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

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The 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

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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
• Blounts disease
• Slipped capital femoral epiphysis
• Skin
• Acanthosis nigricans
• Striae

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Overweight 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.
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Obesity 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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Additional 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

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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
19991591104.
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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 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

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Abdominal 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.
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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

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Visceral Fat DistributionNormal vs Type 2
Diabetes
Type 2 Diabetes
Normal
2-11
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