Title: The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment
1The Obesity/Diabetes EpidemicPerspectives,
Consequences,Prevention, Treatment
Part 4
- Stan Schwartz MD, FACP, FACE
- Private Practice, Ardmore
- Obesity Program
- Cardiometabolic Diabetes Center and Affiliate,
- Main Line Health System
- Emeritus, Clinical Associate Professor
- University of Pennsylvania
2Obesity-Associated Illnesses That Occur in
Childhood
- Idiopathic intracranial hypertension
- Pulmonary disorders
- Obstructive sleep apnea
- Hypoventilation syndrome
- Hypertension
- Hypercholesterolemia
- Proteinuria
- Nonalcoholic fatty liver disease
- Gallbladder disease
- Type 2 diabetes mellitus
- Polycystic ovarian syndrome
- Orthopedic
- Blounts disease
- Slipped capital femoral epiphysis
- Skin
- Acanthosis nigricans
- Striae
3Overweight and Obesity Increase the Risk of CV
Disease Mortality
Men
Women
Relative Risk of Cardiovascular Disease Mortality
Overweight
Normal weight
Obese
gt18 25 30
gt40
BMI, kg/m2
Data are from 1 million men and women (average
age, 57 years) followed for 16 years who never
smoked and had no history of disease at
enrollment. Calle EE, et al. N Engl J Med.
19993411097-1105.
4Obesity and Metabolic SyndromeA Cluster of
Coronary Heart Disease Risk Factors
GeneticSusceptibility
DietPhysical InactivityStress
RaisedBlood Pressure
Obesity
AutonomicDysfunction
ProthromboticState
ProinflammatoryState
InsulinResistance
AtherogenicDyslipidemia
?High-Density Lipoprotein Cholesterol
?Triglycerides
?Small Low-Density Lipoprotein Particles
Slide Source Obesityonline.org
Adapted from Grundy SM. J Clin Endocrinol Metab.
2005892595-2600.
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6Additional Risk Factors
- Each additional risk factor increases chronic
disease risk - hypertension (gt140/90)
- impaired glucose tolerance (110 125 mg/dl)
- hypertriglyceridemia (gt150mg/dl)
- hypercholesterolemia (gt240mg/dl, gt160mg/dl LDL)
- low HDL-C (lt35mg/dl)
- family history (parent/sibling) of early CHD,
hpt, DM - Mgt55, Fgt65
- Age Mgt45 or Fgt55
7Risk Factor Sum and 16-Year Coronary Heart
Disease Risk Framingham Offspring Study
Low HDL-C, high cholesterol, high BMI, high
systolic BP, high triglyceride, high
glucose. Wilson et al. Arch Intern Med
19991591104.
8Obesity, IRS, Type 2 Diabetes and Atherosclerotic
Disease
- Obesity carries with it increase CV Risk Factors
- Risk factors for macrovascular disease accrue
before the diagnosis of diabetes as gt 50 of
patients with newly diagnosed Type 2 diabetes
have pre-existing cardiovascular disease. - 2-4 fold gt risk of ASVD in diabetic vs. normal
patients - Cardiovascular disease causes 80 of all diabetic
mortality- 75 coronary, 25 cerebral vascular - Type 2 diabetes is associated with an increased
risk of morbidity and mortality from
cerebrovascular disease versus the general
population, and gt HgA1c, gtrisk
9Abdominal Fat Distribution Increases the Risk of
Coronary Heart DiseaseThe Iowa Womens Health
Study
Relative Risk
3
2
Waist-Hip Ratio Tertile
1
3
2
1
Body Mass Index Tertile
Folsom et al. Arch Intern Med 20001602117.
10Elevated Visceral Fat
- Metabolically more active
- Greater effect on visceral organs
- Greater Insulin Resistance
- hyperinsulinemia
- impaired glucose tolerance
- Type 2 diabetes
- Hyperlipidemia
- Hypertriglyceridemia
- Hypercholesterolemia
- Hypertension
11Visceral Fat DistributionNormal vs Type 2
Diabetes
Type 2 Diabetes
Normal
2-11
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