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My Bikini Belly Overview


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Sequelae of Altered Metabolism in Visceral

The proposed mechanism of action of fat patterning on metabolic syndrome is linked to In obesity and type 2 diabetes, there is an increased content of lipids within and around muscle fibers. Researchers have suggested that the accumulation of triaclyglycerols within the skeletal muscle may play an important role in insulin resistance. In obese individuals with elevated amounts of visceral adipose tissue, there is a strong correlation between visceral adipose tissue and insulin resistance independent of subcutaneous (abdominal and nonabdominal) adipose tissue and cardiovascular fitness. It has been suggested that the discrepancies in the literature regarding the independent effect of visceral or subcutaneous adipose tissue on insulin resistance are due to the large variations of abdominal obesity within the study populations.

Susceptibility to Mood Enhancement by Diet

There is another link between macronutrient intake, stress, and mood. Chronic dysfunction of the stress-sensitive hormone cortisol and its controlling hypothalamic pituitary adrenal (HPA) axis is associated with depression and anxiety and with abdominal obesity. Moreover, protein-rich meals that prevent a meal-induced fall in arousal also stimulate the release of cortisol in unstressed people, and the degree of this effect is positively correlated with the probability of poor psychological well-being. Chronically, a carbohydrate-rich diet is associated with better overall mood state and lower average plasma cortisol than a high-protein diet. Acutely, a carbohydrate preload, but not protein or fat load, enhances cortisol release during stress. This may be related to findings from both human and animal research that suggest that eating carbohydrate-rich and perhaps high-fat foods can help restore normal HPA axis function and gluco-corticoid stress responses. Raised levels of cortisol in...

Body Composition Applications During Growth

Fat or adipose tissue distribution is recognized as a risk factor for cardiovascular disease in both adults and children. An android or male fat pattern, with relatively greater fat in the upper body region, is associated with negative metabolic predictors whereas a gynoid or female fat pattern, with relatively greater fat in the hip and thigh areas, is associated with less metabolic risk. More and more studies are showing that the syndrome develops during childhood and is highly prevalent among overweight children and adolescents. While the concept of the metabolic syndrome referred initially to the presence of combined risk factors including VAT, dyslipidemia, hypertension, and insulin resistance

Body Composition Applications During Aging

In adults, excess abdominal or VAT is recognized as an important risk factor in the development of coronary heart disease and non-insulin dependent diabetes mellitus. Waist circumference and the waist hip ratio are commonly used to predict visceral fat accumulation in epidemiological studies. However, waist circumference is unable to differentiate VAT from SAT. As a result, persons with similar waist circumferences could have markedly different quantities of VAT and abdominal SAT. Skinfold thickness has been used as a continuous

Regulation of Synthesis

HMG-CoA to mevalonic acid in the polyisoprenoid synthetic pathway. Peripheral tissue cholesterol synthesis is much less responsive to regulatory factors compared to the liver, which is controlled by a variety of dietary, hormonal, and physiological variables. Studies indicate that endogenous cholesterol synthesis is significantly increased in obesity and in patients with the metabolic syndrome. Obesity, insulin resistance, and diabetes have pronounced effects on both cholesterol absorption and synthesis. Findings in type 1 diabetes appear to be related to low expression of ABCG5 G8 genes, resulting in high absorption and low synthesis of cholesterol. Cholesterol absorption efficiency is lower and cholesterol synthesis is higher in obese subjects with type 2 diabetes compared to obese subjects without diabetes, suggesting that diabetes modulates cholesterol metabolism to a greater extent than obesity alone. Similarly, low cholesterol absorption and high synthesis appear to be part of...

Higher Level Data Analysis Unsupervised And Supervised Learning

To date, the higher level computational analysis of gene expression data has centered on two approaches (10). Unsupervised learning, or clustering, involves the aggregation of a diverse collection of data into clusters based on different features in a data set. For example, one could divide a group of people into clusters based on any combination of eye color, waist size, or height. Similarly, one can gather data about the various expressed genes in a collection of tumor samples and then cluster the samples as best as possible into groups based on the similarity of their aggregate expression profiles. Alternatively, one could cluster genes across all samples, to identify genes that share similar patterns of expression in varying biologic contexts. Such approaches have the advantage of being unbiased and allow for the identification of structure in a complex data set without making any a priori assumptions. However, because many different relationships are possible in a complex data...

Environmental Factors

Evidence of a strong environmental element to T2D has come from the studies of Barker and Hales. In a number of separate studies, a strong relationship of the development of glucose intolerance and other associated factors of the insulin resistance syndrome with low birth weight or thinness at birth has been demonstrated. Furthermore, these associations are not confined to those with growth retardation in utero but extend to the whole range of birth weights. As a consequence of these epidemiologic studies, the 'thrifty phenotype' hypothesis has been proposed, whereby nutritional deficiencies in utero lead to poor fetal and infant growth and the subsequent development of T2D in later life, especially when combined with obesity due to excess food intake and lack of physical activity. These changes are recognized to be due to insulin resistance, which is favorable for survival in the immediate postnatal period but plays a significant role in the progression to T2D and metabolic syndrome,...

Sonography and Ectopic Pregnancy

The sequencing of TA versus TV sonography is situation- and operator-dependent. Usually, TA scanning is performed first. Among other differences, TA scanning is less invasive and offers a wider field of view and easier orientation to the pelvic organs. A full bladder is required for an appropriate acoustic window. TA scanning is often diagnostic. When TA sonography is not diagnostic, TV scanning should be performed. With TV scanning, the shallower depth of field and higher frequencies made possible by the lack of interposed abdominal fat allows better visualization of small structures such as early pregnancies. Orientation to the pelvic organs is more difficult with TV scanning than with TA. A full bladder is not required. There are reports of negative TV but positive TA sonography in cases of EP, so both studies should be performed if the study performed first is not diagnostic. I4

Developmental Origins of Cardiovascular Disease Type 2 Diabetes and Obesity in Humans

Fetal Origins Adult Disease

Fetal growth restriction and low weight gain in infancy are associated with an increased risk of adult cardiovascular disease, type 2 diabetes and the Metabolic Syndrome. The fetal origins of adult disease hypothesis proposes that these associations reflect permanent changes in metabolism, body composition and tissue structure caused by undernutrition during critical periods of early development. An alternative hypothesis is that both small size at birth and later disease have a common genetic aetiology. These two hypotheses are not mutually exclusive. In addition to low birthweight, fetal 'overnutrition caused by maternal obesity and gestational diabetes leads to an increased risk of later obesity and type 2 diabetes. There is consistent evidence that accelerated BMI gain during childhood, and adult obesity, are additional risk factors for cardiovascular disease and diabetes. These effects are exaggerated in people of low birthweight. Poor fetal and infant growth combined with recent...

Bilateral Upper Urinary Tract Obstruction

The classic presentation of bilateral upper urinary tract obstruction often differs clinically when compared to unilateral obstruction. Bilateral upper urinary obstruction most commonly occurs on a more chronic basis, related to an extrinsic process that progresses slowly over time. In this scenario, signs and symptoms directly related to the extrinsic process often prompt the workup which ultimately leads to the diagnosis of bilateral obstruction. When bilateral chronic upper urinary tract obstruction progresses to the point of causing symptoms, manifestations of renal failure are also commonplace. A common presentation for acute bilateral upper urinary obstruction is related to bilateral obstructing ureteral or UPJ stones. The tip-off to this diagnosis can be the development of bilateral flank pain in the setting of anuria however, more commonly the bilateral stones will be only partially obstructing and the patient will maintain an adequate urine output. Urgent management of...

Definition of obesity

Convey information on regional fat distribution. The latter is important, as it is now well established that central or visceral fat deposition is a major independent determinant of the metabolic and cardiovascular risk associated with an increase in fat mass.9-11 Recent evidence-based guidelines therefore recommend the use of both BMI and waist circumference in the assessment of overweight or obese patients.1 Table 19.1 summarizes the current classification of overweight and obesity by BMI, waist circumference and associated disease risk in Caucasians.1 There are now also data to indicate that in south Asians12 and other Asian populations,13 for the same level of BMI or waist circumference health risks may be higher than in Caucasians. Lower cut offs have therefore been recommended for both BMI and waist circumference in adult Asians (Table 19.2).14 The levels of BMI or waist circumference that can be used to define obesity related risk in other ethnic groups or populations (for...

Coronary artery disease

Assessed coronary artery disease associated with an increase in waist circumference, that reached an odds ratio of over 12 in patients with familial hypercholesterolemia.73 Weight gain has also been associated with a significant increase in coronary risk.30 Thus, a weight gain of 15 kg after age 21 was associated with an increased coronary risk of 83 in women and 46 in men.

Lifestyle intervention

With regard to dietary therapy, a review of 48 randomized controlled trials5 concluded that an average weight loss of 8 can be obtained over 3-12 months with a controlled energy low-calorie diet (LCD) aimed to reduce caloric intake by 500-1000 kcal day (2092-4184kJ day), and that this weight loss effects a decrease in abdominal fat. It also appears that lower-fat diets with energy reduction promote greater weight loss than energy reduction alone. Very low-calorie diets (VLCDs), generally involving the use of protein and dietary supplements, can produce greater initial weight losses that LCDs, but long-term (> 1 year) weight loss appears to be only marginally greater.80 Importantly, unless accompanied by physical activity, weight loss with dietary measures is not associated with an improvement in car-diorespiratory fitness as measured by maximum oxygen consumption.5,15 A review of 13 randomized controlled trials provides strong evidence that physical activity alone results in rather...

Pharmacological Treatment

Valproate has been reported to induce a metabolic syndrome (especially in younger women), characterized by obesity, hyperinsulinemia, lipid abnormalities, polycystic ovaries and hyperandrogenism. In a cohort of Finnish women taking valproate for seizures, 80 of the women who started taking valproate before the age of 20 years had polycystic ovaries compared with 43 of all women taking valproate 104 . Replacing valproate with lamotrigine reduced the severity of this metabolic syndrome in 16 women, which seems to suggest a partial reversibility 105 . Whether this finding generalizes to a psychiatric population is not yet clear, since the study only included women with epilepsy.

Aboriginal populations

The common CHD risk factors among Aboriginal people include obesity, abdominal obesity, diabetes, elevated blood pressure, low HDL cholesterol, and tobacco use. The prevalence of cigarette smoking is generally high and increasing among Aboriginal people the prevalence varies greatly between reserves.98'102 The prevalence of diabetes in the Strong Heart Study was an astounding 48 in the 45-64 year age group compared to approximately 5-5 in the US general population, and the prevalence of obesity was between 26 and 41 , with an average BMI of 31 and waist-hip ratio of 0-96 in men.103 Interestingly, the prevalence of hypertension and elevated serum cholesterol among Aboriginal people appears to be lower when compared to the general US population. In Canada, however, the prevalence of hypertension requiring drug treatment, and elevated cholesterol requiring medication, was significantly increased among Aboriginal people compared to a similar sample of non-Aboriginal people.98 In addition,...

Measures of Body Fatness

Dual-energy X-ray absorptiometry This method is based on the principle that transmitted X-rays at two energy levels are differentially attenuated by bone mass and soft tissue mass, and the soft tissue mass is subdivided into fat mass and lean mass. Reproducibility of dual-energy X-ray absorptiome-try (DXA) is approximately 0.8 for bone, 1.7 for fat, and 2.0 for body weight. One concern regarding DXA is whether changes in soft tissue hydration influence body fat estimates. A few studies have shown small but systematic and predictable errors in DXA soft tissue composition analysis with body fluid balance changes. Using DXA, it is possible to obtain abdominal fat estimates. Unfortunately, these cannot be separated into subcutaneous and visceral components. Anthropometric methods are also applicable as 'surrogate' measurements of visceral adipose tissue. Circumferences are more reliable than skinfolds, and in recent years the most widely used anthropometric technique has been the waist...

Metabolic Characteristics of Visceral and Subcutaneous

Enzyme releases free fatty acids, which are then released into the bloodstream and taken up by tissues, with the exception of the brain and red blood cells, for energy use or storage. The rate of basal lipolysis is higher in gluteal-femoral fat tissue than in abdominal tissue in both men and women. This may be due to greater cell size in that region. In the abdominal area, basal lipolysis is higher in subcutaneous fat than in visceral fat. However, when stimulated hormonally, rates of lipolysis may differ between men and women. Lipolytic rates have been shown to be higher in the visceral compared to the subcutaneous region in men, whereas the opposite trend is seen in women.

Correlates and Possible Determinants of Fat Distribution

Consumption, physical activity, and ethnicity, are associated with either an android or a gynoid shape. The underlying reasons for the observed associations between these variables and fat patterning remain to be elucidated. Correlates of fat distribution are important to understand since they may confound relationships between fat patterning and physiological outcomes or morbidity or mortality outcomes. There is evidence that body shape and amount of visceral fat are partially determined by genetics. After eliminating effects of age and overall fatness, studies have shown that heritable factors can account for as much as 20-50 of the variability in waist-to-hip ratio. Aging is accompanied by changes in both weight and fat distribution. The largest increase in body weight occurs between young adulthood and middle adulthood. Independent of weight gain, abdominal fat increases with aging. This increase tends to be most pronounced between young adulthood and middle age in men and between...

Intraabdominal Pressure

In severely obese people, the excess visceral fat is thought to increase intraabdominal pressure. Animal research shows that experimentally induced acute increases in intraabdominal pressure to the levels seen in the abdomens of very obese people cause increases in pleural pressure, intracranial pressure, and central venous pressure. The investigators postulated that in humans, increased intraabdominal pressure may contribute to hypertension, insulin resistance and type 2 DM, obesity-hypoventilation syndrome, pseudotumor cerebri, incisional hernia, and urinary incontinence. Massive weight loss following obesity surgery normalizes the increased intraabdominal pressure and reduces or eliminates all the symptoms listed previously.

Late Gestational Glucocorticoids and Programming of Metabolism

In recent years the health of millions throughout the world has been threatened by an upsurge in the incidence of 'the metabolic syndrome' or 'Syndrome X', the constituents of which include type 2 diabetes (glucose intolerance insulin resistance), hyperlipidemia, hypertension and obesity.19 Since Prof. David Barkers initial investigations, demonstrating an association between birthweight and the incidence of type 2 diabetes,20 it has become well established that an individual's intrauterine environment influences their risk of developing the metabolic syndrome and that fetal exposure to glucocorticoids is the likely mediator of this effect.21

Aging and Renal Function

The serum concentration of Pi increases with a physiological decline in renal function associated with aging (but not renal disease per se). Healthy individuals excrete approximately 67 of their absorbed phosphate via the urine and the remainder via the gut as endogenous secretions. As the glomerular filtration capacity of the kidneys declines, the serum Pi concentration increases and more Pi is retained by the body. PTH secretions increase but the typical serum PTH concentrations, although elevated, remain within the upper limits of the normal range, at least for a decade or so. Thereafter, however, serum Pi and PTH both continue to climb as renal function declines and increased rates of bone turnover lead to measurable bone loss. This situation probably affects millions in the United States each year as they enter the 50s and proceed into the 60s many of these individuals are overweight or obese and have the metabolic syndrome, which

High Fat Diets and Obesity Possible Influence of n3 PUFAs

The peptide hormone insulin is produced in the pancreas and secreted in proportion to the degree of adiposity. Similar to leptin, insulin levels are correlated with amount of abdominal fat (Porte et al., 1998 Woods et al., 1996 Woods, Figlewicz Lattemann, Schwartz, & Porte, 1990 Woods et al., 1998). It is transported into the brain where it acts to decrease food intake and body weight (Schwartz, Figlewicz, Baskin, Woods, & Porte, 1992 Woods et al., 1996). High insulin resistance is a characteristic of obesity, hypertension, and non-insulin-dependent diabetes mellitus. There is an inverse relationship between insulin action and triglyceride content. With the ingestion of fat, insulin secretion is increased. Insulin stimulates fatty acid synthase, an enzyme that catalyzes all reactions involved in lipogenesis, and thereby results in the accumulation of triglycerides (Sul, Latasa, Moon, & Kim, 2000). Monounsaturated fatty acids (such as oleate) and saturated fatty acids (such as...

Biomedical Anthropology and the Evolution of Diabetes Thrifty Genotypes and Phenotypes

Shifts to modern lifestyles with increased food abundance, a lack of periodic food shortages, and a reduction in energy expenditure rendered a once adaptive genotype detrimental. The result is obesity, type 2 diabetes, and other characteristics of Syndrome X or insulinresistance metabolic syndrome, including high blood lipids and hypertension (Raven, 1988). Many authors have expanded on this hypothesis in other populations including additional selective pressures of cold stress from water and long ocean-going voyages for Pacific Island populations (Bindon & Baker, 1985 Zimmet et al., 1982) and extreme cold stress for Eskimo and Aleut populations (Shepard & Rode, 1996). High seasonal energy demands during slavery for African Americans posed an additional stress (Gibbs, Cargill, Lieberman, & Reitz, 1980 Lieberman, 2003). Most of the literature on genetic thriftiness has focused on selective pressures operating in adulthood. Kuzawa (1998) focuses on human infancy and early...

The Couch Potato Syndrome

We have recendy reported experimental evidence suggesting that maternal undernutrition can induce sedentary behaviour, hyperphagia and concomitant obesity in offspring independent of postnatal dietary influences. We had previously shown that maternal undernutrition throughout pregnancy in the rat results in hypertension, hyperinsulinemia and hyperleptinemia in the offspring when they reach adulthood.6 Obesity was not present until after puberty and was associated with hyperphagia. In the course of these studies we noted that the onset of the abnormal eating behaviours occurred prior to puberty, thus preceding the development of obesity. This led us to speculate that the prenatal maternal environment might also affect other components of behaviour associated with the Metabolic Syndrome. These results suggest that maternal undernutrition can lead to the development of both overeating and diminished exercise behaviour concomitant with the physiological features of the Metabolic Syndrome....

Spontaneous animal models for organspecific autoimmune diseases

During the first few weeks after hatching, obese strain (OS) chickens develop a hereditary spontaneous autoimmune thyroiditis (SAT) that resembles human Hashimotos disease in all clinical, histopathological, endocrinological and immunological aspects. The thyroid glands of OS chickens become heavily infiltrated by mononuclear cells, finally resulting in complete destruction of their architecture entailing clinical symptoms of hypothyroidism (Figure 1), such as small body size - albeit with relatively high body weight due to the deposition of subcutaneous and abdominal fat - lipemic serum, long silky feathers, cold sensitivity, low laying capacity, diminished fertility and poor hatchability. In common with Hashimoto's thyroiditis, the infiltrated thyroid glands show high numbers of well-developed germinal centers as a characteristic hallmark that is unique to this model and absent in EAT. The serum of OS chickens contains autoantibodies to thyroglobulin (Tg-AAb), to thyroid microsomal...

Regulators of Lipolysis and Fat Storage

The processes of lipolysis and fat storage are regulated by hormonal factors, which either enhance or suppress the activities of HSL and LPL. Through the action of glucocorticoid receptors, glucocorticoids enhance LPL activity and promote abdominal deposition of fat. The density of glucocorticoid receptors is greater in the visceral abdominal depot than in the subcutaneous abdominal depot. Therefore, an increase in glucocorticoid secretion is associated with increases in abdominal fat deposition compared to other fat depots. An increased androgenic profile is associated with upper body fat accumulation in women, but studies on men are conflicting. Significant inverse associations between fat distribution and testosterone have been found in population studies on men. Reduced visceral fat has also been observed when testosterone treatment was administered to men. These findings challenge the hypothesis that an androgenic hormone profile contributes to a more 'male type' of fat pattern...

Impaired glucose tolerance

Impaired glucose tolerance predicts cardiovascular events whether or not this is manifested as overt diabetes. Hyperinsulinaemia is a common accompaniment of impaired glucose tolerance and, as mentioned earlier, the two are frequently associated with other risk factors such as hypertension, obesity, and dyslipidaemia in the metabolic syndrome.

Fat Distribution and Disease Risk

Since fat distribution is correlated with age as well other risk factors for disease, such as smoking, alcohol consumption, physical activity, and menopause in women, it is important to control for the effects of these variables in order to obtain an estimate of the independent effect of central obesity on morbidity. The impact of some of these correlates of fat distribution may be subtle and unlikely to seriously distort relationships between fat patterning and disease. However, age, the ultimate risk factor for disease and death, is sufficiently highly correlated with fat distribution to result in substantial distortion. Similarly, cigarette smoking is related adequately strongly to fat patterning and to various diseases and outcomes to make analyses that do not adjust for smoking difficult to interpret. Researchers have found positive correlations between fasting glucose, insulin, blood pressure, total cholesterol, LDL cholesterol, and triaclyglycer-ols using imaging techniques,...

Genotype To Phenotype Correlations

Atrium Proper

The genetic defect is in the PRKAG2 gene which encodes for the gamma subunit of the kinase AMPK. AMP-activated protein kinase is a sensor of the body's ATP level. AMP-activated protein kinase is activated by an increase in the ratio of AMP to ATP. AMP-activated protein kinase increases the availability of ATP by increasing glucose absorption, inhibiting glycogen synthesis, increasing fatty acid oxidation, and decreasing fatty acid synthesis. The phenotype consistently observed in addition to WPW syndrome is excess glycogen in the myocytes of the heart. 10 Hypertrophy of the heart is also observed in a percentage of the patients. Several genetic animal models expressing either the R302Q mutation 8 or the mutation N488I 9 as a transgene have been generated. All of them have the preexcitation syndrome and excessive myocardial glycogen phenotype. The model expressing the R302Q mutation has the preexcitation syndrome, increased cardiac glycogen, and inducible supraventricular reentry...

Insulin Resistance and Hyperinsulinemia

'Insulin resistance' refers to the phenomenon of insensitivity of the cells of the body to insulin's actions. Different tissues may have different insulin sensitivities. For example, adipose tissue may be more sensitive to insulin than muscle tissue, thus favoring the deposition of fatty acids in adipose tissue and diminished fatty acid oxidation in muscle. Insulin resistance is usually associated with hyper-insulinemia. Hyperinsulinemia is an independent marker that predicts the development of atherosclerosis. A causal relationship between hypertension and hyperinsulinemia has not been well established. Hypertension associated with hyperinsulinemia could be due to increased renal sodium retention, increased intracellular free calcium, increased sympathetic nervous system activity, or increased intraabdominal pressure due to increased visceral fat deposition.

Components from skimmed milk and weight loss 121 Calcium and weight loss

Yogurt, resulted in a larger decrease in body fat, body weight, waist circumference and trunk fat when compared to a non-dairy control. Trunk fat loss was 81 greater than the control samples and also resulted in a significant decrease in waist circumference (-0.58 versus -3.99 cm). Other researchers have specifically focused on calcium and implications in weight loss (Zemel, 2001, 2003a, 2003c, 2004, Zemel and Miller, 2004, Schrager, 2005).

Anthropometric Techniques

Figure 2 Cross-sectional images of the abdomen obtained by MRI. (A) Small subcutaneous fat area and enlarged visceral fat area. (B) Small visceral fat area in comparison with subcutaneous fat depot. Figure 2 Cross-sectional images of the abdomen obtained by MRI. (A) Small subcutaneous fat area and enlarged visceral fat area. (B) Small visceral fat area in comparison with subcutaneous fat depot. waist-to-hip, waist-to-thigh, waist-to-height, and subscapular-to-triceps skinfolds. Skinfold thicknesses and skinfold ratios have not been found to be very well correlated with metabolic measurements or with visceral fat and are not recommended for use as indicators of fat patterning. Numerous equations using combinations of anthropometric measurements to predict the amount of visceral fat have not offered substantial improvement over the simpler measurements, and an accurate equation has yet to be developed. Waist circumference (WC) alone and waist-to-hip ratio (WHR) are the most popular...

Abnormalities of Hormones and Other Circulating Factors

Syndrome, including abdominal obesity, insulin resistance, impaired glucose homeostasis, hypertension, and lipid abnormalities. These similarities led to the hypothesis that a dysregulation of the HPA axis in the form of functional hypercortisolism could potentially be a cause for abdominal obesity and its different metabolic consequences. High levels of emotional or physical stress are thought to increase cortisol secretion or turnover and thereby increase visceral obesity. are higher in obese people. Females have higher serum leptin levels than males, but this association does not appear to be due to estrogen levels. Leptin is found in greater concentrations in abdominal subcutaneous fat compared to visceral fat. The mechanisms for these differences are not known, but it is possible that this may play some role in the differential metabolic responses of subcutaneous and visceral fat.


Obesity is more than a problem in its own right since it is closely linked to other diseases such as hypertension, diabetes, and cardiovascular disease. Many long-term studies have shown a greater risk of these diseases with increasing levels of obesity, even when other risk factors are present (5). Later studies have refined these conclusions and have demonstrated that the distribution of fat, especially in the abdominal area, is an additional factor (5). A waist circumference of over 40 in. (102 cm) in men and over 35 in. (89 cm) in women signifies increased risk in those who have a BMI of 25.0 to 34.9. A number of efforts have been initiated to educate the public on altering behavioral risk factors such as improper dietary habits and lack of exercise. Examples include the Dietary Guidelines for Americans (Table 3), revised editions of which are periodically issued by the U.S. Department of Agriculture (USDA) (7). Recently the first federal guidelines on the identification,...

Type of Alcohol

One way in which the different types of beverages may exert their different effects on the development of coronary heart disease is via abdominal obesity. It has been suggested that beer drinkers are at a higher risk of developing abdominal obesity than wine drinkers (Figure 7). These beverage-specific differences may be explained by either the traits of the drinker or the different substances in the different beverages. Wine consumption in many populations is related to higher socioeconomic status, higher education, and more optimal health behaviour in general compared with beer and spirits consumption. Because these factors are negatively associated


For routine clinical use, anthropometric measurements (circumference measures and skinfold thickness) have been preferred due to ease of measurement and low cost. Waist circumference and the waist-hip ratio measurements are commonly used surrogates of fat distribution, especially in epidemiology studies. Waist circumference is highly correlated with visceral fat and was recently included as a clinical risk factor in the definition of the metabolic syndrome. Specifically, waist circumferences greater than 102 cm (40 in) in men and greater than 88 cm (35 in) in women are suggestive of elevated risk.

Disease Process

Adenocarcinoma in the head of the pancreas accounts for 80-90 of pancreatic cancer. Pancreatic cancer is a devastating disease because it is rapidly fatal the case fatality ratio is 0.99, median survival is 6 months or less, 1-year survival is approximately 20-30 , and 5-year survival is less than 5 . There is no effective screening modality for pancreatic cancer. The disease is difficult to diagnose and detect because the disease process is either silent or present with nonspecific symptoms, such as unexplained weight loss, back pain, nausea, jaundice, and altered intestine habits. In approximately 80-90 of cases, the cancer is diagnosed at a nonresectable stage when even small tumors have metastasized to other organs, most commonly the liver. Patients undergo cachexia, a complex metabolic syndrome clinically presenting with progressive weight loss and depletion of reserves of adipose tissue and skeletal muscle. Pancreatic cancer cells are particularly resistant to radiotherapy and...

Studies in humans

Several studies have been performed in subjects with various diseases that might be suspected to be consequences of HPA axis activation over prolonged periods. Conditions with increased cortisol secretion due to tumours (such as Cushing's syndrome) or with elevated exposure to glucocorticoids due to therapeutic interventions are followed by insulin resistance, abdominal obesity, hypertension, dyslipidaemia, osteoporosis, cognitive impairments and immune deficiencies (Seeman & Robbins 1994). These are consequences of elevated glucocorticoid exposure where the mechanisms are essentially known.

Ethnic diversity

Interpopulation differences in CVD.39 The extent to which chronic diseases, including CVD, occur within and among different populations is determined by genetic-environmental interaction, which occurs in a wide and variable array, ranging from the essentially genetic to the predominantly environmental. This is perhaps best illustrated by the knowledge gained from studies in migrant groups, where environmental changes due to altered lifestyles are superimposed on genetic influences. These natural experiments have been of great value in enhancing the understanding of why CVD rates differ among ethnic groups. The classic Ni-Hon-San study of Japanese migrants revealed how blood cholesterol levels and CHD rates rose from Japan to Honolulu and further still to San Francisco, as Japanese communities in the three areas were compared.40 The experience gleaned from the study of south Asians, Chinese and Pima Indians further elucidates the complexities of ethnic variations in CHD.41-43 The...


Veldhuis This area presents a lot of challenges to me. One of the difficulties I'm having as an endocrinologist with the testosterone theory, is that I don't see this syndrome X (metabolic syndrome) appearing across puberty in boys. At this stage their testosterone goes up 10-30-fold, but they get just mild insulin resistance. This makes me wonder whether insulin resistance is a marker for some other activity in Bj rntorp I know what you are saying. The problem with these studies as I see them is that people lump obesity into one pot. You have to separate central obesity and peripheral obesity.


Type 2 diabetes is a multifactorial disease with genetic and environmental factors playing a key role in its pathogenesis. Central to the etiology is a defect in insulin action, hepatic glucose output, and insulin secretion. Although insulin resistance is frequently the first detectable abnormality in the progression of T2D, insulin resistance by itself does not cause the disease, which is only manifested when there is a coexisting insulin secretory defect. T2D typically occurs in middle-aged and elderly people but there is an increasing trend of T2D occurring in young individuals. The main question yet to be answered is whether T2D is one disorder or a group of disorders with hyperglycemia as the end point in disease pathogenesis. Insulin resistance is common to several other disorders, including ischemic heart disease, hypertension, dyslipidemia, central obesity, and coagulation defects the clustering of these disorders is known as the metabolic syndrome or the insulin resistance...

Appetite and Obesity

A number of experimental approaches have been used to assess the impact of early life nutritional exposures on long-term feeding behaviour and obesity. Although the nature and severity of the insults applied vary gready, the general finding is that either balanced undernutrition or restriction of specific nutrients promotes increased food intake and relative adiposity in adult life.9,6567 We have noted that mild protein restriction in rat pregnancy leads to increased deposition of abdominal fat in male offspring, in keeping with other reports of increased adiposity following mild or severe maternal food restriction.68 Prenatal high protein diets, which are generally considered to be a risk factor for low birth weight in human pregnancy also have programming effects on fat deposition. Daenzer et al have demonstrated that feeding a high protein (40 by weight) diet in rat pregnancy resulted in a greater fat mass in the offspring at 9 weeks of age.69


The interplay between insulin and leptin regulation of glucose and lipid homeostasis is well known and forms the basis for the complexities of the metabolic syndrome-associated phenotypes. As discussed above, recent findings in both diabetic and Zucker rats, may indicate that these hormones may also have a concerted effect on protein peptide homeostasis in part through the modulation of PepT1 expression. In terms of a classical biochemistry view, it would appear obvious and essential that the three major sources of nutrients (lipid, carbohydrates, and protein) would be subject to coordinate regulation.


The suggestion that low birth weight may contribute to later development of metabolic syndrome and attendant cardiovascular sequelae (including endothelial dysfunction) has been supported by studies documenting an association of birth weight and or catch-up growth and an altered adult lipid profile, although relationships are not always found.41'44 In one of the earliest studies, amongst children aged between 7-11 years involved in the Bogalusa Heart Study, an association between low birthweight and raised serum triglycerides was found, although no correlation with cholesterol was apparent.45 In a study from Finland nearly half of a cohort of 12 year old small for gestational age children were in the highest quartile for serum total cholesterol of the appropriate for gestational age children, but poor catch up growth predicted higher cholesterol.46 Associations between birth length, birth weight, ponderal index and total serum cholesterol were also examined in 545 Danish men and women...

Peripheral Tissues

The within-country studies include the Multiple Risk Factor Trial Intervention (MRFIT) study, which followed 360 000 middle-aged men screened and followed up for CHD mortality. MRFIT showed a strong positive correlation between cholesterol levels at initial screening and later death from CHD. The Framingham Heart Study, started in 1949, is another prospective survey that followed a large cohort of Americans and examined lipid levels and risk of CHD, particularly the relationships between lipoprotein fractions and CHD. It showed a strong association between elevated LDL cholesterol and increased incidence of CHD and an inverse association between HDL cholesterol and CHD risk. Framingham has drawn attention to the value of the ratio of total cholesterol to HDL cholesterol, where a ratio of 3 or less suggests the disease is static and a ratio of 4 or higher suggests the disease is progressive. Framingham also drew attention to the incremental effect of additional risk factors in the...

Riglers Sign

Bas Relief Sign Radiology

It refers to the demarcation of both the inner and outer surface of the bowel wall by the simultaneous presence of air in the lumen and outside the serosa (Fig. 7-13). Sometimes, only the serosal surface of the bowel is delineated because its lumen is completely filled with fluid. Large accumulations of air are needed to demonstrate the bas relief sign. Furthermore, it is nonspecific, sometimes simulated by abundant abdominal fat and by distended adjacent bowel loops (Fig. 7-14).


Importantly, the rise in risk of developing type 2 diabetes begins at BMI levels as low as 22, suggesting that adults should try to maintain a BMI between 18-5 and 21-9 to minimize their risk of type 2 diabetes and other disease. In addition to BMI, abdominal fat distribution, as indicated by an increased waist to hip ratio, is also an important independent predictor of type 2 diabetes.48,49 An increased prevalence of obesity has also been recently implicated in the rising prevalence of glucose intolerance in childhood in North America.50


Lipid abnormalities in overweight and obese individuals are typically characterized by high triglycerides, increased small LDL particles and low HDL cholesterol levels.61 In the presence of abdominal obesity, high serum triglycerides are commonly associated with a clustering of metabolic risk factors known as the metabolic syndrome (atherogenic lipopro-tein phenotype, hypertension, insulin resistance, glucose intolerance, prothrombotic and proinflammatory states). Thus, in obese patients elevated serum triglycerides are a marker for increased cardiovascular risk. The US National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) therefore recognizes the metabolic syndrome as a secondary target of risk reduction therapy, after the primary target - LDL cholesterol.61 Numerous studies document the short- and medium-term benefits on blood lipids associated with lifestyle modification, including weight reduction.62 Current evidence-based guidelines thus recommend weight...

Imaging Techniques

Computed tomography and magnetic resonance imaging (MRI) are considered the most precise methods for measuring body fat distribution. MRI has the advantage of not exposing subjects to radiation. Dual energy X-ray is primarily used to measure bone mineral content and total body fat. This technique can measure total abdominal fat, but it cannot differentiate between visceral and subcutaneous fat. Figure 2 shows two different cross-sectional images of the abdomen obtained by MRI. These images are constructed from 256 x 256 pixels, which vary from white to black with different shades of gray. Each pixel represents 2.4 mm2. The fat regions are depicted as the lighter portions of the images. The subcutaneous fat area delineates the perimeter of the abdomen, whereas the visceral area is contained within the subcutaneous area. Figure 2A represents a cross section of an abdomen with a relatively small subcutaneous fat area in comparison with an enlarged visceral fat area. Figure 2B shows a...


Waist circumference can be used to assess obesity-related health risks in public health and clinical settings. Because it consists of only one measurement instead of two, it introduces less measurement error than WHR. A large waist has been shown to reflect both generalized obesity and centralized body fat distribution, which suggests that waist circumference could replace both BMI and WHR as a simple indicator of the need for weight management. Also, waist circumference tends to be more highly correlated with visceral fat than WHR. It has been shown that hip circumference alone is inversely associated with cardiovascular disease risk after controlling for age, BMI, smoking, and waist circumference. Therefore, some predictive information may be lost if hip circumference is not assessed. If an index of body shape, independent of total body fatness, is desired the WHR may be preferred over waist alone because it is less highly correlated with total adiposity. Waist-to-hip ratio is a...

Severe Complications

The metabolic syndrome (insulin resistance syndrome syndrome X) is a clustering of problems associated with resistance to insulin and or hyperin-sulinemia that includes obesity, high central (i.e., intra- and peri-abdominal) distribution of fat, hypertension, and dyslipidemia. Females with poly-cystic ovarian syndrome also show clustering of these features. The criteria for diagnosis of the insulin resistance syndrome in childhood have not been defined, but some obese children show clustering of extreme values for the parameters of the metabolic syndrome. Hypertension, hyperinsulinemia, and dyslipidemia in obese children are indications for vigorous intervention to prevent morbidity and early mortality.


The relationship of dietary carbohydrates to CVD appears to be mediated through indirect mechanisms contribution to total energy and its effect on overweight and obesity influence on central obesity effects on plasma lipids, especially triglycerides and effects on glycemic control. The balance between carbohydrates and fat as sources of energy as well as the fiber component of the diet are also areas of interest while considering this relationship. In feeding experiments, an increase in dietary energy from carbohydrates is usually associated with a moderate increase in fasting plasma triglyceride levels in the first few weeks but these return to near original levels in the first few weeks. Epidemiologically, high carbohydrate intakes are associated with low plasma cholesterol and variable plasma triglyceride concentrations.43


Surfaces of eviscerated carcasses and internal organs) condemnation, reinspection, and final disposition (segregation of carcass, carcass parts, or organs with signs of disease, extraneous contamination, or adulteration and reinspection of salvaged product) sanitary slaughter and dressing (prevention of contamination of edible carcass components with digestive tract contents) chilling (prompt cooling of carcasses and their edible components, such as liver, heart, gizzard, and necks, where appropriate) plant sanitation preoperational and operational cleaning and sanitation activities through the implementation of plant-specific Sanitation Standard Operating Procedures (SSOPs) residue monitoring (random screening of abdominal fat tissues for a number of potentially harmful chemicals) monitoring compliance with FSIS food safety performance standards (zero fecal contamination prior to chilling, E. coli and Salmonella testing) and verification of each plant's HACCP program. 3

Dynamic Six Pack Abs

Dynamic Six Pack Abs

Reasonable care has been taken to ensure that the information presented in this book is accurate. However, the reader should understand that the information provided does not constitute legal, medical or professional advice of any kind.

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