Obesity, Metabolic Syndrome
Metabolic Risk Factors: Obesity is a risk factor for ASCVD. It causes hypercholesterolemia, hypertension, hyperglycemia and the emerging risk factors (atherogenic dyslipidemia, insulin resistance, proinflammatory state, prothrombotic state). Furthermore, the majority of obese persons who develop ASCVD typically have a clustering of major and emerging risk factors (metabolic syndrome).
The metabolic syndrome is a constellation of metabolic risk factors that consist of the following : – Increase blood pressure – Increase glucose associated with insulin resistance – Prothrombotic state.
Diabetic persons have a high risk for metabolic syndrome:
Most persons with multiple metabolic risk factors are insulin resistant. This observation leads to the concept that insulin resistance is the cause of the metabolic syndrome and also leads to alternative term for the metabolic syndrome, namely the insulin resistance syndrome.
Fats and Metabolic Syndrome:
Further to the insuline resistance, there are other risk factors of the development of metabolic syndrome :
- Nonesterified fatty acids (NEFAs)
- Inflammatory cytokines PAI-1
Obese persons release increased amounts of NEFAs into the circulation then NEFAs derived by lipolysis of adipose tissue triglycerides .the greater the amount of fat in adipose tissue, the more the amounts of NEFAs released will be.This greater release of NEFAs proceeds despite the higher insulin levels that are present in obese persons. Even though high insulin levels suppress adipose tissue lipolysis, they cannot reduce NEFA release to normal in obesity.
Excessive release of NEFAs into muscle leads to insulin resistance. The mechanisms whereby increased fatty acids in muscle cause insulin resistance have not been fully elucidated.
excess releasing of NEFAs into liver increase the Triglyceride content of liver ( Fatty liver). fat accumlation in the liver lead to insulin resistance as it does in muscle .Reduction in insulin action in liver allows for enhanced glyconeogenesis and increased hepatic glucose output; this will appear hyperglycemia in patient who have reduced insulin secretory capacity.
Inflammatory cytokines. obeses have increasing in production of cytokines as TNFα, IL-6. these increased synthesis may interfere with the action of insulin to suppress lipolysis and act as insulin resistance in adipose tissu.
Other products of adipose tissue may influence development of the metabolic syndrome. 1-Adiponectin is one potentially important product which has antiinflammatory and antiatherogenic propertiesObese persons have low levels of adiponectin so deprived of its protective effects against the metabolic syndrome 2- Leptin is play a systemic role beyond being an adipose tissue-derived appetite suppressant and have a beneficial effect on the liver to protect against fatty liver. Its mechanism may be to enhance fatty acid oxidation in the liver. 3-Resistin is a hormone which opposes the action of insulin.
Obesity-induced metabolic syndrome as a multidimensional risk factor for ASCVD and type 2 diabetes many researches indicate that the presence of the metabolic syndrome is associated with increased risk for both ASCVD and type 2 diabetes. persons with the metabolic syndrome have at least a 2-fold increase in risk for ASCVD, compared with those without . Risk for type 2 diabetes in both men and women is increased about 5-fold. the risk for diabetes is highest in those with impaired fasting glucose or IGT. Once a patient develops type 2 diabetes, risk for ASCVD is enhanced. Not only is relative risk for coronary heart disease (CHD) raised by 2- to 3-fold, but once CHD becomes manifest in a patient with diabetes.
Atherogenic dyslipidemia. is one of the metabolic abnormalities that define the metabolic syndrome, the cluster of cardiovascular risk factors frequently associated with intra-abdominal (or visceral) obesity.
Elevated blood pressure. obese people have a high risk of high blood pressure than a lean people . hypertension is a major risk of cardiovascular disease . the common complications of hypertension are CHD, stroke, left ventricular hypertrophy, heart failure, and chronic renal failure.
Elevated plasma glucose. – Diabetic people have a high risk of ASCVD. In epidemiological studies, the onset of diabetes is accompanied by increased risk for ASCVD, suggesting that hyperglycemia per se is atherogenic. whether the hyperglycemia of type 1 diabetes promotes atherogenesis has been uncertain. The major cause of death in persons with type 1 diabetes is CVD.
A variety of mechanisms have been proposed whereby hyperglycemia might promote atherosclerosis Another possibility is that insulin resistance is a reason of independently atherogenesis.
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