Diabetes mellitus obesity increases risk

The consequences of hypertriglyceridemia are not well understood, but there may be an increased risk of cardiovascular disease and pancreatitis (SEDA-13, 123). Patients with an increased tendency to develop hypertriglyceridemia include those with diabetes mellitus, obesity, increased alcohol intake, and a positive family history. With a short course (16 weeks) of isotretinoin it is sufficient to ensure there is no hyperlipidemia before the start of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks (1207). 

Insulin resistance, frequently accompanied by obesity, is an important risk factor for HF development. Diabetes Mellitus itself increases the risk for HF as well. Those who are positive for urinary albumin excretion may develop more sever HF and are more at risk for mortal events. A recent report showed that diabetes is a potent, independent risk factor for mortality in patients hospitalized with HF. Interestingly, the excess risk in diabetic patients appears to be particularly prominent in females. In treating the patient with diabetes, one should pay attention to such variables. 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

The risk of gout increases as the serum uric acid concentration increases, and approximately 30% of patients with levels greater than 10 mg/dL (greater than 595 pmol/L) develop symptoms of gout within 5 years. However, most patients with hyperuricemia are asymptomatic. Other risk factors for gout include obesity, ethanol use, and dyslipidemia. Gout is seen frequently in patients with type 2 diabetes mellitus and coronary artery disease, but a causal relationship has not been established. 

Fifth, the increased risk of obesity and diabetes mellitus in Hispanics warrants careful consideration of SGA use in this population. Although there is variance in the data from studies assessing the incidence of metabolic syndrome in Hispanics being administered SGAs, one study pointed to a significantly higher incidence compared to non-Hispanics. Further research in this area is warranted. 

Abdominal obesity is associated with a threatening combination of metabolic abnormalities that includes glucose intolerance, insulin resistance, hyperinsulinemia, dyslipidemia (low HDL and elevated VLDL), and hypertension. This clustering of metabolic abnormalities has been referred to as syndrome X, the insulin resistance syndrome, or the metabolic syndrome. Individuals with this syndrome liave a significantly increased risk for developing diabetes mellitus and cardiovascular disorders. For example, men with the syndrome are three to four times more likely to die of cardiovascular disease. 

In untreated women, the main risk factors for endometrial carcinoma are age, obesity, nulliparity, late menopause (and possibly early menarche), the Stein-Leventhal syndrome, exposure to exogenous estrogens, radiation, and certain systemic diseases, including diabetes mellitus, hypertension, hypothyroidism, and arthritis (SED-14, 1451) (88). Certain of these risk factors indicate that an altered endocrine state with increased estrogen stimulation is a predisposing cause, and one might thus in theory expect estrogen treatment (and notably hormonal replacement therapy) to increase the risk (SEDA-22, 466). 

One of the risks associated with use of combined hormonal contraceptives is venous thromboembolism, but in women without other contributing risk factors the risk of thrombosis is less than that observed during pregnancy. The risk of thromboembolism increases with both age and the presence of other risk factors, such as obesity or an immobilizing illness. There is also a small risk of arterial disease, particularly if the woman has a previous history of arterial disease, hypertension, diabetes mellitus or if she is obese. 

Measurement of the waist-to-hip ratio has proven to be useful in diagnosing male-type or female-t3q>e obesity. This ratio is acquired by measuring the circumference around the waist, and about the hips, and performing division. The units of each measurement is centimeters, while the ratio has no unit. A waist/hip ratio of 1.0 or greater (for men) or 0.8 or greater (for women) is associated with a distinct increase in health risk for non-insulin-dependent diabetes mellitus (NIDDM), hypertension, and atherosclerosis (Bjomtorp, 1985). 

Since hypercholesterolemia (in particular, LDL cholesterol) increases the risk of CHD, it seems reasonable to lower cholesterol levels in patients whose levels put them at risk. Before treatment, other risk factors such as hypertension, cigarette smoking, obesity, and glucose intolerance need to be evaluated and corrected. Disorders that exacerbate hyperlipoproteinemia (e.g., chronic ethanol abuse, hypothyroidism, diabetes mellitus) need to be treated before lipid-lowering measures are taken (discussed earlier. Table 20-7). 

The World Health Organization estimates that by 2015, the number of overweight people globally will increase to 2.3 billion, and more than 700 million people will be obese. Mayo clinic data indicate that the prevalence of diabetes increased 3.8% every year. The total prevalence of diabetes mellitus in US is expected to more than double from 2005 to 2050 in all age, sex and race groups. Data from the National Diabetes Information Clearing House, states at least 65% of people with diabetes die of some form of heart disease or stroke. Among women with CHD, diabetes is the strongest risk factor for heart failure in US (American Heart Association, 2008, Rosamond et al., 2008). In 2002, the direct... 

Among various types of fat deposition, visceral fat type obesity is one risk factor for metabolic diseases such as diabetes mellitus, hypercholesterolemia, hyperlipidemia, hypertension, and atherosclerosis. The risk of diseases such as diabetes mellitus and coronary heart disease, as well as all-cause mortality, increases in proportion to the increase in body adipose above optimal, but intra-abdominal distribution of fat in the body is associated more closely with disease risk. 

Sugars that are in free solution in foods, and therefore provide a substrate for oral bacteria, leading to the formation of dental plaque and caries. These are known as extrinsic sugars. As discussed in section 7.3.3.1, it is considered desirable to reduce the consumption of extrinsic sugars because excessive amounts are associated with dental decay as well as obesity (section 6.3) and possibly also an increased risk of developing diabetes mellitus (section 10.7). 

This situation occurs among some professional football players, sumo wrestlers, and a few other types of power athletes. Excessive energy consumption for greater BMIs is desirable in these sports because of the association of mass and strength. Down-linemen in football have been reported to have BMIs in the obese range (BMI > 30). The obese body weights and excess fat place these athletes at increased risk of diabetes mellitus type 2, hypertension, and cardiovascular and other diseases. 

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