Depresi n y Obesidad

1. Depresi�n y Obesidad Dr. Felix Ml. Esca�o Polanco Endocrin�logo Pdte. Sociedad Dominicana para el Estudio de la Obesidad (SODEO) Scherezade 6 de Marzo 2008

3. Pathways by which ghrelin may influence chronic energy balance. Ghrelin produced by the stomach or the gut can be transported by the bloodstream to specific neuronal circuits situated in hypothalamus or the brainstem that are regulating food intake as well as energy expenditure. It still remains uncertain whether or not ghrelin has to cross the blood-brain barrier (BBB) to influence these central structures. During transport via circulating blood, serum HDLs and presumably other proteins such as albumin bind ghrelin. Ghrelin however may also signal the brain by activating the afferent vagal nervous system as either an endocrine or a paracrine signal directly at the stomach level. Ghrelin-responsive GHS-Rs are expressed at gastric vagal nerves, and vagotomy prevents some of ghrelin�s effects on energy balance. Incoming information represented or triggered by ghrelin is, however, believed to be constantly sensed and analyzed in hypothalamus and the brainstem, independent from its origin or afferent pathway used. Based on constant integration of this and other afferent information about the status of acute and chronic changes in energy balance, an efferent response seems to involve several pathways to balance energy stores and adipose tissue mass. These mainly include the sympathetic nervous system (SNS), the hypothalamic-pituitary adrenal (HPA) axis, and the hypothalamic-pituitary thyroid (HPT) axis. In addition, ghrelin is thought to be produced in brain centers of energy balance control, and, although present there in very small amounts, brain-derived ghrelin might play an additional role in the regulation of energy homoeostasis (51 123 152 198 372 ). Pathways by which ghrelin may influence chronic energy balance. Ghrelin produced by the stomach or the gut can be transported by the bloodstream to specific neuronal circuits situated in hypothalamus or the brainstem that are regulating food intake as well as energy expenditure. It still remains uncertain whether or not ghrelin has to cross the blood-brain barrier (BBB) to influence these central structures. During transport via circulating blood, serum HDLs and presumably other proteins such as albumin bind ghrelin. Ghrelin however may also signal the brain by activating the afferent vagal nervous system as either an endocrine or a paracrine signal directly at the stomach level. Ghrelin-responsive GHS-Rs are expressed at gastric vagal nerves, and vagotomy prevents some of ghrelin�s effects on energy balance. Incoming information represented or triggered by ghrelin is, however, believed to be constantly sensed and analyzed in hypothalamus and the brainstem, independent from its origin or afferent pathway used. Based on constant integration of this and other afferent information about the status of acute and chronic changes in energy balance, an efferent response seems to involve several pathways to balance energy stores and adipose tissue mass. These mainly include the sympathetic nervous system (SNS), the hypothalamic-pituitary adrenal (HPA) axis, and the hypothalamic-pituitary thyroid (HPT) axis. In addition, ghrelin is thought to be produced in brain centers of energy balance control, and, although present there in very small amounts, brain-derived ghrelin might play an additional role in the regulation of energy homoeostasis (51 123 152 198 372 ).

5. El Tejido Adiposo: Un �rgano End�crino The evolving view of adipose tissue: an endocrine organ Previously, adipocytes were considered to be little more than inert storage depots, storing fat as triglyceride in the fed state, and releasing fuel as fatty acids and glycerol in times of fasting. It is now clear that adipocytes are highly active endocrine glands that secrete important hormones, cytokines, vasoactive substances, and other peptides. These exert marked influences on metabolic function and cardiovascular risk in a number of organ systems throughout the body. The following slides describe some of the principal adipocyte-derived agents, and summarise their metabolic and cardiovascular effects. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003;144:2195-200. The evolving view of adipose tissue: an endocrine organ Previously, adipocytes were considered to be little more than inert storage depots, storing fat as triglyceride in the fed state, and releasing fuel as fatty acids and glycerol in times of fasting. It is now clear that adipocytes are highly active endocrine glands that secrete important hormones, cytokines, vasoactive substances, and other peptides. These exert marked influences on metabolic function and cardiovascular risk in a number of organ systems throughout the body. The following slides describe some of the principal adipocyte-derived agents, and summarise their metabolic and cardiovascular effects. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003;144:2195-200.

7. INDICE DE MASA CORPORAL (IMC) EN LA POBLACION GENERAL Y POR SEXO. (EFRICARD, 1998). IMC M % H % TOTAL % KG/M� TOTAL 4093 2085 6178 < 25 2087 51.0 1274 54.4 3361 54.4 26-29 1259 30.8 547 29.2 1806 29.2 > 30 747 18.3 264 16.4 1011 16.4

9. Increase in prevalence of obesity in Canadian boys. Wave is only starting (see younger ages). Same trend in girls.Increase in prevalence of obesity in Canadian boys. Wave is only starting (see younger ages). Same trend in girls.

11. Screening detecci�n depresi�n Beck Depression Inventory (BDI) contiene 21 apartados divididos en 2 categor�as: - S�ntomas cognitivos (1-13) - S�ntomas som�ticos (14-21) (Puntuaci�n de 10 en BDI limite de depresi�n moderada) PHQ-9(Cuestionario Salud Pcte.) contiene 9 apartados con el score siguiente: 0 � 4 Normal 5 � 9 Depresi�n Leve 10-14 Depresi�n Moderada 15-19 Depresi�n Moderada � Severa 20-27 Depresi�n Severa