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46 Cards in this Set
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What is hyperplastic obesity? |
Increased number of fat cells within the body. Tends to be associated with fewer serious health risks. Depends primarily on the diet of the mother while the person was still in womb and early stages of life. Harder to develop new fat cells in adulthood therefore hyper plastic obesity begins in childhood |
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What is hypertrophic obesity? |
Increase in size of each fat cell.
Linked to diabetes, heart disease, high BP. Usually fat distribution around the waist - usually seen in obese male. |
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The combination of: A decrease in insulin-mediated anti-lipolysis + An increase in catcholamin-mediated lipolysis = |
Increased circulating levels of non-esterised fatty acids in plasma |
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VAT produces both pro and anti-inflammatory factors including: |
adipokines cell signalling proteins - leptin, adiponectin and resisting TNFa IL6 |
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What factors are involved in the feeling of satiety? |
Mechanical stretch of the stomach via the vagus nerve Hormones made by adipocytes such as gherkin, leptin and adiponectin Hormones made by stomach and GIT - Glucagon Like Peptide, Peptide YY Oxytocin, CRH, insulin and glucagon |
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What is leptin? |
A satiety hormone, regulates appetite and energy balance of body. Produced by adipocytes when they are 'full' of tri-acyl-glycertides (TAG) Acts as a signalling factor from adipose tissue to the central nervous system, regulating food intake and energy exposure |
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What does Leptin down-regulate? |
Acts at the level of the hypothalamus and down-regulates neuropeptide Y, leading to decreased hunger, increased activity and increased thermogenesis. |
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What is leptin resistance? |
desensitisation for the leptin signal. Changes in metabolism produce abdominal weight gain in body genders, thigh and hip weight gain in females, chronic fatigue, sleep problems, CV distress. Additional adipose tissue then contributes to further leptin resistance. |
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What can leptin also modify? |
Insulin sensitivity tissue metabolism stress reponses reproductive function All mediated through hypothalamic-pituitary axis. |
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High concentrations of leptin in obesity are associated with what? |
An apparent loss of its characteristic anorexic actin within the hypothalamic region of the brain. Obesity is associated with leptin resistance as evidenced by hyperleptinaemia - worsens with increasing obesity. |
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What can reverse leptin resistance? |
Reducing triglyceride levels. Drugs used to reduce triglyceride levels reversed both hypertriglyceridemia and impaired leptin transport. |
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Why are triglycerides an importance cause of leptin resistance? |
mediated by impaired transport across blood brain barrier |
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Which diet can improve leptin resistance? |
Low GI. Lower leptin concentration occurs without evidence of increased hunger suggesting functional improvement. |
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What is Ghrelin? |
Produced in fundus of stomach. Plays a role in long term regulation of energy metabolism and short term regulation of feeding. In obesity ghrelin concentration is low. |
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What is adiponectin? |
An adipocyte specific protein hormone. |
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Who has more adiponectin? |
lean subjects more adiponectin the less full our fat cells our. |
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Aside from obese individuals, who else may have low levels of adiponectin? |
insulin resistance and type 2 diabetes |
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Physiological cause of excess fat mass |
Not just excess calories. Insulin resistance can also cause excess fat mass - reaction to a high glycemic diet. Gut derived hormones Impaired diet induced thermogenesis low serotonin levels. |
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How does insulin control storage and release of fatty acids in and out of adipocytes? |
Regulation of several lipase enzymes Activation of glucose transport into the at cell via recruitment of glucose transport protein 4 (GLUT4) |
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How does insulin resistance affect the liver? |
Normally sends two signals to the liver: Stop making glucose Store glucose In insulin resistance both processes respond poorly to signal, putting patient in state of excess glucose levels |
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Why can an endocrine disorder be linked to obesity? |
Gut hormones are disturbed. Can be argued that secretion of these hormones are regulated by the presence or absence of highly viscous dietary fibre. |
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What is food induced thermogenesis? |
How much of the food consumed is converted to heat. After food is ingested there is a rise in energy expenditure, which accounts for 10% of the day's energy expenditure. |
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When can the thermic effect of food be blunted? |
when insulin resistance is high and may account for the thermic effect of food in obesity. |
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How can a diet low in tryptophan be linked to obesity? |
leads to low serotonin levels which the brain interprets as starvation. The stimulation results in preference for carbs. Feeding a carb high meal leads to increased tryptophan delivery to brain resulting in elevated manufacture of serotonin. |
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Factors hindering weight loss? |
low thyroid production high or low cortisol inflammation digestive and liver insufficience oestrogen dominance excess testosterone |
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How can you decrease lipogenesis? |
Reduce calories reduce glycaemic load increase energy output - exercise and increase thermogenesis. |
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How can you stimulate fat loss? |
Low GL foods Protein (Thermogenic) Low carbohydrate Exercise daily - 25 min low intensity |
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What is hydroxycitrate? |
Lipogenic inhibitor suppresses appetite critical to use low fat diet - only inhibits conversion of carbs to fat. Dosage 1500mg three times a day |
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How can omega 3 be beneficial for weight loss? |
Improve insulin sensitivity anti inflammatory lipid lowering actions |
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Which tea can stimulate thermogenesis? |
Green team |
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How can calcium support weight loss? |
attenuate weight gain during the overconsumption of an energy-dense diet. May up-regulate uncoupling proteins associated with increasing thermogensis |
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How can carnitine, B2 and B3 aid weight loss? |
Essential for be a oxidation of fatty acids in mitochondria and therefore efficient utilisation of fats for energy. C required to transport fatty acids across mito membrane. C linked with improved lipid metabolism. |
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How can alpha lipoic acid aid weight loss? |
Decreases hypothalamic AMPK activity |
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Which mineral can aid weight loss? |
Chromium Demonstrates lower body weight yet increase lean body mass. Dose - 400Ug |
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Excessive leptin levels caused by leptin resistance may be improved by? |
Carnitine Omega 3 Conjugated linoleic Acid Vit D may inhibit secretion of leptin by adipocytes |
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Aetiology of anorexia? |
Lack of control over life or situations dysfunctional families positive reinforcement that fat makes you unloveable Nutritional deficiencies menarche |
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How to create appropriate meal plan for anorexics? |
rigid with meal times focus on energy dense and nutrient dense foods create play together but be firm client to keep food diary (check calories after client has left) |
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Examples of high calorie/ nutrient dense foods |
nut butters avocado brazil nuts egg whole milk soy milk quinoa dried fruit sardines in oil smoked mackerel smoothies |
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What is re-feeding syndrome? |
During starvation insulin levels decrease. Re-feeding can cause increase in insulin release and increase shift of phosphate, glucose, potassium, Mg and water often resulting in oedema. |
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How can re-feeding syndrome be prevented? |
50mg of thiamine before each meal and gradual calorie intake |
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Common post anorexia problems? |
Gut symbiosis and low HCL Food intolerances low absorption capability repro problems poor immunity dentition problems anaemia and low mineral levels anxiety and depression poor skin, hair and nails |
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Anorexics posses many risk factors for zinc deficiency such as? |
females between age of 12-25 women due to urinary excretion because of oestrogen increased urinary excretion due to stress those that have higher phytates and fibre |
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Zinc deficiency can manifest as? |
Weight loss disorders of appetite and food intake amenorrhea depression skin disorders Usually all present in AN |
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Which strains of probiotics should be included in re-feeding procedures? |
L Bulgaricus and S Thermophilus. Trials have shown increase in immune function |
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How can L-Arginine aid recovery of anorexics? |
Protection against CV risks |
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Why should the nervous system be supported during anorexic support? |
Hypercorisolemia is common in AN patients so may benefit from adrenal support. |
