American Diabetes Association Recommendations Regarding Diagnosis of Diabetes Mellitus

Classic Symptoms Plus Casual Plasma Glucose Concentrations > 200 mg dl (11.1 mmol l) or Fasting Plasma Glucose > 126 mg dl (7.0 mmol l) or 2-hour Plasma Glucose > 200 mg dl (11.1 mmol l) during Oral Glucose Tolerance Test > 110 mg dl and < 126 mg dl > 126 mg dl (7.0 mmol l) mellitus Normal fasting plasma glucose Impaired fasting plasma glucose Provisional diagnosis of diabetes tolerance a two-hour postload glucose > 140 (7.8 mmol l) and < 200 mg dl (11.1 mmol l) is defined as...

Metabolic Inflexibility Associated with Obesity

Healthy skeletal muscle adapts to differing concentrations of plasma substrates (carbohydrates and fats) and hormones (primarily insulin). When a substrate is in oversupply, healthy skeletal muscle is able to adjust and activate processes that are necessary for appropriate oxidation or storage. Accordingly, healthy muscle is also able to adjust substrate utilization in response to hormonal changes. This process has been termed metabolic flexibility and constantly occurs in daily life when...

Exercise Training Effects on Fasting Plasma Glucose

In a recent meta-analysis of controlled clinical trials (11 randomized and three nonrandomized) on the effects of exercise training on glycemic control in individuals with type 2 diabetes, Boule and colleagues39 reported a significant (P < 0.001) beneficial exercise effect on glycosylated hemoglobin (HbA1c) (-0.66 percent) compared to the controls. The authors concluded that exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications. The difference...

Muscle Mitochondria And Uncoupling Protein In Obesity

Energy contained in the food we eat is preserved in the chemical potential of adenosine triphosphate (ATP) after carbohydrates, lipids, and proteins are oxidized to carbon dioxide and water. Oxidation takes place inside mitochondria, and the energy of electron transfer through the electron-transport chain is maintained by extrusion of protons from the matrix, producing an electrochemical gradient across the inner mitochondrial membrane. Dissipation of the protein gradient through the F1 ATPase...

Exercise Training Effects on HDL Cholesterol

Durstine and Haskell36 reported that in cross-sectional studies endurance athletes have 20 percent to 30 percent higher levels of HDL cholesterol when compared to inactive controls. Cross-sectional studies also suggest a dose-response relationship between amount of exercise and HDL-C concentrations. However, exercise-training studies, according to Durstine and Haskell, have not been as consistent, as many studies have reported a significant training benefit on HDL-C levels, while many other...

Interrelationships Of Nutrient Metabolism And The Effect On Glucose Homeostasis

Competition between nutrients as sources of metabolic fuel has been known for more than eight decades. However, quantitatively, the most important interaction is between glucose and fatty acids (5). As already mentioned above, if there is a perturbation of the energy-supply system in the body, such as an abundance of fatty acids, a competition ensues between glucose and fatty acids as sources of metabolic fuel. This phenomenon came to be significantly recognized when Randle and colleagues...

Post Operative Anastomotic Leak

Mean time to presentation Within 1-2 days post-op Can progress to systemic sepsis and organ failure During the immediate perioperative period, obesity-related medical comorbidi-ties change dramatically. Blood pressure often decreases to the normal range without medications, and blood-pressure monitoring is important to document during all postoperative visits. Hypotension is commonly seen, especially if there is poor fluid intake or persistent postoperative vomiting. The need for reinstituting...

Info

TG VLDL I Glu utilization t Glu output FIGURE 11.1 The pathogenesis of glucose intolerance in obese subjects. FFA, free fatty acids TG, triglycerides glu, glucose IFG, impaired fasting glucose IGT, impaired glucose tolerance. abdominal subcutaneous) fat is associated with insulin resistance. In contrast, insulin sensitivity correlates less well with stores of femoral and gluteal subcutaneous fat. The mechanisms by which abdominal fat deposition induces insulin resistance and glucose intolerance...

Current Surgical Therapies for Morbid Obesity Patient Selection

In keeping with the National Institutes of Health Consensus Development Conference Statement on Gastrointestinal Surgery for Morbid Obesity, patients with a BMI exceeding 40 kg per m2 or 35 kg per m2 with obesity-related comorbidities are candidates for the surgical treatment of morbid obesity.10 Surgery for morbid obesity should be offered to patients who are well-informed and motivated, and who are acceptable to operative risks. Patients should be evaluated preoperatively by a...

Stomal Stenosis Stricture

Nausea, vomiting, early satiety, food intolerances, abdominal pain Endoscopic balloon dilatation, repeat dilatation required in 17 of dietary indiscretions and vomiting associated with bulimia are ruled out, a stomal stricture at the gastrojejunal anastomosis should be considered. The reported prevalence of stricture ranges from 2.8 percent-7 percent.14,15 The presenting complaint is vomiting and postprandial pain in the gastric pouch (Table 8.3). A barium swallow often detects narrowing at the...

Laparoscopic Adjustable Gastric Banding

The operation is performed almost exclusively laparoscopically. There are several variations in port placement and number, but five or six incisions are usually necessary. The band is introduced in its open form. The stomach is exposed, and a retrogastric tunnel is created from the lesser curve side of the inferior border of the hiatus to the angle of His with a Lap-Band passer tool. This tool is then articulated at the angle of His to create the tunnel. The Lap-Band is threaded into the eye of...

Conclusion

Obesity is a national health problem in the U.S. Thirty percent of the current American population is obese, compared with only 13 percent in 1960, placing a tremendous economic burden on the health-care system to care for the increased number of obesity-related health problems. An additional 30 billion is spent annually on medical weight-loss programs that use caloric restriction, exercise, or behavior modification and on appetite-suppressing medications. Though clouded in a history of...

I

Skeletal muscle Lean body mass REE Glut 4 expression Glucose uptake Mitochondrial enzyme activity Peak VO2 aerobic activity Decreased FFA and TG, increased HDL, increased insulin sensitivity, and improved glucose tolerance Reduced risks of type 2 diabetes and cardiovascular disease FIGURE 11.2 The beneficial effects of exercise training on carbohydrate and lipid metabolism. SQ, subcutaneous REE, resting energy expenditure Glut, glucose transporter. to insulin this explains, in part, the...

Peripheral Signals In The Regulation Of Food Intake

Regulation Food Intake

The peripheral hormones that regulate food intake include several gastrointestinal, pancreatic, and adipocyte-derived peptides Table 1.2 . Based on extensive studies in rodents and limited human data, these peptides can be classified as having orexigenic e.g., ghrelin or anorexigenic e.g., insulin, peptide YY, glucagon-like polypeptide, cholecystokinin, leptin effects. Selected Central Neuropeptides that Modulate of Food Intake Neuropeptide Y alpha-Melanocyte stimulating hormone Agouti-related...

Pancreatic Signals

Insulin was the first peripheral signal shown to regulate food intake through interaction with central-hypothalamic neurons 87 . Protagonists of popular diets have claimed in the lay press that limitation of insulin secretion is the mechanism for hunger control in subjects fed low-carbohydrate, ketotic diets. Yet, the scientific Behavioral and Metabolic Effects of Leptin Inhibition of food intake 55-57 Stimulation of physical activity 53-55 Induction of fat-mass loss 55-57 Preservation of...

History

Weight loss in relation to intestinal resection was observed in the late 19th century. Trzebicky16 first noted nutritional imbalances in canines following proximal and distal small-bowel resection. Weight loss in humans after gastric or small-intestinal resection was reported by Von Eiselsberg in 1895.2 Jensenius demonstrated that after distal small-bowel resection in a canine model, there was an increased loss of fat in the stool. Kremen later demonstrated that resection of greater than 50...

Extrapancreatic Effects Of Gip And

Health Effects Overnutrition

GIP receptor mRNA has been found in a variety of tissues outside the pancreas, including stomach, intestine, brain, heart, and adipose tissue. The function of GIP in many of these tissues remains unclear, but a role of GIP in adipose-tissue metabolism and a possible function in the development of obesity has recently generated much interest. Fat is a potent secretagogue of GIP in humans, and functional GIP receptors have been identified on adipocytes 36 . Twenty-four-hour secretory patterns of...

Table of Contents

SECTION I Pathophysiology and Treatment of Obesity Neuroendocrine Regulation of Food Samuel Dagogo-Jack, M.D., M.B.B.S., M.Sc., F.R.C.P., F.A.C.P. The Enteroinsular Achieving a Healthy Body Weight Diet and Exercise Interventions for Type 2 Connie W. Bales, Ph.D., R.D., and Jama L. Purser, P.T., Ph.D. Metabolic Syndrome Recognition, Etiology, and Physical Fitness as a William E. Kraus, M.D. and Cris A. Slentz, Ph.D. Metabolic Alterations in Muscle Associated with John P. Thyfault, Ph.D. and G....

Peripheral Neuropathy and Peripheral Vascular Disease

The health-care cost of problems related to the diabetic foot, the most common cause of hospitalization in patients with diabetes, is estimated to be more than 1 billion annually 73 . In 2003, the total annual cost of diabetic peripheral neuropathy and its complications were estimated to be between 4.6 and 13.7 billion 74 . In large cohort studies, prevalence rates for neuropathy have ranged from 7.5 percent at time of diagnosis of diabetes, to 50 percent 25 years after initial diagnosis 75 ....

Coronary Vascular Disease

In 2000, 37.2 percent of people with diabetes age 35 years or older were diagnosed with cardiovascular disease 13 . Prevalence of ischemic heart disease among people with diabetes was approximately 14 times that of those without diabetes in people 18 to 44 years of age 2.7 percent versus 0.2 percent , three times more in people 45 to 64 years of age 14.3 percent versus 4.7 percent , and approximately twice more in people 65 years of age or older 13 . Classical risk factors for coronary artery...

Diabetes and Physical Limitations

People with diabetes have a higher prevalence of risk factors, such as obesity and sedentary behavior, and higher prevalence of health conditions, such as vision loss, depression, and cardiovascular disease, that are associated with physical limitations 54 . In a nationwide, cross-sectional analysis, people with diabetes had a higher proportion of physical limitation than people without diabetes overall 66 percent versus 29 percent, p lt 0.001 , for men 59 percent versus 24 percent, p lt 0.001...