Metabolic syndrome

Question 1

What are the three grades of obesity?

Answer 1

Grade 1 BMI 30-35 kg/m2
Grade 2 BMI 35-40 kg/m2
Grade 3 BMI ≥40 kg/m2 (morbid obesity)

Question 2

What is the BMI for overweight?

Answer 2

BMI 25-30 kg/m2

Question 3

How many people are obese vs obese and overweight in Sweden?

Answer 3

15% obesity in Sweden

50% Obesity and overweight

Question 4

What is sagittal abdominal diameter?

Answer 4

Sagittal abdominal diameter (SAD) is a measure of visceral obesity, the amount of fat in the gut region. It is the distance from the small of the back to the upper abdomen.

Question 5

What are the limits for sagittal abdominal diameter for men and women?

Answer 5

22 - men

20 - women

Question 6

What are the levels for HDL and LDL for people with diabetes?

Answer 6

HDL are low

LDL are high

Question 7

What is lipid disease often connected with?

Answer 7

Diabetes

Question 8

Which factors were significally associated with acute myocardial (issue death due to inadequate blood supply to the affected area)

Answer 8

• Current and former smoking
• Diabetes
• Hypertension
• Abdominal Obesity
• Psychosocial
• Daily fruits & vegetables
• Exercise
• Alcohol intake
• ApoB/ApoA1 ratio

Question 9

What were 76% of all myocardial infarctions in the world according to the interheart-studie?

Answer 9

Smoking
Hypertension
Diabetes
Lipids

Question 10

What is hypertension?

Answer 10

Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated

Question 11

What is the symptom of polycystic ovary syndrome

Answer 11

women high BMI don’t have ovulation because the adipose tissues turn the female hormones to male (androgens).
PCOS is due to a combination of genetic and environmental factors. Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition

Question 12

What is fatty liver disease?

Answer 12

Fatty liver disease (FLD), also known as hepatic steatosis, is a condition where excess fat builds up in the liver. Often there are no or few symptoms. Occasionally there may be tiredness or pain in the upper right side of the abdomen. Complications may include cirrhosis, liver cancer, and esophageal varices

Question 13

What is the consensus of worldwide definition of the metabolic syndrome? From International Diebates Federation (IDF)

Answer 13

According to the new IDF definition, for a person to be defined as having the metabolic syndrome they must have:
Central obesity (defined as waist circumstance)
Plus any two of the following 4 factors:
- Raised TG level
- Reduced HDL, cholesterol
- Raised blood pressure ´
- Raised fasting plasma glucose

Question 14

What are viewed as 2 of the most causative factors of metabolic syndrome?

Answer 14

Central obesity and insulin resistance

Question 15

What is atherogenic dyslipaemia?

Answer 15

Combination of raised TG and low concentrations of HDL-c together with elevated apoliprotein B (ApoB), small dense LDL and small HDL, particles, all of which are independently atherogenic, which commonly observed in patients with both type 2 diabetes and the metabolic syndrome.

Question 16

What is IGT – Impair glucose tolerance – and the usual consequenses?

Answer 16

Impaired glucose tolerance means that blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis. With impaired glucose tolerance you face a much greater risk of developing diabetes and cardiovascular disease

Question 17

Hur ställer man diagnosen diabetes?

Answer 17

Om man saknar symtom krävs minst två fasteplasmaglukosvärden på eller över 7.0 mmol/l. Om man inte är fastnade när provet tas kan man ställa diagnos på ett plasmaglukosvärde över 11,1 mmol/l.

Question 18

What does the level 6.1-6.9 mmol/l indicate?

Answer 18

prediabetes

Question 19

What is Glucose clamp technique ?

Answer 19

Glucose clamp technique is a method for quantifying insulin secretion and resistance. It is used to measure either how well an individual metabolizes glucose or how sensitive an individual is to insulin.
Give glucose in one arm and insulin in other.
If sensitive to insulin, need to give more glucose in the other arm to hold a good value – insulin clamp

Question 20

WHO clinical criteria for the metabolic syndrome

Answer 20

In order to make a diagnosis of the metabolic syndrome a patient must present with glucose intolerence, impaired glucose tolerance (IGT) or diabetes and/or insulin resistance, together with two or more of the following components :

• Impaired glucose regulation or diabetes
• Insulin resistance
• Raised arterial pressure
• Raised plasma triglycerides
• Central obesity
• Microalbuminuria

Question 21

What is the limit for diabetes during fastning?

Answer 21

If your fasting blood sugar is 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

Question 22

What are the reference value for diabetes and impaired glucose tolerance during oral glucose tolerance test (OGTT)

Answer 22

Diabetes if p-glucose after 2 hours >11mmol/l or f-p- glucose 7mmol/l

IGT if p-glucose after 2 hours ≤11mmol/l and ≥7,8 mol/l

Question 23

What is Hyperinsulinemia?

Answer 23

a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose.
With a reduced response to insulin, the beta cells of the pancreas secrete increasing amounts of insulin in response to the continued high blood glucose levels resulting in hyperinsulinemia.
Beta cells eventually fail to work :/

Question 24

What is hyperglycemia?

Answer 24

, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l

Question 25

What is Impaired glucose tolerance (IGT)?

Answer 25

Impaired glucose tolerance means that blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis.

With impaired glucose tolerance you face a much greater risk of developing diabetes and cardiovascular disease.
- have 50% less beta cell activity
With life style changes 50/50 diabetes of not.

Question 26

Why is metabolic syndrome important?

Answer 26

Epidemic disease, common
Increased risk of cardiovascular disease
Components in metabolic syndrome increase perse the risk of CVD
Diabetics have same risk to fall ill in myocordial infaction (MI) as a patient that have earlier experienced MI
Difficult classification
Lifestyle intervantions difficults, behavior modifications

Question 27

What are some complication that can follow with diabetes?

Answer 27

• Myocardial infection, macrovascular-disase, stroke
• heart failure
• Eyes - retinopathy
• kidneys - nefropathy
• nerves - neuropathy
• Feet - poor circulation, neuropathy, wounds

Question 28

What can differ in LDL between normal and diabetes patients?

Answer 28

Diabetes can have a more but smaller and dense LDL particles so it looks like the same total volume.
Each LDL is carried by one Apo B. So diabetes patients have a higher amount of Apo B

Question 29

What happens during obesity?

Answer 29

• Increased CHYLO-TG intake
• More TG stored in adipose tissue
• -> raise blood glucose concentration
• FFA can be stored in liver
• overactive gluconeogenesis in liver

Question 30

Lifestyle modification:

What is the result of changing diet to carbs with low GI?

Answer 30

Reduced glucose peaks and reduced LDL

Question 31

What are some positive aspects of excersie?

Answer 31

Reduced weight, increased HDL, reduce TG
Increase insulin receptors in muscle
Reduce stress hormones (adrenaline and noradrenaline)
Reduce blood pressure

Question 32

What do smoking do?

Answer 32

Increase insulin resistance
Impairs lipids (HDL, LDL)
Increase both micro- and macrovascular complications, coagulation factors

Question 33

If have imparied glucose tolerance what is better, use matformin or make lifestyle changes?

Answer 33

If have impaired glucose tolerance normally will have diabetes within 10 years
- Lifestyle group reduced the cases of diabetes the most - 58%