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203: Reproduction and endocrinology > T1 L11:APPETITE AND WEIGHT > Flashcards

T1 L11:APPETITE AND WEIGHT Flashcards

1
Q

what measures can you use to measure someone’s weight

A

Body mass index (BMI)
kg / m2
Waist circumference

Skin-fold thicknesses

Bioelectrical impedance analysis

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2
Q

what groups do we have to be careful when measuring weight

A

Ethnic groups

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3
Q

what are the 5 ranges of BMI that someone can fall into

A 
< 18.5 underweight
18.5-24.9 normal
25-29.9 overweight
30-39.9 obese
≥40 morbid obesity
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4
Q

what percentage of adults are obese in England

A

25%

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5
Q

what are the health risks of obesity (3)

A 
Metabolic syndrome / type 2 diabetes
Cardiovascular disease
Respiratory disease
Liver disease
Cancer
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6
Q

what BMI category can health risks start from

A

overweight category
Men -25
women -24

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7
Q

what is metabolic syndrome

A

Constellation of closely associated CV risk factors and T2 diabetes

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8
Q

what is the underlying pathophysiological mechanism
of metabolic syndrome

(there are 2, 1 of which has 2 consequences the other has examples)

(3 marks )

A

Insulin resistance :
 Gluconeogenesis
 Dyslipidaemia

Pro-inflammatory cytokines
TNF-, IL-6 (from ‘overloaded’ white adipose tissue)

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9
Q

what are the signs associated with metabolic syndrome

4 marks

A

Visceral obesity
Dyslipidaemia
Hyperglycaemia
Hypertension

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10
Q

what type of body fat shape is metabolic syndrome associated with? and what type of fat distribution and BMI as well?

A

apple shape

Central (visceral) fat
Body mass index > 30

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11
Q

what can adipocyte cells release that influences hormones

A

ADIPOCYTOKINES

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12
Q

what is the risk of D2

A

AGE
OBESITY
FAMILY HISTORY
ETHNICITY

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13
Q

what are the symptoms of CVD and metabolic syndrome

4 marks

A 
increased:
 
blood volume and blood viscosity
 vascular resistance
 hypertension
 left ventricular hypertrophy
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14
Q

what respiratory symptoms link with metabolic syndrome

4 marks

A

Obstructive sleep apnoea
Hypoxia / hypercapnia
Pulmonary hypertension
-ight heart failure

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15
Q

what can obesity do to the liver

3m

A

Non-alcoholic fatty liver
Non-alcoholic steatohepatitis
May progress to cirrhosis, portal hypertension, hepatocellular cancer

Gallstones

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16
Q

what are the types of cancer associated with obesity and what mechanisms are associated as well?

A

Types of cancer include

Breast, endometrial, oesophagus,
colon, gall bladder, renal, thyroid

Mechanisms include- increase in
 insulin,  free IGF-I,  oestrogen,
adipo-cytokines, reflux

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17
Q

How can obesity affect the reproductive system

A

Polycystic ovarian syndrome

  • oligomenorrhoea hirsutism, acne
  • Subfertility
  • Endometrial hyperplasia
  • Insulin resistance

Male hypogonadism

Adverse pregnancy outcomes

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18
Q

what can obesity cause to the joints

A

Osteoarthritis

Gout

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19
Q

what psychological features can obesity cause

A

Depression

Eating disorders

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20
Q

what are the rare and common genetics associated with obesity

A

Rare :
Obesity-associated syndromes
Prader-Willi

COMMON
Polygenic
Susceptibility genes
Heritability of weight ~ heritability of height

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21
Q

what are the thyroid and adrenal related causes of obesity

A

Hypothyroidism

Cushing’s syndrome

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22
Q

what are the 2 main environmental features that contribute to obesity

A

Diet

physical activity

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23
Q

what type of diet leads to obesity

A

High fat

High sugar

24
Q

what % can physical activity count for total energy expenditure

A

20-50% total energy expenditure

25
what is the SOCIAL NETWORKING: theory of obesity
Those with more obese friends tend to be obese
26
what is FETAL PROGRAMMING
stimuli/insults at critical periods that have persistent biological effects
27
what is the mechanism of fetal programming
Mechanism: epigenetic modification of gene expression
28
give examples of fetal programming | 3marks
Example: (3) programmed’ adrenal axis overactivity in adulthood Causal factor for metabolic syndrome Increased vulnerability to coronary heart disease
29
describe the association between cortisol and fetal weight with 9am levels
Babies with a lower birth weight have a higher cortisol level
30
what is the LIFE COURSE MODEL
Factors operating at every stage of life affect health outcomes later in the future ‘PATHWAY OF RISK’ between events and health outcomes
31
what is the 3 possible worst outcomes of the life course model associated with
Worst outcome’ associated with: (3) Low birth weight Excessive weight gain in infancy / childhood Adult obesity
32
How does the gut microbe influence diabetes t2 and metabolic syndrome
Differences in gut bacteria Can be induced by diet e.g. high fat diet Transplantation of faecal material alters insulin sensitivity Mice and humans
33
what are the slow acting hormones and what do they signal
LEPTIN INSULIN decrease food intake increase body expenditure
34
what are the Rapid-acting peptides that regulate meal sizes
Released from GI tract Cholecystokinin (CCK) -reduce eating Ghrelin -increase eating PYY-via hypothalamus -decrease eating for up to 12 hours
35
what type of neurons originate from the HYPOTHALAMUS(ARCUATE NUCLEUS)
‘Accelerator neurons’ AgRP neurons- release NPY Nyp-increases eating by decreasing satiety AGRP- blocks the melanocortin receptor Brake neurons’ POMC neurons -these are melanocortin peptides that decrease eating sensation
36
what is the LEPTIN (MICE))experiment
‘ob/ob mouse’ - Leptin deficient ‘db/db mouse’ -Mutation of leptin receptor ‘ob’ gene product = leptin Mouse models of obesity
37
what does leptin treatment do in mice
It reduces obesity in the ob/ob mouse
38
what does Leptin do in humans
it behaves as the starvation signal and it causes permissive effect on puberty
39
what causes obesity in humans that is related to Leptin
Leptin deficiency due to mutation of receptor
40
how do you treat Obesity via lifestyle (diet) | 4marks
DIET -500-1000 kcal energy deficiency -Low energy density low sat fat, low sugar  fruit & veg (substitute for other foods) - decrease portion sizes, decrease snacking - Structured meals / meal replacements may help promote greater weight loss
41
how do you treat Obesity via lifestyle Pt 2
PHYSICAL ACTIVITY Exercise 7 days / wk 30 mins moderate-high intensity OR 60 mins low intensity 10,000 steps
42
what is the concept of a VLCD
Primary care programme Patients with T2DM diagnosis < 6 years prior VLCD (830 kcal/day) for 3-5 months - Initially, total diet replacement with formulae - Then stepped food reintroduction (2-8 weeks) - Long-term maintenance with structured support
43
what is the target for lifestyle modification
- 10% weight loss ( ideal weight) - 1-2 lb (0.5 – 1 kg) per week - Some evidence that ‘ambitious’ goals promote more weight loss
44
what are the problems with lifestyle mods | 4marks
- Most patients can achieve ~ 5-10 % weight loss / 1 year - ‘Yo-yo’ dieting / regaining weight lost - ‘Obesogenic environment’ - Weight loss results in hunger, satiety, metabolic rate
45
what are the best outcomes for lifestyle modifications | 3marks
- Sustainable lifestyle changes - Diet combined with exercise / physical activity - Ongoing management is required to maintain weight loss
46
what does Orlistat do
MECHANISM Binds & inhibits lipases in the lumen of the gut Prevents the hydrolysis of dietary fat into absorbable free fatty acids / glycerol Excrete ~ 1/3rd dietary fat
47
adverse effects of orlistat
Flatulence, oily faecal leakage, diarrhoea decreased absorption fat soluble vitamins so : ADEK Supplement
48
what does Metformin do
oral hypoglycaemic agents
49
PHARMACOLOGICAL THERAPY-evaluate
PROBLEMS - Can only increase by 3-4 fold the proportion of patients who achieve 5% weight loss in a year - Weight re-gain after treatment stopped THE FUTURE All identified gut peptides / neuropeptides / their receptors are potential therapeutic targets / options! -Gut hormones in combination most likely way forwards…
50
what are the surgical treatments available
Laparoscopic adjustable banding Roux-en-Y gastric bypass
51
what is the Laparoscopic adjustable banding
Restrictive only Inject / withdraw saline to adjust the diameter of the band
52
what is the Roux-en-Y gastric bypass
- Restrictive - Malabsorptive - Alterations in gut hormones and bile acid flow contribute to weight loss Micronutrient deficiencies -Supplement with iron, B12, folate, calcium, vitamin D Dumping syndrome -GI & vasomotor symptoms
53
why is the Roux-en-Y gastric bypass better long term than Laparoscopic adjustable banding
Endocrine factors important in effects - Plasma from operated rats to sham-operated rats - Ate 1/3rd less Increased satiety seems to be key - “I don’t like burgers any more……” - F-MRI studies
54
Evaluate SURGICAL TREATMENT
ADVANTAGES -Weight loss 25-30% -Resolve or improve co-morbidities Brings cost savings ``` DISADVANTAGES -Perioperative mortality / morbidity --Depends on procedure and experience of surgeon -Long-term follow-up Micronutrient deficiencies -Some weight re-gain --Patients will still be obese -Expense --Though cost effective by 2 - 5 years, depending on co-morbidities and weight ```
55
what are the UK NICE guidelines for surgery
``` After failure of other options if BMI > 40 kg/m-2 BMI > 35 with co-morbid conditions Or first line BMI > 50 kg/m-2 ``` Recent onset T2DM: Expedite bariatric surgery if BMI > 35 Consider surgery if BMI > 30
56
what is the UK Position bariatric surgery:NHS guidelines
- As per NICE but….. - Must have been obese for at least 5 years - Must engage with non-surgical weight-loss programme for 12-24 months first
57
What is the expected % weight loss from - Lifestyle interventions - Bariatric surgery
Weight loss 25-30%-surgery 10% weight loss

203: Reproduction and endocrinology (53 decks)

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