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Obesity Metabolic Syndrome
1. Obesity is defined as a BMI of 30 kg/m2 or higher and is a growing global problem affecting over 1.7 billion people worldwide. 2. Factors that contribute to obesity include increased caloric intake, decreased energy expenditure, genetics, and behavioral/cultural influences. 3. Medical complications of obesity include increased risk of heart disease, stroke, diabetes, cancers, and other serious diseases. Losing weight can significantly improve health outcomes.
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Obesity Metabolic Syndrome
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- 2. Sponsored Medical Lecture Notes– All Subjects USMLE Exam (America) – Practice
- 3. 3 Definition • A BMIof 25.0 to 29.9 kg per m2 is defined as overweight; • a BMI of 30.0 kg per m2 or more is defined as obesity.
- 4. 4 Historical Perspective Paleolithic Era> 25,000 years ago
- 5. 5 Obesity - HowBig A Problem… • 1.7 billion worldwide are overweight or obese • The US has the highest percentage of obese people. • By 2012, only four states had a prevalence of obesity less than 35%. And the numbers are growing…
- 7. 7 Epidemiology of Obesity •31.3% of U.S. males 34.7% of U.S. females • 30% increase in the last 10 years obesity • (BMI 40) has also increased and affects 4.7% of the population. • It is predicted that in 2045 the number of obese OSB is 1 2 populations • Health care costs - >$100 billion/year • Results in 300,000 preventable deaths each year in the U.S.
- 9. Body Mass Index(BMI) • the most • widely used method to gauge obesity is the Body Massindex (BMI) (in kg/m2), • which is equal to weight height 2
- 10. A circumference of waistis the mediated index of amount of visceral fat, or abdominal obesity. Чоловіки >102 см. > 94 сm Жінки >88 см> 80cm
- 11. 11 Obesity and LifeExpectancy If current rates of obesity are left unchecked, the current generation of American children will be the first in two centuries to have a shorter life expectancy than their parents. Olshansky SJ, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. NEJM, 352(11):1138- 1145, 2005
- 12. 12 Classification of Overweight andObesity BMIBMI ClassificationClassification <18.5 Underweight – 18.5-24.9 Normal weight – 25-29.9 Overweight – 30-34.9 Obesity Class I – 35-39.9 Obesity Class II – 40-49.9 Obesity Class III – 50 and above Super Obesity
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- 14. 14 What causes Obesity? •Nutrient and Energy model of obesity: Metabolism Appetite regulation Energy expenditure Genetics Behavioral and cultural factors
- 15. 15 Contributors to weightgain • Socio-economic status • Smoking cessation • Hormonal • Inactivity • Psychosocial/emotions • Medications
- 17. 17 Medical Complications of Obesity Pulmonarydisease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Gall bladder disease Gynecologic abnormalities abnormal menses infertility PCOS Osteoarthritis Gout Phlebitis venous stasis Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Severe pancreatitis CHD Diabetes Dyslipidemia Hypertension Cataracts Stroke
- 18. 18 Nutrient and Energy Modelof Obesity Obesity results from increased intake of energy or decreased expenditure of energy, as required by the first law of thermodynamics. EnergyEnergy IntakeIntake AdiposeAdipose tissuetissue EnergyEnergy ExpenditureExpenditure
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- 20. Central controllers of appetite Increase factors NPY MCH AgRP Orexin Endocan nabinoid Decrease factors α-MSH CART GLP-1 Serotonin Psychological factors Neural afferents (vagal) Gutpeptides CCK, PYY Ghrelin Metabolites Glucose Ketones Hormones Leptin Insulin Cortisol Cultural factors NPY, neuropeptide Y; MCH, melanin-concentrating hormone; AgRP, Agouti-related peptide; MSH, melanocyte-stimulating hormone; CART, cocaine- and amphetamine-related transcript; GLP-1, glucagon-related peptide-1; CCK, cholecystokinin.
- 21. Signals that impingeon the hypothalamic center include neural afferents, hormones, and metabolites. Vagal inputs are particularly important, bringing information from viscera, such as gut distention. Hormonal signals include leptin, insulin, cortisol, and gut peptides. Among the latter are ghrelin, which is made in the stomach and stimulates feeding, and peptidemass increases by enlargement of adipose cells through lipid deposition, as well as by an increase in the number Appetite is influenced by many factors that are integrated by the brain, most importantly within the hypothalamus
- 22. The growth ofadipose tissue • The process by which adipose cells are derived from a mesenchymal preadipocyte involves an orchestrated series of differentiation steps mediated by a cascade of specific transcription factors. One of the key transcription factors is peroxisome proliferator-activated receptor (PPAR-),
- 24. • The factthat intraabdominal adipocytes are more lipolytically active than those from other depots. • Release of free fatty acids into the portal circulation has adverse metabolic actions, especially on the liver. • The adipokines and cytokines secreted by visceral adipocytes play an additional role in systemic complications of obesity The growth of adipose tissue
- 25. 1970 1980 19902000 2013
- 26. The adipocyte isan endocrine cell that releases numerous regulated molecules • These include the energy balance-regulating hormone leptin, cytokines such as tumor necrosis factor (TNF)and interleukin (IL)-6, complement factors such as factor D (also known as adipsin), prothrombotic agents such as plasminogen activator inhibitor I, and a component of the blood pressure regulating system, angiotensinogen. • Adiponectin, an abundant adipose-derived protein whose levels are reduced in obesity, enhances insulin sensitivity and lipid oxidation and it has vascular protective effects, • whereas resistin and RBP4, whose levels are increased in obesity, may induce insulin resistance. These factors, and others not yet identified, play a role in the physiology oflipid homeostasis, insulin sensitivity, blood pressure control, coagulation, and vascular health, and are likely to contributeto obesity-related pathologies.
- 27. Function adypotcyts Adipocyte Others PAI-1 Angiotensinogen RBP4 Complement factors FactorD/adipsin Enzymes Aromatase 11-HSD-1 Substrates Free fatty acids Glycerol Cytokines TFN- IL-6 Hormones Leptin Adiponectin Adipocyte Resistin
- 28. 28 Leptin • A majorregulator of adaptive responses is the adipocytederived hormone leptin, which acts through brain circuits (predominantly in the hypothalamus) to influence appetite, energy expenditure, and neuroendocrine function The peptide leptin, a name derived from the Greek root leptos, meaning thin. • Protein hormone produced by fat cells. • Experiment: Leptin deficient mice: Hyperphasic Insulin resistant Infertile • Leptin administration reversed all the symptoms.
- 29. Energy expenditure includes thefollowing components: (1) resting or basal metabolic rate; (2) the energy cost of metabolizing and storing food; (3) the thermic effect of exercise; (4)adaptive thermogenesis, which varies in response to chronic caloric intake Basal metabolic rate accounts for ~70% of daily energy expenditure, whereas active physical activity contributes 5–10%. Thus, a significant component of daily energy consumption is fixed.
- 30. Adaptive thermogenesis occurs inbrown adipose tissue (BAT), which plays an important role in energy metabolism in many mammals. In contrast to white adipose tissue(WAT), which is used to store energy in the form of lipids, BAT expends stored energy as heat. A mitochondrial uncoupling protein (UCP-1) in BAT dissipates the hydrogen ion gradient in the oxidative respiration chain and releases energy as heat. The metabolic activity of BAT is increased by a central action of leptin, acting through the sympathetic nervous system, which heavily innervates this tissue.
- 31. Metabolic Syndrome X? Syndrome("New World") Insulin dependent diabetes mellitus (or breach of tolerance to carbohydrates) and insuli resistance Obesity (in android type) Dyslipidemia Coronary Artery Disease hypertension Microalbuminuria Hiperurikemiya Hiperleptynemiya and resistance to leptin Violation of blood rheology
- 32. Insulin Resistance andType 2 Diabetes Mellitus • Hyperinsulinemia and insulin resistance are pervasive features of obesity, • Insulin resistance is more strongly linked to intraabdominal fat than to fat in other depots.
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- 34. Determination of insulinresistance (IR)? (Formula HOMA) rate - 59 – 161 insulin resistance - below 59% Defining the function of beta cell 20 x insulin x 100 % (glucose - 3.5) rate - 70 -150 below 70% - a decline of beta-cell function IP = (insulin) x (glucose) Х 100% 22,5
- 35. How to determinethe type of distribution of adipose tissue? IVH = CV (sм) СH capacity waist, - measured by the smallest circumference below the rib cage on the navel capacity hips - for the largest circumference at the buttocks Diagnostic value of the IVT 0,8 – 0,9 An intermediate type of distribution of adipose tissue < 0,8 Hinoid (peripheral) type distribution of adipose tissue > 0,9 m > 0,85 F Android (abdominal, visceral, central) type distribution of adipose tissue
- 36. Treatment of metabolic syndromeX Weight loss Increased physical activity Treatment of hypertension Antyhiperhlikemichna therapy aspirin lipid-lowering therapy
- 37. The criteria forcompensation of carbohydrate metabolism in patients with type 2 diabetes (WHO, 1998) Indicators norm risk makroanhio patiy risk microangio pathies Glycated hemoglobin HbAlc (%) < 6,5 >6,5 >7,5 Capillary blood glucose (mmol) After fasting food within 2 hours (peak) < 5,5 < 7,5 > 5,5 > 7,5 > 6,1 > 9,0
- 38. How activation ofPPAR γ enhances the action of insulin and normalizes blood glucose levels?increased differentiation preadipotcytes adipocytesadipocytes PPAR γ AvandiyaAvandiya and insulinand insulin liver Decrease formation of glucose in the liver EuhlykemiyaEuhlykemiya Reduced lipolysis and circulating free fatty acids ↑insulin sensitivity and the capacity for glucose disposal / deposition of lipids Skeletal muscleSkeletal muscle PPAR γγ
- 39. Hyperglyce mia Blood glucose after meals ↓Acarbose ↓Metformin Capture glucose Metformin Rozihlitazon Synthesis of glucose Metformin Rozihlitazon insulin secretion Rozihlitazon sulfonyl urea repaglinide
- 40. Cancer • Obesity inmales is associated with higher mortalityfrom cancer, including cancer of the esophagus, colon,rectum, pancreas, liver, and prostate; obesity in females isassociated with higher mortality from cancer of the allbladder,bile ducts, breasts, endometrium, cervix, andovaries. • Some of the latter may be due to increased ratesof conversion of androstenedione to estrone in adiposetissue of obese individuals. • It was recently estimated that obesity accounts for 14% of cancer
- 41. Bone, Joint, andCutaneous Disease Obesity is associated with an increased risk of osteoarthritis, no doubt partly due to the trauma of added weight bearing and joint malalignment. The prevalence of gout may also be increased. Among the skin problems associated with obesity is acanthosis nigricans, manifested by darkening and thickening of the skin folds on the neck, elbows, and dorsal interphalangeal spaces. Acanthosis reflects the severity ofunderlying insulin resistance and diminishes with weight loss. Friability of skin may be increased, especially in skin folds, enhancing the risk of fungal and yeast infections Finally, venous stasis is increased in the obese.
- 42. Pulmonary Disease • Obesitymay be associated with a number of pulmonary abnormalities. • These include reduced chest wall compliance, increased work of breathing, increased minute ventilation due to increased metabolic rate, and decreased functional residual capacity and expiratory reserve volume. Severe obesity may be associated with obstructive sleep apnea and the “obesity hypoventilation syndrome” with attenuated hypoxic and hypercapnic ventilatory responses. Sleep apnea can be obstructive (most common), central, or mixed and is associated with hypertension.
- 43. Reproductive Disorders Disorders thataffect the reproductive axis are associated with obesity in both men and women. Male hypogonadism is associated with increased adipose tissue, often distributed in a pattern more typical of females. In men >160% ideal body weight, plasma testosterone and sex hormone-binding globulin (SHBG) are often reduced, and estrogen levels (derived from conversion of adrenal androgens in adipose tissue) are increased. Gynecomastia may be seen. Obesity has long been associated with menstrual abnormalities in women, particularly in women with upper body obesity. Common findings are increased androgenproduction, decreased SHBG, and increased peripheral conversion of androgen to estrogen. Most obese women with oligomenorrhea have the polycystic ovarian syndrome (PCOS), with its associated anovulation and ovarian hyperandro genism; 40% of women with PCOS are obese.
- 44. Cardiovascular Disease • Obesity,especially abdominal obesity, is associated with an atherogenic lipid profile; with increased low-density lipoprotein (LDL)cholesterol, very low density lipoprotein, and triglyceride;and with decreased high-density lipoprotein cholesterol and decreased levels of the vascular protectiveadipokine adiponectin. • Obesity is also associated with hypertension. Measurement of blood pressure in theobese requires use of a larger cuff size to avoid artifactual increases. • Obesity-induced hypertension is associated with increased peripheral resistance and cardiac output, increased sympathetic nervous system tone, increased salt sensitivity, and insulin- mediated salt retention; it is often responsive to modest weight loss.
- 45. AteroselerozAteroseleroz A chronic, focallesions of the arteries characterized by accumulation in the inner wall of arteries apoproteyin-B-containing lipoproteins and cholesterol, reactive growth of connective tissue with the formation of fibrous plaques and their rupture, thrombosis, calcification.
- 47. Адаптовано з E.Topol.Atlas of Atherothrombosis.- 2005 Consequences of obliterating atherosclerosis of the lower extremities.
- 48. What Is Cholesterol? •We may associate cholesterol with fatty foods, but most of the waxy substance is made by our own bodies. • The liver produces 75% of the cholesterol that circulates in our blood. • The other 25% comes from food. • At normal levels, cholesterol actually plays an important role in helping cells do their jobs. But cholesterol levels are precariously high in more than 100 million Americans.
- 49. Symptoms of HighCholesterol • High cholesterol does not cause any symptoms. But it does cause damage deep within the body. • Over time, too much cholesterol may lead to a buildup of plaque inside the arteries. Known as atherosclerosis, this condition narrows the space available for blood flow and can trigger heart disease. • The good news is high cholesterol is simple to detect, and there are many ways to bring it down.
- 50. Cholesterol Most of thecholesterol in the blood is carried by proteins called low density ipoproteins or LDL. This is known as the bad cholesterol because it combines with other substances to clog the arteries.
- 51. 'Good' Cholesterol Up toa third of blood cholesterol is carried by high-density lipoproteins or HDL. This is called good cholesterol because it helps remove bad cholesterol, preventing it from building up inside the arteries. The higher the level of HDL cholesterol, the better. People with too little are more likely to develop heart disease. Eating healthy fats, such as olive oil, may help boost HDL cholesterol.
- 52. Triglycerides The body convertsexcess calories, sugar, and alcohol into triglycerides, a type of fat that is carried in the blood and stored in fat cells throughout the body. People who are overweight, inactive, smokers, or heavy drinkers tend to have high triglycerides, as do those who eat a very high-carb diet. A triglycerides score of 150 or higher puts you at risk for metabolic syndrome, which is linked to heart disease and diabetes.
- 53. Normally: cholesterol plasma 5.2mmol / l, triacylglycerol - 2.3 mmol / l, beta-lipoprotein - 6000 mg / l. Land Surveying basic level of blood lipids: total cholesterol - 5,2-6,2 mmol / l, triacylglycerol - 2,3-4,5 mmol / l. Elevated levels of major blood lipids: total cholesterol -> 6.3 mmol / l, triacylglycerol -> 4.5 mmol / l. Атеросклероз
- 54. 500432210 The relative size, nm Exogenous tryatsyl- glycerol Endogenous triacylglycerol cholester olesters cholestero l esters Lipids core В-48, Сs, Е, А-І, А-ІІ В-100, Cs, Е В-100А-І, А-ІІ, Е, Cs lipoproteins chylomicronsLPVLDLPLDLPHD Major classes of lipoproteins XM and VLDL - vehicles for transfer to tissue triacylglycerol, and LDL – for carrying cholesterol to tissues, HDL - are responsible for reverse cholesterol transport (for textiles). Fraction LPVH3 more active for reverse cholesterol transport of tissues.
- 55. Cholesterol in Food Cholesterol-richfoods, like eggs, shrimp, and lobster are no longer completely forbidden. Research shows that the cholesterol we eat has only a small effect on blood cholesterol levels for most people. Daily cholesterol limits are 300 mg for healthy people and 200 mg for those at higher risk. One egg has 186 mg of cholesterol.
- 56. Drugs with predominanteffect on plasma total cholesterol and low density lipoprotein cholesterol: - Inhibitors of HMG-CoA reductase; - Bile acid sequestrants; - Probucol. II. Drugs with predominant effect on the level of plasma tryatsylahlitseryniv tryatsylahlitseryniv and very low density lipoproteins - Fibrates; - Nicotinic acid; - Polyunsaturated omega-3 fatty acids - eykozopentayenova and dokozoheksayenova; maksepa. Атеросклероз Lipid lowering agents. Lipid-lowering drugs should be taken for patients with life-time detection of lipid metabolism. It is imperative that lipid-lowering agents, lowering levels of LDL and VLDL in the blood, reduced to, and better yet, improved antiatherogenic HDL levels.
- 57. Lipid lowering agents Statins– inhibitors HMG-CoA reductase reduction of intracellular cholesterol concentration leads to an increase / restore function of cell receptors for LDL, LDL cholesterol decreased by 25-40%, triglycerides - by 10-40%, and HDL - increased by 5-15%. Lovastatin and Simvastatin - lipophilic Pravastatin and Fluvastatin - hydrophilic Lovastatin - taken from the fungus Aspergillus terrus natural C Atorvastatin - active in the initial state Natural statins are only in the liver and peripheral tissues reach
- 58. VII NATIONAL CONGRESSOF CARDIOLOGY UKRAINE Dose dependency: 10 mg - small doses 20-40 mg - average dose 80-100 mg - high doses Effective average doses of statins! Therapeutic Cascade statins: The first level of the therapeutic cascade: the earliest action (weeks / months) → improved endothelial function, reduced vascular inflammation processes - the stabilization of atherosclerotic plaques (vasodilation, "shrinkage") The second level of the therapeutic cascade: stop the progression of the old plaques and the appearance of new, existing regression (30%!) The third level of therapeutic cascade: reached c / o 4 years or more since the beginning of the application, to 18-30% reduced cardiac and total mortality • The fourth level of therapeutic cascade: a beneficial effect on nekardialnu pathology - a 30% lower incidence of diabetes, Alzheimer's disease, vascular dementia
- 59. Вихідний 6 місяців12 місяців Вихідний 6 місяців 12 місяців 12 місяцівВихідний 6 місяців Results 12 month statin therapyResults 12 month statin therapy T2-weighted magnetic resonance imaging (MRI)T2-weighted magnetic resonance imaging (MRI)
- 60. Атеросклероз Fibrates. • Practical significance clofibrate,fenofibrate (lipantyn) gemfibrozil, ufibrat. Fibrates increase the activity of lipoprotein lipase and thus accelerate the catabolism of VLDL, increase the synthesis of LDL receptors, inhibit the formation of VLDL in the liver. In type III HLP, they are the drugs of choice. Fibrates are used in daily doses of 300-400 mg to 2 g • May cause gastrointestinal tract, myositis, hepatitis, cholelithiasis.The most common stones formed in the gallbladder when using clofibrate.
- 61. - contain omega-3and omega-eykozopentayenovu 3 dokozoheksayenovu acid. taken at a daily dose of 2-3 g, which reduces the formation of VLDL in the liver and to a reduction of this class of lipoproteins in patients with type IV and V HLP. inhibit platelet aggregation, improve blood rheology. The preparation of fish oil has proven to be an effective mullion when combined hipertryatsylhlitsernemiyi with hypercholesterolemia (type IIb HLP). Атеросклероз Products of unsaturated fatty acids
- 62. 63 Consequences of Obesity Hippocrates recognized that: “sudden death is more common in those who are naturally fat than in lean.”
- 63. 64 Treating Obesity • Measureheight and weight (BMI) • Calculate waist circumference • Assess comorbidities • What labs does the patient need? • Is the patient ready and motivated enough to loose weight? • Which diet should you recommend? • Discuss a physical activity goal
- 65. 66 Weight Loss Strategies •Diet therapy • Increased Physical Activity • Pharmacotherapy • Behavioral Therapy • Surgery • Any combination of the above
- 66. 67 Rate Of WeightLoss • A realistic goal is from 5% to 15% from baseline in 6 months of obesity treatment. • Weight should be lost at the rate of 1-2 lbs per week, based on the caloric deficit between 500- 1000 Kcal/day.
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- 68. 69 Dieting • Dieting ishighly ineffective - 95% long term failure rate • Often results in higher weight than before the diet
- 69. WHAT AND HOWOFTENWHAT AND HOW OFTEN You can eat in atherosclerosis?You can eat in atherosclerosis? Meat - up to three times a week. Low-fat cheese, meat and fish pies - once a week. Homemade cakes, cookies or cakes, dress-ted using margarine or oil – twice a week. Potato chips or potatoes, fried in butter – once every two weeks.
- 70. 71 Principles Of Dieting •Women should consume atleast 1200 kcal/day, men 1500 kcal/day. • Select a diet that has: >75g/day proteins (15% of total calories) > 55% total calories from carbs ▪ Fat should contribute 30% or less of total calories Atleast 3 meals/day. High fiber (20-30g/day), fruits and vegetables. Supplement the diet with multivitamis and minerals. Avoid sugar containing beverages and fat spreads.
- 71. What about allthe diets that are out there? How much does a diet • Weight Watchers ($13 registration fee, $15 weekly fee) • Jenny Craig (consultation $200-370, $65 meals/week) • Tops Club ($20/week) • Nutrisystem.com ($50/week) Atkins Diet 72
- 73. Medications A) Serotonin Nor-epinephrineReuptake Inhibitor: reduces food intake. Sibutramine: initial dose 10mg/day, max 20mg/day. B) Orlistat: Lipase inhibitor. Alters metabolism, dec absorption of dietary fat. 120mg PO TID 74
- 74. Surgery • Roux-en-Y gastricbypass. • Lap band procedure Criteria: a) BMI > 40 or >35 with 2 comorbidities. b) Failure of non surgical methods c) Presence of 2 or more medical conditions that would benefit with weight loss. 75
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Editor's Notes
- #4 In 1997, the International Obesity Task Force,10 convened by the World Health Organization (WHO), recommended a standard classification of adult overweight and obesity
- #5 Paleolithic: the first period in the development of human technology of the Stone Age
- #6 Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. According to the U.S. surgeon general, approximately 25 percent of American adults are completely sedentary, and more than 60 percent are not regularly active at the recommended level of 30 minutes per day.5 About 14 percent of young people between 12 and 21 years of age report no recent physical activity. Nearly one half of young persons between these ages are not vigorously active. An estimated 300,000 preventable deaths occur each year in the United States because of unhealthy diet and physical inactivity,6 which are known contributors to obesity.
- #13 Presently, there is no precise clinical definition of obesity based on the degree of excess body fat that places an individual at increased health risk. General consensus exists for an indirect measure of body fatness, called the weight-for-height index or body mass index (BMI). The BMI is an easily obtained and reliable measurement for overweight and obesity and is defined as a person&apos;s weight (in kilograms) divided by the square of the person&apos;s height (in meters) Other Measurements Waist Circumference &gt;35 inches in women or 40 inches in men indicates hazardous fat distribution Waist/Hip Ratios &gt;0.8 indicates hazardous fat distribution
- #15 The search for genetic factors involved in obesity should not obscure the truth that the environmental factors probably more important.
- #16 In most cases, however, the increasing prevalence of overweight and obesity reflects changes in society and behaviors over the past 20 to 30 years. Lifestyle patterns are influenced by an overabundance of energy-dense food choices and decreased opportunities and motivation for physical activity. Loss of ovarian function results in: Reduced resting metabolic rate Reduced muscle mass Increased fat mass Increased accumulation of abdominal adipose tissue
- #18 Waist circumference measurements greater than 40 inches (102 cm) in men and 35 inches (89 cm) in women also indicate an increased risk of obesity-related comorbidities.
- #19 Excess body fat results from an imbalance of energy intake and energy expenditure (total energy expenditure includes energy expended at rest, in physical activity and for metabolism)
- #29 Leptin, a hormone secreted by fat cells that was discovered in 1994, was found to not only control food intake, but also to impact other functions that are affected by energy balance which could relate to obesity. High leptin levels trigger growth and readiness for reproduction. Research has shown that overweight individuals have high concentrations of leptin in the blood, indicating that these individuals do not respond to leptin by reducing food intake. Furthermore, endocrine research has found that obese patients respond poorly to leptin, suggesting the presence of leptin resistance.
- #34 The recent increases in the prevalence of overweight and obesity are reflected across all ages, racial and ethnic groups, and education levels in the U.S. In reviewing the following three charts, for instance, one can see that the “average” American categorized under obesity is aged 50-59, Black/non-Hispanic with less than a high school diploma
- #60 Figure 6.23. The effects of cholesterol lowering can be measured in humans by magnetic resonance imaging (MRI). In this study, statin effects are significant after 12 months both in aorta (left plots, lower pictures) and carotid arteries (right plots), by reducing plaque burden (assessed by the vessel wall area and thickness) but not the lumen area, as in a reverse Glagov effect. Reproduced with permission from (63]. Рисунок 6.23. Эффекты понизить холестерина могут быть измерены в humans магнитным изображением резонанса (MRI). В этом изучении, эффекты statin существенны после 12 месяцев как в аорте (левые планы, низшие картины), так и артерии (правильные планы) сонной артерии, сокращая груз (оцененный областью стены сосуда и толщиной) настенной тарелки, но область люмена, как в обратном эффекте Glagov. Воспроизведенный с разрешения от (63].
- #64 A 100 kg woman is at the same risk for coronary artery heart disease as a woman who smokes 1 ppd 40% of coronary artery disease is attributed to being overweight
- #65 Waist circumference should be measured at a level midway between the lower rib margin and iliac crest with the tape all around the body in horizontal position
- #69 No. 1 = Germany (58% of the population) No. 2 = United States of Amerika (57%) No. 3 = Australia (56%)
- #77 The Roux-en-Y gastric bypass procedure involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.