Metabolic Syndrome

Question 1

inability of insulin to suppress ___ in adipose tissue and ___ by alpha cells in silets results in increased gluconeogenesis

Answer 1

failure of insulin to suppress lipolysis in adipose and glucagon secretion by alpha cells

Question 2

NCEP Adult Treaatment Panel III criteria for metabolic syndrome

Answer 2

Waist circumference Men >40in women >35in

Low HDL Men <40 women <50

HyperTG >150

HTN 130/85 or on Rx

Impaired fasting glucose or diabetes (100mg or taking Rx)

(3 or more criteria)

Question 2

adiopnectin and leptin ___ with insulin resistance

TNFa and resistin ___ with insulin resistance

Answer 2

adiopnectin and leptin decrease with insulin resistance

TNFa and resistin decrease with insulin resistance

Question 3

in MS, ___ from adipose cells that normally controls appetite center of brain is ineffective (resistance)

Answer 3

leptin

Question 4

Inflammation hypothesis of insulin resistance

Answer 4

enlarged fat cells attract macrophages and secrete inflammatory signals

signals work in muscle cell via JNK kinase

block insulin receptor IRS-1

Question 4

TGs are transfered to LDL and HDL, and VLDL particles gain cholesterol esters by action of ___

this reuslts in increased catabolism of HDL by liver and loss of ___ resulting in low HDL concentration

Answer 4

CETP

loss of Apo(A)

Question 5

lipid overload hypothesis

Answer 5

enlarged fat cells leak fatty acids >

> DAGS accumalate in muscle cells >

>inhibit insulin signaling thorugh novel PKCs (nPKCs) >

then block IRS-1

Question 6

the enhanced secretion of ____ and ___ produced by adipocytes and monocyte derived macrophages results in mor insulin reisstance and lipolyisis of adipose tissue TG stores to circulating FFAs

Answer 6

Il-6 and TNFa

Question 7

____ and ___increase hepatic production of fibrinogen and adipocyte production of Plasminogen activator inhibitor (PAI-1) resulting in a prothrombotic state

Answer 7

Cytokines and FFAs

Question 8

Treatment of dyslipidemia in MS

Answer 8

LDL: HMG-CoA reductase inhibitors (statins)

Ezetimibe

Hyper TG Fibric acid derivatives

Niacin

**Low HDL: **Fibrates or Niacin

Question 10

insulin resistance in MS tends to involve primarily ___ and ___ tissue

Answer 10

fat and muscle

Question 11

IL-6 and other cytokines increase hepatic ___ production

Answer 11

glucose

Question 12

Hyperinsulinemia may result in ____ and ____, contributing to HTN

Answer 12

enhanced sodium abs

increased sympathetic activity

Question 12

Orlistat mechanism

Answer 12

inhibitor of gastric and pancreatic lipases

decrease abs of dietary fat by 30%

Question 13

Fasting plasma glucose levels
DM
Impaired
Normal

2 hourOGTT
DM
Impaired
Normal

Answer 13

Fasting plasma glucose levels
DM >126
Impaired 100-125
Normal

2 hourOGTT
DM >200
Impaired 140-199
Normal

Question 14

suppression of _____ production by insulin is defective in insulin resistance, leading increased flux of FFA to liver, resulting in increased TGs

Answer 14

VLDLproduction

Question 16

lipotoxicity theory (most accepted)

Answer 16

increased fatty acids from adipocytes lead to changes in post-insulin receptor function in muscle cells

decreases IRS-1 function > decrease in insulin mediated glucose uptake

(also involved in beta cell failure, indirectly)

Question 17

in the liver increased FFAs result in an increased production of ____ and ____, as well as secretion of ____

Answer 17

production of glucose and TGs

secretion of VLDLs

Question 18

lipid profile in metabolic syndrome

Answer 18

low HDL

elevated TGs

moderate increase in LDL (which are more atherogenic and smaller)

Question 20

treatment of HTN in metabolic syndrome

Answer 20

ACEi

ARBS

Question 21

protrombotic state due to

Answer 21

Fibrinogen and PAI-1