1/5. obesity and life underwriting.obesity is increasing in the US population and currently affects one-third of adults. The physiology of obesity is complex and predisposition to obesity is influenced by multiple genes and environment. obesity may be measured by body fat percentage, body mass index (BMI), or visceral adiposity. life insurance companies generally use height and weight (build) determinations. The purpose of this paper is to review the life risks and physiology of obesity, and to suggest that the current trend to liberalize traditional build table ratings may not be prudent. A case history will be utilized to demonstrate these points.- - - - - - - - - - ranking = 1keywords = adiposity (Clic here for more details about this article) |
2/5. syndrome of lipodystrophy, hyperlipidemia, insulin resistance, and diabetes in treated patients with human immunodeficiency virus infection.OBJECTIVE: To describe the syndrome of lipodystrophy, hyperlipidemia, insulin resistance, and diabetes in patients with human immunodeficiency virus (hiv) infection treated with protease inhibitor drugs. methods: This is a case series of patients referred from an infectious disease clinic to a diabetes-endocrinology clinic in an academic medical center because of severe metabolic problems that occurred during the course of otherwise-successful treatment of hiv infection. The clinical course, abnormalities on physical examination, laboratory data, and complications are described and analyzed. The pathogenesis of the syndrome is discussed and compared with that of type 2 diabetes, lipoatrophic diabetes, and mouse models of lipodystrophy. RESULTS: In six male patients receiving antiretroviral therapy for hiv infection, a syndrome of lipoatrophy of the face, legs, and buttocks, hyperlipidemia (predominantly hypertriglyceridemia), and type 2 diabetes mellitus was noted. Two patients had pronounced abdominal obesity, in contrast to their thin extremities. Five of the six patients were receiving protease inhibitor drugs, which have been thought to contribute to metabolic abnormalities. In two patients, ischemic heart disease had developed. CONCLUSION: protease inhibitors frequently cause insulin resistance and lipoatrophy in subcutaneous adipose tissue. These abnormalities are associated with visceral adiposity, hyperlipidemia, diabetes, and cardiovascular consequences and represent an important and unsolved problem in the treatment of hiv-infected patients.- - - - - - - - - - ranking = 1keywords = adiposity (Clic here for more details about this article) |
3/5. Managing 'metabolic syndrome' and multiple risk factors.BACKGROUND: risk factors tend to cluster and are shared across common diseases seen in general practice. The 'metabolic syndrome' is a cluster of fasting hyperglycaemia, abdominal adiposity, dyslipidaemia and hypertension. This syndrome is associated with both insulin resistance and behaviourally modifiable risk factors such as smoking, physical activity and unhealthy diet. OBJECTIVE: This article aims to provide pragmatic guidance on conditions that are lifestyle based and present as a number of disease states that require multiple interventions. Management of comorbidity and multiple risk factors is discussed using a case vignette. DISCUSSION: Metabolic disease states have common bases and their management is directed toward identifying all the risk factors, establishing absolute risk and intervening sequentially.- - - - - - - - - - ranking = 1keywords = adiposity (Clic here for more details about this article) |
4/5. Surgical treatment of regional adiposity. lipectomy versus surgically induced weight loss.Recognition of abdominal fat distribution as a significant risk factor raised the question whether surgical treatment of regional adiposity might be feasible or desirable. This is a review of cosmetic and therapeutic lipectomy in man and experimental lipectomy in rodents examining morphologic and metabolic aspects as well as conditions for growth and regrowth of adipose tissue. Potentially detrimental metabolic effects of lipectomy are discussed in the context of the "metabolic sink" hypothesis. Data are also presented on the distribution of weight loss after gastrointestinal surgery for morbid obesity. An obesity-related "elephantiasis" syndrome in superobese men is described. "Giant lipectomy" in one such case, removing a record 50 kg during one operation, with pre- and postoperative determination of body fat is reported. It is concluded that lipectomy is not a treatment for obesity with very rare exceptions. Regrowth of adipose tissue is possible under special circumstances. Surgically induced massive weight loss does not seem to cause preferential regional weight loss, though risk-reducing beneficial metabolic effects are achieved after gastrointestinal obesity surgery.- - - - - - - - - - ranking = 5keywords = adiposity (Clic here for more details about this article) |
5/5. Right heart failure due to ventricular adiposity: 'adipositas cordis'--an old diagnosis revisited.adiposity of the heart is characterized by an increase in the amount of epicardial and other adipose tissue. The most pronounced changes involve the right ventricle. The adipocytes may be interposed between myocytes, and in severe cases the normal mechanics and function of the ventricle are impaired. adiposity of the heart is usually an incidental finding at autopsy, and only rarely is it of clinical significance. This report describes a 46-year-old female with multiorgan failure secondary to bronchopneumonia, purulent pericarditis, tamponade and sepsis, whose clinical course was altered due to severe adiposity of the heart, so-called 'adipositas cordis'.- - - - - - - - - - ranking = 5keywords = adiposity (Clic here for more details about this article) |