Review book Flashcards
What is the most common eating disorder?
binge eating disorder
What percent of obese patients have binge eating disorder
50%
What 2 criteria are needed for BED?
Eating large amounts of food in discrete amount of time and lack of control
What are other criteria for BED?
3 of the following:
Eating more rapidly than normal
Eating beyond fullness
Eating large amounts when not hungry
Hiding eating d/t embarrassment
Feeling disgusted, guilty
Also have to feel distressed about it
How many episodes per week and for how many months do you have to have symptoms of BED?
1 time per week for 3 months
What is the most sensitive test for diabetes?
OGTT
2 hour sugar >200 is DM with 75 gm sugar load
What do you have to watch for in regards to false lows with A1c?
If someone has an anemia
What percentage of Diabetics have a BMI > 25?
90%
(34% overweight, 60% BMI >30)
How do you diagnose Prader willi?
DNA methylation studies
What is age of obesity in Prader Willi?
2-5yo
What is treatment for Prader Willi?
Calorie restriction and behavioral therapy with Growth and sex hormone replacement at puberty
What is the chromosomal deletion in Prader Willi?
15q(underexpressed) on paternal chromosome
What are some features of Prader Willi?
Delayed speech and motor development
Thin upper lips
Almond eyes
Smaller at birth
Hypotonia/floppiness at birth
Weight gain at about age 2
At what BMI is it recommended to measure waist circumference and why?
25-34.9 to further assess CV risk. Over 35, doesn’t offer much further risk stratification
What is waist measurement in men/women that associated with greater CM risk?
Males 102 cm(40”)
Women 88cm(35”)
What BMI cutoff should be used for screening and confirmation of excess adiposity in Asians?
23
What is waist circumference cutoff in Asians?
> = 85cm(33.5”) in men
= 74-80cm (29-31.5”)
What are some factors when measuring waist circumference?
Measure at iliac crest
Measure at end of normal expiration
Snug but not compress skin and parallel to floor
What is the best test to measure body fat composition at the MOLECULAR level?
Isotope dilution hydrometry(Deuterium)
Is Isotope dilution hydrometry used in clinical practice?
NO
How is isotope dilution hydrometry done?
All cells except body fat will take up the tracer so this amount is substracted from total body mass/weight to get fat mass
What percent body fat diagnoses obesity in Men? in Women?
Men >=25%
Women >=32%
Which ethnic group in each gender has highest body fat?
Caucasian males and hispanic females
Pro of calipers to measure body fat?
Inexpensive
Con of using calipers?
Not accurate at high BMI
User dependant - variable
Pros of DXA for body fat?
Accurate
Relatively inexpensive
Gold Std
Cons DXA?
May not accommodate those of larger BMI
Pros of BIA?
Relatively accurate
Inexpensive
Commonly used
Cons of BIA?
Hydration dependent
Avoid if has cardiac electrical device
How does hydration affect BIA measurement?
Dehydration - increased body fat(Avoid diuretics, alcohol and caffeine)
Diluted - decreased body fat - so avoid water 2-4 hours before the test
What are some things other then the hydration rules you should consider with BIA?
Avoid strenuous exercise before
Avoid eating 3-4 hours before
What is vitamin deficiency is first to show up in Vegans?
Vitamin D will be deficient within a year
What other vitamin deficiencies are associated with vegans?
Vitamin D, B12, calcium, iron, Zn, Omega 3, Lysine
When does B12 deficiency show up in Vegans?
Years later unless pernicious anemia
Which amino acid are Vegans at risk for?
Lysine
What are pros of underwater densitometry?
Very accurate
What are cons of underwater densitometry?
Time consuming and cumbersome
What are pros of CT/MRI for measuring body fat?
Very accurate
What are cons of CT/MRI for measuring body fat?
Expensive
Radiation exposure with CT
What is best imaging for visceral fat?
MRI with spectroscopy
What AHI is considered mild OSA?
5-15
What AHI is considered moderate OSA?
15-30
What AHI is considered severe OSA?
> 30
What is diagnostic criteria for OSA?
- AHI or RDI >15 or
- AHI or RDI 5-15 and at least one of the following: Daytime sleepiness, unrefreshing sleep, waking up gasping, fatigue, insomnia, witness apnea, loud snoring
What is Apnea?
respiratory pauses lasting >=10 secs
What is Hypopnea?
shallow breathing leading to O2 desat of >=4%
What is RDI?
respiratory effort related arousals(RERA) during sleep
Which is more sensitive RDI or AHI?
RDI
Why does naltrexone alone not cause weight loss?
Naltrexone relies on buproprion to cleave POMC into alpha MSH and B endorphin. The Bendorphin binds to opiate receptors which causes a negative feedback loop on POMC. Thus naltrexone binds to it displacing bendorphins
What are some clinical signs of Cushings?
Moon facies
Easy brusing
Truncal obesity
HTN/Hyperglycemia
Wide striae >1 cm
Acne
Dorsal fat pad(buffalo hump)
Proximal muscle weakness,
Osteoporosis
Thin extremities
What is the most common cause of Cushings?
Iatrogenic
What is initial screening for Cushings?
24 hour urinary cortisol x 2
Buccal salivary swab cortisol thru the night x 2
1mg dexamethasone test
What is RQ?
Respiratory quotient = VCO2 eliminated/O2 consumed
It can determine which macronutrients are being metabolized by the body for energy
What is the RQ for fats?
0.7
What is the RQ for Carbs?
1.0
What is the RQ for protein?
0.8
What is RQ for mixed nutrients?
0.8
What is the RQ for HiiT, sprinting?
1.0 - using carbs as fuel source
What is RQ for endurance activities, low energy, inactivity?
0.7 - using fats as fuel source
What are some causes of Excess Weight loss in RNYB?
1)Short channel and malabsorption esp if not following diet/exercise recommendations
2)Eating d/o
3)Cancer
4)SIBO
5)Stricture
6)Depression or other psych d/o
What are symptoms of stricture after MBS?
Localized abd pain
Dysphagia
Food aversion
What would you suspect in obese female with HA, positional diplopia and visual changes?
IIH - Pseudotumor cerebri
What would definitively diagnosis IIH?
lumbar puncture displaying elevated opening pressure
What are some features of pseudotumor cerebri(IIH)?
Visual changes
Diplopia when standing
HA
Obesity
Papilledema
What is tx for IIH?
> 5-10% weight loss either thru LS or MBS
Low sodium diet
Can also use carbanic andhydrase inhibitors such as acetozolamide and topamax
Surgical intervention is reserved for intractable HA and deteriorating vision
When is BMI used in children?
Age 2
What is used to measure for obesity in children under 2?
Weight for length
What is class 1 obesity in children?
> 95-120% of the 95 percentile
What is class 2 obesity in children?What is associated BMI?
120-140% of 95 percentile
BMI 35-39
What is class 3 obesity in children?
> 140% of 95 percentile
BMI >40
What is considered overweight in children?
85-95th percentile of %BMI
What is the diagnostic criteria for metabolic syndrome?
3 of the 5
WC of 102 cm/40” in Men or 88 cm/35” Women
TGL >150
BP >130/85 or on medication
HDL <40 men, <50 women or on med
FBG >100 or on med for elevated glucose
What are some inflammatory changes associated with Metsyn?
Decreased adiponectin - adipose dysfunction
Increased inflammatory cytokines
Increased levels of resistin
What physiological changes are seen with Anorexia?
Decreased LH and FSH d/t central hypogonadism
Bradycardia
Low Mag, low potassium, metabolic alkalosis
Osteoporosis due to decreased osteoblast/osteoclast activity
What is diagnostic criteria for Anorexia?
Restricted eating leading to weight loss
Fear of gaining weight
Body image distortion/lack of recognition of seriousness of weight loss
What are the 2 types of Anorexia?
Restricted type
Binge eating/purging
What BMI is associated with mild severity of Anorexia?
17-18.5
What BMI is associated with moderate severity of Anorexia?
16-17
What BMI is associated with severe severity of Anorexia?
15-16
What BMI is associated with extreme severity of Anorexia?
<15
What is early adiposity rebound?
It’s a phenomenon in childhood where The BMI reaches its lowest point and then begins to increase at an age earlier than expected Often before the age of five. It is considered a risk factor for development of obesity later in adolescence and adulthood. It is also associated with an increased likelihood of developing health risks such as cardiovascular disease diabetes and other obesity related conditions.
Describe the typical pattern of bmi in children as they grow.
BMI rapidly increases in first year and then slows down and have a decline in bmi during the first few years of life reaching a minimum point known as the adiposity nadir. Then increases again at age 5-7 which is normal. But if increases before age 5 then EAR.
What factors contribute to early adiposity rebound?
Genetic
Early Feeding
Dietary habits
physical activity levels
environmental
What vitamin deficiency causes ataxia and nystagmus?
Thiamine
What vitamin deficiency is associated with night blindness?
Vitamin A
What vitamin deficiency is associated with Romberg sign?
B12
What vitamin deficiency causes loss of proprioception and vibration?
B12
When does thiamine deficiency happen after surgery?
Usually, days to weeks after surgery
Often presenting with ascending weakness like GB syndrome
When does B12 deficiency occur after surgery?
Months to years after surgery
When does copper deficiency occur after surgery?
Months to years after surgery
How does copper deficiency present?
With a myelopathy with macrocytic anemia and neutropenia. Has spastic gait, ataxia, parathesias in stocking glove pattern
If confabulation is seen after MBS, what vitamin deficiency is present?
Thiamine - Korsokoff
If Dementia/memory change is seen after MBS, what vitamin deficiency is present?
Niacin/Folate(B9) or B12
Do higher or lower levels of VO2 max indicate increased efficiency?
Higher
What makes up efficiency of VO2 max?
Oxygen absorption(Lungs)
Oxygen distribution(Heart)
Oxygen utilization(muscles)
Pathology in any of these can decrease VO2 max
What are units of VO2 max?
ml/kg/min
What % decrease in VO2 max occurs as we age at 65yo?
30% decrease compared to age 20
Does decreasing body fat increase or decrease VO2 max?
Increases
Do males or females have higher VO2 max?
Males
What is athletic VO2 max? Avg male/female?
90
45 and 35 respectively
What increases VO2?
Hyperthermia
Shivering/excess movement
Exercise
Overfeeding(TEM)
What decreases VO2?
Hypothermia
Hypothyroidism
Fasting/starvation
Paralysis
What increases VCO2(and therefore RQ)?
Met Acidosis
Hyperventilation
Excess carb intake
Hypermetabolism
What decreases VCO2 and RQ?
Met alkalosis
Hypoventilation
Starvation/ketosis
Hypometabolism
What is Weir equation?
REE = VCO2 + VO2
What LFT is most specific for MAFLD in adults and children?
ALT
What are spectrum of MAFLD?
Hepatic steatosis
Hepatosteatits - fatty liver with inflammation
Metabolic steatohepatitis (MASH) is the present of >5% hepatic fat with inflammation, hepatocyte injury +/- cirrhosis
What % of fat in liver is seen in MASH?
> 5%
What drugs can reduce MASLD?
GLP1 and PPAR(thazolidinediones)
What conditions underestimate the risks of a particular BMI?
Sarcopenia
Increased age
Asian(southeast)
Osteoporosis
What conditions overestimate the risks of a particular BMI?
CHF
Nephrotic syndrome
Cirrhosis
Bodybuilders
What meds cause folic acid deficiency?
Methotrexate
Bactrim
Alcohol
Phenytoin
Sulfasalazine
What vitamin deficiency is seen with Beri Beri?
Thiamine
What symptoms seen with Beri Beri?
Wet - CV
Dry - neurological
What is seen with B2 deficiency?
Riboflavin - sore throat, chelitis, stomatitis, glossitis, itchy eyes
What is seen with B3 deficiency?
Niacin - Pellagra(dermatitis, diarrhea, dementia and death)
What is seen with B5 deficiency?
Panthotenic acid - Rare, parathesia, hypoglycemia, restlessness, apathy
What is seen with B6 deficiency?
Microcytic anemia, peripheral neuropathy
What is seen with B9 deficiency?
Folate - Macrocytic anemia without neurological findings, mouth ulcers, irritability, NTD in pregnancy
What is seen with B12 deficiency?
Cyanocobalamin - Subacute combined degeneration, glossitis, neuro manifestations
What factors falsely elevated cause elevated blood pressure when measuring?
Improper cuff size
Arm hanging unsupported
Legs crossed
Supine position
How should you properly take a BP?
Back supported, legs uncrossed, BP supported at level of heart; Cuff bladder length should encircle 80-100% arm, no talking when taking measurement and on bare skin
What conditions is NES associated with?
Depression/insomnia
How many episodes of nocturnal eating per week meets criteria for NES?
2 per week
What is difference between SRED and NES?
SRED is a sleep d/o not an eating d/o. Can be caused by meds - ambien, pts unaware of eating during the night
NES - pts aware and may eat after dinner, have morning anorexia, insomnia and nighttime hyperphagia, is an eating d/o
What is lean body mass?
water, muscles, tendons, ligaments, bone, organs and essential fat
How does lean body mass differ from fat free mass?
Lean body mass includes essential fat from bone marrow, internal organs and CNS.
What percent of total body mass does lean body mass make up?
75%(40% muscle, 25%organs, 10%bone
In who is lean body mass less in?
Females
Sedentary
Decreases as age increases
What is higher lean body mass associated with?
Increased health
What is increased fat mass associated with?
Increased health risks
What do most DXA measure?
Fat, Soft tissue and bone
What may more advanced DXA measure?
Fat, soft tissue, bone AND decipher type of fat so LBM
FFM is often within what percentage of LBM?
5%
If you see papilledema what is next step?
Brain imaging to assure no other causes then IIH
What is correlation of BMI and mortality?
BMI btwn 25-35 reduces life expectancy by 2-4 years
BMI of 40-45 by 8-10 year(=smoking)
What is correlation of BMI to heart failure?
Risk increases 2 fold if BMI >30
What is correlation of BMI to Afib?
For every 1 unit increase in BMI, risk increases by 4%
What is correlation of BMI to DM?
90 % DM have BMi over 25 years
What is correlation of BMI to stroke?
For every 1 unit increase in BMI there is increase in ischemic stroke by 4% and hemorrhagic stroke by 6%
What is correlation of BMI to sleep apnea?
BMI >30 their is 30% risk of OSA
