METABOLIC SYNDROME in LOW BMI BILL ROMERO, MD, MS, CNS.
-
Upload
jessie-bradley -
Category
Documents
-
view
214 -
download
0
Transcript of METABOLIC SYNDROME in LOW BMI BILL ROMERO, MD, MS, CNS.
METABOLIC SYNDROMEin
LOW BMI
BILL ROMERO, MD, MS, CNS
Body Mass Index (BMI)
BMI is a weight to height ratio. The heavier the weight, relative to the same
height, the higher the BMI. Estimates the fat percentage Same weight and height will have the same
BMI, regardless of body fat percentage. May have normal BMI even if Body Fat %
is in Obese Range (>25%).
BMI Table BMI = [( lbs/inches² ) (weight in pounds X 703 )] / height in inches²
BMI vs. Fat Percentage
Same weight and height but varying fat percentages.
Fat Percentage
Most commonly measured by bio-impedance
Small amount of electricity is passed through body and resistance is measured
The more fat, the more resistance.
Normal Weight Obesity It is possible that one can weigh “normal’ and be
medically obese Normal Weight Obesity Same risk factors as “overweight” obesity
Classifications:– Normal: 25% and below– Overweight: Above 25 to 29%– Obese: 30 to 40%– Morbidly Obese: Above 40%
Carbohydrate Metabolism
An unhealthy diet, high in refined carbohydrates, causes rapid elevation of blood sugar. The pancreas responds by increasing insulin output.
Keith Vosseller, Lance Wells, M. Daniel Lane, and Gerald W. HartElevated nucleocytoplasmic glycosylation by O-GlcNAc results in insulin resistance associated with defects in Akt activation in 3T3-L1 adipocytes PNAS 2002; 99: 5313-5318.
Insulin Resistance
If the capacity of the insulin receptors is compromised due to nutrient insufficiencies and excess in sugar consumption the internal message to the cells is reduced and the efficiency of the cell is compromised.
Premise
Obesity causes a biochemical change: insulin resistance
Insulin resistance leads to progressive weight gain (vicious cycle)
Insulin resistance must be recognized and treated
Proper nutrition, exercise and medications can reduce insulin resistance and reverse obesity.
Metabolic Syndrome
Obesity Insulin Resistance Hypertension Hyperlipidemia
Prothrombotic State Proinflammatory State
DIAGNOSIS
Insulin Resistance– Fasting Glucose to Fasting Insulin (G:I Ratio) <
4.5 (Legro, et al)– 2-Hr Insulin 5X greater than Fasting Insulin– Fasting Insulin >20– Elevated insulin levels in OGTT with Insulin
Test– Waist to Hip Ratio
Glycemic Index Ranks carbohydrates on
how fast their sugar can raise glucose compared to equivalent amount of sugar.
Practical Use: allows us to choose “slow-release” carbohydrates
Included in Nutritional Data of food in Europe; proposed to be included in the US
FOOD KCal GI
Table Sugar 100 100
White Bread 100 70
Pumpernickel Bread
100 51
Fruit GI
Pear 33
Apple 45
Pineapple 63
Glycemic Load
Compares carbohydrates on volume needed to raise blood sugar. For example, watermelon has a high glycemic index but because it is mostly water, you can eat more of it than table sugar to raise your blood sugar
A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium, and a GL of 10 or less is low
Pharmacologic Intervention
Morbid obesity with laboratory verified insulin resistance
Not compliant with diet or exercise Metformin 500 mg BID or 1000 mg XR OD
with meals
MANAGEMENT: Dietary
Three Fundamental Principles1. Timing: Eat small meals every three hours
Levels of Satisfaction
>140 Stuffed
120-140 Full
90-120 Satisfaction
70-90 Hungry
<70 Starving
Adrenaline - shaky, irritable, hungryCortisol – store sugar from already depleted supplyGlucagon – release sugar from liver
MANAGEMENT: Dietary1. Timing: Eat every three hours regardless of
hunger.
Inadequate caloric intake during the day leads to:
a. Reactive Hypoglycemia
b. Nocturnal Eating Syndrome
c. Central Adiposity
Many of us do not eat enough during the day.
It is self-perpetuating…
MANAGEMENT: Dietary2. Quantity: Best way to assess caloric needs is to measure Basal
Metabolic Rate
Rule of Thumb: Weight in pounds X 10 then add the weight. For example: 220 lbs X 10 = 2200 + 220 = 2400
To lose 1 pound a week, prescribe a diet 500 cal less than BMR. In this case, about 1800 calories. Goal: Lose 1% of weight per
week. 200 lbs = 2 lbs/week
Weight Reduction Prescribe Weight Reduction through Energy Deficit
Select a Realistic Goal Weight
1. Select a BMI 2 units below current BMI
2. Approximate BMR BMR = Wt in lbs X 10 + Wt
= (200 X 10) + 200 = 2200
Reduce BMR by 500 to 1000 calories = 1500-1800 cal
3. Use a Bio-impedance Analyzer to measure BMR
BMRc BMRa BMI %Fat
2200 1670 28 33
MANAGEMENT: Dietary3. Quality: Each meal
must have proteins, fats and carbohydrates
300 Cal
1/3 CHO 100 100
1/3 Prot 1002/3 Prot & Fats 200
1/3 Fats 100
B S L S D
300 150 400 150 500
Choosing Foods
Carbohydrates (100cals)
Proteins and Fats (100cals)
1 sl multigrain bread 1 oz red meat
4 c salads/veggies 1-1/3 oz white meat
½ c rice, pasta, oatmeal 1 oz seafood
6 inch pita or wrap 1 slice cheese
½ c beans 1 whole egg
1 small potato 2 eggwhites
Breakfast: 300 calories
Rule of Hand
Dinner should be about 500 calories
Each finger = 100 Kcal
3 fingers = protein Index = complex
carbohydrates Thumb = simple
carbohydrates