Metabolic syndrome

Question 1

What are the definitions of metabolic syndrome?

Answer 1

Abdominal/central obesity
Hypertriglyceridaemia
Low HDL cholesterol
Hypertension
Fasting hyperglycaemia
Microalbuminuria
By the ATPIII criteria must have 3

Question 2

How does metabolic syndrome affect mortality and morbidity?

Answer 2

All cause mortality greatly increased

Cardiovascular mortality: CHD, MI and stroke especially

Question 3

How is insulin resistance linked to metabolic syndrome?

Answer 3

Central adiposity leads to insulin resistance

Obese patients secrete double the amount of insulin to achieve the same amounts of glucose control

Question 4

How does insulin regulate adipose tissue mass?

Answer 4

Insulin drives the proliferation of preadipocytes and differentiation of mature adipocytes

Question 5

How are obesity and type II diabetes linked?

Answer 5

Obesity increases BMI

Greater BMI has a greater risk of type II diabetes

Question 6

Which clinical events are more likely with insulin resistance?

Answer 6

Hypertension
Stroke
Cancer
CHD

Question 7

What do the 2014 NICE guidelines state?

Answer 7

4 classes of obesity

4 treatment stages

Question 8

What are the 4 classes of obesity?

Answer 8

25-30
30-35
35-40
40+

Question 9

What are the 4 treatments for obesity?

Answer 9

Increasing severity
Lifestyle advice
Diet and physical activity
Drugs
Surgery

Question 10

How is exercise linked to obesity?

Answer 10

Higher levels of exercise reduce the chance of metabolic syndrome
Cardiovascular fitness and weight correlate with all-cause mortality
Risk of dying is lowest in the fit, regardless of fat mass

Question 11

What do the NICE guidelines suggest for exercise?

Answer 11

30 mins on 5 days of the week

Reduce time spent inactive

Question 12

What is dietary intervention for the treatment of obesity?

Answer 12

Energy intake less than energy expenditure
600kcal/deficit = slow but sustainable weight loss
Low calorie diets unlikely to be nutritionally complete

Question 13

What are pharmalogocial interventions for the treatment of obesity?

Answer 13

Considered only after trying diet, exercise and behavioural changes
Two present currently: Orlistat and Liraglutide

Question 14

How does Orlistat work?

Answer 14

Inhibitor of pancreatic lipase

Can cause fatty diarrhoea and wind

Question 15

How does Liraglutide work?

Answer 15

Works via GLP-1
GLP-1 is released in response to eating
Is quickly degraded by dipeptidyl peptidase IV
Liraglutide is a GLP-1 analogue, resists degradation
Sub-cutaneous daily injection

Question 16

What are surgical interventions for the treatment of obesity?

Answer 16

Only when meeting all the following criteria:
BMI 40 or more
BMI 35 or more and a significant disease that would benefit
All other methods tried unsuccessfully
Fit for anaesthesia and surgery
Commits to long term follow up

Is the first line option if BMI is over 50

Question 17

What is bariatric surgery?

Answer 17

Adjustable gastric band
Roux en Y gastric bypass
Vertical sleeve gastrectomy
All 3 lead to significant weightless at 1-2 years
Remission of diabetes and obesity related complications
Reduced mortality

Question 18

What are the complications of bariatric surgery?

Answer 18

Mortality <0.3%
Nutritional deficiencies 15%
Resurgery 8%