Άσκηση και Παχυσαρκία
Η παχυσαρκία ως επιβαρυντικός παράγοντας στηνυγεία – Συνοδές ασθένειες
Σακκάς Γεώργιος PhD
Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού
ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ
Άδειες Χρήσης
•Το παρόν εκπαιδευτικό υλικό υπόκειται σε άδειεςχρήσης Creative Commons.
•Για εκπαιδευτικό υλικό, όπως εικόνες, που υπόκειταισε άλλου τύπου άδειας χρήσης, η άδεια χρήσηςαναφέρεται ρητώς.
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Χρηματοδότηση
•Το παρόν εκπαιδευτικό υλικό έχει αναπτυχθεί στα πλαίσιατου εκπαιδευτικού έργου του διδάσκοντα.
•Το έργο «Ανοικτά Ακαδημαϊκά Μαθήματα ΠανεπιστημίουΘεσσαλίας» έχει χρηματοδοτήσει μόνο τη αναδιαμόρφωσητου εκπαιδευτικού υλικού.
•Το έργο υλοποιείται στο πλαίσιο του ΕπιχειρησιακούΠρογράμματος «Εκπαίδευση και Δια Βίου Μάθηση» καισυγχρηματοδοτείται από την Ευρωπαϊκή Ένωση (ΕυρωπαϊκόΚοινωνικό Ταμείο) και από εθνικούς πόρους.
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Σκοποί ενότητας
•Η απόκτηση γνώση για τις σχετιζόμενες με τηνπαχυσαρκία συνοδές ασθένειες και πως αυτέςεπηρεάζουν το προσδόκιμο ζωής των ατόμωναυτών.
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Περιεχόμενα ενότητας - Contents
•Associated Comorbidities (συνοδές ασθένειες)
–Cardiovascular Disease
–Respiratory Complication
–Stroke
–Autonomic Nervous System
–Diabetes
–Dyslipidemia
–Gastroesophageal Reflex
–Arthritis
–Urinary Incontinence
–Non-alcoholic Liver Disease
–Psychological Disorders
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What is Obesity – What is the risk
Overweight is BMI of 25 to 29.9 Kg/m2
Obesity is BMI anything above 30 Kg/m2
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Obesity - Metabolic Syndrome (MetS)
•MetS composed of:
–Insulin resistance
–Abnormal fasting glucose levels
–Increased cholesterol (total, LDL) and TG
–Increased blood pressure
–Increased WHR or central adiposity (visceral fat)
•MetS is associated with
–Obesity & Diabetes
–CardioVascular Disease (CVD)
•Optimal BMI for a healthy life from age 18 to 85 is the23 to 25 (23-30 African American)
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Obesity - Metabolic Syndrome (MetS)
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•The life-shortening effect of obesity rises if(obese) young people stay obese until themiddle and older ages compared to if theybecome obese into an older age.
MetS affects the whole body
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Obesity and Cardiovascular Disease
•Studies have shown that
–adolescence obesity predicts mortality (θνησιμότητα) rates by80% in male and 100% in female patients
–the risk of death is independent of adult BMI but dependentof “since when” the adult was obese
•Obesity is associated with reduced life expectancy(προσδόκιμο ζωής)!
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Cardiovascular Impact of Increased Fat MassAdipose Tissue Circulation
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•Increased Adipose tissue leads to edema
•Adipose tissue has an extensive capillary network
•Resting blood flow is 2-3ml/min/100g fat
•Increased after meal to 20ml/min/100g fat
•In obesity, perfusion is reduced in 1.5ml/min/100gfat meaning that the water between the fat cells(interstitial space) is not accessible leading toincreased edema
•In addition, 30% of the circulated IL6 (Interleukin-6)comes from the adipose tissue
•IL6 modulates CRP – marker of chronic inflammation –that can trigger acute coronary syndrome
•At any given level of activity,the cardiac workload andperipheral resistance aregreater for obese subjects
•Due to increased leftventricular filling pressure andvolume – chamber dilation –there is a high risk for LeftVentricular Hypertrophy (LVH)
•In weight reduction a decreasein central blood volume givesrelief from edema anddyspnea
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Left Ventricular Hypertrophy(υπερτροφία της αριστερής κοιλίας)
•Lipid deposition can impair tissue or organ function inthree ways:
•Fat around organs can modify function due to
•increased pressure (compression)
•periorgan fat cells secreting various actingmolecules
•Lipids accumulation may lead to cell dysfunctionor cell death – known as Lipotoxicity
•Fat deposition in cardiac muscle (epicardial fat)could lead to cardiomyopathy
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Lipid Deposition in Organs
•Venous Stasis (φλεβική στάση), lower leg edema andcellulitis (κυτταρίτιδα) due to venous valvularincompetence
•Venous thrombosis and pulmonary embolism – 2.5 timesmore risk with waist circumference >100 cm
•Abnormal endothelial function due to decrease NO (nitricoxide) meaning increased oxidative stress
•Decrease in NO function leads to increasedvasoconstriction and increased vascular resistance
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Vascular Disease in Obesity
What is Hypertension?
Hypertension or high blood pressure is a condition in which theblood pressure in the arteries is chronically elevated.
Blood pressure is the force of blood that is pushing up againstthe walls of the blood vessels.
If the pressure is too high, the heart has to work harder to pump,and this could lead to organ damage and several illnesses such asheart attack, stroke, heart failure, aneurysm, or renal failure.
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What is Hypertension?
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Hypertension in Obesity(υπέρταση)
•The majority of hypertensive patients areoverweight
•Hypertension is 6 times more frequent in obesethan in lean subjects
•Weight gain in a previously lean subject is apotent risk for developing hypertension
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Hypertension in Obesity
•A 10 kg increase in body weight is associatedwith 3 mmHg higher systolic and 2.3mmHg higherdiastolic blood pressure
–This is translated into 12% risk for Coronary HeartDisease (CHD) and 24% for stroke
•Blood Pressure = Cardiac Output * SystemicVascular Resistance
–C.O. is increased due to oxygen demand from theexcess fat tissue, SVR is increased due to endothelialdysfunction (NO etc)
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Peripheral Vascular Resistance in Obesity(περιφερεική αγγειακή αντίσταση)
•Obesity is associated with inflammation
•Strong correlation between IL6, CRP and obesity
•IL6 stimulates CRP from the liver
•Increased IL6 is correlated with systolic and diastolicblood pressure
•Obesity is considered a
“low-grade systemic inflammation”
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Respiratory Complications in Obesity(αναπνευστικές διαταραχές)
•Obese subjects have
–Increase demand for ventilation
–Increased breathing workload
–Respiratory muscle inefficiency
–Decreased functional reserve capacityand expiratory reserve volume
–Closure of peripheral lung units
•Ventilation-Perfusion mismatch(supine position)
•Obesity is a classic cause of alveolarhypoventilation (κυψελιδικόςυποαερισμός)
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Apnea in Obesity(υπνική άπνοια)
•Obesity is by far the most importantrisk factor for sleep disorders
•Sleep Apnea – repeated episodes ofobstructive apnea and hypopneaduring sleep, together with daytimesleepiness or alteredcardiopulmonary function
•Hypertension rises with sleepdisorders
•Sleep apnea is associated withincreased levels of CRP
•Sleep Apnea – Hypertension –Atherosclerosis
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Pulmonary Hypertension in Obesity(πνευμονική υπέρταση)
•15-20% of Sleep Apnea patients suffer fromPulmonary Hypertension
•MetS is associated with Pulmonary Hypertension
•Mechanism: Obesity relates to sleep apnea –relates to alveolar hypoventilation – relates toalveolar hypoxia = pulmonary vasoconstriction
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Stroke & Obesity(εγκεφαλικό επεισόδιο)
•Many studies have shown association between BMI –WHR – Stroke
•Obesity is a potential risk factor for strokeindependently from cholesterol levels, hypertension &diabetes
•Overweighted men (25 – 29.9 BMI) had 1.32 timeshigher risk for Total Stroke, 1.25 for HemorrhagicStroke and 1.35 for Ischemic Stroke
•If your BMI increases by 1 unit your risk increases by
–4% for Ischemic Stroke
–6% for Hemorrhagic Stroke
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Coronary Artery Disease in Obesity(στεφανιαία νόσο)
•Obesity is associated with advancedatherosclerosis in the Right Coronary Artery &Abdominal Aorta
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Coronary Artery Disease in Obesity
•Central adiposity is moreimportant for atherosclerosisthan total body fat
•The levels of HDL , LDL,hypertension, diabetes,smoking and glycohemoglobinaccounted for the 15% ofatherosclerosis found in obesepatients…the rest is explainedby central fat (visceral fat)
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Arrhythmias in Obesity(αρρυθμίες)
•“Sudden death is more common in those who are naturallyfat than in the lean” Hippocrates
•Obese subjects have an increased risk of arrhythmias andsudden death even in the absence of cardiac dysfunction
•Abnormal prolonged QT interval found in obese patients
•QT abnormalities are associated with central adiposity orinsulin resistance
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Autonomic Nervous System & Obesity(αυτόνομο νευρικό σύστημα)
•ANS regulates cardiovascular system and energyexpenditure
•10% increase in body weight = decline in parasympathetictone = increase in resting heart rate
•Increase of resting HR is associated with high mortalityrates
•10% reduction in body weight in severely obese subjectresulted improvement in cardiac function
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Diabetes in Obesity(διαβήτης)
•More than 95% type 2diabetes is attributedto obesity
•The risk of type 2diabetes increases withweight gain
•With weight loss, type2 diabetes and insulinresistance is improved,diabetes medication isreduced
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Dyslipidemia in Obesity(δυσλιπιδαιμία)
•Obesity is associated with increased totalcholesterol, increased LDL, decrease HDL andincreased TG levels
•With weight loss, lipidemia is improved by40% and stays there until weight is regained
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Gastroesophageal Reflux in Obesity(γαστρο-οισοφαγική παλινδρόμηση)
•Obesity is a major riskfactor forgastrointestinal refluxdisease (γαστρο-οισοφαγικήπαλινδρόμηση)
•Improvement of thesesymptoms have beenfound in the majority ofthe patients who lostweight
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Degenerative Joint Disease in Obesity(ασθένειες του κολλαγόνου)
•Obesity is clearly a cause of large jointdegeneration (ασθένειες του κολλαγόνου) andarthritis
•With weight loss, obese patients have foundrelief from pain in hips, knees, feet and lowerback
•Arthroplasty is safe when the patients are withinthe normal weight range
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Urinary Incontinence in Obesity(ακράτεια ούρων)
•Obesity appears to be an important etiologicfactor in stress urinary incontinence (ακράτειαούρων), probably through the mechanism ofincreased abdominal pressure
•With weight loss, studies have showndecrease in intra-abdominal pressure,decrease in sagittal abdominal diameter anddecrease in stress urinary incontinence
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Non-alcoholic Steatohepatitis in Obesity(μη αλκοολική στεατοηπατίτιδα)
•Nonalcoholic Liver Disease and NonalcoholicSteatoHepatitis are strongly associated withobesity and type 2 diabetes
•NASH may result in cases of cirrhosis and liverfailure
•Deposition of fat in the liver is the primarysuspect but the pathophysiology is unknown
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Psychiatric and Social Disorders in Obesity(ψυχιατρικές διαταραχές)
•The morbidly obese frequently suffer from poor self-imageand social stigmatization
•They are at special risk for affective disorders, anxiety andsubstance abuse (drugs)
•Repeated diets could lead to depression, anxiety and foodpreoccupation
•After weight loss, patients have been shown to have bettermood, self-esteem and to become more socially active
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Summary
•Obesity is always followed by something else…
•From metabolic syndrome and urinaryincontinence to psychiatric disorders
•The years that somebody has been obese, highlyrelated to the risk of death
•Reduction of body mass (kg) results in asignificant improvement in total health
•The combination of exercise and diet is theoptimal way to loose weight and keep it away
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Τέλος Ενότητας
ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ