Nutrition and Metabolism Quiz

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Questions and Answers

At what BMI range was the nadir of the curve observed among never smokers?

22-23 (correct)

20-22

24-25

23-24

Which group had a lower BMI range for the nadir of the curve compared to never smokers?

Healthy never smokers (correct)

Individuals with no health concerns

Smokers

Those with shorter follow-up durations

What BMI range was observed for individuals with longer durations of follow-up?

24-25

20-22 (correct)

22-23

23-24

Who is the listed author affiliated with in the context provided?

Department of Clinical Nutrition (A) Signup and view all the answers

What role does Hamed Mohammadi hold at Tehran University of Medical Sciences?

Assistant Professor (B) Signup and view all the answers

What physiological process is affected by proprotein convertase subtilisin/kexin type 1 (PCSK1)?

Glucose homeostasis and food intake regulation (D) Signup and view all the answers

What condition is predominantly caused by leptin receptor (LEPR) deficiency?

Constant hunger and rapid weight gain (A) Signup and view all the answers

How does PCSK1 influence food intake?

Disrupts the regulation of food intake (B) Signup and view all the answers

What is a likely consequence of LEPR deficiency?

Uncontrolled appetite and obesity (A) Signup and view all the answers

Which aspect of metabolism is most affected by PCSK1?

Glucose regulation (C) Signup and view all the answers

What is the primary function of Proopiomelanocortin (POMC) in the body?

Causes weight loss (B) Signup and view all the answers

How does a deficiency in POMC affect an individual?

Impairs the ability to lose weight (B) Signup and view all the answers

Which of the following statements about POMC is true?

Deficiency in POMC can lead to weight loss difficulties (D) Signup and view all the answers

Which system is primarily influenced by Proopiomelanocortin (POMC)?

The neuron system affecting weight (A) Signup and view all the answers

What might be a consequence of altered POMC levels in the body?

Difficulty in losing weight (B) Signup and view all the answers

What is generally considered the acceptable duration for short-term use?

3 months (D) Signup and view all the answers

Which of the following statements about IMCIVREE™ (setmelanotide) is correct?

It is designed for short-term use of up to 3 months. (A) Signup and view all the answers

In the context of pharmaceutical treatments, what does the term 'short-term' typically refer to?

Up to 3 months (C) Signup and view all the answers

What implication does 'short-term use' have for patients using IMCIVREE™ (setmelanotide)?

Patients may need alternative treatments after 3 months. (B) Signup and view all the answers

Why is it important to define the duration of short-term use in pharmaceutical contexts?

To inform prescribing practices and patient expectations. (B) Signup and view all the answers

What is a possible characteristic of deep hunger in children?

An insatiable feeling of always needing food. (A) Signup and view all the answers

At what age range may children experience unexpected weight gain?

From infancy to age 10. (B) Signup and view all the answers

Which statement best describes the implications of deep hunger in children?

It may result in excessive weight gain. (B) Signup and view all the answers

How does deep hunger differ from normal eating behaviors in children?

It results in a constant feeling of needing food. (D) Signup and view all the answers

What underlying issue might deep hunger in children suggest?

Possibly growth-related nutritional needs. (C) Signup and view all the answers

Which conditions must be confirmed by genetic testing for IMCIVREE™ to be considered appropriate?

Obesity due to POMC, PCSK1, or LEPR deficiency (A) Signup and view all the answers

What type of obesity is NOT a candidate for treatment with IMCIVREE™?

Obesity associated with general obesity (D) Signup and view all the answers

What is the significance of genetic testing in the usage of IMCIVREE™?

It confirms the type of obesity suitable for treatment (A) Signup and view all the answers

Which of the following conditions are excluded from the use of IMCIVREE™?

Obesity not confirmed by genetic testing (B) Signup and view all the answers

Which of the following statements about IMCIVREE™ is correct?

It is FDA-approved for obesity with POMC, PCSK1, or LEPR deficiency. (A) Signup and view all the answers

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Study Notes

Pharmacotherapy in Obesity

Obesity pharmacotherapy involves using medications to manage obesity.
Early drug approvals focused on efficacy, not risk-benefit analyses. This changed in 1962.
Several amphetamine derivatives for weight loss were removed from the market due to safety concerns.
Recently approved medications face stricter regulations and clinical efficacy standards.

BMI and All-Cause Mortality

A systematic review and meta-analysis of 230 cohort studies (with 3.74 million deaths among 30.3 million participants) examined the relationship between BMI and mortality.
The analysis revealed a non-linear dose-response relationship.
A nadir of relative risk was observed at BMIs between 23 and 24 for never smokers and 20 to 22 for longer follow-up periods.

History of Anti-Obesity Medications

Initial drug approvals (1940s) only required demonstration of efficacy exceeding placebo.
Desoxyephedrine's approval in 1947 led to numerous amphetamine derivatives for weight loss.
Due to subsequent safety concerns, many amphetamine derivatives have been removed from the market.
Modern regulations require stringent safety evaluation and proof of clinical efficacy for new anti-obesity medications.

Recently Recalled Anti-Obesity Medications

Sibutramine (Meridia): Removal due to increased risk of cardiovascular events in high-risk patients.
Lorcaserin (Belviq): Removal following a safety analysis that indicated an increased incidence of certain cancers.

FDA-Approved Medications for Weight Management

Nine FDA-approved anti-obesity medications (AOMs) remain on the market.
Six approved for long-term weight loss, one of which targets specific monogenic obesity mutations.
Another is a "device" that functions as a medication.

Approved for Short-Term Use

Phentermine (Adipex, Lomaira): Sympathomimetic to suppress appetite.
Diethylpropion (Tenuate): Sympathomimetic to suppress appetite.

Approved for Long-Term Use

Orlistat (Alli, Xenical): Inhibits intestinal lipase, reducing fat absorption.
Phentermine-topiramate (Qsymia): Combination of sympathomimetic and carbonic anhydrase inhibitor to decrease appetite and binge eating.
Bupropion-naltrexone (Contrave): A combination of dopamine and norepinephrine reuptake inhibitor along with mu-opioid receptor antagonist.
Liraglutide 3.0mg (Saxenda): GLP-1 receptor agonist to decrease appetite, increase fullness, and satiety.
Gelesis100 (Plenity): Superabsorbent hydrogel particles of cellulose-citric acid matrix that increase fullness.
Setmelanotide (Imciveree): Melanocortin-4-receptor agonist to decrease appetite.
Semaglutide 2.4mg (Wegovy): GLP-1 receptor agonist that reduces hunger and increases satiety.

Safety and Side Effects – Orlistat

Side effects include fatty/oily stools, fecal urgency, oily spotting, increased defecation, and fecal incontinence.
Orlistat may reduce absorption of fat-soluble vitamins (A, D, E, and K).
Possible side effects are liver failure, oxalate nephropathy, and nephrolithiasis.
The medication's mechanism may include unabsorbed fat producing calcium soaps, reducing calcium availability, and increasing renal oxalate excretion leading to supersaturation of oxalate in renal tubules and possibly kidney stones.

Safety and Side Effects (General)

Many AOMs have potential side effects including nausea, vomiting, abdominal pain, diarrhea, dizziness, dry mouth, constipation, insomnia, anxiety, injection site reactions, skin darkening, sexual dysfunction, and depression.
AOMs should be used with caution in certain medical conditions, including hypertension, coronary disease, glaucoma, hyperthyroidism, and individuals taking MAOIs.
Pregnant women need medical advice before using these drugs.

IMCIVREE (Setmelanotide)

It's the first FDA-approved therapy for obesity due to specific rare genetic conditions (e.g., POMC, PCSK1, and LEPR deficiencies).
Administered as a daily subcutaneous injection.
It targets specific brain areas controlling appetite, satiety, and metabolism.
Potential side effects include sexual function issues, depression, skin darkening, and benzyl alcohol toxicity. Additional common side effects include injection site reactions, nausea, headache, diarrhea, abdominal pain, back pain, fatigue, and vomiting.

Usage of IMCIVREE

Use is restricted to people who have confirmed POMC, PCSK1, or LEPR deficiency related obesity with genetic testing.
It's not for general or other types of obesity.

Why Use IMCIVREE

Targeting POMC, PCSK1, or LEPR deficiency, to help people who struggle with extreme, insatiable hunger and food cravings.
Addresses deep hunger that feels like constant need for food.
Can help people maintain healthy weights throughout their lives, and may be especially helpful for managing obesity in infants and children with abnormal weight gain patterns.

Semaglutide 2.4mg (Wegovy)

The FDA approved Semaglutide for obesity in adults.
It's a long-acting GLP-1 analog for weekly subcutaneous injections.
It slows gastric emptying to reduce hunger and energy intake.
It has direct effects on the brain, contributing to satiety.

SEMAGLUTIDE 2.4 Safety Considerations

Possible side effects linked to nausea, diarrhea, vomiting, and constipation.
Known as a cause of gastrointestinal issues, hepatobiliary disorders, gallbladder disorders, and mild pancreatitis, this complication is mostly moderate to mild.
Semaglutide is contraindicated for those with documented or suspected medullary thyroid cancer or MEN2 history.
Semaglutide 2.4 mg use should be discontinued two months prior to conception, per manufacturer recommendation.

Gelesis100 (Plenity)

The FDA-approved AOM, Gelesis100, is a hydrogel matrix.
Capsules are ingested with water 30 minutes before meals to promote fullness by occupying around one-fourth of stomach volume.
It's a medication for overweight/obese adults (BMI 25-40).

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Description

Test your knowledge on BMI ranges, the roles of PCSK1 and LEPR in metabolism, and their implications on health. This quiz covers key physiological processes and their associations with dietary intake. Ideal for students and professionals interested in nutrition and medical sciences.