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FisiopatologiaFisiopatologia

NutrizioneNutrizione

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Body Mass Index Associated Disease RiskObesity Class BMI (kg/m2) Risk

Underweight

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Leptina: dal greco leptos: magro

Proteina di 167 AA

Localizzata sul cromosoma 7q31

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A simplified schema of the circuitry that regulates energy balance. When sufficient energy is stored in adipose tissue and theindividual is well fed, afferent adiposity signals (insulin, leptin, ghrelin) are delivered to the central neuronal processing units, in the

hypothalamus. Here the adiposity signals inhibit anabolic circuits and activate catabolic circuits. The effector arms of these centralcircuits then impact on energy balance by inhibiting food intake and promoting energy expenditure. This in turn reduces the energystores and the adiposity signals are obtunded. Conversely, when energy stores are low, the available anabolic circuits take overat the expense of catabolic circuits to generate energy stores in the form of adipose tissue, thus generating an equilibrium

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A simplified schema of the circuitry that regulates energy balance. When sufficient energy is stored in adipose tissue and the

individual is well fed, afferent adiposity signals (insulin, leptin, ghrelin) are delivered to the central neuronal processing units, in the

hypothalamus. Here the adiposity signals inhibit anabolic circuits and activate catabolic circuits. The effector arms of these central

circuits then impact on energy balance by inhibiting food intake and promoting energy expenditure. This in turn reduces the energy

stores and the adiposity signals are obtunded. Conversely, when energy stores are low, the available anabolic circuits take over

at the expense of catabolic circuits to generate energy stores in the form of adipose tissue, thus generating an equilibrium

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Obesity and insulin resistance. Adipocytes release a variety of factors (free fatty acids and adipokines) that mayplay a role in modulating insulin resistance in peripheral tissues. Excess FFA and resistin are associated with insuliresistance; in contrast, adiponectin, whose levels are decreased in obesity, is an insulin-sensitizing adipokine. Leptiis also an insulin-sensitizing agent, but it acts via central receptors (in the hypothalamus). The PPAR is an adipocytnuclear receptor that is activated by a class of insulin-sensitizing drugs called thiazolidinediones (TZDs). Themechanism of action of TZDs may eventually be mediated through modulation of adipokine and FFA levels thatfavor a state of insulin sensitivity.

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Gastrointestinal Gallstones, pancreatitis, abdominal hernia, NAFLD (steatosis, steatohepatitis, and cirrhosis), and possibly GERD

Endocrine/metabolic

Metabolic syndrome, insulin resistance, impaired glucose tolerance, type II diabetes mellitus, dyslipidemia, polycystic ovarysyndrome

Cardiovascular Hypertension, coronary artery disease, congestive heart failure, arrhythmias, pulmonary hypertension, ischemic stroke, venousstasis, deep vein thrombosis, pulmonary embolus

Respiratory Abnormal pulmonary function, obstructive sleep apnea, obesity hypoventilation syndrome

Musculoskeletal

Osteoarthritis, gout, low back pain

Gynecologic Abnormal menses, infertility

Genitourinary Urinary stress incontinence

Ophthalmologic Cataracts

Neurologic Idiopathic intracranial hypertension (pseudotumor cerebri)

Cancer Esophagus, colon, gallbladder, prostate, breast, uterus, cervix, kidney

Postoperativeevents

Atelectasis, pneumonia, deep vein thrombosis, pulmonary embolus

Medical Complications Associated with Obesity

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Effetti della dieta:

Grassi insaturi

Sodio

Fibre

Frutta e verdura

CarniRestrizione calorica

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Deficit nutrizione

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Una dieta adeguata deve fornire:

Energia sotto forma di carboidrati, lipidi e proteine

AA e acidi grassi per la sintesi di proteine e lipidiStrutturali

Vitamine e minerali

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Malnutrizione primaria: uno solo o la totalitadi questi componenti vengono a mancare nella dieta

Malnutrizione secondaria: lapporto di nutrienti eadeguato e la malnutrizione puo derivare da

malassorbimento, alterazzione dei processi di

utilizzazione e immagazzinamento delle sostanzenutritizie, da una perdita eccessiva di nutrienti o da

un aumento del fabbisogno nutrizionale.

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