mortality from COVID-19?

A

Younger (18-59) rather than older
Males
Non-white ethnicity

33
Q

What is long COVID?

A

When symptoms remain after clearance of acute infection (~4 weeks) and cannot otherwise be explained

34
Q

Symptoms of long COVID

A

Fatigue
Dyspnoea
Cardiac abnormalities
Cognitive impairment
Sleep disturbances
PTSD-like symptoms
Muscular pain
Headache

35
Q

Who are the people most at risk after vaccination?

A

Less healthy lifestyles
Older frail people
Higher BMI
Living in areas of high deprivation

36
Q

Three stages of the overactive inflammatory response in SARS-CoV-19

A

Early infections stage
Pulmonary phase
Hyper-inflammatory stage

37
Q

What is involved in the early infections stage?

A

Fever, dry cough etc.

38
Q

What is involved in pulmonary phase?

A

Shortage of breath, chest abnormalities on imaging

39
Q

What is involved in the hyper-inflammatory stage?

A

Cytokine storm leading to ARDS, multiple organ failure and death
Elevated IL-6, TNF-alpha, IL-1b, CRP

40
Q

A Western diet leads to activation/inhibition of the innate immune system and activation/inhibition of the adaptive immune response

A

Leads to activation of innate immune system and inhibition of the adaptive immune system

41
Q

What happens when there is overnutrition of adipose tissue?

A

Overnutrition driver hyperplasia and hypertrophy and causes adipose tissue expansion with vascularisation, leads to hypoxia and cell death and increased numbers of immune cells

42
Q

How is insulin resistance fuelled in obese adipose tissue?

A

Via inflammation and increased lipolysis

43
Q

How do fat cells effect the immune response in SARS-CoV-2?

A

Increased inflammation and there is death through virally driven hyperinflammation
Suppressed immune responses
More pro-inflammatory mediators
Reduced antiviral and anti-inflammatory responses

44
Q

How does adipose tissue act as a virus reservoir?

A

Higher viral load for longer
Poor recovery from disease
Prolonged viral shed from obese individuals
Reduced efficacy of vaccines and antivirals

45
Q

True or false:
Obesity exacerbates the ageing of the immune system

A

True - mirrors immune deficit in elderly individuals

46
Q

What do interferons do?

A

Lead to RNA and viral protein destruction

47
Q

What are the three main classes of interferons?

A

Type I - IFN alpha, IFN beta
Type II - IFN gamma
Type III - IFNI

48
Q

What do type I interferons do?

A

Stimulate resistance to viral replication in all cells
Leads to viral RNA destruction
Promotes NK cell activation

49
Q

What do type II interferons do?

A

Immune-induced responses
Coordinates response from innate to adaptive immunity (T-cells)

50
Q

What do type III interferons do?

A

Present the antiviral activity
First line of defence against viral infections
Regulates innate and adaptive immune responses

51
Q

How does obesity cause impaired virus clearance and high viral load?

A

By regulating ACE2 and raising ER stress

CVDM (16 decks)

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