This document discusses the relationship between blood pressure and metabolic syndrome. It makes three key points:
1. Several factors contribute to hypertension in metabolic syndrome, including obesity, insulin resistance, dyslipidemia, and sympathetic nervous system activation. High insulin levels and an upregulated renin-angiotensin system in adipose tissue may also play a role.
2. Insulin resistance is associated with an 11% lower risk of developing hypertension for each unit increase in insulin sensitivity. Insulin resistance can increase blood pressure through effects on vascular smooth muscle contraction, sodium reabsorption, and activation of the renin-angiotensin system.
3. Insulin resistance and hyperinsulinemia may
This document discusses metabolic syndrome, which is a cluster of risk factors for heart disease that includes diabetes, obesity, high cholesterol, and high blood pressure. It notes the increasing prevalence of metabolic syndrome in children and adolescents. While there is no consensus on diagnosing metabolic syndrome in younger populations, most agree that having two or more of the following constitutes metabolic syndrome: insulin resistance, elevated cholesterol/triglycerides, low HDL, obesity, and high blood pressure. The document focuses on insulin resistance as a unifying mechanism, exploring its relationship to excess fat, especially visceral fat, and adipocytokines like adiponectin that impact inflammation and insulin sensitivity.
The document discusses the metabolic syndrome, including its definition, major features, epidemiology, pathophysiology, approach to diagnosis, and management. Regarding management, lifestyle modifications like weight loss through calorie restriction and increased physical activity are emphasized. Pharmacological treatments and metabolic/bariatric surgery may also be considered in some cases to treat individual components of the metabolic syndrome.
This document discusses the history and definitions of metabolic syndrome. It notes that metabolic syndrome was first described in the 1920s and involves clustering of conditions like hypertension, hyperglycemia, and hyperuricemia. In 1988, Reaven coined the term "Syndrome X" and the condition came to be recognized as involving insulin resistance. Current definitions from organizations like ATP III and IDF define metabolic syndrome as involving abdominal obesity plus two or more of the following: high triglycerides, low HDL, high blood pressure, and high fasting glucose. The document explores the links between insulin resistance, central obesity, and metabolic syndrome in driving cardiovascular and diabetes risk.
The document discusses the metabolic syndrome, which is a constellation of metabolic risk factors associated with increased risk of type 2 diabetes and cardiovascular disease. It explores the origins and definitions of metabolic syndrome, including the roles of genetics, environment, diet, and lifestyle factors. It also examines the clustering of metabolic syndrome risk factors and how factor analysis can be used to study these relationships between variables.
Metabolic syndrome is a growing health concern caused by unhealthy lifestyles like poor diet and physical inactivity. The presentation summarizes diagnostic criteria for metabolic syndrome and discusses preventive strategies focused on lifestyle modifications like following a healthy diet high in fruits/vegetables and low in saturated fat, engaging in regular physical activity, managing stress, and avoiding smoking. Adopting these lifestyle changes can help prevent and treat metabolic syndrome and related diseases like diabetes and cardiovascular disease.
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
The document discusses metabolic syndrome, which is characterized by insulin resistance and increased waist circumference. It is associated with dyslipidemia, glucose intolerance, hypertension, and proinflammatory cytokines. Clinical features include increased waist circumference, hypertension, and lipoatrophy. Treatment focuses on lifestyle changes like diet, physical activity, and behavior modification to address obesity, lipid levels, blood pressure, and insulin resistance.
This document discusses metabolic syndrome, which is a cluster of risk factors for heart disease that includes diabetes, obesity, high cholesterol, and high blood pressure. It notes the increasing prevalence of metabolic syndrome in children and adolescents. While there is no consensus on diagnosing metabolic syndrome in younger populations, most agree that having two or more of the following constitutes metabolic syndrome: insulin resistance, elevated cholesterol/triglycerides, low HDL, obesity, and high blood pressure. The document focuses on insulin resistance as a unifying mechanism, exploring its relationship to excess fat, especially visceral fat, and adipocytokines like adiponectin that impact inflammation and insulin sensitivity.
The document discusses the metabolic syndrome, including its definition, major features, epidemiology, pathophysiology, approach to diagnosis, and management. Regarding management, lifestyle modifications like weight loss through calorie restriction and increased physical activity are emphasized. Pharmacological treatments and metabolic/bariatric surgery may also be considered in some cases to treat individual components of the metabolic syndrome.
This document discusses the history and definitions of metabolic syndrome. It notes that metabolic syndrome was first described in the 1920s and involves clustering of conditions like hypertension, hyperglycemia, and hyperuricemia. In 1988, Reaven coined the term "Syndrome X" and the condition came to be recognized as involving insulin resistance. Current definitions from organizations like ATP III and IDF define metabolic syndrome as involving abdominal obesity plus two or more of the following: high triglycerides, low HDL, high blood pressure, and high fasting glucose. The document explores the links between insulin resistance, central obesity, and metabolic syndrome in driving cardiovascular and diabetes risk.
The document discusses the metabolic syndrome, which is a constellation of metabolic risk factors associated with increased risk of type 2 diabetes and cardiovascular disease. It explores the origins and definitions of metabolic syndrome, including the roles of genetics, environment, diet, and lifestyle factors. It also examines the clustering of metabolic syndrome risk factors and how factor analysis can be used to study these relationships between variables.
Metabolic syndrome is a growing health concern caused by unhealthy lifestyles like poor diet and physical inactivity. The presentation summarizes diagnostic criteria for metabolic syndrome and discusses preventive strategies focused on lifestyle modifications like following a healthy diet high in fruits/vegetables and low in saturated fat, engaging in regular physical activity, managing stress, and avoiding smoking. Adopting these lifestyle changes can help prevent and treat metabolic syndrome and related diseases like diabetes and cardiovascular disease.
Introduction, Integration of CM risk factors, Targeting obesity, Management of hypertension, Management of dyslipidemia, Antiplatelet therapy, Management of microalbuminuria, CB1 blockade
The document discusses metabolic syndrome, which is characterized by insulin resistance and increased waist circumference. It is associated with dyslipidemia, glucose intolerance, hypertension, and proinflammatory cytokines. Clinical features include increased waist circumference, hypertension, and lipoatrophy. Treatment focuses on lifestyle changes like diet, physical activity, and behavior modification to address obesity, lipid levels, blood pressure, and insulin resistance.
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
Metabolic syndrome is defined by having at least 3 of the following 5 risk factors according to the National Cholesterol Education Program Adult Treatment Panel III: abdominal obesity as measured by waist circumference, high triglyceride levels, low HDL cholesterol levels, high blood pressure, and high fasting blood glucose levels. Meeting these criteria indicates an increased risk of heart disease, stroke, and diabetes.
The metabolic syndrome is a constellation of conditions that increases the risk of atherosclerotic cardiovascular disease and type 2 diabetes. It is characterized by central obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. The metabolic syndrome is caused by excess caloric intake and sedentary lifestyle and predisposes patients to insulin resistance. It affects 10-40% of adults worldwide and presents a major health challenge.
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome ...HM Learnings
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome I Endocrine Physiology
The slides will discuss the following:
1. Definition of metabolic syndrome
2. Diagnosis
3. Causes
4. Pathophysiology
5. Consequences
6. Treatment
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
This document discusses weight control strategies for patients with metabolic syndrome. It defines metabolic syndrome as a constellation of risk factors that promote cardiovascular disease. Weight loss through diet and exercise is the first-line treatment, aiming for 7-10% weight loss in the first year. Bariatric surgery may be considered for patients with a BMI over 40 or over 35 with comorbidities if medical treatment fails. The risks and types of bariatric surgeries are outlined, noting that surgery provides the greatest sustainable weight loss for treating metabolic syndrome and reducing cardiovascular risk factors.
Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
Metabolic syndrome is characterized by insulin resistance, abnormal glucose metabolism, and lipid abnormalities. It is caused by resistance to insulin in the liver, skeletal muscle, and fat tissue which overworks the pancreas. Over time, the pancreas loses function and leads to type 2 diabetes. Metabolic syndrome starts with high triglycerides and is associated with an increased risk of cardiovascular disease. Treatment focuses on aggressively reducing cardiovascular risk through medical checks, lifestyle changes like a low calorie diet, and increasing physical activity.
Guest Lecture at University of Delhi - The Entangled Relationship between Dia...Vinod Nikhra
The talk at Ramjas College, University of Delhi on 18th Feb 2015. It highlights the latest issues in biological and molecular research which link overweight/obesity with diabetes, metabolic syndrome and aging.
This document discusses metabolic syndrome, which is a combination of medical disorders that increase the risk of cardiovascular disease and diabetes when occurring together. It affects about 20% of the Malaysian population. The core components include hypertension, high triglycerides, low HDL cholesterol, obesity, and impaired glucose tolerance. There are different criteria for diagnosing metabolic syndrome, but central to all definitions is insulin resistance. If left untreated, metabolic syndrome can increase the risk of serious health conditions such as heart disease, stroke, and type 2 diabetes.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
Metabolic Syndrome and Dietary Guidelines for its preventionnutritionistrepublic
The document summarizes dietary guidelines for preventing metabolic syndrome, obesity, diabetes and related disorders in Asian Indians. It recommends a diet with 50-60% calories from complex carbohydrates, 10-15% from proteins, less than 30% from total fats including less than 7% from saturated fats. It emphasizes whole grains, pulses, vegetables and fruits, moderate intake of dairy and non-vegetarian foods, and healthy cooking oils like olive and canola oil. Regular physical activity and lifestyle modifications are also recommended.
The document discusses non-alcoholic fatty liver disease (NAFLD) and its relationship to metabolic syndrome. It begins by defining NAFLD and its subtypes, including simple steatosis and non-alcoholic steatohepatitis (NASH). It then discusses the risk factors and pathophysiology of NAFLD, noting its association with obesity, diabetes, and other components of metabolic syndrome. The document outlines current diagnostic and treatment approaches for NAFLD, including lifestyle modifications involving diet, exercise and weight loss. It also discusses potential drug therapies and newer treatment strategies being explored.
Metabolic syndrome is diagnosed when a patient has at least 3 of 5 conditions: high fasting glucose, high blood pressure, high triglycerides, low HDL cholesterol, and increased waist circumference. It is associated with increased risks of heart disease, stroke, diabetes, and kidney disease. Lifestyle changes including weight loss, increased physical activity, and a healthier diet are recommended as first-line interventions to reduce metabolic risk factors.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
This document summarizes the history and epidemiology of diabetes. It discusses how diabetes was described historically as a melting of flesh and limbs into urine. It outlines the diagnostic criteria for diabetes according to the American Diabetes Association. It also summarizes key statistics on the rising incidence and prevalence of diagnosed diabetes in the United States from 1980 to 2010 according to the Centers for Disease Control and Prevention. Furthermore, it discusses diabetes-related complications and characteristics of chronic diseases. Lastly, it presents objectives and guidelines for diabetes prevention, control and care from Healthy People 2020 and the American Diabetes Association.
Metabolic syndrome is a clustering of risk factors that increase the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, elevated blood glucose, and abnormal lipid levels. The primary cause is abdominal obesity which leads to chronic inflammation and a prothrombotic state. Lifestyle changes focused on diet and exercise are the most important management strategies, while pharmacotherapy may be added if risk factors do not improve sufficiently with lifestyle changes alone.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
This document summarizes recent evidence on cardiovascular disease risk factors and lipid management. Key points include:
- Lowering LDL cholesterol and other apoB-containing lipoproteins reduces cardiovascular risk in a linear, dose-dependent manner with no lower limit.
- HDL cholesterol raising therapies have not been shown to reduce cardiovascular risk beyond modest reductions in apoB.
- Triglycerides associate with risk, but this is mediated by changes in non-HDL cholesterol and apoB levels rather than triglyceride levels alone.
- Calculated and direct LDL cholesterol measurements provide similar risk information in most cases, but direct measurement may be needed in some patients with high triglycerides or metabolic conditions.
A 67-year-old woman with poorly controlled type 2 diabetes and hypertension presented with severe muscle weakness and was found to have hyperglycemia, hyperkalemia, and elevated creatinine. Examination revealed facial hirsutism and signs of Cushing's syndrome. Laboratory testing, including a C-peptide measurement, should be performed to determine the cause of her diabetes.
By Juliana C N Chan, MBChB, MD, FRCP Professor of Medicine & Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
Metabolic syndrome is defined by having at least 3 of the following 5 risk factors according to the National Cholesterol Education Program Adult Treatment Panel III: abdominal obesity as measured by waist circumference, high triglyceride levels, low HDL cholesterol levels, high blood pressure, and high fasting blood glucose levels. Meeting these criteria indicates an increased risk of heart disease, stroke, and diabetes.
The metabolic syndrome is a constellation of conditions that increases the risk of atherosclerotic cardiovascular disease and type 2 diabetes. It is characterized by central obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. The metabolic syndrome is caused by excess caloric intake and sedentary lifestyle and predisposes patients to insulin resistance. It affects 10-40% of adults worldwide and presents a major health challenge.
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome ...HM Learnings
Metabolic Syndrome- Pathophysiology, Treatment I Insulin Resistance Syndrome I Endocrine Physiology
The slides will discuss the following:
1. Definition of metabolic syndrome
2. Diagnosis
3. Causes
4. Pathophysiology
5. Consequences
6. Treatment
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
This document discusses weight control strategies for patients with metabolic syndrome. It defines metabolic syndrome as a constellation of risk factors that promote cardiovascular disease. Weight loss through diet and exercise is the first-line treatment, aiming for 7-10% weight loss in the first year. Bariatric surgery may be considered for patients with a BMI over 40 or over 35 with comorbidities if medical treatment fails. The risks and types of bariatric surgeries are outlined, noting that surgery provides the greatest sustainable weight loss for treating metabolic syndrome and reducing cardiovascular risk factors.
Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.
This document discusses metabolic syndrome, including its definition, causes, risk factors, prevalence in different populations, and treatment approaches. Metabolic syndrome is a cluster of conditions that increases the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, insulin resistance, and dyslipidemia. Lifestyle interventions like diet modification, increased physical activity, and weight loss are effective first-line treatments to reduce the risk factors of metabolic syndrome. The document reviews evidence on how different diets, exercises and weight management can help control metabolic syndrome.
Metabolic syndrome is characterized by insulin resistance, abnormal glucose metabolism, and lipid abnormalities. It is caused by resistance to insulin in the liver, skeletal muscle, and fat tissue which overworks the pancreas. Over time, the pancreas loses function and leads to type 2 diabetes. Metabolic syndrome starts with high triglycerides and is associated with an increased risk of cardiovascular disease. Treatment focuses on aggressively reducing cardiovascular risk through medical checks, lifestyle changes like a low calorie diet, and increasing physical activity.
Guest Lecture at University of Delhi - The Entangled Relationship between Dia...Vinod Nikhra
The talk at Ramjas College, University of Delhi on 18th Feb 2015. It highlights the latest issues in biological and molecular research which link overweight/obesity with diabetes, metabolic syndrome and aging.
This document discusses metabolic syndrome, which is a combination of medical disorders that increase the risk of cardiovascular disease and diabetes when occurring together. It affects about 20% of the Malaysian population. The core components include hypertension, high triglycerides, low HDL cholesterol, obesity, and impaired glucose tolerance. There are different criteria for diagnosing metabolic syndrome, but central to all definitions is insulin resistance. If left untreated, metabolic syndrome can increase the risk of serious health conditions such as heart disease, stroke, and type 2 diabetes.
Metabolic Syndrome, Diabetes, and Cardiovascular Disease ... Metabolic Synd...MedicineAndFamily
This document discusses metabolic syndrome, diabetes, and cardiovascular disease. It provides an overview of diabetes prevalence in the US and shows that diabetics are at significantly higher risk of cardiovascular events like coronary disease and stroke. It then discusses insulin resistance, the natural history of type 2 diabetes, and how obesity and insulin resistance can lead to metabolic defects and increased risk of conditions like kidney disease. Lastly, it examines the prevalence of metabolic syndrome in the US according to different definitions and shows that metabolic syndrome is associated with higher rates of cardiovascular disease and mortality.
Metabolic Syndrome and Dietary Guidelines for its preventionnutritionistrepublic
The document summarizes dietary guidelines for preventing metabolic syndrome, obesity, diabetes and related disorders in Asian Indians. It recommends a diet with 50-60% calories from complex carbohydrates, 10-15% from proteins, less than 30% from total fats including less than 7% from saturated fats. It emphasizes whole grains, pulses, vegetables and fruits, moderate intake of dairy and non-vegetarian foods, and healthy cooking oils like olive and canola oil. Regular physical activity and lifestyle modifications are also recommended.
The document discusses non-alcoholic fatty liver disease (NAFLD) and its relationship to metabolic syndrome. It begins by defining NAFLD and its subtypes, including simple steatosis and non-alcoholic steatohepatitis (NASH). It then discusses the risk factors and pathophysiology of NAFLD, noting its association with obesity, diabetes, and other components of metabolic syndrome. The document outlines current diagnostic and treatment approaches for NAFLD, including lifestyle modifications involving diet, exercise and weight loss. It also discusses potential drug therapies and newer treatment strategies being explored.
Metabolic syndrome is diagnosed when a patient has at least 3 of 5 conditions: high fasting glucose, high blood pressure, high triglycerides, low HDL cholesterol, and increased waist circumference. It is associated with increased risks of heart disease, stroke, diabetes, and kidney disease. Lifestyle changes including weight loss, increased physical activity, and a healthier diet are recommended as first-line interventions to reduce metabolic risk factors.
Ueda2016 metabolic syndrome in different population,which one is appropriate ...ueda2015
Metabolic syndrome is a cluster of disorders including high blood pressure, high insulin levels, excess body weight, and abnormal cholesterol that increases the risk of diseases like diabetes and heart disease. There is wide variation in the reported prevalence of metabolic syndrome across populations and definitions, and questions remain about its applicability and predictive power equally in all groups. Key determinants include obesity, especially abdominal obesity, and insulin resistance, but genetic and lifestyle factors also contribute to risk.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
This document discusses metabolic syndrome, including its history, criteria for diagnosis, epidemiology, risk factors, complications, etiology, and prevention. Metabolic syndrome is defined as a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The prevalence of metabolic syndrome is high worldwide and increasing, with risk factors including older age, female gender, obesity, physical inactivity, and genetic factors. Complications of metabolic syndrome include increased risk of type 2 diabetes, cardiovascular disease, and mortality. Prevention focuses on lifestyle changes like healthy diet, exercise, and weight management.
This document summarizes the history and epidemiology of diabetes. It discusses how diabetes was described historically as a melting of flesh and limbs into urine. It outlines the diagnostic criteria for diabetes according to the American Diabetes Association. It also summarizes key statistics on the rising incidence and prevalence of diagnosed diabetes in the United States from 1980 to 2010 according to the Centers for Disease Control and Prevention. Furthermore, it discusses diabetes-related complications and characteristics of chronic diseases. Lastly, it presents objectives and guidelines for diabetes prevention, control and care from Healthy People 2020 and the American Diabetes Association.
Metabolic syndrome is a clustering of risk factors that increase the risk of cardiovascular disease and diabetes. It is characterized by abdominal obesity, high blood pressure, elevated blood glucose, and abnormal lipid levels. The primary cause is abdominal obesity which leads to chronic inflammation and a prothrombotic state. Lifestyle changes focused on diet and exercise are the most important management strategies, while pharmacotherapy may be added if risk factors do not improve sufficiently with lifestyle changes alone.
This document discusses metabolic syndrome, its causes and consequences. Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, diabetes and stroke. It is becoming more common due to lifestyle factors like poor diet, lack of exercise and obesity. Refined carbs and sugar are major contributors, comprising 80-90% of the effect. Adopting a whole foods, plant-based diet has been shown to successfully treat and reverse metabolic syndrome in many cases by promoting weight loss and improving related health markers.
This document summarizes recent evidence on cardiovascular disease risk factors and lipid management. Key points include:
- Lowering LDL cholesterol and other apoB-containing lipoproteins reduces cardiovascular risk in a linear, dose-dependent manner with no lower limit.
- HDL cholesterol raising therapies have not been shown to reduce cardiovascular risk beyond modest reductions in apoB.
- Triglycerides associate with risk, but this is mediated by changes in non-HDL cholesterol and apoB levels rather than triglyceride levels alone.
- Calculated and direct LDL cholesterol measurements provide similar risk information in most cases, but direct measurement may be needed in some patients with high triglycerides or metabolic conditions.
A 67-year-old woman with poorly controlled type 2 diabetes and hypertension presented with severe muscle weakness and was found to have hyperglycemia, hyperkalemia, and elevated creatinine. Examination revealed facial hirsutism and signs of Cushing's syndrome. Laboratory testing, including a C-peptide measurement, should be performed to determine the cause of her diabetes.
This document discusses several studies related to blood pressure and hypertension. The Improving the Detection of Hypertension trial found that home blood pressure monitoring over 1 week may be the most reliable method for diagnosing hypertension. The JAMP trial found that nighttime blood pressure levels and a rising pattern were associated with higher risk of cardiovascular disease, especially heart failure. The OSLO-ISCHEMIA study found that increased exercise systolic blood pressure was associated with greater risk of coronary heart disease over many years of follow up. Dietary approaches like the DASH diet were shown to lower blood pressure when combined with sodium restriction.
Unit 7_Hypertension in Special Groups.pptxImanuIliyas
This document discusses hypertension in special groups. It begins by outlining objectives to identify special groups with hypertension and appropriate management strategies. It then discusses hypertension among groups such as those with diabetes, chronic kidney disease, pregnant women, HIV/AIDS patients, the elderly, and children. For each group, it provides considerations for evaluating and managing their hypertension. It also includes case studies and classifications to illustrate approaches to hypertension in pregnancy.
This document discusses adrenal mild hypercortisolism, also known as subclinical Cushing syndrome. Some key points:
- Mild hypercortisolism is usually caused by benign adrenal adenomas and results in slightly elevated cortisol levels without typical Cushing syndrome symptoms.
- The definition and diagnostic criteria of mild hypercortisolism are debated, but a low-dose dexamethasone suppression test is commonly used. Cortisol levels above 1.8 mg/dL or 5 mg/dL after the test are considered diagnostic by some studies.
- Mild hypercortisolism has been associated with metabolic syndrome, cardiovascular disease, osteoporosis, and increased mortality,
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
This patient is a 55-year-old male with uncontrolled hypertension, uncontrolled type 2 diabetes, stage 1 chronic kidney disease, and dyslipidemia who presents with fatigue, headaches, and erectile dysfunction. His medical history and lab results indicate high cardiovascular risk. The treatment plan involves lifestyle modifications, optimizing medications to better control his blood pressure and blood glucose, and monitoring by a multidisciplinary team to reduce complications.
Hypertension is highly prevalent in the elderly population. The risk of hypertension increases dramatically with age, with over 90% of people over 70 having hypertension. In the elderly, hypertension is characterized by an elevated systolic blood pressure with a normal or low diastolic blood pressure due to arterial stiffening caused by reduced elasticity of arteries with age. Multiple changes occur in the arteries with aging that result in increased systolic blood pressure and decreased diastolic blood pressure. Hypertension is the most important modifiable risk factor for cardiovascular disease in the elderly. Lifestyle modifications and medication are effective for treating hypertension in the elderly, with the goal of reducing blood pressure and cardiovascular risk.
This document discusses familial hypercholesterolemia (FH), a genetic disorder characterized by very high levels of LDL cholesterol that increases the risk of premature cardiovascular disease. It provides information on:
- FH is caused by mutations that impair LDL receptor function, leading to less clearance of LDL from the bloodstream. It exists in both heterozygous and homozygous forms.
- Heterozygous FH patients have a better prognosis than homozygous patients due to higher LDL receptor function. Treatment involves lifestyle changes and lipid-lowering medications like statins.
- Two clinical trials found that the PCSK9 inhibitor evolocumab significantly reduced LDL levels in both heterozygous and homozyg
This document discusses anesthetic considerations for obesity and bariatric surgery. It covers the pathophysiological effects of obesity on various organ systems like cardiovascular, respiratory, gastrointestinal and metabolic effects. It also discusses challenges in airway management and pharmacokinetic changes in obese patients. Surgical treatments for obesity like gastric bypass and sleeve gastrectomy are also mentioned. Monitoring and dosing of anesthetic drugs needs adjustment for obese patients based on their lean or total body weight depending on the drug's lipophilicity.
This document provides guidelines for the management of severe pre-eclampsia and eclampsia. It summarizes the assessment and monitoring of both the woman and fetus. For the woman, it outlines how to measure blood pressure and proteinuria as well as vital signs and lab work that should be monitored. For the fetus, it recommends ultrasound assessments and cardiotocography. It provides guidance on controlling hypertension, including recommended antihypertensive medications, and preventing seizures with magnesium sulfate. The overarching goal is to standardize care to stabilize women and optimize timing of delivery to improve outcomes for both mother and baby.
Anemia is common in patients with diabetes mellitus and chronic kidney disease. Erythropoietin production by the kidneys regulates red blood cell production but is deficient in kidney disease, leading to anemia. Three case studies describe patients with diabetes and various degrees of anemia and kidney impairment. The document discusses the pathogenesis, evaluation, and management of anemia in diabetes, including the role of erythropoietin deficiency and treatment targets. It concludes regular anemia screening and early treatment can help prevent complications in diabetes patients.
Interpretation and Clinical Significance of some Clinical Laboratory Tests - ...Bigin Gyawali
Certainly, clinical laboratory tests play a crucial role in assessing the function and health of various organ systems in the body. Let's discuss the clinical significance of some common laboratory tests for each of the mentioned systems:
1. **Cardiovascular System:**
- **Complete Blood Count (CBC):** Evaluating red blood cell count, hemoglobin, and hematocrit levels can help identify anemia, which may contribute to cardiovascular issues.
- **Lipid Profile:** Measures cholesterol levels (LDL, HDL, and total cholesterol), triglycerides, and can help assess the risk of atherosclerosis and cardiovascular disease.
2. **Endocrine System:**
- **Thyroid Function Tests (TFTs):** TSH, T3, and T4 levels are assessed to diagnose thyroid disorders. An imbalance in thyroid hormones can affect metabolism and cardiovascular function.
- **Hemoglobin A1c (HbA1c):** Monitors long-term glucose control and is essential in managing diabetes, a condition that can impact multiple organ systems, including the cardiovascular and renal systems.
3. **Gastrointestinal System:**
- **Liver Function Tests (LFTs):** Assess the health of the liver by measuring enzymes (ALT, AST, ALP), bilirubin, and proteins. Abnormalities may indicate liver disease or dysfunction.
- **Stool Tests (e.g., fecal occult blood):** Detects blood in the stool, which may indicate gastrointestinal bleeding or conditions such as colorectal cancer.
4. **Hematologic System:**
- **Coagulation Panel (PT, aPTT, INR):** Evaluates the blood's clotting ability. Abnormalities may suggest bleeding disorders or an increased risk of thrombosis.
- **Complete Blood Count (CBC):** Assesses the cellular components of blood, including red and white blood cells and platelets, helping to diagnose anemias, infections, and blood disorders.
5. **Renal System:**
- **Blood Urea Nitrogen (BUN) and Creatinine:** Evaluate kidney function. Elevated levels may indicate impaired renal function, suggesting acute or chronic kidney disease.
- **Urinalysis:** Examines urine for abnormalities such as protein, blood, or glucose, providing insights into kidney and urinary tract health.
6. **Respiratory System:**
- **Arterial Blood Gas (ABG) Analysis:** Assesses oxygen and carbon dioxide levels in the blood, helping diagnose respiratory and metabolic disorders.
- **Pulmonary Function Tests (PFTs):** Measures lung function, aiding in the diagnosis and monitoring of conditions such as asthma or chronic obstructive pulmonary disease (COPD).
Interpretation of these tests requires a comprehensive understanding of the patient's medical history and clinical presentation. Abnormal results can guide further diagnostic investigations and help healthcare professionals develop appropriate treatment plans. Regular monitoring of these parameters is vital for managing chronic conditions and preventing complications.
Perioperative management of diabetes mellitusSourav Mondal
A detailed stepwise approach for the perioperative management of diabetes mellitus.
Sources taken from latest edition of Harrison, Millers, Stoeltings and ADA Guidelines.
By a anaesthetist, for a anaesthesist
UPDATES ON HPT DISORDERS OF PREGNANCY by dr yahya.pptxMaryamYahya8
This document provides an overview of hypertensive disorders in pregnancy. It defines the main categories of hypertensive disorders such as chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It discusses the pathophysiology, risk factors, diagnosis, and management of these conditions. Hypertensive disorders are a major cause of maternal and fetal morbidity and mortality worldwide. Accurate classification is important for optimizing care and reducing health risks.
In this slide i outlined an open source article, how already 12 years have elapsed over it's publication. I thought it is interesting and i am also sharing it's fulltext link: https://diabetes.diabetesjournals.org/content/56/6/1718
- A study analyzed risk factors for progression to advanced liver disease in 6,462 subjects with NAFLD identified from Finnish population health surveys between 1992-2012. Subjects were followed until 2013 through national registers.
- Each additional alcohol drink per day was associated with a 43% increased risk of liver events such as cirrhosis or liver cancer. Genetic factors such as PNPLA3 and TM6SF2 variants also predicted progression.
- The results suggest that even alcohol consumption within generally accepted limits may be harmful for individuals with underlying NAFLD, and that drinking habits and genetics are important co-factors in disease progression.
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of LDL cholesterol that can lead to premature heart disease. The underlying causes are defects in genes responsible for clearing LDL from the blood. If left untreated, high LDL levels from birth can cause heart attacks or strokes by early adulthood. Treatment involves lifestyle changes and cholesterol-lowering medications like statins. New therapies that block PCSK9 protein are helping to further lower LDL levels. For the most severe cases, liver transplantation may be considered to replace the non-functioning liver gene. Regular screening and treatment are important to manage risk and prevent early cardiovascular problems in those with FH.
This document discusses various laboratory tests used for the diagnosis and monitoring of diabetes, including the oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), glycated albumin, fructosamine assay, and C-peptide assay. It provides details on each test, including what they measure, indications for use, limitations, and normal/abnormal ranges. It also outlines recommendations from diabetes organizations for screening and diagnosing both type 1 and type 2 diabetes using blood glucose criteria and HbA1c levels.
This document discusses several experiments on the transfer of bacteria from hands and other surfaces. It finds that washing hands with soap and water for 20 seconds or more significantly reduces bacterial growth compared to rinsing with water alone or not washing. It also examines the transfer of bacteria from gloves, aprons, hair, sneezes and other sources, as well as the importance of thoroughly washing cutting boards between uses. Proper handwashing technique is important to wash all areas of the hands.
The document discusses mutations, which are changes in the DNA base sequence. A mutation occurs when one base, like a C, is changed to another base like a G. Mutations can happen spontaneously during DNA duplication before cell division. Certain chemicals and radiation can increase the risk of mutations occurring. While mutations may cause small changes to a protein, they often do not have a significant effect, as the protein may still function similarly. A mutation that alters a protein's shape could change its catalytic activity if the protein is an enzyme.
Child abuse can have long-lasting negative effects on children and society. There are several types of child abuse, including physical, emotional, neglect, sexual abuse, and bullying. Learning to recognize the signs and symptoms of abuse is the first step to helping abused children. Physical signs may include unexplained injuries, while behavioral signs could be excessive absence from school or stealing food. Parents may exhibit warning signs like misusing drugs or blaming the child. Recognizing and preventing child abuse benefits children and promotes overall well-being.
The document discusses a potential fourth stimulus package. It was prepared by Yousef Elshrek and likely analyzes or proposes a new economic stimulus plan to address the ongoing impacts of the COVID-19 pandemic. In just a few sentences, the summary captures the key details that the document is about a fourth stimulus and was written by Yousef Elshrek.
This document provides information about alcohol, tobacco, and drug awareness for school staff. It defines substances and substance abuse, outlines signs of substance abuse including behavioral and physical signs for various substances. It describes school staff responsibilities including prevention, intervention, referral for treatment, and protocols. Signs of abuse are provided for specific substances like alcohol, tobacco, marijuana, stimulants, inhalants, hallucinogens, and narcotics. Referral processes and definitions are also outlined.
SARS-CoV-2 is the virus that causes COVID-19. It is a coronavirus that infects humans and other animals through the mouth or nose. Once inside the body, the virus's protein spikes attach to human cells and fuse with the cell membrane to release its RNA genome inside. The cell's machinery then produces more copies of the virus which are released to infect other cells until the immune system eliminates the infection. Coronaviruses get their name from the crown-like spikes on their envelopes that they use to enter and infect human and animal cells.
1. The document discusses different types of genetic mutations including point mutations, frameshift mutations, nonsense mutations, missense mutations, silent mutations, conservative mutations, and nonconservative mutations.
2. Mutations originate at the DNA level but their effects are seen at the protein level. Mutations can be classified based on their effects on DNA or proteins.
3. The main types of mutations are point mutations and frameshift mutations at the DNA level, and missense and nonsense mutations at the protein level.
The Johnson & Johnson COVID-19 vaccine uses an adenovirus to deliver genetic material encoding the SARS-CoV-2 spike protein to human cells. The body's immune system then produces antibodies against the spike protein to prevent future infection. Clinical trials showed the vaccine was 66% effective overall and 85% effective against severe disease with a single dose. It received emergency use authorization in the United States and European Union in early 2021.
Moderna's COVID-19 vaccine works by using mRNA to instruct the body to produce viral spike proteins, which train the immune system to recognize and fight the virus. The mRNA is encapsulated in lipid nanoparticles that fuse with cells, prompting them to make proteins that trigger an immune response. This involves B cells producing antibodies, T cells killing infected cells, and memory cells forming to recognize future infections. Clinical trials showed over 90% efficacy. Moderna partnered with NIH to develop the vaccine and has worked to scale up production.
The Pfizer-BioNTech COVID-19 vaccine was developed through a partnership between Pfizer and BioNTech. Clinical trials showed it to be over 90% effective in preventing COVID-19. The mRNA vaccine works by instructing cells to produce the spike protein of the SARS-CoV-2 virus, training the immune system to recognize and attack the real virus. It requires two doses administered three weeks apart to provide full protection.
DNA and RNA are both nucleic acids composed of nucleotides that contain a phosphate, sugar, and nitrogenous base. DNA has the sugar deoxyribose and bases adenine, thymine, guanine, and cytosine. RNA has the sugar ribose and replaces thymine with uracil. DNA stores genetic information in the cell nucleus while RNA assists in protein synthesis by carrying messages from DNA and joining amino acids.
The document summarizes the two-step process of protein synthesis: transcription and translation. During transcription, a gene's DNA sequence is copied into mRNA. An enzyme called RNA polymerase binds to DNA and reads its bases to build a complementary mRNA strand. This mRNA strand can then leave the nucleus. During translation, the mRNA binds to a ribosome where transfer RNA (tRNA) molecules match its base triplets and deliver the corresponding amino acids to form a protein chain. The ribosome joins the amino acids together until a full protein is synthesized.
Scientists designed the first COVID-19 vaccines by studying the coronavirus spike protein and making tweaks to stabilize its shape. They used cells to mass produce the spike protein and cryo-electron microscopes to verify its 3D structure matched the virus. Some vaccines contain the genetic instructions for the spike instead of the protein itself. With years of prior coronavirus research, scientists developed these first vaccines in record time to potentially protect billions from COVID-19.
This document provides information about how to read codon charts to determine the amino acids that correspond to mRNA sequences. It contains the following key points:
1) Codons are sequences of 3 nucleotides that code for specific amino acids. Codon charts show the relationship between mRNA codons and the amino acids they encode.
2) Examples are provided of using both rectangular and circular codon charts to determine the amino acids encoded by mRNA sequences.
3) Common mistakes like using the tRNA anticodon instead of the mRNA codon are discussed. The document emphasizes using the mRNA codon and going through the chart systematically.
DNA and RNA are both nucleic acids composed of nucleotides that contain a phosphate, sugar, and nitrogenous base. DNA has the sugar deoxyribose and bases adenine, thymine, guanine, and cytosine. RNA has the sugar ribose and replaces thymine with uracil. DNA stores genetic information in the cell nucleus while RNA assists in protein synthesis by carrying messages from DNA and joining amino acids.
Proteins are essential components of our bodies that perform a wide variety of functions. They make up about 42% of our dry body weight and are the basic building blocks of tissues like skin, tendons, muscles and bones. Proteins exist in many forms and their three-dimensional structures allow them to interact with other molecules in unique ways to perform critical roles like building tissues, catalyzing chemical reactions, transporting molecules, and fighting infections. They are constantly being broken down and rebuilt using amino acids from our diets to maintain the body's systems.
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin 🙏🤓🤔🥰
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
2. • Recent evidence has shown that adults
with
metabolic
syndrome
have
significantly higher systolic blood pressure
(SBP) than normal during childhood.
• However, it has not been welldocumented the extent to which systolic
blood
pressure
predicts
metabolic
syndrome in male adolescents.
• Early treatment of metabolic syndrome
components decreases morbidity and
mortality.
3. • The obesity epidemic has spread in
children around the world and may
lead to an increased incidence of
metabolic syndrome.
• Furthermore, some evidence suggests
that this metabolic derangement
persists into adulthood.
• Therefore, identification of children at
risk of developing metabolic syndrome
later in life can be critical in the overall
effort to reduce mortality.
4. • Blood pressure measurements tend to be
omitted in routine assessments of children.
• When it is measured, the variation of
normal BP with age can lead to missing
the diagnosis of hypertension.
• Normal ranges are :
1.
2.
3.
Prehypertensive = 90th centile to 120 mmHg
Stage 1 hypertension = 95 th centile upwards
Stage 2 hypertension = 99 th centile + 5 mmHg
5. Any reading equal to or above the readings in the simplified table indicates
potentially abnormal blood pressures in one of three ranges: prehypertension;
stage 1 hypertension; or stage 2 hypertension and identifies blood pressures that
requires additional evaluation
6. • Childhood obesity, can be
identified by high triglyceride
(TG) levels, hyperinsulinemia,
high C-reactive protein* (CRP)
level, and a family history of
hypertension or diabetes as
determinants of adult metabolic
syndrome.
_________________________________________
• *Possible mechanisms by which CRP could provide protection from
SLE. Clearance pathway: CRP binds to nuclear remnants, such as
apoptotic cells, snRNPs or altered chromatin, and then binds to FcγR
on macrophages.
• It activates complement, resulting in the binding of C1q and C3 split
products to CRs.
• This leads to improved opsonization of potential autoantigens and
the secretion of anti-inflammatory cytokines, such as IL-10 and TGFß.
7. Regulatory pathway: CRP binds to activating FcγR on macrophages, inducing the
production of inflammatory cytokines and anti-inflammatory cytokines, such as IL-10
and TGF-ß. These macrophages develop a suppressive phenotype, producing more IL10 and TGF-ß, which downregulate Th1 cells and inflammatory macrophages found in
SLE and may lead to Treg cells that provide long-term suppression in SLE. CR:
Complement receptor; CRP: C-reactive protein; FcγR: Fcγ receptor; snRNP: Small
nuclear ribonucleoprotein particle; SLE: Systemic lupus erythematosus.
8. • Regulatory pathway: CRP binds to activating
FcγR on macrophages, inducing the production
of
inflammatory
cytokines
and
antiinflammatory cytokines, such as IL-10 and TGFß.
• These macrophages develop a suppressive
phenotype, producing more IL-10 and TGF-ß,
which downregulate Th1 cells and inflammatory
macrophages found in SLE and may lead to Treg
cells that provide long-term suppression in SLE.
CR: Complement receptor; CRP: C-reactive
protein; FcγR: Fcγ receptor; snRNP: Small
nuclear ribonucleoprotein particle; SLE: Systemic
lupus erythematosus
9. • During childhood, the adults with
metabolic syndrome had significantly
higher systolic blood pressure (SBP)
than that of normal adults at that age.
• Researchers from Japan showed that
elevated SBP in obese children is
associated with hyperinsulinemia and
visceral fat accumulation regardless of
family history of hypertension.
10. • The cause of hypertension in Metabolic
Syndrome is multifactorial and likely
includes all the elements of the syndrome,
including obesity, insulin resistance, and
dyslipidemia.
• Obesity may be the most important factor,
however, the other elements of the
syndrome also play a role in creating and
mediating the changes that ultimately
result in hypertension
11. • However, the potential of SBP in male
adolescents to predict the incidence of
metabolic syndrome later in life remains
unknown.
• Therefore SBP in male adolescents is an
independent predictor for metabolic syndrome
in male adolescents and could be included in
routine metabolic risk assessment.
12.
13.
14. • Taller children have slightly higher average
BPs. Centile values shown are for 50th height
centile: average BPs vary by ± 3-5mmHg for
5th 95th height centiles (so range typically
varies 6-10mmHg for height at any age).
15. Proposals of Definition of Metabolic
Syndromein Children and Adolescents
• The first proposal of definition was published in 2003.
• It was elaborated by assessing adolescents from 12 to
19 years old using modified criteria, based on the
criteria
of
NCEP/ATP-III,
including
abdominal
circumference over percentile 90, blood pressure over
the limits established by the National Blood Pressure
Education Program, lipids over the limits established
by the National Cholesterol
• Education Program for children, and glycemia over the
• values for adults.
• The general prevalence found in this population of 1219 years old patients was 4.2%, and when only obese
patients over the percentile 95 were considered, the
prevalence was 28.7% .
16. • The second proposal of definition is very
similar to the previous one, but the cut
offs were inferior regarding abdominal
circumference and lipid profile.
• Thus, prevalence is higher (when
considering patients with BMI percentile
adjusted over the percentile 85.
17. • The third proposal chose BMI to serve
as a base, justifying that it would be
less dependent on ethnical variations –
It should be aware that abdominal
circumference may vary according to
the race.
• The prevalence in moderately obese
patients (considering those who had Z
of 2 and 2.5) and in severe obese
patients (with Z over 2.5 of pattern
deviations (Table 1).
18. • The most appropriate definition that
include SBD that is the proposed by the
IDF.
• It divided children into age groups.
• There was not a well defined proposal for
children under
• 6 years of age, due to the lack of data.
• Differently from the criteria presented
above, in this proposal, for a matter of
convenience, the cut-offs were fixed for
pressure, lipids and glycaemia, and
abdominal circumference points were
assessed by percentile.
19. • In children aged 6-10, the cut-offs of
metabolic and blood pressure variables were
not well defined, assessing simply adiposity
(considering abdominal circumference over
the 90 percentile).
• The same criteria would be used for children
aged 10-16; regarding glycemic metabolism,
1. Fasting glycaemia ≥100 mg/ dL,
2. Triglycerides ≥150 mg/ dL,
3. HDL cholesterol below 40 mg/ dL or
using a hypolipemiant drug, and blood
pressure limits ≥130 or ≥85 mmHg or
using a antihypertensive drug.
20. • If the patient had altered abdominal circumference
and two more factors, the metabolic syndrome
diagnosis would be
• established.
• The difference is that, for adolescents over 16
• years of age, there is a differentiation between
HDL ≤40 for men and ≤50 for women (Table 2)
• Thus, discussions and doubts exist about which
criterion to use.
• Evidently, the IDF criterion, though more
convenient, could fail to include some children in
the diagnosis of Metabolic Syndrome.
• On the other hand, it would be of easier acceptance
as it does not use multiple tables to assess several
anthropometric and metabolic criteria.
21.
22. Blood Pressure Levels for the 50th, 90th, 95th and 99th Percentiles of Systolic and Diastolic
Blood Pressure by Percentiles of Height in Boys and Girls of Age 3 to 18 years
23.
24.
25.
26. The Relation between blood
pressure and Metabolic syndrome
• Several epidemiologic studies have shown that
obesity represents an independent risk factor
for the development of cardiovascular
diseases, including hypertension, myocardial
ischemic disease, and cardiac arrhythmias.
One of the most appealing concepts in obesityrelated hypertension is that a specific etiology
can be identified. There is now substantial
evidence that human obesity is characterized
by abnormalities in sympathetic cardiovascular
control.
27. • The application of sensitive techniques to
assess sympathetic nervous system (SNS)
activity in humans, including catecholamine
levels, norepinephrine (NE) spill over
techniques, and microneurography have
furthered this concept.
• Catecholamine levels in obesity have been
conflicting, with high, normal, and low levels
reported.
• However, studies examining weight loss have
found that the fall in blood pressure (BP) was
highly correlated with reductions in plasma
NE.
28. • Examination of NE spill over in obesity has
shown regional over activity in the kidneys.
• High renal SNS activity could lead to
sodium retention and abnormal glomerular
hemodynamic that could raise BP.
• Microneurography,
which
determines
muscle sympathetic outflow, has shown
consistent elevation in obesity, but no
difference between normotensive and
hypertensive obesity.
29. • However, the hyperinsulinemia of obesity
may act in concert with the SNS to elevate
BP, as the combination of the two seems
to produce vascular constriction.
• Leptin also has several cardiovascular
actions that may contribute to BP
regulation.
• Epidemiologic studies also found that SNS
activity predicts hypertension in obese
subjects
30. • The Insulin Resistance Atherosclerosis
Study, a large prospective study, set out to
determine the association between insulin
sensitivity
and
risk
factors
for
cardiovascular disease.
• There is an 11% lower risk of developing
incident hypertension with every one unit
greater of insulin sensitivity measured by
the frequently sampled intravenous glucose
tolerance test (FSIGT).
• The association between in insulin
resistance and hypertension relates to
several different mechanisms.
31. • Insulin is a vasodilator when given IV to
persons of normal weight and also increases
renal sodium reabsorption .
• The cellular mechanisms of vascular smooth
muscle contraction may be altered in insulin
resistance.
• Normally, insulin has been shown to reduce
intracellular calcium ions by inhibiting the
voltage operated channel and by activating Ca
ATPase resulting in the efflux of Ca ions from
the cell, thus decreasing cytosolic Ca ions and
decreasing vascular resistance.
• In the environment of insulin resistance, this
vasodilatory effect is lost whereas the sodium
reabsorption is preserved.
32. • In addition, angiotensinogen, angiotensin
converting enzyme and angiotensin type 1
receptors are present within human adipose tissue.
Studies suggest that the regulation of the adipose
renin-angiotensin system is correlated with the
degree of obesity and that angiotensin II may
modulate adipose tissue blood flow, growth and
metabolism. Thus, an up regulated adipose reninangiotensin system may contribute to insulin
resistance and hypertension in obese individuals
(Prasad & Quyyumi, 2004, p.1509).
33. • In addition, angiotensinogen, angiotensin
converting enzyme and angiotensin type 1
receptors are present within human adipose
tissue.
• Studies suggest that the regulation of the
adipose renin-angiotensin system is correlated
with the degree of obesity and that angiotensin
II may modulate adipose tissue blood flow,
growth and metabolism.
• Thus, an up regulated adipose reninangiotensin system may contribute to insulin
resistance and hypertension in obese
individuals.
34. • Several studies suggest that angiotensin II
may modulate the actions of insulin.
• Insulin and the renin-angiotensin system
share the P13 kinase and MAP kinase
signaling
pathways
and
tyrosine
phosphorylation of the insulin receptor
substrate 1 (IRS1) and substrate 2 (IRS2).
• Insulin receptor mediated activation of
IRS1 and IRS2 activates the P13 kinase
pathways where the angiotensin II mediated
activation inhibits the P13 kinase pathway.
35. • When activated, the renin-angiotensin
system may inhibit the metabolic actions of
insulin but promote the mitogenic actions of
the MAP kinase pathway.
• Further, both hyperglycemia and insulin
activate the renin-angiotensin system by
increasing
the
expression
of
angiotensinogen, angiotensin II and the
angiotensin I receptor which may contribute
to the development of hypertension in
patients with insulin resistance.
36.
37.
38. • There is also evidence that insulin resistance
and hyperinsulinemia lead to SNS
activation, which may contribute to the
pathogenesis of hypertension.
• As a result of sympathetic activation, the
kidneys increase sodium reabsorption, the
heart increases cardiac output, and the
arteries respond with vasoconstriction
resulting in hypertension