Obesity & Anorexia of Aging Flashcards
what are some FUNCTIONS of ADIPOSE TISSUE? (5)?
- INSULATION
- MECHANICAL SUPPORT
- secretion of ADIPOKINES
- IMMUNE CELL FXN
- ENERGY RESERVE
adipocytes
type of FAT STORING CELLS
- stores calories into the form of TRIGLYCERIDES
- synthesizes into glucose > mobilization of energy
adipokines
type of CELL SIGNALING MOLECULES that help to signal satisfying or “full” feelings
- helps with lipid metabolism and sensitivity to insulin
what are the FOUR CLASSIFICATIONS of ADIPOSE TISSUE?
- WHITE ADIPOSE TISSUE (WAT)
- BROWN ADIPOSE TISSUE (BAT)
- BONE MARROW ADIPOSE TISSUE (MAT)
- BEIGE ADIPOSE TISSUE
white adipose tissue
- comes from CONNECTIVE TISSUE
- is often the MOST ABUNDANT in the body
- only has SINGULAR LIPID DROPLETS
- seen often more in the visceral/peripheral areas, music. and bone marrow
- has a lot of different cells [macrophages, mast cells, fibroblasts, BV, nerves]
important for releasing FREE FATTY ACIDS & GLYCEROL > energy metabolism
brown adipose tissue
- comes from MUSCLE TISSUE
- has more droplet types; has a lot of MITOCHONDRIA
- has IRON; what gives the tissue its brown color
important for generating HEAT due to oxidation of fatty acids & glucose
describe the functions of BAT
- important for generating METABOLIC HEAT [this is not associated with muscle activity–nonshivering thermogenesis]
- neonates; BAT seen b/w shoulder blades & kidneys–important for HEAT generation
- protection from OBESITY; considered to be a more healthier distr. of fat
bone marrow adipose tissue
- found in ALL BONES; most abundant in LONG BONES
has release of ADIPOKINES; that affects both OSTEOBLASTS & OSTEOCLASTS–overall important for bone development & RBC production [osteoporosis/fractures] - increases with obesity and age
beige adipose tissue
- is found in the WAT/ has mitochondria like BAT (but less)
- diminished with obesity
beiging or browning
seen in WAT when patients have CHRONIC EXPOSURE to the COLD or EXERCISE
- can be removed once moving to warmer temperatures and greater adaptation to exercise
- often is recommended due to browning effects of “mitochondria” in BAT – helps for protection from metabolic syndromes
what do adipocytes secrete?
adipokines
**remember important for a lot of things;
- cell signaling
- work like hormones
- appetite reg.
- inflammatory responses
- bone metabolism
- insulin sensitivity
- coagulation
what can cause a DYSREGULATION of the secretion & function of adipokines?
- having an excessive amount of WAT
how does the body regulate the amount of food and balance our energy?
- through both CENTRAL & PERIPHERAL PHYSIOLOGICAL SIGNALS
- the HYPOTHALAMUS plays a big role in this balance by regulating neuron activity
- the GI TRACT plays a role of secretion of specific HORMONES to control appetite
orexigenic neurons
- PROMOTES appetite
- STIMULATES eating
- DECREASES metabolism
anorexigenic neurons
- SUPPRESSES appetite
- INHIBITS eating
- INCREASES metabolism
can the hypothalamus cause issues for regulation of food intake & balance?
yes; the hypothalamus has connections to many HIGHER BRAIN SYSTEMS associated with our reward systems, memory, pleasure, and ADDICTIVE BEHAVIORS
- if not balanced; patients can OVERRIDE urges and appetites
- common cause of why people tend to treat food as a REWARD, PLEASURE, or have good memories with food
obesity
- an INCREASE in BODY ADIPOSE TISSUE
- adults; BMI greater than 30 kg/m2
- children; > 95% percentile
- is an EXCEEDED CALORIE INTAKE vs. one’s CALORIC EXPENDITURE
- is the 5th leading cause of death in the USA
what are some comorbidities associated with obesity?
a lot;
- HT
- HLD
- GERD
- STROKE
- osteoporosis
- COPD/ASTHMA/SLEEP APNEA
- CKD
risk factors for obesity
- genetics
- metabolic abnormalities [cushing’s dz, hypothyroidism, polycythemic dz]
- environmental factors [q/q of food, socioeconomic status, exposure to obesogens]
- depression & mood disorders
what does OBESITY do to the body?
- produces this CHRONIC and LOW-GRADE state of INFLAMMATION within the WAT
[this in tune creates a lot of issues–from insulin resistance, metabolic syndrome, risk for lipotoxicity] - causes changes in INTESTINAL MICROBIOME
what is the most effective treatment for OBESITY-RELATED MORBIDITY?
- weight loss (bariatric) surgery
what are the FOUR PHENOTYPES of OBESITY?
- VISCERAL OBESITY
- PERIPHERAL OBESITY
- NORMAL WEIGHT OBESITY
- METABOLLICALY HEALTHY OBESITY
visceral obesity
- where body fat distribution is localized to more of the ABDOMEN and UPPER BODY
- is an “APPLE SHAPE”
- has more obesity complications vs. peripheral
- aka INTRAABDOMINAL CENTRAL OBESITY or MASCULINE OBESITY
peripheral obesity
- where body fat distribution is located to more of the EXTRAPERITONEAL AREA / THIGHS/ BUTTOCKS
- is a “PEAR SHAPE”
- seen in premenopausal women the most
normal weight obesity
- patient has a normal BMI and weight
- does have an increased PERCENT OF BODY FAT / greater than 30%
- still at an increased risk for morbidity/inflammation/complications
metabolically healthy obesity
- patient is obese
- does NOT have any associated complications and actually has a DECREASED risk for morbidity and mortality
GLP-1 antagonists
- works on the endogenous hormone INCRETIN
- INCRETIN; hormone released by the GI tract in response to food
- helps to stimulate INSULIN SECRETION & REDUCE GLUCAGON PRODUC. & slow down gastric / digestion
- decreases glucose + mimics the hypothalamus–patient feels satisfied and full
bariatric surgery
- branch of medicine the manages patients with OBESITY and its related diseases
- seen with patients with a BMI greater than 40+
- caution with BMI of 35+
- always want to have a psych evaluation to assess patient’s reasons for surgery / awareness
- preop care; similar to ABDOMINAL SURGERY or LAPAROSCOPY
what are the THREE BARIATRIC PROCEDURES of FOCUS ?
- GASTRIC BYPASS
- SLEEVE GASTRECTOMY
- ADJUSTABLE GASTRIC BAND
gastric bypass
- the most typical procedure for weight loss
- reduces the SIZE of the stomach by dividing and reconnecting the SI
- changes gut hormones to feel full longer
sleeve gastrectomy
- has high success rate; 90%
- tube is inserted as measurement for the new stomach
- have division and cutting of the stomach; removing up to 80% of the stomach–have stapling
- stomach looks like a BANANA by the end; only retaining 20 - 25% of the original stomach
- reduces appetite of patients
gastric banding
- often has an adjustable inflatable silicone band on the UPPER PART of the stomach
- has self-sealing ports and reservoirs
- pouch can FILL UP; allowing patient to feel full
short-term starvation
- more EXTENDED FASTING
- can be therapeutic - for initial weight loss
how does the body react to STARVATION?
- GLYCOGENOLYSIS; stored form of glucagon begins to break down into glucose [4 - 8 hours]
- GLUCONEOGENESIS; form of glucose that is not from carbs/seen in the liver–causes depletion of nutrients
long term starvation
- more that a couple days of dietary abstinence
- can either be THERAPEUTIC [weight loss for obese people] vs. PATHOLOGIC [poverty, dz, anorexia]
- causes death due to PROTEOLYSIS
proteolysis conditions
- MARASMUS [protein energy malnutrition–loss of muscle mass and fat]
- KWASHIORKOR [deprivation of protein with carb intake–still have some body fat]
- CACHEXIA [aka WASTING SYNDROME; have severe weight loss and muscle mass]
- REFEEDING SYNDROME [where patient starts to eat again–can cause abrupt symptoms of; weakness, dysphagia, blurry v., SOB–due to sudden electrolyte imbalances]
how are patient’s appetite as they grow older?
- decreases significantly
- decreases orexigenic signals
- increases anorexigenic signals
can be due to older age risk factors;
- functional impairments [disabilities, dentures, eye sight]
- medical/psych conditions [depression, grief. polypharmacy]
- abuse or neglect
undernutrition adverse effects
- more malnourishment
- frailty; decrease of calcium > increases risk for fractures
- decreases energy
- increases oxidative stress
- hormone imbalances
treatment for anorexia
- proper supplementation of vitamins & minerals
- IV fluids / enteral feedings
- proper diet consults
