the obesity and nutrition biochemistry,Lecture no 6
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Transcript of the obesity and nutrition biochemistry,Lecture no 6
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Nutrition and Biochemistry(Lecture No. 6)
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OBESITY (MOST COMMON PROBLEM OF OVER NUTRITION)
Accumulation of excess body fats: obesity is the physical state in which the amount of stored fat is excessive. It results when energy intake exceeds energy expenditure.Anyone who is more than 20%, above the standard weight of the people of same, age, sex, and race is generally considered to be overweight. It is still not clear, whether obesity is a disease or symptom which manifests a group of diseases like Gout, D.M., HTN and endocrine disorders.
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IMPORTANCE OF OBESITY:Obese person are more prone to certain disease CVS DISORDERS: HTN, atherosclerosis, angina, varicose veins.LIVER DISEASE: fatty liver, cholecystitis, cholelithiasis.(FFFF)METABOLIC DISEASE: Gout (hyper uricemia), DM-IIGYNECOLOGICAL DISORDERS: Amenorrhea, oligomenorrhea, Endometrial Carcinoma.
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ASSESSMENT OF OBESITY:Amount of fat is difficult to measure directly, so indirect measure is the body mass index (BMI): shown to correlate amount of body fat in most individuals.BODY MASS INDEX: Basically BMI gives relative weight adjusted for height, is calculated both for men and women.BMI = Weight in kg/m2 (Height in meter)2
= Weight in LBs/ (Height in inches) 2 x 7.3BMI healthy Range = 19.5 ……………. 24.9 (Normal)BMI with = 25 ………………..29.9 (Overweight)BMI 30 or =..…………………. 30 (Obese)
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Types TYPES OF OBESITY:
OBESITY IS DIVIDED INTO TWO TYPES:EXOGENOUS: Over feeding or over eating with less physical activity. Many people over eat than calories requirement (more eat either happily or under tension).ENDOGENOUS: there may be one or more endogenous factors e.g.Endocrinal, metabolic, hypothalamic.
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PATHOLOGICALLY TYPES OF OBESITY:HYPERPLASTIC: Hyperplastic is lifelong,
characterized by ↑in no. of adipose cells and↑ size of adipose cells.
Fats distribution is peripheral and central but when individual is exposed to weight reduction adipose cells shrink in size but ↑in number of cells persistently remains same.
HYPERTROPHIC: (Adults-on-set) Seen in adults after 20 years, it is characterized by hypertrophy of cells of adipose ↑ (size of cells) without ↑in no. of adipose cells i.e. ↑of cell only. Long term weight reduction response is fairly good
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ANDROID (Apple shaped or upper body obesity): excess of fat is located in central abdomen waist to hip ratio is more than F 0.8: M 1.0
GYNOID (Pear shaped or lower body obesity): Excess of fat is distributed in lower extremities waist to hip ratio is less than F 0.8: M 1.0
Waist more than 40”in Males at risk CHD,, ,, ,, 35” in Females ,, ,, CHD
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CAUSES OF OBESITY: Obesity is most commonly due to over eating
than required calories:I. GENETIC INFLUENCE: Obesity occurs more
frequently among members of certain familiesII. PHYSIOLOGICAL: over eating than
requirement, during pregnancy endocrine play role ↑in wt or obesity, post-menopausal in women, prolong use of oral contraception.
III. METABOLIC: DM-II hyperlipidemia IV. HYPOTHALMIC INJURIES: and lesions
causes people to eat more & more and become obese.
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5. ENDOCRINAL DISORDER: it is due to hormonal imbalance e.g. hypo-thyroidism, Cushing syndrome, hypo-parathysidism.
6. AGE: Moderate accumulation of adipose tissue may occur at any age but more common at middle age.
7. SEX: adult women are more prone to obesity as compared to men. 15% body wt. is twice that of young men. Women in menopause, become obese and more frequent to become obese in pregnancy and prolong use of oral contraceptive use.
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METABOLIC CHANGES DURING OBESITY:
CHANGES IN FAT METABOLISM: Insulin resistance in adipose tissue causes ↑ “hormonal sensitive lipase” which causes↑ FFA, ↑TAGS, ↑Cholesterol in Plasma.
Serum TAGS level: ↑Tags level due to hyperinsulinism in obese patient.
Serum Cholesterol level: ↑Hyper cholesterolemia due to ↑cholesterol productions in obesity results.
Mobilization of FFA: ↑Insulin Resistance in adipose causes l↑evel of Level of hormonal sensitive lipase which result ↑FFA level, ↑TAG level, ↑ Cholesterol level.
CHANGES IN CARBOHYDRATES: Obesity is associated with ↑Hyper-insulinemia (β cell of islets of Langer-Hans stimulates to produce↑ insulin) more aggravate promoting i)↑Lipo-genesis ii) inhibit lipo-lysis
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CHANGE IN ACID- BASE STATUS:Massive obesity associated ē Hypoventilation leading to CO2 Retention, ↑acidosis ↓in pH leading to obesity Hypoventilation syndrome (Pickwickian syndrome). ENERGY METABOLISM BMR: obese persons BMR, appears to normal. His surface area large, total O2 consumptions is ↑than 25%, than normal. Use of O2 is greater, burns as fuel than normal, yet continuous to store fat.
CLINICAL FEATURES OF OBESITY: mostly are asymptomatic when obesity is marked, exertional Dispnea, depression, Tiredness, easy fateagueability, Alveolerhyporventilation ē CO2 retention.
Sign: exertional dyspnea, intertigo, pinkstriae, on abdomen, thighs, white striated in fold below breast and inguinal regions, ē HTN, D.M, ankleoedema.
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WEIGHT REDUCTION:The goals of wt. management in obese pts are first to induce negative energy balance – to reduce
body wt.PHYSICAL ACTIVITY:An↑in physical activity can create an energy deficit
and is an important component of wt loss treatment. Physical activity ↑in cardiorespiratory fitness ↓risk for C.V.S disease
CALORIC REDUCTION: Caloric intake should be less than caloric expenditure. ↓of body wt over 6 months often ↓BP ↓lipid level ↓D.M.
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PHARMACOLOGICAL TREATMENT:Obese who have BMI more than 30 can be
treated by SIBUTRAMINE (appetite Suppressant): is
an appetite suppressant that inhibits the re-uptake of both serotonin and non-epi-nephrine.
ORLISTAT (Lipase inhibitor): is a lipase (Pancrectic, Gastric) inhibitors that inhibits Gastric and pancreaticlipesas which breakdown dietry fat into smaller molecules. So no absorption of fat, no obesity
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LEPTIN:Leptin is produced proportional to adipose mass in edipocytes which inform the brain to regulate the amount of fat through
1 apetite control by decreasing appetite
2 by increasing energy expenditure. secretion enhanced during well fed state.
Leptin secretion is suppressed by depletion of fat stores, during starvation,and leptin secretion enhanced during wellfed state.
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SURGICAL TREATMENT: GastroplastyGestro-pyloroplastyLiposuction: It is latest technique having merits and
de-merits.ANTI-OBESITY VACCINES: SCRIPS VACCINE:
Ghrelin hormone that regulate the energy balance and ↓about 20 – 30% wt of mice, yet has to try in humans.
CYTOS ANTI OBESITY VACCINE: (SWISS)It prevents the Ghrelin’s uptake by the brain