Obesity & metabolic syndrome - SR.pdf

Obesity & metabolic syndrome Sandra Ramos [email protected] Obesity in Australia Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. BMI= your weight divided by your height squared. (WHO) 45-75 80% o/w or obese global epidemic just weight 36% ov...

Obesity & metabolic syndrome Sandra Ramos [email protected] Obesity in Australia Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. BMI= your weight divided by your height squared. (WHO) 45-75 80% o/w or obese global epidemic just weight 36% overweight 31% obese Obesity assessment BMI Waist circumference Waist:hip ratio Waist:height ratio Body fat index Classification of overweight ≥ 19 years: BMI 25-30 kg/m2 Classification of obesity ≥ 19 years: BMI ≥30 kg/m2 normal BMI and large waist - higher risk Causes of obesity Family dietary patterns Decreased activity (remotes, cars, etc) Easy access to food car or bike The energy density of food - composition pre-packaged food Psychological causes (eg. food as a reward) Large food portions esp if stigmatised Medications (eg. some anti-depressants, steroid hormones, anti-diabetic agents eg. insulin, sulphonylureas) Secondary to other conditions (PCOS, hypothyroidism, Cushing's syndrome, GH deficiency) Genes (eg. fatso gene) genes big factor Hypothalamic and appetite neural signals from GIT, hormones gut-brain same quantity in protein and sugar - 40% longer resp. blocks NPY BY APIPOSE CELLS satiety signals BINDS TO RECEPTORS IN ARC NUCLEUS rising leptin pomote weight loss in starvation, but not long term effect STIMULATE HUNGER sugar - reward pleasure system insulin inhibits NPY release less potent than leptin appetite Adipocytes development Adipocytes size Overeating initially increases size of cells Hypertrophy of individual cells Adipocytes can increase in size approx 1000x “Critical size hypothesis” – Maximum size for a cell – Once this is reached new pre-adipocytes recruited Adipocytes number The number of adipocytes can increase via adipogenesis Mainly childhood 5-fold increase 2-22yr Can increase by 20-fold New cells can form in adulthood if the maximum cell size reached increase in adipogenesis obese children - higher risk in adults but still under research Inflammatory adipokines & metabolic syndrome adipocytes- pro-inflammatory and insulin resistance immune dysfunction - atherosclerosis adipokines - thrombosis ENHANCE HYPERTENSION in obesity II thrombosis matrix metalloproteases promotes atherosclerosis break plaques - promote thrombosis angiogenesis and adipogenesis increased Chronic diseases associated with obesity 40% of all cancers in world sex hormone metabolism increase sympathetic tone Obesity hypoventilation syndrome Sleep apnoea Diabetes type 2 Osteoarthritis Hypertension Heart disease GORD NAFLD extra adipose in hypopharynx bronchial inflammation - airway disease joint disease - increased adiposity embolism hyperandrogenaemia Stroke Cancer Gout Infertility Depression CKD Hernia Varicose vein Atherosclerosis increases intrarenal fat, albumunuria and reduced GFR Metabolic syndrome Criteria for metabolic syndrome Waist circumference of ≥ 102 cm in men and 88 cm in women Elevated triglycerides 150mg/dL or greater Low high-density lipoprotein cholesterol (HDL) less than 40 mg/dL in men or less than 50 mg/dL in women Elevated fasting glucose of 100 mg/dL or greater Blood pressure values of systolic 130 mmHg and/or diastolic 85 mmHg Amboss Intervention feeding time higer caloric intake in morning than night severe obesity negative perception - affect decision making target for treatment semaglutide metformin