Endocrine and Metabolic Conditions

Question 1

Normal BMI

Answer 1

18.5 to <25 kg/m2

Question 2

Overweight BMI

Answer 2

25 to <30 kg/m2

Question 3

Class 1 Obesity

Answer 3

30 to <35 kg/m2

Question 4

Class 2 Obesity

Answer 4

35 to <40 kg/m2

Question 5

Class 3 Obesity

Answer 5

≥40 kg/m2

Question 6

BMI parameters

Answer 6

Set based on measured adiposity and the levels at which risk of adverse outcomes increase

Question 7

Elevated BMI linked with

Answer 7

Greater risk of fatal and combined fatal and nonfatal CHD

Greater risk of fatal stroke, ischemic stroke, and hemorrhagic stroke

Greater risk of combined fatal and nonfatal CAD

Greater risk for T2DM

Greater risk of all-cause mortality

Risk of hypertension and dyslipidemia, musculoskeletal and functional limitations

Question 8

Pear shape

Answer 8

Wider hips, smaller top half

Common in women

Question 9

Apple shape

Answer 9

Smaller hips, wider top half

Common in men

Makes it more difficult to breath due to the organs being pressed together

Lower limb stress (bad knees)

CVD risk due to abdominal fat

Lower back pain

Question 10

Overweight and obesity

Answer 10

Risk of abdominal adiposity

Excessive abdominal adiposity is associated with greater health risk

Question 11

Adults with a BMI of 18.5 to <25 kg/m2 or with a BMI of 25 to <30 kg/m2 without indicators of increased health risk

Answer 11

Should be counseled to engage in behaviors that will avoid weight gain

Question 12

Adults with a BMI of 25 to <30 kg/m2 with indicators of increased health risk or a BMI ≥30 kg/m2

Answer 12

Should be counseled to engage in behaviors to lose weight

Question 13

Adults with a BMI of 27 to <30 kg/m2 with a comorbidity or a BMI ≥30 kg/m2 who have been unsuccessful with weight loss

Answer 13

May require pharmacotherapy as an adjunct to a comprehensive lifestyle weight loss program

Question 14

Adults with a BMI of 35 to <40 kg/m2 with a comorbidity or a BMI ≥40 kg/m2 who have been unsuccessful with weight loss

Answer 14

Should be referred to a bariatric surgery specialist to consider this treatment option as an adjunct to a comprehensive lifestyle weight loss program

Question 15

Creating goals

Answer 15

Don’t center goals that are regarding weight

Instead, make goals that pertain to promoting health

Question 16

Dietary approaches for weight loss

Answer 16

Achieved when a diet resulted in a sufficient energy deficit regardless of the specific composition of the diet

CEPs DON’T PRESCRIBE DIETS

Question 17

High glycemic-load and low glycemic-load diets

Answer 17

Research is mixed for support of either diet

Question 18

High protein diets

Answer 18

Have shown more promise but the evidence is still unsure

More concerned about adequate protein diet before high protein diets

Need about 1.2-2.0 grams of protein/day; minimum is 0.8 grams

Question 19

Mediterranean diet

Answer 19

Ideal cardiovascular diet

Less red meat, poultry, butter, and sugar

Increased fish, olive oil, grains, fruits, vegetables, cheese, and yogurt

Heart disease and cancer prevention

Question 20

Meal replacements

Answer 20

Shakes

Nutrition bars

Frozen food

We know the calories and nutritional values making it easier to track calories

Question 21

Very-low calorie diets (VLCDs)

Answer 21

Highly engineered powdered supplements that are rich in protein and average in the range of 600-800 kcal/day

Administered under medical supervision out-patient or in-patient

The problem is there is no good transition time to get out of the VLCDs diet

Designed to achieve weight loss goal in a short time frame

Question 22

Physical activity (exercise training) for weight loss

Answer 22

Not a great way to lose weight due to the time it takes

There was no significant change in weight in studies in which physical activity was <150 minutes per week

150+ minutes/week there is significant weight loss

Only a modest weight loss occurs with physical activity

Question 23

RT for weight loss

Answer 23

Not a lot of studies have done

RT can increase a person’s overall physical function which increases total daily energy expenditure

Question 24

Physical activity (lifestyle changes)

Answer 24

Increasing someone’s physical activity can aid in weight loss

Question 25

Short term adherence to physical activity

Answer 25

2-6 lbs improvement over time in weight reduction No improvement in other areas like cardiac health, etc

Question 26

Long-term adherence to physical activity

Answer 26

Lifestyle behavior changes is the main goal 200-300 minutes/week of moderate to vigorous PA to increase total energy expenditure overall Wearable monitors will aid in tracking activity LIFESTYLE MODIFICATION IS A CRITICAL FACTOR IN WEIGHT MANAGEMENT AND RISK FACTOR REDUCTION

Question 27

Prevention of weight gain

Answer 27

2.2-4.4 lbs of annual weight gain Inverse relationship between adiposity and PA Modest increases in energy expenditure of 50-100 kcal/day may be sufficient to prevent or reduce average weight gain

Question 28

Diabetes

Answer 28

Screening recommended in asymptomatic people at any age who are overweight or obese or have one additional risk factor for diabetes 45+ and at least every 3 years after that age

Question 29

Diabetes risk factors

Answer 29

Lack of physical activity First-degree relative with diabetes High risk because of race or ethnicity (African American, Latino, Native American) Hypertension History of CVD

Question 30

Diabetes screening tests

Answer 30

Fasting plasma glucose 65-gram oral glucose tolerance test Hemoglobin A1C

Question 31

Fasting plasma glucose

Answer 31

Measures glucose levels in a person who has been fasting for at least eight hours

Question 32

75 gram oral glucose tolerance test

Answer 32

OGTT requires fasting before drinking a glucose solution. Following a two-hour waiting period, blood is drawn When sugar is consumed, insulin is released causing the levels to go up then right back down Someone who's glucose tolerant won't have the level go back down and will stay elevated

Question 33

Hemoglobin A1C test

Answer 33

Does not require fasting, and measures the blood level of glycosylated hemoglobin over the past two to three months (90 days)

Question 34

Type 1 diabetes mellitus (T1DM)

Answer 34

Destruction of beta cells in the pancreas causes the production of insulin to be damaged=insulin deficiency 5-10% of all diabetic cases More commonly diagnosed in children and adolescents Genetic and environmental factors (viral infections) Increased risk for other autoimmune disorders

Question 35

Type 2 diabetes mellituse (T2DM)

Answer 35

Insulin resistance with relative insulin deficiency Can progress to an insulin secretory defect with insulin resistance 90-95% of all diabetic cases Obesity and abdominal adiposity Hyperglycemic develops gradually with no classic symptoms

Question 36

Type 2 diabetes mellitus obesity risk factors

Answer 36

Visceral fat accumulation (fat around the organs) Central adiposity

Question 37

Type 2 diabetes mellitus risk factors👀👀👀👀

Answer 37

Age ≥ 45 years BMI ≥ 25 kg/m2 or central adiposity (defined by waist circumference) Habitual physical inactivity Having a first-degree relative with DM African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity If a female, delivering a baby weighing > nine pounds or having a past diagnosis of GDM Having polycystic ovary syndrome Presence of HTN Presence of a low level of HDL cholesterol Presence of a high TG level Previous diagnosis of IGT or IFG A history of vascular disease

Question 38

Diabetes complications

Answer 38

Affects all normal metabolic actions of insulin, including glucose transport, hexokinase activity, glycogen synthesis, and glucose oxidation Have multiple comorbidities The increase of the production of glucose by hepatocytes and portal adipocytes are key factors in the development of the complications

Question 39

Macrovascular complications of diabetes

Answer 39

Coronary artery disease Stroke Peripheral artery disease

Question 40

Microvascular complications of diabetes

Answer 40

Renal disease Diabetic retinopathy Diabetic neuropathy

Question 41

Treatment of T2DM lifestyle approaches

Answer 41

Implementation of an intensive lifestyle modification of increased PA and adoption of heart-healthy diet Similar to weight management approaches Reduce body weight by 5-10%

Question 42

Prevention of T2DM lifestyle approaches

Answer 42

Weight loss Lifestyle group Compare medication or lifestyle approach focused on weight loss to reduce onset of developing T2DM

Question 43

Pharmacotherapy in diabetes

Answer 43

Insulin Glucosidase, Metformen, etc.

Question 44

Exercise and PA in patients with T1DM

Answer 44

Benefits of physical activity on endothelial function Favorable changes in lipid, lipoprotein, and apolipoprotein levels Improvements in HbA1c levels and reduced insulin requirements

Question 45

Exercise and PA in patients with T2DM

Answer 45

RT can improve insulin activity Higher rates in Westernized environments than other environments

Question 46

Metabolic syndrome

Answer 46

A disorder characterized by IGT, dyslipidemia, and HTN, which together were associated with an increased risk of T2DM and CVD Primary underlying mechanism for the syndrome was attributed to insulin resistance at the level of the skeletal muscle

Question 47

Criteria for metabolic syndrome (WHO)

Question 48

Risk factors and comorbidities of metabolic syndrome

Answer 48

Puts individual at risk for other diseases like CHD

Question 49

Metabolic syndrome physical activity

Answer 49

PA individuals with metabolic syndrome had a lower CVD risk than inactive individuals with metabolic syndrome