Obesity impaired glucose tolerance

Any relationship between obesity and stroke is likely to be confounded by the positive association of obesity with hypertension, diabetes, hypercholesterolemia and lack of exercise, and the negative association with smoking and concurrent illness. Nevertheless, stroke is more common in the obese, and abdominal obesity appears to be an independent predictor of stroke (Suk et al. 2003). The constellation of metabolic abnormalities including central obesity, decreased high density lipoprotein, elevated triglycerides, elevated blood pressure and impaired glucose tolerance is known as the metabolic syndrome and is associated with a three-fold increase risk of type 2 diabetes and a two-fold increase in cardiovascular risk (Eckel et al. 2005 Grundy et al. 2005). 

In a 4-year Swedish intervention with orlistat in 3,305 obese patients, it was found that orlistat reduced weight by extra 2.7 kg and decreased the incidence of type 2 diabetes from 9.0% to 6.2% (hazard ratio 0.63). The preventive effect associated with orlistat treatment was almost only in patients with impaired glucose tolerance at baseline (20% of the population) [12]. 

It is shown that orlistat could prevent or retard the development of type 2 diabetes and reduce LDL-cholesterol. Thus, orlistat could be the choice in obese subjects with a high risk of development of type 2 diabetes (e.g. impaired glucose tolerance) and at enhanced risk of cardiovascular disease (e.g. hypertension and high LDL). Orlistat should be avoided in patients who are unable to reduce their fat intake and in patients with chronic diarrhoea. 

This increasing risk of diabetes with obesity is particularly disturbing, since the prevalence of obesity has increased in an epidemic fashion over the last 20 years. It is therefore not surprising that the prevalence of type 2 diabetes and impaired glucose tolerance has risen during this same time period. ... 

A study of Mexican Americans showed no linkage of RBP4 with obesity, insulin resistance, and impaired insulin secretion. However, elevation of plasma RBP4 and its association with impaired glucose tolerance was observed in this study (Chavez... 

In 3000 autopsies of persons aged 15-34 whose deaths were caused by either accident, homicide, or suicide, the extent of fatty streaks and raised lesions in the right coronary artery (RCA) and abdominal aorta positively correlated with high-density lipoprotein cholesterol (HDL-C), hypertension, impaired glucose tolerance (IGT), and obesity. Because they also were associated negatively with HDL-C and positively with smoking for atherosclerosis of the abdominal aorta, controlling risk factors should start in adolescence (8). 

Patients with this condition present with obesity with a characteristic moon face, abdominal striae, osteoporosis, hypertension and muscular weakness. Biochemical features include impaired glucose tolerance with a diabetic type of glucose tolerance curve (because of the glucocorticoid action of cortisol) and sodium retention with potassium depletion (because of the mineralocorticoid action of cortisol). 

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