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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

The Obesity/Diabetes Epidemic: Perspectives, 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

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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

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  1. The Obesity/Diabetes Epidemic:Perspectives, 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

  2. Obesity-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 • Blount’s disease • Slipped capital femoral epiphysis • Skin • Acanthosis nigricans • Striae

  3. 3.0 2.6 2.2 1.8 1.4 1.0 0.6 Overweight and Obesity Increase the Risk of CV Disease Mortality Men Women Relative Risk of Cardiovascular Disease Mortality Normal weight Overweight Obese >18 25 30 >40 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. 1999;341:1097-1105.

  4. Obesity and Metabolic Syndrome:A Cluster of Coronary Heart Disease Risk Factors GeneticSusceptibility DietPhysical InactivityStress RaisedBlood Pressure Obesity AutonomicDysfunction ProthromboticState InsulinResistance ProinflammatoryState AtherogenicDyslipidemia Triglycerides High-Density Lipoprotein Cholesterol Small Low-Density Lipoprotein Particles Slide Source: Obesityonline.org Adapted from Grundy SM. J Clin Endocrinol Metab. 2005;89:2595-2600.

  5. Additional Risk Factors • Each additional risk factor increases chronic disease risk • hypertension (>140/90) • impaired glucose tolerance (110 – 125 mg/dl) • hypertriglyceridemia (>150mg/dl) • hypercholesterolemia (>240mg/dl, >160mg/dl LDL) • low HDL-C (<35mg/dl) • family history (parent/sibling) of early CHD, hpt, DM • M>55, F>65 • Age M>45 or F>55

  6. 6 5 Risk factors (n) 4 0 1 3 2 Relative Risk of CHD 3 2 1 Men Women 0 Risk 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 1999;159:1104.

  7. Obesity, 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 diabetesas> 50% of patients with newly diagnosed Type 2 diabetes have pre-existing cardiovascular disease. • 2-4 fold > 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 > HgA1c, >risk

  8. Abdominal Fat Distribution Increases the Risk of Coronary Heart DiseaseThe Iowa Women’s Health Study Relative Risk 3 2 Waist-Hip Ratio Tertile 1 3 2 1 Body Mass Index Tertile Folsom et al. Arch Intern Med 2000;160:2117.

  9. Elevated Visceral Fat • Metabolically more active • Greater effect on visceral organs • Greater Insulin Resistance • hyperinsulinemia • impaired glucose tolerance • Type 2 diabetes • Hyperlipidemia • Hypertriglyceridemia • Hypercholesterolemia • Hypertension

  10. Visceral Fat Distribution:Normal vs Type 2 Diabetes Type 2 Diabetes Normal 2-11

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