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3. Mondays > 302 Gut hormones and Obesity > Flashcards

302 Gut hormones and Obesity Flashcards

1
Q

In what ways does obesity harm health?

A

-Heart disease
-Stroke
-Cancer
-Liver disease
-Reproductive complications
-Depression and anxiety
-Asthma
-Type 2 diabetes
-Osteoarthritis
-Back pain
-Sleep apnoea

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2
Q

What within the body plays a role in metabolic adaptation?

A

-Decreased energy expenditure
-Thyroid hormones
-Testosterone
-Cortisol
-Gut hormones
-Leptin

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3
Q

What is the function of gut hormones?

A

-Key regulators of bodyweight
-Act on homeostatic and hedonic brain circuits to modify eating behaviour

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4
Q

What is the function of hedonic pathways?

A

Related to pleasant sensations
-They’re cortical brain areas that process external sensory info like reward cognition and executive functions

They interact with homeostatic signals to regulate body weight influenced by environmental conditions

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5
Q

Which types of cells sense nutrients?

A

EEC

Enteroendocrine cells
-They release gut hormones as autocrine, paracrine, and endocrine regulators

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6
Q

Where are EC (enterochromaffin) cells found?

A

In the stomach, small and large intestine

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7
Q

Where are L cells found?

A

In the distal small intestine and colon

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8
Q

Where are K cells found?

A

In the proximal small intestine

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9
Q

Where are I cells found?

A

In the proximal small intestine

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10
Q

Where are D cells found?

A

In the stomach (gastric corpus and antrum), and small intestine

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11
Q

Where are G cells found?

A

In the stomach (antrum) and duodenum

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12
Q

Where are A (X-like) cells found?

A

Mainly in the stomach

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13
Q

Which gut hormones do L cells respond to?

A

GLP-1
GLP-2
PYY5-HT

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14
Q

Which gut hormones do EC cells respond to?

A

5-HT

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15
Q

Which gut hormones do K cells respond to?

A

GIP
5-HT

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16
Q

Which gut hormones do I cells respond to?

A

CCK
5-HT

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17
Q

Which gut hormones do D cells respond to?

A

Somatostatin

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18
Q

Which gut hormones do G cells respond to?

A

Gastrin

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19
Q

Which gut hormones do A (X-like) cells respond to?

A

Ghrelin

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20
Q

Name some appetite supressing (anorexigenic) substances in the gut

A

-Peptide YY 36 (PYY)
-Glucagon-like peptide 1(GLP-1)
-Oxyntomodulin (OXM)
-Cholecystokinin (CCK)
-Glucose-dependent insulinotropic polypeptide (GIP)
-Bile acids
-Neurostatin
-Uroguanylin
-Gastric leptin
-Amylin
-FGF19

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21
Q

Name some appetite inducing (orexigenic) substances in the gut

A

Ghrelin

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22
Q

What is the function of the Arcuate nucleus?

A

A part of the hypothalamus that integrates circulating signals of hunger and satiety reflecting energy stores and nutrient availability

-‘Accelerator’ neurones produce NPY that stimulate feeding and blocks neuronal melanocortin receptors by producing agouti-related peptide (AgRP)
-‘Brake’ neurones produce melanocortin peptides that inhibit eating

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23
Q

What is NPY?

A

Neuropeptide Y

It stimulates food intake

24
Q

Which long term regulators are released proportionate to the fat storage of the body?

A

Insulin and Leptin

They have sustained inhibitory effects of food intake while increasing energy expenditure

25
Q

What is the function of short term regulators of food intake?

A

They mark the onset and termination of eating

26
Q

What is the function of ghrelin?

A

It stimulates appetite by activating NPY/AgRP expressing neurones

It rises quickly when stomach is empty and fall rapidly when food is consumed

27
Q

What is the function of Cholecystokinin?

A

It’s released during eating to promote the sense of fullness that encourages an end to the meal

28
Q

What is the function of PYY (Neuropeptide Y)?

A

It decreases food intake by inhibiting gut motility

It’s released before nutrients arrive in the lower small intestine and the colon. Further release is stimulated by nutrients within the lower small intestine and the colon

It remains high in the blood before meals and has more central effects

29
Q

What is the function of Glucagon-like peptide-1 (GLP-1)?

A

It stimulates insulin secretion and inhibits glucagon secretion

30
Q

Where is GLP-1 produced?

A

In EEC-L cells and certain neurones within the nucleus of the solitary tract in the brainstem

31
Q

What are incretins?

A

A type of gut hormones

They regulate how much insulin is secreted after eating

32
Q

What is the function of DPP-4 enzymes?

A

It inactivates incretins

33
Q

What are GLP-1 receptor agonists for?

A

Medications used to treat diabetes T2 and obesity

34
Q

What effects do GLP-1 receptor agonists have on the pancreas?

A

Pancreas
-Increased beta-cell function
-Increased insulin biosynthesis
-Increased glucose-dependent glucagon secretion
-Decreased glucose-dependent glucagon secretion

35
Q

What are the effects of GLP-1 receptor agonists have on the heart?

A

-Decreased cardiovascular risk
-Decreased fatty acid metabolism
-Increased cardiac function
-Decreased systolic blood pressure
-Decreased inflammation

36
Q

What is the function of leptin?

A

It contributes to the felling of fullness

It has effect son the central hypothalamus and peripheral tissues

37
Q

Where is leptin secreted?

A

Mainly in white adipose tissue

It’s levels are correlated with the amount of body fat

38
Q

What happens to different levels of gut hormones during a very low energy diet?

A

There is increased hunger and increased desire to eat

-Significant reduction in PYY , cholecystokinin (CKK), insulin, leptin, and amylin levels
-Increase in Ghrelin, GIP, and pancreatic polypeptide

39
Q

What effect does exercise have on levels of gut hormones?

A

Increased circuiting PYY

Supressed appetite and ghrelin

40
Q

What is the effect of obesity on the body?

A

-Dysregulation of energy homeostatic signals

-Consistent overriding of homeostatic signals of energy availability leads to disjointed eating and energy requirements
– Causes dysregulation of the metabolic mechanisms controlling energy homeostasis including secretion of gut hormones

-Leptin resistance in common

41
Q

What are some psychological co-morbidities of obesity?

A

Mood disorder 15.6%
Anxiety 24%
Binge eating 16.3%
Avoidant personality disorder 17%
Substance misuse
Night eating syndrome
Body image disturbance
Childhood maltreatment

42
Q

What is night eating syndrome?

A

When you eat a lot after dinner, have trouble sleeping, and eat when you wake up at nigh

43
Q

What is the staging tool for obesity?

A

EOSS
Edmonton Obesity Staging System

44
Q

Name some medications associated with weight gain

A

Risperidone
Lithium
Quetiapine
Aripiprazole
Olanzapine
Valproic acid
Citalopram
Duloxetine
Venlafaxine
Zopiclone
Trazadone
Zoplidem
Pregablin
Gabapentin

Steroids
Insulin

45
Q

Name some anti-obesity agents

A

CNS stimulants like Phentermin/Topiramate
Phentermine
Lorcaserin
Benzamphetamine
Bupropion/Naltrexone
Orilstat

Others: metoformin, zonisamide, amuylin agonists, SGLT2 inhibitors

46
Q

What effects does GLP-1 receptor agonists have on the brain?

A

Decreased body weight
Decreased food intake
Increased satiety

47
Q

What effects do GLP-1 receptor agonists have on the stomach?

A

Decreased gastric emptying

48
Q

What effect do GLP-1 receptor agonists have on the liver?

A

Decreased endogenous glucose production
Increased hepatic insulin sensitivity
Increased hepatic insulin sensitivity
Decreased de novo lipogenesis
Decreased steatosis

49
Q

What is steatosis?

A

Fatty liver disease

50
Q

Who qualifies for weight loss surgery?

A

Patients with BMI above 40
BMI 35-39.9 and a severe obesity related comorbidity Eg. diabetes

51
Q

What are the 4 common bariatric procedures?

A

LAGB
-Laparoscopic Adjustable Gastric Banding
-An adjustable band at the top of stomach

Sleeve gastrectomy
-Removing a large part of the stomach

BPD-DS
-Biliopancreatic diversion with duodenal switch
-Removing a lot of the stomach and then bypassing that majority the the intestine
-(Less common)

Roux-en-Y
-Only the top part of stomach remains and is attached directly to intestine

52
Q

What is the mechanism of weight loss after surgery?

A

-Increases in satiety promote hormones
-Reduction in hunger promoting hormones
-Reduced food intake
-Central effects
-Altered bile acid metabolism
-Altered intestinal microbiota

53
Q

What is the hind gut hypothesis?

A

That diabetes control results from the expedited delivery of nutrient chyme to the distal intestine, enhancing a physiologic signal that improves glucose metabolism

GLP-1 is the main contributor

54
Q

What do GIP levels correlate with?

A

The length of intestine exposed to ingested nutrients

55
Q

How does GIP stabilise glucose levels?

A

It enhances glucose-stimulates insulin secretion and promotes the secretion of glucagon when glucose is low

56
Q

What is the outcome of obesity surgery on diabetes?

A

Diabetes remission after 2 years but relapse at 10 years

3. Mondays (126 decks)

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