Chapter 2 Exam Flashcards
(155 cards)
1
Q
4 components of Metabolic Syndrom
A
- high blood pressure
- high insulin levels
- excess body weight
- abnormal cholesterol levels
2
Q
2 most important risk factors of Metabolic Syndrome
A
- extra body weight around the middle and upper parts of the body (central obesity, Apple shaped)
- Insulin Resistance, results in elevated blood sugar levels
3
Q
which metabolic disorder is metabolic syndrome closely related to
A
insulin resistance
4
Q
3 names given to metabolic syndrom
A
- syndrome X
- the deadly quartet
- insulin resistance syndrome
5
Q
what is the prevalence of metabolic syndrom
A
1 in 4 adults (25%)
6
Q
what percent of adults over 40 have metabolic syndrome
A
40%
7
Q
by how much has the prevalence of metabolic syndrome increased over the past decade
A
61%
8
Q
5 factors that increase your risk of developing metabolic syndrome
A
- age
- race
- obesity
- history of diabetes
- other diseases
9
Q
Which race does metabolic syndrome affect the most?
A
generally more common among blacks and mexican americans
10
Q
what BMI rating increases your risk of developing metabolic syndrome
A
BMI greater than 25
11
Q
when should you seek medical advice about metabolic syndrome
A
if you have 1 of the 4 components its important to test for the others so you know if you have metabolic syndrome or not
12
Q
3 ways to prevent metabolic syndrom
A
- Commit to a healthy diet
- get moving: 30 min per day of moderately strenuous activity on most days of the week
- schedule regular check-ups
13
Q
how to diagnose metabolic syndrom
A
- Waist circumference: >35in in women, >40in in men
- triglyceride: levels of 150mg/dl or higher
- blood pressure: 130/85mmHg or higher
- Fasting blood glucose: level of 110mg/dl or higher
- HDL lower than 50mg/dl in women and 40mg/dl in men
14
Q
people who have metabolic sydrome often have 2 other problems that can either cause the condition or make it worse, what are they
A
- excess blood clotting
2. low levels of inflammation throughout the body
15
Q
what is the primary target of therapy for metabolic syndrome
A
insulin resistance
16
Q
what are you trying to prevent with the treatment of metabolic syndrom
A
- type II diabetes
- heart attack
- stroke
17
Q
what is the treatment to reduce the insulin resistance in overweight and obese individuals
A
an aggressive regimen of self care strategies focusing on diet and exercise
18
Q
what components does your doctor routinely monitor to see if lifestyle changes are workin
A
- weight
- blood glucose
- cholesterol
- blood pressure
19
Q
how can insulin resistance be controlled
A
- losing 5-10% of your body weight
- exercise for at lease 30 minutes per day
- stop smoking
- eat fiber rich foods
20
Q
what types of medications can control metabolic syndromes individual risk factors
A
- weight loss drugs (meridia, xenical)
- insulin sensitizers (metformin)
- aspirin
- medications to lower blood pressure
- medications to regulate cholesterol
21
Q
who is less likely to develop metabolic syndrome
A
middle aged men with moderate PA and C-V fitness
22
Q
how much exercise does CDC-ACSM recommend for all adults to engage in to prevent chronic diseases
A
30 min per day
23
Q
between the years 1986-2001 the prevalence of metabolic syndrome in 24 y/os was found to have increased in what country
A
finland
24
Q
most studies have found that metabolic syndrome is inversely associated with what
A
physical activity or physical fitness
25
what is the general definition of diabetes
diabetes is the impairment of metabolization of carbs, fat, and protein due to insufficient secretion of insulin or insulin resistance
26
what do the A1c test results mean?
how much glucose is bound to hemoglobin
27
for a person without diabetes, what are the typical A1c result levels
about 5%
28
what are the A1c test results if you are prediabetic
5.7-6.3%
29
what are the A1c test results if you have diabetes
6.5% or above
30
at what age does the American Diabetes Association recommend taking the A1c
age 45 if you are overweight or obese and repeated every 3 years
31
what is Type I diabetes
insulin dependent
1. body lacks or has no insulin production
2. abrupt onset of symptoms
3. usually diagnosed in children or young adults and was previously known as juvenile diabetes
32
what age does Type I diabetes typically occur in males and females
females: age 5-6
males: age 10-14
33
what is type II diabetes
non-insulin dependent
| 1. the body does not produce enough insulin or the body ignores the insulin produced
34
why is insulin necessary for the body
necessary for the body to be able to use glucose to produce energy
1. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead diabetic complications.
35
what populations are affected by type II diabetes
1. individuals above the age of 40
| 2. more common in AA, latinos, Natives, asian, native hawaiians, and pacific islanders
36
what is gestational diabetes
high blood sugar levels during pregnancy
| 1. possibly due to hormones from the placenta impairing the action of the mothers insulin
37
how does gestational diabetes affect the fetus
causes a condition called macrosemia (large and heavy baby)
38
for how long has diabetes been considered a deadly disease
2,000 years
39
when was the distinction between type I and type II determined?
1935
40
what are the classic signs of type I diabetes
1. frequent urination
2. unusual thirst
3. extreme hunger
4. unusual weight loss
5. extreme fatigue and irritability
41
what are the classic signs of type II diabetes
1. any of the type I symptoms
2. frequent infections
3. blurred vision
4. cuts/bruises that are slow to heal
5. tingling or numbness in the hands/feet
6. recurring skink gum, or bladder infections
42
what are the causes of the following diabetes symptoms
1. frequent urination
2. unusual thirst
3. weight loss
4. exhaustion
5. numbness
1. Frequent Urination- Stems from a lack of insulin
2. Unusual Thirst- Goes hand in hand with urination
3. Weight loss- The pancreas stops making insulin, therefore the body looks for an energy source other than glucose
4. Exhaustion- Not enough glucose for energy
5. Numbness or Tingling (Neuropathy)- Glucose destroys the nervous system, particularly affects the extremities
43
what are the 3 known risk factors for type I diabetes
1. family history
2. genetics
3. geography
44
what are the 3 possible risk factors for type I diabetes
1. viral exposure
2. low vitamin D levels
3. other dietary factors
45
what are the know risk factors for type II diabetes
1. impaired glucose tolerance or impaired fasting glucose
2. people over age 45
3. family history
4. overweight
5. no regular exercise
6. low HDL and high blood pressure
7. racial and ethnic groups
8. women who had gestational diabetes
46
what is the etiology of Type I diabetes
1. environmental trigger
2. immune system attacks pancreas beta cells
- insulin production decrease
47
etiology of type II diabetes
1. insulin release depressed after a meal
2. insulin resistance
- fewer insulin receptors on cells (down regulations)
- associated with obesity and pregnancy
48
etiology of gestational diabetes
high blood sugar levels in pregnant women who have never had diabetes
-hormones block insulin from doing its job
49
what percent of 20+ year old people have pre-diabetes
35%
50
epidemiology of men and women over 20 with diabetes
11. 8% men
| 10. 8% women
51
how much higher are the prevalence percentages of diabetes in Asian, hispanic, and non hispanic blacks
1. 18% higher in Asian
2. 66% higher in hispanics
3. 77% higher in non hispanic blacks
52
what percent of pregnancies result in gestational diabetes
2-10%
53
what percent of post pregnant women develop type II
5-10%
54
for individuals who have diabetes, what other diseases are they now more prone to develop?
1. Heart disease 2-4x more likely
2. stroke risk 2x more likely
3. hypertension 2/3 of 20+years
4. diabetic retinopath 28.5% of 40+
5. kidney failure 44%
6. nervous system damage 60-70%
7. ampuations 60%
8. dental disease 2x more likely
55
people who have a blood glucose level above 250mg/dl are not recommended to work out. why?
because they do not have insulin to break it down and working muscles would require more glucose so the body would release more making the blood glucose levels to rise even more
56
what reduces the risk of diabetes by 58%
losing weight and increase in physical activity
57
by what percent does the drug metformin reduce the risk of diabetes
31%
58
if fasting glucose drops b 1% how does that help?
leads to a 40% drop in eye, kidney and nerve issues
59
if blood pressure drops 10mmHg how does that help
leads to 12% decerased risk for complications
60
if you have control of LDL levels how does that help
leads to 20-50% reduction in cardiovascular problems
61
what are the goals of diabetes treatment
1. Minimize the elevation of blood glucose levels
2. Avoid causing any abnormally low blood glucose levels
3. Reduce weight/body fat (especially those with type II diabetes)
4. Increase sensitivity to insulin
5. Improve overall health and fitness
62
what are the prescription drugs for type I
insulin injections
63
what are the prescription drugs for type II designed to do
1. Increase insulin output by the pancreas
2. Decrease amount of glucose released from liver
3. Increase cell response to insulin
4. Decrease absorption of carbohydrates in small intestine
5. Slow emptying of stomach to delay absorption of carbs
64
how is diet involved in the treatment of diabetes
1. Make healthy food choices
2, Eat several meals throughout the day
3. Eat plenty of complex carbohydrates with each meal
4. Check blood glucose levels before and after each meal
--Should be 90-130 mg/dL before
--Less than 180 mg/dL within a few hours after eating
65
how is exercise beneficial in the treatment of diabetes
1. Improves body’s use of insulin (Type II)
2, Decreasing body fat (also helps improve insulin sensitivity in type II diabetics)
3. Improved muscle strength and endurance
4. Increased bone density
5.Lower blood pressure and bad cholesterol levels
6. Improved cardiovascular function – decreased risk of heart disease
7. Increased energy levels
8. Reduces stress and anxiety
66
what are the guidelines for exercise for the treatment of type I diabetes
1. Consult a physician before starting a new program
2. Exercise after meals, not before
3. Monitor blood glucose levels closely before, during, and after physical activity
4. May need to increase food intake before exercise
5. Adjust insulin intake as needed
6. Inject insulin in non-active muscle groups
7. Do not exercise if blood glucose levels exceed 250mg/dL
67
what are the guidelines for exercise for the treatment of type II diabetes
1. Always consult a physician before starting a new program
2. Avoid exercising when medications are at peak levels
3. Start slowly with mild exercise – increase intensity gradually
4. Avoid extremely high intensity exercise (can cause the body to release stress hormones that increase blood glucose levels)
5. Exercise 3-4 times per week using a combination of cardio and strength training
6. Do not exercise if blood glucose levels are above 250mg/dL with ketones present or above 300mg/dL without ketones
7. Drink plenty of water
8. Wear proper footwear with dry socks to avoid sores and blisters
9. Discontinue exercise and seek medical attention if any unexpected pain occurs
10. Always wear a medical identification bracelet
68
what is the general definition of overweight and obesity according to WHO
excessive fat accumulation that may impair health
69
how is BMI calculated
weight(kg)/height^2(m)
or
weight(lb)x703/height^2(in)
70
what waist circumference for men and women is considered to be an increased risk for overweight and obesity
Men >35 in (88cm)
| Women >40 in (100cm)
71
what is a normal BMI
18.5-24
72
what BMI is overweight
25-29
73
what percent body fat is considered to be normal
20-25%
74
what percent of overweight and obesity occurs in adulthood
70%
75
how many deaths can be attributed to overweight and obesity
111K-635K per year in the United States
76
if you are overweight or have obesity what are a few things you have an increased risk for
1. Diabetes
2. liver disease
3. sleep apnea
4. hypertension
5. cancer
6. depression
7. eating disorders
77
what is an interesting fact concerning men between the age of 30-83 years who are overweight but physically fit?
men who are overweight but physically fit suffered fewer deaths from all causes than unfit but normal weight men
78
what is the trend with overweight children
children who gain more weight than peers tend to become overweight aduls with an increased risk for hypertension, elevated insulin, hypercholesterolemia, and heart disease
79
what are 5 specific health risks of excessive body fat
1. impaired cardiac function from increased mechanical work and autonomic and left ventricular dysfunction
2. hypertension, stroke, and deep vein thrombosis
3. insulin resistance in children and adults and type II diabetes
4. renal disease
5. sleep apnea, mechanical ventilatory contraints
80
what are 2 ways that adipose tissue mass increases
1. fat cell hypertrophy: existing adipocytes enlarge or fill with fat
2. fat cell hyperplasia: total adipocyte number increases
81
how many adipocytes does an average sized person have
25-30 billion
obese people have 3-5 times this
82
what are the effects of weight loss and gain
Loss: in adults the major change in adipose cellularity in weight loss is shrinkage of adipocytes with no change in cell number
Gain: moderate weight gain from overeating in adults enlarges existing adipocytes rather than stimulating new adipocyte development
83
what are the general options for treatment of obesity
1. diet
2. exercise
3. behavior change
4. pharmacotherapy
5. surgery
84
what percent weight loss does the NIH recommend
10%
85
what does the diet therapy consist of for obesity
1. calorie restriction
- should be based on measured or estimated RMR+physical activity
- 3500 kcal for 1 lb weight loss
86
types of diet therapies for obesity
1. hypocaloric: restrict to 500-750 kcal/day
2. high protein low carbs
3. meal replacements
87
what are the stages of change for behavioral therapy
```
precontemplation
contemplation
preparation
action
maintenance
```
88
how many kcal should be burned for the maintenance of weight loss
2500-2800 kcal/week
requires 60-90 min/day
89
what 2 drugs have been removed from the market for obesity
fenfluamine and meridia
90
what are 2 approved market drugs for obesity
1. phentermine (adipex): appetite suppressant
| 2. orlistat (zenical, alli) intestinal lipase inhibitor
91
what treatment option produces the greatest amount of weight loss and best long term weight maintenance
surgery
1. possible 50% excess weight loss (25% actual)
intestinal bypass
adjustable gastric banding
92
for the exercise prescription for obesity what is the mode, frequency, intensity and duration a person should do
1. Mode: weight bearing
2. frequency: daily
3. intensity: 50-60% VO2, 60-80% heart rate reserve
4. duration: 20-30 min/day, target 60-90 min/d
93
what criteria should you use for resistance training
60-80% of 1 RM
8-15 repetitions
two sets with 2 or 3 min rest between
perform 2-3 days/week
94
define hypertension
1. force of the blood pushing against the walls of the arteries
2. Hypertension is when, on two separate occasions, diastolic or systolic measurements exceed 140mmHg/90mmHg
95
what is range of pre hypertension for systolic BP
120-139mmHg
96
what is the range of pre hypertension for diastolic BP
80-89 mmHg
97
how many people does hypertension affect
76 million americans ages 20+
98
what is the equation for Blood pressure
BP=Cardiac output x Total peripheral resistance
99
pathogenic mechanisms leading to hypertension must lead to what 2 other factors
increased total peripheral resistance and to increased Cardiac output
100
define essential hypertension
hypertension that has an unidentifiable cause
genetically based diseases and syndromes with a number of underlying inherited biochemical abnormalities
101
define secondary hypertension
hypertension that occurs due to a secondary factor
| -often presents as renal or endocrine hypertension
102
what is renal hypertension
usually attributable to derangement in the renal handling of sodium fluids
103
what is endocrine hypertension
usually attributable to an abnormality of the adrenal glands
104
what are 4 health problems related to hypertension
1. the heart can expand, leading to heart failure
2. small blisters can form in the brains blood vessels, which may cause a stroke
3. blood vessels in the kidneys can narrow, which may cause kidney failure
4. arteries throughout the body harden faster
105
pathophysiology of hypertension
hypertension damages the endothelium, which predisposes the individual to atherosclerosis and other vascular pathologies. Increased afterload on the heart caused by hypertension may lead to left ventricular hypertrophy
106
signs and symptoms of hypertension
1. headache
2. dizziness
3. palpitations
4. easy fatiguability
5. epistaxis
6. hematuria
7. blurring of vision
107
when looking at hypertension what are you looking for in the patients history
1. risk factors for CHD and stroke
2. symptoms and signs of CHD
3. heart failure
4. renal disease
5. endocrine disorder
6. past and present use of medications
7. lifestyle habits
108
what is the auscultatory method for blood pressure reading
1. person should be seated for 5 min
2. caffeine and smoking should be avoided for at least 30 min
3. use appropriate sized cuff
4. systolic BP
5. diastolic BP
109
What are the different laboratory tests to diagnose hypertension
1. urinalysis
2. hematocrit
3. Blood Chemistry
- sodium, postassium, creatinine, lipid profile
4. electrogardiogram
110
how should you monitor hypertensive individuals with an additional CDH risk factor in terms of exercise
monitor their exercise test with electrocardiogram before having them start a vigorous intensity program (>60% VO2R)
111
define contraindications
a factor that serves as a reason to not perform a particular medical treatment as if could cause harm to the patient
112
what are contraindications for hypertension for exercise testing
systolic bp greater than 200 mmHg or diastolic BP greater than 110 mmHg at rest
113
what are some of the medications involved in the drug therapy for severe hypertension
1. diuretics
2. beta-blockers: catecholamine blocker, eases the workload on the heart by lowering BP
3. ACE inhibitors: prevents the formation of aniotensin 2
4. ARBs (angiotension renin blockers):prevents the formation of angiotensin 2
5. aldosterone antagonists: prevents aldosterone from retaining salt
114
ACSM concludes that people with mild hypertension can expect systolic and diastolic blood pressures to fall an average of what amount in response to regular aerobic exercise
8-10mmHg and 6-10mmHg
115
for people with normal resting BP exercise training can lower the systolic and diastolic bp by an average of how much
4 mmHg and 3 mmHg
116
which form of exercise is better for lowering blood pressure
aerobic training is better than strength
117
for the exercise prescription of hypertension, what is the frequency, intensity, time, and type of exercise they should do
1. frequency: aerobic most days of the week
2. Intensity: moderate intensity aerobic, that is 40-60% VO2R
3. Time: 30-60 min of continuous or intermittent (min 10 mni)
4. Type: primarily aerobic exercise along with resistance
118
for the exercise prescription of hypertension, what is the frequency, sets, reps, and stations the individual should do
1. frequency: 2-3 days per week
2. at least one set
3. reps: 8-12 per set for healthy adults, 10-15 per set at lower resistance for older people
4. 8-10 exercises that condition the major muscle groups
119
define hyperlipidemia
general term used to refer to chronic elevations in the fasting blood concentrations of triglyceride, cholesterol or specific subfractions of each
120
define dyslipidemia
a combination of genetic, environmental, and pathological factors that can work together to abnormally alter blood lipid and lipoprotein concentrations
121
define hypercholesterolemia
implies elevated blood cholesterol concentration >240 mg/dl
122
define hypertriglyceridemia
denotes only elevated triglyceride concentration
| -anything beyond 150mg/dl is considered elevated
123
define postprandial lipemia
characterized by exaggerated levels of triglycerides in the blood and failure to return to baseline levels within 8-10 hours after consumption of dietary fat
124
define hyperlipoproteinemia or dyslipoproteinemia
elevated lipoprotein concentrations
125
for every mmol/L decrease in total cholesterol, by how much does it lower the relative risks for CHD mortality and CHD related events
24.5% and 29.5%
126
for every mmol/L reduction in LDL-C, by how much does that lower the relative risks for CHD mortality and coronary related events
28% and 26.6 respectively
127
what percent of adults 20+ have a total serum cholesterol level above 200mg/dl
44.4%
128
transport of cholesterol and triglyceride is generally described in terms of what two processes
1. LDL receptor pathway
| 2. reverse cholesterol transport
129
exaggerated or prolonged lipemia is associated with what
increased CAD risk
130
Pathophysiology of Metabolic Dyslipidemia
1. elevation of bloodborne fatty acids observed with metabolic dyslipidemia affects the vascular endothlium and leads to:
2. reduced nitric oxide production
3. induced adhesion characteristics
4. induced adhesion characteristics
5. facilitated oxidative damage
6. inflammation
7. diminished vascular compliance and reactivity
131
signs and symptoms of hyper lipidemia
majority lacks signs and symptoms
132
what is the 1 exception for signs and symptoms of hyperlipidemia
Hypercholesterolemia
- xanthomas
- atheromas
133
signs and symptoms of Familial lipoprotein lipase deficiency
1. abdominal pain
2. recurrent acute pancreatitis
3. development of cutaneous xanthomata (white deposites on the skin due to fat retention
4. milky plasma
134
what is the typical clinical screening like for hyperlipidemia
1. analysis of blood lipid profile
2. measured every 5 years
3. can begin at age 20
135
what is the desirable level of blood cholesterol
less than 200 mg/dl
136
what is the borderline high classification of blood cholesterol
200-239 mg/dl
137
what is the high classification of blood cholesterol
240 mg/dl and above
138
what are the 4 basic measurements of cholesterol in blood testing
1. total
2. LDL ( less than 150)
3. HDL ( men >40mg/dl, women >50mg/dl)
4. Triglyceride estimates
139
7 treatment options for hyperlipidemia
1. engage in regular PA
2. consume heart healthy diet
3. lose weight
4. prevent weight regain after weight loss
5. quite smoking
6. improve stress management
7. lipid lowering medication
140
what are the recommended amounts of cardiovascular exercise when it comes to hyperlipidemia
1. 150-300 min of moderate intensity per week
OR
75-150 min of vigorous intensity per week
2. 8-10 miles of running per week
3. 3-5 or more days per week to help reach dose recommendations
141
Is resistance training recommended for hyperlipidemia
there is limited effect on improving blood lipid and lipoprotein concentrations so cardiovascular training should be prioritized
142
about how many calories per week of moderate to high intensity aerobic exercise is required to produce favorable changes in blood fats/lipids
1000 calories
143
what type of exercise programs produce the strongest effects on HDL and triglyccerides
high duration (45+ min ) intensity and frequency (daily)
144
what occurs during single bouts of aerobic exercise when it is prolonged and intense in terms of cholesterol
it can result in immediate and significant increases in HDL
145
by how much can marathon races increase HDL-C
15-25%
146
what is the LDL receptor hypothesis
LDL receptors bind LDL particles and extract them from the fluid that bathes the cell
- LDL is taken into the cells and broken down, yielding its cholesterol to serve each cells needs
- it removes LDL from bloodstream
- receptor number varies depending on the cell demands
- when need is low, excess cholesterol accumulates
147
what is the exogenous pathway of cholesterol
1. Begins in intestine: dietary fats are packaged into lipoprotein particles (chylomicrons) which enter into bloodstream to be delivered to adipose tissue and muscle
148
how is chylomicron removed from the circulation
removed by a specific receptor on liver cells
149
what is the endogenous pathway of cholesterol
1. LDL is a component
2. begins when the liver secretes a large VLDL particle into the bloodstream
3. its core consists mostly of triglyceride synthesized in the liver with a smaller amount of cholesterol esters
- Apoprotein B-100
- Apoprotein E
150
When VLDL reaches the capillaries of adipose tissue or muscle and triglyceride is extracted, what new kind of particle is formed
Intermediate density lipoprotein (IDL)
151
how quickly are half of the IDL particles removed from the circulation
within 2-6 hours of their formation because they bind very tightly to liver cells which extract their cholesterol to make new VLDL and bile acids
Tight binding is attributable to apoprotein E, whose affinity for LDL receptors on liver cells is greater tan that of apoprotein B-100
152
what is the heterozygote form of Familial Hypercholestrolemia
1 mutant gene and 1 nomral gene
-this means that their plasma LDL level is twice the normal level and gein to have heart attacks by the time they are 35 years old
153
what is the FH homozygotes of familial hypercholesterolemia
2 defective receptor genes
have cells that either have no functional LDL receptors at all or very few and therefore cannot bind, internalize and degrade LDL efficiently
154
what is the actual LDL receptor hypothesis state
states that much of the atherosclerosis in the general population is caused by a dangerously high blood level of LDL resulting from failure to produce enough LDL receptors
155
if the LDL receptor hypothesis is correct what does that mean
1. the human receptor system is designed to function in the presence of low LDL levels
