Week 111 - Obesity Flashcards by Carey Girling

What risk are women at from having a high BMI, more so than men?

Type II diabetes

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What BMI is required to be considered for bariatric surgery in Wales?

50+

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what type of collagen provides mechanical strength?

fibrillar - type 1

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Define catabolism

breaking down complex nutrients into simple molecules

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What is the main risk of having a high BMI?

CVD

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What are the restrictive surgical options for morbid obesity?

laparoscopic gastric banding (LGB) laparoscopic sleeve gastectomy (LSG)

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What type of collagen forms tendons primarily?

type 1

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Define anabolism

building up of complex molecules required for life

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What is classed as clinically obese?

30+ BMI

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What are the malabsorptive surgical options for morbid obesity?

laparoscopic biliopancreatic diversion with duodenal switch (BPD with DS)

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What is the function of fibril-associated collagen?

link fibrillar collagens together

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What molecules is energy stored in?

ATP and NAD+

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What does a BMI chart not take into account?

Age or gender

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How does gastric banding and sleeve gastrectomy generally work?

decrease food intake by decreasing stomach size

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What do sheet-forming and anchoring collagens function as?

Form 2D networks in basal laminae and connect it to skin/underlying connective tissue

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What does NAD+ act as?

An electron carrier

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Why is using a BMI chart not good for women?

Have a higher % body fat which increases with age

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How does BPD with DS generally work?

decreases calorie consumption absorbed by GI tract

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What do transmembrane collagens act as?

adhesive receptors

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What does NAD+ become once it has been reduced?

NADH + H+

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What is the best way to measure obesity?

Waist circumference

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What are the combined surgical options for morbid obesity?

laparoscopic gastric bypass

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What amino acids are the polypeptide chains of collagen primarily made up of?

Proline and glycine

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NAD+ carries electrons associated with what process?

catabolism of O2 during respiration

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What is the first line of treatment in obese patients?

Diet and physical activity

How does gastric bypass generally work?

Combines decreasing stomach size with decreasing calorie consumption

What arrangement do fibrillar collagens have?

Quarter stagger arrangement

What does NADP+ function as?

Electron donator

Why were drugs like Rimonabant removed?

Increased risk of depression and suicide

What are the problems of gastric bands?

misplacement of band band erosion half of patients will require further surgery

What is quarter stagger packing?

Molecules are displaced 1/4 of their length

NADP+ donates electrons in what processes?

Anabolic processes

What else is sibutramine used for?

antidepressant

What is done in sleeve gastrectomy surgery?

Subtotal gastrectomy (removes most of stomach) so becomes a tube

What cells compose tendons?

tenocytes and fibroblasts

Define the respiratory exchange ratio

CO2 produced / O2 used

How did Rimonabant work?

Mimiced effect of endocannabinoids in brain

What are the benefits to LSG?

reduced portion size reduced transit time - arrives faster to SI so GLP-1 released quicker

What are the function of tendons?

transmit muscle forces with minimal elongation

What fuel do red blood cells use?

glucose

What effect does GLP-1 have in humans?

decreases appetite by maintaining blood glucose levels and slows gastric emptying

What are the problems associated with LSG?

Reflux Stenosis Dilatation

What fuel do white blood cells use?

glucose

What is the mechanism of GLP-1?

decreases glucagon secretion by alpha cells in pancreas

What is done in biliopancreatic diversion with duodenal switch (BPD with DS) surgery?

Sleeve gastrectomy performed (70% stomach removed), and two pathways are created from small intestine with one common channel.

What fuel does the liver use?

fatty acids

When do levels of GLP-1 increase?

After ingestion of food

What is the aim of having two pathways in the small intestine with one common channel before entering the large intestine?

Reduce the amount of time the body has in absorbing calories from the diet in the small intestine and selectively limit the digestion of fat by forcing bile to travel down the longer pathway

What fuel does the brain use?

Glucose (or ketone bodies in starvation)

How is the digestion of fat selectively limited in a BPD with DS?

The longer pathway (biliopancreatic loop) carries bile from the liver to the common channel and the shorter pathway takes food straight to the common channel - so chance that they meet and fat is digested is lowered

State the process of B-oxidation in the liver

fatty acids --> 2 acetyl CoA + energy

What are the advantages of BPD with DS?

Can eat normal portion sizes Excellent comorbdity resolution 90% EWL at 2 yrs

Statet the process of ketogenesis in the liver

2 acetyl CoA --> 4 ketone bodies

What are the disadvantages of BPD with DS?

Very demanding operation hospital stay Lifetime high protein diet 0.5% mortality

What fuel does the heart use?

Ketone bodies

What is done in laparoscopic gastric bypass?

Bypasses most of the stomach and small intestine via food channel to avoid digestion

What fuel does the kidney cortext use?

Fatty acids and Ketone bodies

What are the problems with LRYGB?

Dumping syndrome Hospital stay

When are there high levels of ketone bodies

Starvation

What are the benefits of LRYGB?

75% EWL at 2 years Type II diabetes mellitus resolution rates 85%

How long does it take for fat to be liberated from deposits to enter the bloodstream?

15-20minutes exercise or after 24 hours starvation

What are the problems with obese patients undergoing surgery?

Intubation/ventilation problems

What happens during the first 24 hours of starvation?

Glycogenolysis Glycogen --> glucose

Give the equation for BMR

weight (kg) x 24kcal / day

What conditions increase a persons BMR?

hyperthyroidism exposure to cold regular exercise fever

What conditions decrease a persons BMR?

hypothyroidism starvation hypothermia sustained idleness

what four marcromolecules form extra cellular matrix (ECM)? cartilage

collagen elastin proteoglycans glycoproteins

Define metabolism

chemical transformations made by cells and tissues during life

How does orlistat work

prevents the digestion and absorption of fat by binding to GI lipases

What ethnicity is predisposed to a higher risk of obesity?

Pima indians

What drug used to obesity acts as a cannabinoid receptor 1 agonist?

Rimonabant

What drugs are used to decrease glucagon secretion thus hepatic glucose output, and decrease gastric emptying?

GLP-1 analogues

What is drug required to be tested before being considered for bariatric surgery?

Orlistat

What BMI is required to be considered for bariatric surgery in England?

40+ or 35+ with comorbidities

what type of cartilage is pressure tolerant?

articular cartilage

What % water is the body made up of?

55%

What is the function of protein in the body?

form structural proteins, enzymes, transport/binding proteins found in membranes/cytoplasm and blood

What is the only drug that can be prescribed to obese patients?

Orlistat

Name the obesity related comorbidity

T2DM Hypertension Obstructive sleep apnoea OA Depression Subfertility Increased rates of CV disease/cancer

What drug used to treat obesity acts as a pancreatic lipase inhibitor?

Orlistat

what do ligaments do?

link bone to bone

What firstline drug is prescribed to obese patients to treat diabetes type II?

Metformin

What drug used to treat obesity acts as a reuptake inhibitor of serotonin?

Sibutramine

What do tendons do?

link muscle to bone

What % protein is the body made up of?

19%

What % lipid is the body made up of?

19%

What is the function of water in the body?

provides medium for the rapid transport and metabolism of metabolites

How does Metformin work?

Suppresses glucose production by liver

What are the main environmental causes of obesity?

High food intake+Lack of physical activity

what type of joint is the knee?

synovial hinge

How in theory would an SNRI work as an appitite supressant?

Blocking seratonin reuptake in GUT - increased Satiety Blocking noadrenaline reuptake - increased sympathetic tone (AP firing rate) -> increased metabolism

How does Orlistat work?

Pancreatic lipase inhibitorInhibits fat absorbtion in the gut

Name some of the conditions you are at risk of by being obese?

- hypertension - stroke - type 2 diabeties - mycardial infarction (heart attack) minors: - sleep apnea - GORD - gallstones - cancer - osteoarteritis

What is the definition of Metabolic syndrome?

Someone who is- Centerally Obese (measured via waist circumfrence) - diabetic - hypertensive

What BMI is classes as obese?

> 30