Abdominal obesity

Westphal, S. A., 2008. Obesity, Abdominal Obesity, and Insulin Resistance. Clinical Cornerstone 9 (1), 23-31.http //www.who.int/mediacentre/factsheets/fs311/en/... 

Ventilatory impairment results from inspiratory muscle weakness, central hypoventilation, thoracic restriction, upper airway narrowing, extreme obesity, abdominal distension, and improperly fitting thoracolumbar orthoses. In NMD, pulmonary infiltrates and respiratory failure are precipitated by mucus plugging due to an ineffective secretion clearance, especially during acute respiratory infections (2,7). 

Insulin resistance occurs when the normal response to a given amount of insulin is reduced. Resistance of liver to the effects of insulin results in inadequate suppression of hepatic glucose production insulin resistance of skeletal muscle reduces the amount of glucose taken out of the circulation into skeletal muscle for storage and insulin resistance of adipose tissue results in impaired suppression of lipolysis and increased levels of free fatty acids. Therefore, insulin resistance is associated with a cluster of metabolic abnormalities including elevated blood glucose levels, abnormal blood lipid profile (dyslipidemia), hypertension, and increased expression of inflammatory markers (inflammation). Insulin resistance and this cluster of metabolic abnormalities is strongly associated with obesity, predominantly abdominal (visceral) obesity, and physical inactivity and increased risk for type 2 diabetes, cardiovascular and renal disease, as well as some forms of cancer. In addition to obesity, other situations in which insulin resistance occurs includes... 

Additional factors considered to play a part in coronary heart disease include high blood pressure, smoking, male gender, obesity (particularly abdominal obesity), lack of exercise, and drinking soft as opposed to hard water. Factors associated with elevation of plasma FFA followed by increased output of triacylglycerol and cho-... 

Patients with multiple risk factors, particularly those with diabetes, are at the greatest risk for IHD. Metabolic syndrome is a constellation of cardiovascular risk factors related to hypertension, abdominal obesity, dyslipidemia, and insulin... 

Positive for sharp right upper quadrant abdominal pain radiating to the back, nausea, vomiting, recent unintentional weight loss (although patient is still obese) and chronic cough negative for chest pain or shortness of breath... 

Insulin resistance has been associated with a number of other cardiovascular risks, including abdominal obesity, hypertension, dyslipidemia, hypercoagulation, and hyperinsulinemia. The clustering of these risk factors has been termed metabolic syndrome. It is estimated that 50% of the United States population older than 60 years of age have metabolic syndrome. The most widely used criteria to define metabolic syndrome were established by the National Cholesterol Education Program Adult Treatment Panel III Guidelines (summarized in Table 40-2). 

EF is a 45-year-old woman who presents to the dermatologist for evaluation of facial acne. She has a history of a 25 lb (11.36 kg) weight gain, irregular menses, and frequent vaginal yeast infections over the past 2 years. She complains of increased facial hair growth and lower extremity muscle weakness. Physical examination reveals facial acne, facial hirsutism, truncal obesity, thin skin, and purple abdominal striae. Her past medical history is significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, and rheumatoid arthritis. 

Children with GH-deficient or GH-insufficient short stature also may present with abdominal obesity, prominence of the forehead, and immaturity of the face. 

TP, a 22 year-old woman, presents to your office for a routine gynecologic examination. She entered menarche at the age of 12. Her last menstrual period was 3 months ago. Her periods are often irregular and occur about every 2 to 3 months. She has had all normal Pap smears in the past and no history of sexually transmitted infections. She is currently in a monogamous relationship with a male partner. She has had a total of four sexual partners. She is not taking oral contraceptives and does not routinely use condoms. She has never been pregnant in the past, but she plans on starting a family in the near future. As you examine the patient, you note facial and chest acne, increased facial and abdominal hair, and obesity. 

GW is a 61 -year-old man who presents to your clinic with a chief complaint of abdominal discomfort and cramping for the past 3 weeks not relieved with over-the-counter medications. While obtaining your medical history, he states that he also has seen small amounts of blood in his stool on and off for 4 months. He has a past medical history positive for hypertension and obesity. He states that he has smoked 1 pack of cigarettes per day for the past 40 years and drinks 4 to 6 beers every couple of days. 

ATP III recognizes the metabolic syndrome as a secondary target of risk reduction after LDL-C has been addressed. This syndrome is characterized by abdominal obesity, atherogenic dyslipidemia (elevated triglycerides, small LDL particles, low HDL cholesterol), increased blood pressure, insulin resistance (with or without glucose intolerance), and prothrom-botic and proinflammatory states. If the metabolic syndrome is present, the patient is considered to have a CHD risk equivalent. 

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. 

Excess fat can be located in the central abdominal area (android, upper body obesity). This fat is associated with a greater risk for hypertension, insulin resistance, diabetes, dyslipidemia, and coronary heart disease. That distributed in the lower extremities (gynoid, lower body obesity) is relatively benign, healthwise. 

Lovejoy JC, Bray GA, Greeson CS, Klemperer M, Morris J, Partington C, Tulley R. Oral anabolic steroid treatment, but not parenteral androgen treatment, decreases abdominal fat in obese, older men. Int J Obes Relat Metab Disord 1995 19(9) 614-24. 

A 59-year-old obese woman with normal renal function, taking metformin 500 mg tds, took orlistat 120 mg tds for 3 months (147). She developed abdominal pain and diarrhea, for which she was given cimetidine, and became weak and dizzy, with blurred vision, reduced consciousness, agitation, and confusion. Her pH was 6.5, bicarbonate 2 mmol/1, base deficit 38 mmol/1, and lactate 21 mmol/1. She required rehydration, bicarbonate, inotropic support and renal replacement therapy. 

In a systematic review of 11 trials of the use of guar gum to treat obesity, the most common adverse events were abdominal pain, flatulence, diarrhea, and cramps 11 patients (3%) dropped out owing to adverse events (3). 

A 35-year-old obese woman with a previously undiagnosed pituitary gonadotroph adenoma developed multiple ovarian cysts and abdominal distension after 1 month of leuprolide therapy (69). 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

It is well known that obesity, especially abdominal obesity, has a number of metabolic consequences, including insulin resistance (Frayn, 2005). Insulin resistance is a state that occurs when normal concentrations of insulin produce a subnormal biological response and the decay of glucose regulation, which eventually leads to type 2 diabetes (Krentz, 1996). Insulin sensitivity varies in healthy individuals, but obese individuals are very often insulin resistant (Frayn, 2005). 

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