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Health Risks and Comorbid Conditions

Health Risks and Comorbid Conditions. Outline. Overview of the Metabolic Syndrome Risks of Obesity and the Metabolic Syndrome Specific Health Risks Answers to Questions & Summary. Question # 1. Which of the following is not part of the Metabolic Syndrome? High HDL-cholesterol (> 50 mg/dL)

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Health Risks and Comorbid Conditions

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  1. Health Risks and Comorbid Conditions

  2. Outline • Overview of the Metabolic Syndrome • Risks of Obesity and the Metabolic Syndrome • Specific Health Risks • Answers to Questions & Summary

  3. Question # 1 Which of the following is not part of the Metabolic Syndrome? • High HDL-cholesterol (> 50 mg/dL) • High blood pressure (> 130/85) • High Triglyceride (> 150 mg/dL) • Impaired fasting glucose (100-126 mg/dL) • Increased waist circumference [> 88cm (F) 102cm (M)]

  4. Development of the Concept • 1904 - Life insurance data • 1947 - Vague introduces adipomuscular ratio • 1967 - Crepaldi insulin resistance and disease • 1970 - Feldman Epidemiological relation • 1982 - Ratio of waist to hip circumference related to morbidity and mortality in 2 separate laboratories • 1988 - Reaven describes Syndrome X

  5. Abdominal Adiposity Abdominal Obesity Visceral Subcutaneous Courtesy of Steven Smith, M.D.

  6. 250 250 200 200 Upper Body 150 150 Lower Body Insulin (μU/mL Glucose (mg/dL) 100 100 50 50 Control 0 0 0 30 60 90 120 150 180 0 30 60 90 120 150 180 Time (min) Time (min) Body Fat Distribution and Glucose Tolerance Kissebah JCEM 1982;54:254-260.

  7. Visceral Obesity and Risk of Dyslipidemia Despres JP, et al. Arteriosclerosis. 1990;10:497-511.

  8. Metabolic Syndrome: NCEP ATP III JAMA 2001;285:2486-2497.

  9. Age-Adjusted Prevalence of the Metabolic Syndrome Among 8814 Adults Age > 20 Ford. JAMA 2002;287:356-9.

  10. Abdominal obesity Glucose intolerance High triglycerides Low HDL-cholesterol High blood pressure Insulin resistance Microalbuminuria Small dense LDL Inflammatory markers Thrombotic factors Endothelial dysfunction Hyperuricemia Characteristics of the Metabolic Syndrome Wannabes Full members

  11. Central Fat and Lifestyle Health Risk 1.0 Probability of remaining free of myocardial infarction Waist to hip ratio 0.95 1.0 Probability of survival 0.95 Years of follow-up Lapidus. BMJ 1984;289:1257-61.

  12. Outline • Overview of the Metabolic Syndrome • Risks of Obesity and the Metabolic Syndrome • Specific Health Risks • Answers to questions & Summary

  13. Pathogenesis of Health Problems Associated with Obesity Environment Genes Activity Food Intake Excess fat stores Diseases due to increased fat cell size & visceral fat Diseases due to increased fat mass Diabetes CVD Stigma Osteoarthritis NAFLD Sleep apnea GB Disease Cancer

  14. Lactate Prostaglandin Cholesterolester Transfer Protein (CETP) Angiotensinogen Phospholipid Transfer Protein (PLTP) Prostacyclin Monobutyrin Leptin Free Fatty Acids Adiponectin Plasminogen Activator Inhibitor (PAI-1) Galectin-12 TNF-a Adipsin (ASP) (complement (3a;D) IL-6 Lipoprotein Lipase (LPL) The Fat Cell is an Endocrine Cell Fat Cell

  15. Medical Complications of Obesity Idiopathic intracranial hypertension Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Phlebitis venous stasis Skin Gout

  16. Outline • Overview of the Metabolic Syndrome • Risks of Obesity and the Metabolic Syndrome • Mortality • Morbidity • Specific Health Risks • Answers to questions & Summary

  17. Question # 2 Which of the following is NOT an estimate of excess deaths from obesity? • 450,000 • 365,000 • 325,000 • 275,000 • 112,000

  18. BMI and Mortality by Ethnic Group The American Cancer Society Study Calle NEJM 1999;341:1097.

  19. Relative Risk of Death by BMI Levels from the NHANES I, II, & III Surveys Flegal et al JAMA. 2005;1861.

  20. Range of Estimates of Mortality Associated with Overweight

  21. Obesity Decreases Life Expectancy:The Framingham Study * Compared to a BMI 18.5-24.9 kg/m2 Peeters Ann Int Med 2003;138:24-32.

  22. Question # 3 Which disease has the highest risk in association with obesity? • Breast cancer • Diabetes • Cardiovascular disease • Osteoarthritis • Kidney stones

  23. Outline • Overview of the Metabolic Syndrome • Risks from Obesity and Metabolic Syndrome • Increased mortality • Increased morbidity • Specific Health Risks • Answers to Questions & Summary

  24. Type 2 diabetes Cholelithiasis Hypertension Coronary heart disease 6 6 5 5 4 4 3 3 2 2 1 1 0 0 22 23 29 30 < 21 24 25 26 27 28 < 21 22 23 29 30 24 25 26 27 28 Relationship Between BMI and Comorbidities Is Positive, Even in the “Normal” Range Women Men Relative Risk Relative Risk Body Mass Index(kg/m2) Body Mass Index(kg/m2) Willett WC, et al. N Engl J Med. 1999;341:427-434.

  25. BMI and Chronic Disease Prevalence in the Nurses Health Study Coakley et al IJO 1998;22:958.

  26. Proportion of Disease Prevalence Attributable to Obesity

  27. Age- and Sex-Adjusted Prevalence of Risk Factors for BMI > 30 kg/m2 Gregg et al JAMA 2005;293:1868.

  28. Outline • Overview of the Metabolic Syndrome • Specific Health Risks • Increased risk of diabetes • Increased risk of heart disease • Increased risk of hypertension • Increased risk of cancer • Other increased risks • Answers to Questions & Summary

  29. 93.2 Men Women 54.0 42.1 40.3 27.6 21.3 15.8 8.1 11.6 5.0 6.7 4.3 2.9 2.2 4.4 1.5 1.0 1.0 1.0 Relationship Between BMI and Risk of Type 2 Diabetes Mellitus 100 75 Age-Adjusted Relative Risk 50 25 0 23 - 23.9 < 22 < 23 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35 + Body Mass Index (kg/m2) Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481.

  30. Nurses’ Health Study: Waist Circumference Directly Related to Risk for Type 2 Diabetes *Controlled for age, family history of diabetes, exercise, smoking, saturated fat intake, calcium, potassium, magnesium, and glycemic index. Carey et al. Am J Epidemiol. 1997;145:614.

  31. Prevalence of Type 2 Diabetes Among Diabetic Children in 4 Studies Fagot-Campagna et al. J Pediatr 2000;136:664.

  32. Nurses Health Study: Diabetes & MI/Stroke Hu Diab Care 2002;25:1129.

  33. Outline • Overview of the Metabolic Syndrome • Specific Health Risks • Increased risk of diabetes • Increased risk of heart disease • Increased risk of hypertension • Increased risk of cancer • Other increased risks • Answers to Questions & Summary

  34. BMI and Risk of Coronary Heart Disease in the Nurses Health Study * = p < 0.05 Manson et al NEJM 1995;333:677-85.

  35. 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.

  36. BMI Weight Gain and Cardiovascular Risk Relative Risk Weight Change, kg Body Mass Index (kg/m2) at 18 Years of Age Willett et al JAMA. 1995;273:461-5.

  37. Body Weight and Weight Gain During Adult Life and Risk of CHD Rosengren et al Europ H J 1999;20:269-277.

  38. The Interheart Study: Risk of MI * Adj for Age, Sex & Geography + Adj Age, Sex & Smoking Yusuf et al Lancet 2004;364-352.

  39. Obesity and the Risk of New Onset Atrial Fibrillation Wang et al JAMA 2004;292:2471-77.

  40. 10-Year Cumulative Incidence of Heart Failure in the Framingham Study Kenchaiah et al NEJM 2002;347:305-313.

  41. Outline • Overview of the Metabolic Syndrome • Specific Health Risks • Increased risk of diabetes • Increased risk of heart disease • Increased risk of hypertension • Increased risk of cancer • Other increased risks • Answers to Questions & Summary

  42. Prevalence of Elevated Blood Pressure by BMI Category NHLBI Evidence Report 1988.

  43. Outline • Overview of the Metabolic Syndrome • Specific Health Risks • Increased risk of diabetes • Increased risk of heart disease • Increased risk of hypertension • Increased risk of cancer • Other increased risks • Answers to Questions & Summary

  44. Mortality from Cancer in American Men and Women Calle NEJM 2003;348:1625.

  45. Outline • Overview of the Metabolic Syndrome • Overview of Risks • Specific Health Risks • Increased risk of diabetes • Increased risk of heart disease • Increased risk of hypertension • Increased risk of cancer • Other increased risks • Answers to Questions and Summary

  46. Other Increased Risks • Kidney stones • Complications of pregnancy • Sleep disorders • Osteoarthritis • Stigmatization

  47. Body Mass Index and the Relative Risk of Symptomatic Kidney Stones Taylor et al JAMA 2005;293:455-462.

  48. Pregnancy Complications in Obese and Overweight Nulliparous Women Baeten et al Am J Pub Health 2001;91:436-440.

  49. Moderate Weight Change and Sleep Disordered Breathing Peppard et al JAMA 2000;284:3015-3021.

  50. Adjusted Odds Ratio for Osteoarthritis by Tertiles of BMI Oliveria et al Epidemiology 1999;10:161.

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