W10 Metabolic disorders (AT) Flashcards
Examples of metabolic disorders?
Obesity- a person with excess body fat
Porphyrias- rare disorders that mainly affect the skin or nervous system
Neural tube defects- Congenital defects, caused by incomplete closure of the neural tube within 28 days of conception.
How is obesity diagnosed?
- BMI measures of obesity
- Waist-to-height ratio measures adiposity
- BMI alone should be interpreted with caution particularly in individuals
who are very muscular or have muscle weakness or atrophy, and in those aged 65 years and over.
Body Mass Index: Ranges
- White family background:
- Healthy weight: BMI 18.5 kg/m2 to 24.9 kg/m2
- Overweight: BMI 25 kg/m2 to 29.9 kg/m2
- Obesity class 1: BMI 30 kg/m2 to 34.9 kg/m2
- Obesity class 2: BMI 35 kg/m2 to 39.9 kg/m2
- Obesity class 3: BMI 40 kg/m2 or more
- Black African, African-Caribbean, South Asian, Chinese, other Asian, or
Middle Eastern family background: - Overweight: BMI 23 kg/m2 to 27.4 kg/m2
- Obesity: BMI 27.5 kg/m2 or above—classes 2 and 3 are usually identified by reducing the thresholds above by 2.5 kg/m2
Waist-to-Height Ratio
- If BMI is below 35 kg/m2:
- Increased central adiposity: waist-to-height ratio 0.5 to 0.59
- High central adiposity: waist-to-height ratio 0.6 or more
- If BMI is 35 kg/m2 or more:
- Very high risk of obesity related-health problems, regardless of waist-to-height ratio.
Contributing Factors to Obesity? (5)
- Lifestyle –Diet, physical activity, smoking and alcohol
- Underlying causes – medication or medical conditions
- Mood – depressed or low
- How motivated a patient is to lose weight
- Family history – obesity and other health conditions (e.g. diabetes)
Health Risks of Obesity?
- Type 2 diabetes
- Hypertension
- Cardiovascular disease
- Dyslipidaemia
- Fatty liver disease
- Gallstones
- Some types of cancers
- Reproductive problems
- Respiratory conditions
- Musculoskeletal conditions
- Gastro-oesophageal reflux disease
- Psychological and psychiatric
morbidities.
Lifestyle Interventions of Obesity?
Social prescribing?
Diet?
Exercise?
- Social Prescribing
- local weight loss groups, exercise classes, cookery groups
Diet
* Calorie reduction to encourage weight loss
* Plenty of fruit and vegetables
* Meals based on potatoes, bread, rice, pasta and other starchy foods
* Some milk and dairy foods or dairy alternatives
* Some meat, fish, eggs, beans and other non-dairy sources of protein
* Just small amounts of food and drinks that are high in fat and sugar
- Exercise
- The Chief Medical Officers recommend that adults should do a minimum of 150 minutes moderate-intensity activity a week – for example, 5 sessions of
30-minute exercise a week.
Moderate-intensity activity
* brisk walking
* cycling
* recreational swimming
* dancing
Vigorous-intensity activity
* running
* most competitive sports
* circuit training
Orlistat
Reccomended to patients with a BMI of..?
- Lipase inhibitor, reduces the absorption of dietary fat.
- BMI of ≥ 30 kg/m2 where diet, exercise and behavioural changes fail to achieve an adequate reduction in weight,
- BMI ≥ 28 kg/m2 in the presence of associated risk factors.
- Treatment with orlistat may also be used to maintain weight loss
rather than to continue to lose weight.
- Liraglutide
- Liraglutide binds to, and activates, the GLP-1 receptor to increase insulin
secretion, suppresses glucagon secretion, and slows gastric emptying. - Taken once a day
- BMI of 35 or more
- BMI of 32.5 or more (south Asian, Chinese, Black African or African-
Caribbean origin) - Non-diabetic hyperglycaemia (high blood sugar)
- High risk of heart problems such as heart attacks and strokes
- E.g. Hypertension, hyperlipidemia
Semaglutide
- Binds to, and activates, the GLP-1 receptor to increase insulin
secretion, suppress glucagon secretion, and slow gastric emptying. - Taken once a week
- BMI of 35 or more
- BMI of 32.5 or more (south Asian, Chinese, Black African or African-Caribbean origin)
Bariatric Surgery
BMI of ≥ 40 kg/m2
Between 35–39.9 kg/m2 and a significant disease (such as type 2
diabetes or hypertension) which could be improved with weight loss,
all appropriate non-surgical measures have been tried
Also, BMI of 30–34.9 kg/m2 who have recent-onset type 2 diabetes.
Acute Porphyrias
- Porphyrias are rare disorders that mainly affect the skin or nervous system
- Porphyrins build up because they are not turned into heme
- Hereditary disorders of haem biosynthesis
- Prevalence of about 1 in 75 000 of the population.
Types of Acute Porphyrias (4)
Complications?
- Acute intermittent porphyria
- Variegate porphyria
- Hereditary coproporphyria
- 5-aminolaevulinic acid dehydratase deficiency porphyria
- Increases the chance of developing liver cancer
- Increased chance of developing high blood pressure and chronic kidney disease, which can lead to kidney failure
Symptoms of Acute Porphyrias?
Triggers/Cause?
- Pain in the abdomen, back, or arms and legs
- Constipation, nausea, and vomiting
- Anxiety, confusion, hallucinations, and seizures
- Muscle weakness, paralysis, and breathing problems
- Urinary symptoms, such as dark or reddish-brown urine, urinary retention, or incontinence
- Skin blisters when skin is exposed to sunlight, for people with variegate
porphyria or hereditary coproporphyria
-Certain drugs can induce acute porphyric crises
-Relatives of affected individuals should be screened
Treatment of Acute Porphyrias:
- Haem arginate administered by short intravenous infusion
- Haem replacement in moderate, severe, or unremitting acute porphyria crises.
