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CVDM > Metabolic Disease, Obesity and COVID-19 > Flashcards

Metabolic Disease, Obesity and COVID-19 Flashcards

(51 cards)

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1
Q

What is obesity?

A

Abnormal or excessive fat accumulation that may impair health

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2
Q

What waist circumferences for men and women show an increased rate of obesity related morbidity?

A

Men ≥202cm
Women ≥88cm

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3
Q

Name some factors influencing obesity

A

Genetics
Environment
Energy balance
Fetal nutrition

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4
Q

How does fetal nutrition affect obesity?

A

Under-nutrition of the fetus during intrauterine development may lead to later onset of metabolic disease, and an adverse nutritional environment in utero can lead to programmed susceptibility to disease

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5
Q

Why in the UK do we live in an obesogenic environment?

A

Availability of energy dense foods
Large portion sizes
Cheap food outside of home
Altered eating patterns (snacks instead of meals)
More sedentary lifestyles
Car travel

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6
Q

Name some chronic illnesses that can arise from obesity

A

T2DM
Heart disease
Obstructive sleep apnoea
Cancer
Osteoarthritis
Hypertension

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7
Q

How does obesity cause T2DM?

A

Higher plasma FFA causes increased glucose production with reduced hepatic glucose utilisation, leading to hyperinsulinaemia and hyperglycaemia

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8
Q

How does obesity cause heart disease?

A

Larger body mass causes higher oxygen consumption and cardiac output, leading to myocardial hypertrophy, congestive heart failure or coronary heart disease and sudden death

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9
Q

How does obesity cause obstructive sleep apnoea?

A

Increased chest and abdominal fat causes alterations in breathing which is exaggerated when lying flat

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10
Q

What types of cancer does a BMI ≥30 increase your risk of?

A

Prostate
Breast
Endometrial
Cervical
Colorectal
Gallbladder

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11
Q

How does obesity cause osteoarthritis?

A

Increased weight puts increased pressure on the joints and wears away cartilage

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12
Q

What joints are mostly affected by arthritis in obese individuals?

A

Lower back, knees, hips

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13
Q

What metabolic diseases can increased fructose intake cause?

A

Dyslipidaemia - NASH
Hypertension via increased uric acid
Obesity and insulin resistance
Accelerated ageing process

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14
Q

What is metabolic syndrome?

A

At least 1 of:
- T2DM
- Insulin resistance
- Impaired glucose tolerance
Plus at least 2 of:
- Hypertension
- Obesity
- Hypertriglyceridaemia
- Microalbuminuria

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15
Q

What is the link between T2DM and Alzheimer’s disease?

A

T2DM patients are at a 1.5-2.5% increased risk of dementia
AD patients are more prone to T2DM

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16
Q

Apart from T2DM, what metabolic features increase the risk of Alzheimer’s disease?

A

Body weight extremes and hypercholesterolaemia

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17
Q

AD is associated with increased/reduced glucose metabolism and insulin signalling in the brain

A

Reduced

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18
Q

How can we fix the problem of obesity?

A

Societal engagement
Inform
Motivate - individual sets personal goals
Incentive
Influence - changes in advertising and pricing to alter societal attitudes

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19
Q

Describe the structure of SARS-CoV-2

A

Contains glycoprotein spikes
Has a membrane layer which is alcohol/detergent sensitive
Inside is the virus genome which is RNA and encodes ~27 proteins

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20
Q

How does SARS-CoV-2 enter cells?

A

The spike proteins allow it to bind and enter healthy cells

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21
Q

How is SARS-CoV-2 detected by the immune system?

Study These Flashcards
A

By the spike proteins

22
Q

What are the functions of S1 and S2 of the spike protein of SARS-CoV-2?

Study These Flashcards
A

S1 - recognition site. Allows the recognition and binding to the cell receptor
S2 - facilitates fusion of viral membrane with the cell

23
Q

What cleaves the viral S glycoprotein in SARS-CoV-2?

Study These Flashcards
A

Transmembrane serine protease 2 (TMPRSS2)

24
Q

ACE2:
What is it?
What is its function?

Study These Flashcards
A

Zinc metalloprotease involved in BP control
Catalyses the hydrolysis of angiotensin II to angiotensin 1-7

25
What is the primary receptor for SARS-CoV-2?
ACE2 receptor
26
How many cleavage sites are on SARS-CoV-2?
3, cleavage occurs after binding to ACE2
27
Symptoms of mild-moderate SARS-CoV-2 infection
Headache Loss of smell Cough Nasal obstruction Lack of energy Myalgia Runny nose Sore throat Fever
28
Symptoms of severe SARS-CoV-2 infection
Fever Joint pain Abdominal pain SOB Pneumonia Cough Vomiting Fatigue/malaise Confusion
29
Symptoms that patients in ICU with SARS-CoV-2 had
ARDS Acute respiratory failure Dyspnoea Myocardial injury Arrhythmias Heart failure Kidney failure Encephalopathy
30
Co-morbidities for SARS-CoV-2
Hypertension CKD Liver disease Immunocompromised COPD CVD Cancer
31
True or false: Diabetes is a risk factor for SARS-CoV-2 infection
False Not a risk factor for infection but major risk factors for progression to critical illness Increased risk of hospitalisation, intensive care, ARDS, mechanical ventilation and death
32
In what groups is obesity associated with increased mortality from COVID-19?
Younger (18-59) rather than older Males Non-white ethnicity
33
What is long COVID?
When symptoms remain after clearance of acute infection (~4 weeks) and cannot otherwise be explained
34
Symptoms of long COVID
Fatigue Dyspnoea Cardiac abnormalities Cognitive impairment Sleep disturbances PTSD-like symptoms Muscular pain Headache
35
Who are the people most at risk after vaccination?
Less healthy lifestyles Older frail people Higher BMI Living in areas of high deprivation
36
Three stages of the overactive inflammatory response in SARS-CoV-19
Early infections stage Pulmonary phase Hyper-inflammatory stage
37
What is involved in the early infections stage?
Fever, dry cough etc.
38
What is involved in pulmonary phase?
Shortage of breath, chest abnormalities on imaging
39
What is involved in the hyper-inflammatory stage?
Cytokine storm leading to ARDS, multiple organ failure and death Elevated IL-6, TNF-alpha, IL-1b, CRP
40
A Western diet leads to activation/inhibition of the innate immune system and activation/inhibition of the adaptive immune response
Leads to activation of innate immune system and inhibition of the adaptive immune system
41
What happens when there is overnutrition of adipose tissue?
Overnutrition driver hyperplasia and hypertrophy and causes adipose tissue expansion with vascularisation, leads to hypoxia and cell death and increased numbers of immune cells
42
How is insulin resistance fuelled in obese adipose tissue?
Via inflammation and increased lipolysis
43
How do fat cells effect the immune response in SARS-CoV-2?
Increased inflammation and there is death through virally driven hyperinflammation Suppressed immune responses More pro-inflammatory mediators Reduced antiviral and anti-inflammatory responses
44
How does adipose tissue act as a virus reservoir?
Higher viral load for longer Poor recovery from disease Prolonged viral shed from obese individuals Reduced efficacy of vaccines and antivirals
45
True or false: Obesity exacerbates the ageing of the immune system
True - mirrors immune deficit in elderly individuals
46
What do interferons do?
Lead to RNA and viral protein destruction
47
What are the three main classes of interferons?
Type I - IFN alpha, IFN beta Type II - IFN gamma Type III - IFNI
48
What do type I interferons do?
Stimulate resistance to viral replication in all cells Leads to viral RNA destruction Promotes NK cell activation
49
What do type II interferons do?
Immune-induced responses Coordinates response from innate to adaptive immunity (T-cells)
50
What do type III interferons do?
Present the antiviral activity First line of defence against viral infections Regulates innate and adaptive immune responses
51
How does obesity cause impaired virus clearance and high viral load?
By regulating ACE2 and raising ER stress

CVDM (16 decks)

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