Metabollic syndrome Flashcards
What is Metabolic syndrome ?
A combination of :
0 diabetes ,
0 high blood pressure (Hypertension )
0 obesity - associated with the apple shape - excess fat around waist (abdominal fat ) vs pear shape ( fat around waist )
apple shape - high waist to hip ratio. - high fat to muscle ratio.
pear shape - low waist to hip ratio.- gynoid fat distribution -normal for women.
Diagnosis of metabollic syndrome ?
3 or more of these :
0 Hypertension - consistently above 140 /90 mmHg - most prevalent
0 Waist circumference ( can be BMI in some cases )
- 94 or above - European men
- 90 cm - South Asian men
WOMEN
- 80cm and above - European and south Asian women
if waist circumference is too high - doctor should be measure blood pressure , blood sugar - fasting and lipid profile should be measured.
0 High triglyceride levels
0 low HDL levels in blood. (dyslipidemia )
0 Insulin resistance - causing elevated blood glucose.
- top 4 are the main ones - classic presentation
- there is also :
tendency to develop irritation and swelling / inflammation
- also at increased risk of blood clots e.g DVT.
What is metabolically healthy obesity ?
- obese but do not have the symptoms of metabolic syndrome.
What increases risk of developing metabolic syndrome ?
history of Type 2 diabetes , gestational diabetes (pregnancy )
0 age - increases with age
0 race - African/ Caribbean and Asians higher risk .
0 Other health conditions :
- poly cystic ovarian syndrome (PCOS)(women)
- cardiovascular disease
- non -alcoholic fatty acid disease.(NAFLD)
Causes of Metabolic syndrome ?
Obesity - lack of physical activity
- Insulin resistance - type 2 diabetes
What is Hepatic insulin resistance ?
impaired suppression of glucose production by insulin in hepatocytes
failed regulation of hepatic metabolism —–> excess glucose production .
Treatment of Metabolic syndrome ?
- lifestyle modification - diet and exercise
- treat hypertension , high blood sugar , abnormal fat levels.
Which Type of fat is considered to be the dangerous one ?
Intra - abdominal fat / visceral - located in abdominal activity linked to metabollic complications vs just excess fat .
BMI and waist circumference limitations ?
BMI
0 problematic with children - NMI changes with height - changes a lot during puberty.
0 body mass - muscle can be mistaken by fat.
0 normal range influenced by ethnicity and gender.
0 does not take into consideration of fat distribution e.g apple vs pear shape.
WAIST CIRCUMFERENCE
0 ethnic variation - e.g. African descent -tend to be larger than others.
0 often measured incorrectly
Causes of obesity ./
sustained Positive energy balance caused by ;
0 Lifestyle choices
0 Nutritional choices
0 Eating behaviours
0 Physical activity
0 Environmental factors
0 Polygenic factors
UNCOMMON CAUSES
0 Endocrine disease e.g cushings syndrome , hyperthyroidism
0 Monogenic disorders - single defective genes - FTO gene most common genetic cause - but still rare.
ex - Prader Willi syndrome.
What is Prader Willi syndrome ?
Rare genetic condition - group of genes on chromosome 15 affecting the hypothamulus which produces growth hormones and regulates appetite.
SYMPTOMS
0 excessive appetite /overeating
(cause weight gain) -
* can also lead to type 2 diabetes , heart failure , respiratory difficulties.
0 Restricted growth
0 weak muscles causing flopiness (hypertonia )
0 learning difficulties
0 behavioural problems - temper etc.
0 lack of sexual development
Treatment of Prader Willi syndrome ?
No cure
0 manage diet - balanced diet - avoid sweet treats and high calorie food right from the start.
What are the metabolic and physical consequences of obesity.
METABOLIC
0 Diabetes mellitus
0 Coronary heart disease
0 Stroke
0 Cancers e.g endometrial cancer (women )
0 Infertility
PHYSICAL
0 Anaesthetic risks
0 Cardiac hypertrophy
0 Cor Pulmonale
0 Sleep apnoea - breathing strops while sleeping
- obstructive sleep apnoea
- excessive daytime sleeping , irregular breathing at night - periods of breathing cessation.
- CAUSE :
Fat builds up around neck —-> breathing trunk collaspe ——-> airway blocked , air caant move through.
(complication of severe obesity )
0 Musculoskeletal
0 Pregnancy risks
0 Venous ulceration
0 Immobility
- reduced life expectancy .
Symptoms of obstructive sleep apnoea ?
suspect if they have any one of theses
WHILE SLEEPING
0 loud snoring
0 waking up a lot - also because of the need to urinate (nocturia )
0 gasping , chocking , snorting noises
0 breathing cessation then starting.(witnessed apnoeas)
DURING THE DAY :
0 feel very tired
0 difficulty concentrating
0 mood swings - depression
0 headache upon waking
0 depression
What is AHI score , ESS score?
AHI - Apnoea- Hypoaponea index - measure of severity of sleep apnoea
5 to 14 episodes of apnoea/hypoapnoea per hour - mild
15 -20 - moderate
over 20 - severe
ESS - epworth sleepiness score
11- 14 - mild
15 -18 - moderate
more than 18 - severe.
*epworth sleepiness questionnaire - asks 8 questions to assess tendency to fall asleep during certain situations.
