1. The document discusses metabolic syndrome and related diseases such as obesity, insulin resistance, dyslipidemia, hypertension, and atherosclerosis. 2. Key factors of metabolic syndrome include increased waist circumference, elevated fasting plasma glucose, high blood pressure, and abnormal cholesterol/triglyceride levels. 3. Visceral fat is particularly problematic as it is associated with increased inflammation, insulin resistance, and cardiovascular risk factors compared to subcutaneous fat.

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Biochemistry
Metabolic Syndrome and Related
Disease Metabolic syndrome
Factors
1.
2.
3.
4.
factor
fasting plasma glucose > 110 mg/dl
> 100 mg/dl
1. Obesity
2. Insulin resistance
3. Pro-inflammatory&Pro-thrombotic factor

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1.Obesity ( )
1. Body mass index BMI
2. Distribution of fat deposition
3. Subcutaneous fat and visceral fat deposition
BMI
kg) m2
Diagnosis BMI for Caucasoid BMI for Asian
Underweight <18.5 <18.5
Normal 18.5-24.9 18.5-22.9
Overweight 25-29.9 23-24.9
Obesity ≥30 ≥25
Caucasoid
metabolic
syndrome

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1. Adominal obesity = android type
-
2. Gluteal-femoral obesity = gynoid type
-
Distribution of fat deposition
Adominal obesity metabolic
syndrome
adonpmal
1. Waist circumference
cm (36
) cm (32

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2. Waist-height ratio(WHtR)
WHtR
adominal obesity
3. Waist-hip ratio(WHR)

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Distribution of fat
deposition
adominal gluteal-femerol
obesity obesity

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Waist Waist-height
circumference ratio(WHtR)
Subcutaneous and Visceral fat deposition
- Subcutaneous fat --
- Visceral fat
Subcutaneous fat abdominal fat
metabolic syndrome
metabolic rate glycerol fatty acid
1. energy reservation
2.

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energy reservation
- TAG energy resource
- Mobilize free fatty acid
Visceral fat
fatty acid
visceral fat
VLDL
visceral fat insulin inhibitor
: visceral fat
>>> Lypolysis adipose tissue
- fatty acid source of energy FFA
- β-oxidation fatty acid

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- glycogen
- ketogenesis
substrate Lypolysis
- VLDL fat
VLDL VLDL LDL
LDL
Hormone (endocrine) metabolic
syndrome
- Adiponectin
- Leptin :
vascular wall
- Pro-inflammatory cytokine
adiponectin
>>> adiponectin(ApN)
peptide mature adipocyte
adiponectin
visceral fat visceral fat ApN

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ApN subcutaneous fat
metabolic syndrome
ApN
1. endothelial inflammation Anti-inflammatory
effect
ApN vascular wall
2. vascular endothelial function
endothelial Nitric Oxide Synthase (eNOS)
Nitric oxide (NO) vasodilatation
platelet aggregation
3. Sensitization of insulin
glucose uptake oxidation
glucose
TG LDL
2. Insulin resistance

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insulin
hyperinsulinemia
insulin
insulin β-cell
dysfunction β-cell
β-cell
insulin
β-cell
dysfunction insulin
insulin
- insulin glucose
Glucose transport
1. Facilitated diffusion transport system
2. Na-monosaccharide cotransporter system
insulin

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1. Insulin-sensitive insulin
glucose muscle adipose tissue
glucose Facilitated diffusion
transport system GLUT-4
2. Insulin-insensitive insulin
glucose
glucose insulin
GLUT-6
-
1. glycolysis glucose uptake
2. glucose-6-phosphatase
3.
4. glycogenolysis
-
1. lipogenesis
2. lypolysis
- protein nucleic acid metabolism
1. RNA&DNA

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2.
: insulin resistance
insulin
1. hyperinsulinemia
2. glucose
Diabetes Mellitus
Diabetes Mellitus
-
-
1) relative deficiency of insulin insulin
insulin resistance or DM type2
2) absolute deficiency of insulin insulin
-
Definition of Diabetes mellitus

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- ADA 2010
1) 8
2) HbA1C follow up
A1C half life 2-3
A1C
8
- A1C 9 7% retinopathy
21-63%
A1C 7 9%
Categories of Diabetes Mellitus
- 2
Type 1 rare case
β-cell insulin
virus infected
Type 2 insulin resistant
β-cell insulin
Type 2 Diabetes Mellitus

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1) Insulin resistant
2) Dysfunctional β-cell insulin
DM
1) blood glucose
2) insulin insulin
resistant
glucose
1) sorbitol
- fructose
- fructose glucose sorbitol
sorbitol fructose
- glucose sorbitol
sorbitol fructose
sorbitol
- sorbitol cell cell
organ
2) glycosylation of protein

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- Glucose advance glycation end-
products (AGEs)
- cross-linking protein extracellular matrix
- atherosclerosis
insulin
- DNA, RNA
- Fibroblast collagen fiber cell
Dyslipidemia
Dyslipidemia
- coronary heart
disease
- total cholesterol, triglyceride, LDL, HDL
Metabolism of LDL
- LDL VLDL
- VLDL capillary IDL
- IDL LDL

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- LDL uptake
- LDL oxidation oxidized LDL
uptake
- LDL uptake
Metabolism of HDL
- HDL VLDL, LDL
HDL
Dyslipidemia
1)
High risk group
2) 35
Goal of treatment

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LDL HDL
mg/dL mg/dL
<70 <100
2 <130 <160
0-1 <160 <190
Hypertension
Hypertension
- BP > 140/90
- 2
1) Essential hypertension
2) Secondary hypertension
RAAS
- BP
- Angiotensinogen angiotensin I
angiotensin II
aldosterone BP

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- Rennin Angiotensinogen angiotensin
I
- ACE angiotensin converting enzyme
angiotensin I angiotensin II
- ACEI (ACE inhibitor) ARB (angiotensin
receptor blocker)
- Angiotensin angiotensin I receptor (AT1)
vasoconstriction BP
- Angiotensin angiotensin II receptor (AT2)
vasodilatation BP

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Atherosclerosis
- coronary heart disease
- Occlusion of lumen
- Thrombosis in lumen