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Syndrome X
Endocrine and metabolicconsequences of obesity
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What is obesity?
n BMI greater than 30 kg/m2
n Incidence greater than 30% of populationand growing in size
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Obesity as a consequence of
n Excessive foodintake
n Inappropriatefood choices
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Obesity as a consequence of
n Inadequatephysicalactivity
n Hormonaleffects
n Bioenergeticeffects
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Health risks of obesity in men
n Arthritisn Diabetesn Hypertensionn Gall stones
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Health risks of obesity in women
n Arthritisn Diabetesn Hypertensionn Cancern Gall stones
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Inactivity and CHD risk
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Health risks of obesity
n depend on fatpatterning
n android (“apple”) hashigher risks
n gynoid (“pear”) haslower risks
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Android pattern of obesity
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Gynoid pattern of obesity
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Android obesity and insulinresistance
n Reducedglucosetolerance
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Android obesity and insulinresistance
n Insulinoversecretion
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Android obesity and insulinresistance
n Reducedglucoseutilization
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Android obesity and insulinresistance
n Reducedglucoseutilization
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Android obesity and insulinresistance
n Reducedglucosemetabolism
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Android obesity and insulinresistance
n Reducedcapacity ofinsulin tosuppresshepaticglucoseproduction
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Android obesity and insulindefectsn Insulin
oversecretion isa function ofobesityindependentlyof its pattern
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Android obesity and insulindefectsn Insulin
clearance isreduced
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Insulin oversecretion and resistancein aging
n Aging is oftenasociated with obesity
n Reduced insulin-induced glucoseuptake is seen both inaged and obese
n This is due to reducedperipheral sensitivityto insulin, principallyin the muscle
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Insulin oversecretion andresistance in aging
n Aging is oftenasociated with obesity
n Oversecretion ofinsulin is seen in bothaged and obese
n High fasting plasmainsulin
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Insulin defect acts on portalvascular bedn Insulin
concentration ishigh in theportalcirculation dueto insulinoversecretion
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Insulin defect acts on portalvascular bedn High insulin acts on
the visceral adiposetissue causingincreased visceraladiposity
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Insulin resistance of androidobesen Resides in skeletal musclen Muscle is insensitive to insulin
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Insulin resistance of muscles inthe android obesen Deficient
glucoseuptake
n Deficientglycogensynthesis
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Insulin resistance affects lipidmetabolismn Adipose LPL
hypoactivebecauseadiposetissue isinsulinresistant
n Lower LDLreceptorbinding
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Development of syndrome X
n Peripheralinsulinresistance
n Insulinoversecretion
n More insulinresistance
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Role of androgens in androidobesityn Reduced levels of
SHBG, the high-affinity bindingprotein for androgens
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Role of androgens in androidobesityn Reduced levels of
SHBG, the high-affinity bindingprotein for androgens
n Increased freeandrogen titers
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Exercise counteracts syndrome x
n Fat lossn Increased insulin sensitivityn Reduced blood pressuren Reduced plasma lipids
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Exercise and increased insulinsensitivityn Acute increase in
sensitivityn Associated with
glycogendepletion,increased GLUT-4and glucose uptake
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Exercise and reduced plasmalipids
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Android obesity and muscle fibertypesn Higher
proportionsof fastanaerobicfibers
n Trainingincreasesconversionto red fibers
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Endurance training counteracts
n obesity
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Endurance training counteracts
n hyper-tension
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Endurance training counteracts
n plasmalipids
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Endurance training counteracts
n glucoseintolerance
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Endurance training improves
n glucosedisposal
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Obesity
n Major health problemn Results from inappropriate life-style choicesn Can be reduced and its risks attentuated
with aerobic exercise and better dietarychoices