Overnutrition

Question 1

Obesogenic behaviour

Answer 1

Increased energy intake- gluttony

Decreased energy expenditure- sloth. This is the primary determinant.

Question 2

Obesity etiology

Answer 2

complex and multi-factorial
Some genes are linked, but environment and behaviors are obesogenic and increase prevalence.
Small imbalance between intake and expenditure is responsible.

Question 3

Management of Obesity

Answer 3

Special diets
Lifestyle clinics
CBT
Drugs
Enforced intake restriction: jaw wiring, fixed stomach belts, surgery.

Question 4

Carb restricted diets

Answer 4

Highly satiating
Reduce energy intake.
Safe when:
- fruit and veg intakes are maintained
- Fat quality is appropriate (low in saturates)

Question 5

Orlistate

Answer 5

Inhibits gastrointestinal lipases
Reduces fat abs from gut
Side effects: steatorrhea, with possible anal leakage.

Question 6

Phentermine

Answer 6

appetite suppressant like amphetamine

SEs: raised BP

Question 7

Lorcaserin

Answer 7

Serotonergic appetite suppressant
SEs: few. Moderately effective.
aka Belviq in US

Question 8

Liraglutide

Answer 8

GLP-1 agonist

Increases satiety and reduces food intake

Question 9

Naltroxene/buproprion

Answer 9

Noradrenergic and dopaminergic reuptake inhibitor and opioid receptor antagonist.
Reduces hunger

Question 10

Obesity increases mortality in what diseases?

Answer 10

Ischemic heart disease
Stroke
Diabetes
Some cancers
Liver disease
It shortens the lifespan

Question 11

Obesity is assoc with a decrease in which diseases?

Answer 11

Respiratory diseases in both men and women

and cancer of lung, mouth, pharynx, larynx or esophagus in men

Question 12

Diseases with a relative risk >3 for obesity

Answer 12

Type II DM (insulin resistance)
HTN
Breathlessness
Gallbladder disease
Dyslipidemia
Sleep apnea

Question 13

Diseases w relative risk 2-3

Answer 13

Coronary heart disease/Heart failure
Osteoarthritis
Hyperuricemia and gout
Pre-eclampsia
Cancer

Question 14

How obesity increases risk for CVD

Answer 14

overweight/obesity causes increase BP and dyslipidemia- the 2 main risk factors for CVD

Question 15

Cholesterol and obesity

Answer 15

Increased BMI is associated with increased LDL cholesterol
and decreased HDL
as well as increased LDL/HDL ratio

Question 16

TAGs as an indicator of CHD risk

Answer 16

Better indicator for CHD risk and dyslipidemia
Increased TAG:
- intolerance to dietary fat
- reduced cardioprotective HDL
- Pro-Inflammatory and pro-thrombotic
- Increase in small, dense atherogenic LDL

Question 17

Pathophys changes in CVD

Answer 17

abnormal clotting, HTN, dyslipidemia, inflammation, vascular endothelial dysfxn.

Question 18

CVD and diet

Answer 18

Main risk factors:
Salt- too much
Fat- too much/wrong kind
Carbs- too much/wrong kind
Fibre- not enough
Fruit, veg and nuts- not enough

Question 19

Processed foods

Answer 19

increase salt intake and decreased potassium intake.

XS salt and low K increase risk of HTN

Question 20

Dietary fat effects on clotting

Answer 20

n-3 PUFAs decrease clotting and increase bleeding time but decrease inflammation and TAGs

n-6 PUFAs increase clotting and inflammation, but decrease cholesterol

Question 21

Foods assoc w a lower risk of CHD

Answer 21

PUFAs
Whole grain carbs
MUFAs

Question 22

Glycemic index

Answer 22

Low GI diets (low glucose) improve blood lipids, especially TAGs

Question 23

CVD and dietary carbs

Answer 23

Carbs give excess fructose.
Have low GI but are metab’d in the liver and XS is converted to TAGs–> increase CVD risk.
Doesn’t signal satiety like glucose–> obesogenic

Question 24

Fiber and CVD

Answer 24

High fiber and low GI carb diets improve dyslipidemia and decrease risk of CVD

Red lentils
Pinto beans
Spaghetti
Yellow Split peas

Question 25

Foods assoc with high GI and low fibre

Answer 25

Provide XS fructose Glutinous rice Short grain white rice Fresh mashed potatoes

Question 26

Diabetes Mellitus

Answer 26

Group of disorders comprising abnormalities of metabolism, characterized by hyperglycemia, resulting from insulin deficiency or resistance

Question 27

Type I/ Insulin-dependent

Answer 27

Weight loss, polyuria, polydipsia Ketosis Normally develops in childhood, before 40y

Question 28

Type II/Non-insulin dependent

Answer 28

Often asx Overweight Infections:UTI, vulva Thirst, rarely coma Normally appears >40y in whites, but is becoming more common in children now.

Question 29

Gestational Diabetes

Answer 29

``` asx or presents like type II Risks: overweight/obese had GDM before Had large baby previously (10lb) FHx of DM Black, Hispanic, Am Indian, S Asian, M E background ```

Question 30

Complications of DM

Answer 30

``` Blindness Kidney damage CVD Lower-limb amputations Dementia ``` Controlling glucose, BP and blood lipids decrease these risks

Question 31

Type I factors

Answer 31

mainly a Tcell-med AI disease HLA linked. Environmental factors: - Viruses: Rubella, enterovirus, coxsackie, CMV - Dietary: Cows milk proteins (BSA), gluten before 3 months. VitD intake and breast feeding protect from it.

Question 32

Hygiene hypothesis for DM

Answer 32

Environment for children is too clean--> deficiency in immunoregulation --> DM type I

Question 33

Risk factors for Type II DM

Answer 33

``` Age, FHx, Ethnicity, Social class Diet (SFAs) No physical activity Central obesity Metab syndrome ```

Question 34

Weight and risk for DM-2

Answer 34

for each 1kg increase in weight, risk for DM increases by 4.5%. Pts w central adiposity have higher insulin levels and are more insulin resistant than those w peripheral obesity.

Question 35

Metabolic syndrome

Answer 35

Cluster of disorders: 1- Glucose intolerance 2- Central adiposity (insulin resistance) 3- HTN 4- Dyslipidemia (either increase TAGs or decrease HDL) Causes increase risk for CVD CHD death and non-fatal MI risk increased w the # of metabolic syndrome disorders a pt has.

Question 36

Why central obesity causes insulin resistance

Answer 36

- Fat drains directly to liver via portal system - More NEFA produced than gluteal-femoral fat: NEFA goes to mm. and causes IR - More inflammatory cytokines - Central adipocytes are larger and more IR than peripheral ones - Hyperinsulinemia is directly related to waist circumference

Question 37

Major cause of Metabolic syndrome

Answer 37

Central obesity

Question 38

DM treatments

Answer 38

Type 1: diet/lifestyle change + insulin | Type 2 and GDM: diet/lifestyl +/- oral hypoglycemics (metformin) +/- insulin