The Relationship of Obesity – Cholesterol – Triglycerides

to Metabolic Syndrome: Assessment and Interventions

Presented by Graham Simpson, MD

Institute Physician, Cenegenics® Medical Institute

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

Accumulating scientific research has shown that adipose tissue is an active endocrine and metabolic organ that plays a critical role in the development of cardiometabolic risk factors, diabetes and cardiovascular disease.

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

Adipose tissue plays an important role in the development of low-grade systemic inflammation. Adipose tissue secretes a number of cytokines TNF2, IL1, IL6, adiponectin, leptin, plasminogen activator-1 – these stimulate inflammatory protein production in the liver through activation of NFKB.

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

Macrophage accumulation in adipose tissue also promotes obesity associated inflammation and its sequelae, including endothelial dysfunction, insulin resistance, dyslipidemia, hypertension, impaired thrombolysis, diabetes and atherosclerosis.

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

Liposuction of abdominal subcutaneous adipose tissue has been shown not to improve cardiometabolic risk factors, whereas experimental studies report that reduction of visceral fat improved glucose levels and insulin sensitivity.

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Prevalence of CAD Risk Factors

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Parallels

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Relative Risk of CAD Mortality

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Metabolic Syndrome

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Associations

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Mechanisms of Dyslipidemia

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

ASSESSMENT

1. Blood tests

2. Tape measure

3. Dexa scan

4. IMT

5. Vascular reactivity (FMD)

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Patient Overview

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    AVERAGE MIN MAX

Age   51.8 28 73

Married   139 total

Children   2.4 0 15

   

Ht   70.8 60.4 78.8

Wt   212.7 134 344.5

% body fat   30.3 9.2 44.2

Densitometer   none = 95 Penia = 83 Porosis = 20

Depression   8.3 0 32

QLI   6.6 0 22

   

Glucose   95.3 65 245

A1C   5.6 4.6 11.2

M Gluc   123.2 86 321

F Insulin   7.6 1 59

Uric Acid   6.6 1.6 11.8

Homo   9.9 3.8 20.5

CRP   3.0 0.1 37.8

   

Chol   197.5 109 331

TG   151.4 39 975

HDL   49.7 31 99

LDL   121.3 40 235

   

Total Test   428.6 29 966

Free Test   67.2 5.6 936

DHT   37.8 2 182

E2   23.7 1 158

IGF   159.8 66 315

PSA   1.2 0.1 5.3

DHEA   163.5 2.5 1210

TSH   2.42 0.7 12.66

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What is IMT?

IMT measured the Intima-Media Thickness (IMT) of the common carotid Determines the presence and severity of atherosclerosis

IMT of the carotid artery has been conclusively demonstrated as a surrogate endpoint for cardiovascular disease (CVD)

IMT evaluates CVD itself instead of the risk factors for the disease

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

INTERVENTION

Lifestyle

Paleo-Nutrition

Nutraceuticals

Exercise

Detoxification

Mind-Body Rx Hormone Restoration Pharmaceuticals

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Exhaustive, Scholarly Work

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Eukaryotes

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Paleolithic NutritionA Consideration of Its Nature and Current Implications

S. Boyd Eaton, MD, and Melvin Konner, PhD

NEJM 31Jan85 Vol 312 No.5

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Ancestral vs. Modern Humans

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

PHARMACEUTICALS

1. Metformin

2. Orlistat

3. Niacin

4. Statins

5. Omega 3 fatty acids

6. Fibrates

• Gemfibrozil

• Fenofibrate

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Potential Mechanisms

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The Relationship of Obesity-Cholesterol-Triglycerides to Metabolic Syndrome

PHARMACEUTICALS, cont’d

7. Cholesteryl Ester Transfer Protein Inhibitor (CETP)• Torcetrapib (discontinued)

• JTT-705

8. Endocannabinoid Receptor Antagonism• Rimonabant (first CB1 antagonist)

9. Thiazolidinediones• Pioglitazone

10. Obesity Drugs• Sibutramine (Meridia)

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Hypothetical Model

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Multisite Location

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Effects