Sy x Engl-ubacivati Ispravke

8/7/2019 Sy x Engl-ubacivati Ispravke

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Sinergy ! Univer Univers sit ity iny in Beograd Beograd


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The social and scientific importance of sindrom X is in root of global epidemic of hronic noncomunicable diseases (HNCD),specially Cardiovascular diseases andDiabetes melitus type 2, in wich ethioptho-genesis atherosclerosis play central roleand/or there is glukoregulation disturban glukoregulation disturban- -ciescies .

Thesse diseases are linked with obesity obesity, ,at athherogenerogenic ic dislipidemi dislipidemia and physical a and physical inactivity inactivity. .

Economic reasons are so important because (1:10 is proportion of prices of

prevention and their terapy)

Resons to take these action-study


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Price and unsutible technik of insulin euglicaemicclam for pop ulati on measurments of insulin sensitivityandi p arcial view of investigati on of so much c om p licatedp roblem, than:

General view that factors of Syndrom X are not linked each-other or with IR, nor phynctionaly, nor

methabolicaly. But,

I n 1985. is f ind that aterosklerotic procesis reversibile (AT) and was accented theim po rtance of egzogenic risico faktors like:

stress, obesity, unsuitible nutrition i specialy physical activity .

How we became in situation of global epidemy of HNCD and did not seen hight atherogenic

potential of Syndrom X ?


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S ince 1990 y. up 2002. S indrom X is mainly investiga-

ted in cross sectional studies and factor analisys, but..

Epydemiologist from Bristol, UK (Lawlor Debora andco-worers, in 2004 made big meta-analisys of 22 studieswhich were performed in past 15 years on world plan,and they find that for understanding of pthophysiology of S indrom X is necesarry longitudinal (longterm) studies,and multidisciplinar coloboration of: physiologists, biche-mists, specialist for nutrition, for physical activity andendocrinologist.

In 1996 y, Flier-a S . S ay that :

Insulin resistance became firmly investigatedobject of basical and clinical investigation, it growth upmore and more than is thin domen of clinicaldijabetology, wherethese concept was born before 60 years " J. S . Flier

Results of past investigation


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Aut Auth hor, M.Vidin,or, M.Vidin, 2004 god.2004 god.


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Cr Criteri iteria for a for diagnodiagnosis of sis of Sy X Sy X fromfrom 19981998. (Alberti KG, 1998.). (Alberti KG, 1998.)and Criteria for obesity,and Criteria for obesity,1997 1997. ( WHO, 1997 ). ( WHO, 1997 ) include:include:

S igns (parameters) of glukoregulationhomeostasis :

1. levels of glucoregulation disturbancies2. parameters of insulin sensitivity

signs (parameters) of plasma lipids:1. HDL-cholesterol i2. tryglicerides,

a ntopometrical signs (parameters) of

1. overweight and obesity and2 . parameters of abdominal and / or visceral obesity ..

Th ese way permit investigation of Th ese way permit investigation of pat pat hh oop h ysiology and t h erapy of p h ysiology and t h erapy of sindroma X sindroma X. .


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there were big knoledge of influence of foodm physical activity, stress and bichevioral therapy,but there was not hypothesis of

PATHOPHYSIOLOGY OF SYNDROM X,

Definition of World health organisation (WHO),1997y. for body weight clasification and criteria

from 1998y. for syndrom X ( Sy X ) give a chanceto define pathophysiology of Syndrom X ....Useful facts that can be mached were come from East and from West, sourcelly: Reaven Gerald 1972, 1988and 2005, Dilmjan Vladimir, 1974; than Stern M,1989;

Krier F, 2004; Freendland E, 2002; Alberti KG, 1998;Cefalu S, 2000; Chan U, 2004 ; Katz A, 2000 ;Lawlor D, 2004 ; Hanley M,1998 i Meigs S, 2000,and new others......


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Linkage beetween chronic non comunicable diseases (HNCD),

insulin resistance and some athergenic risico factors (ATRF)


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Procents of some CVD in general rate of deathfrom CVD in USA-in 1999 year


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Clasification of Clasification of at athheroserosc clerolerosis stage sis stage(Apollo lipids,Edu.sci,2005)

N o m e n c l a t u r eo f

l e s i o n s

P r o g r e s i o nS t a g e M e c h a n i s -

m u s

F r s tI n i c i a l

b e e n g

C l i n i c a lc o r e l a t i o n

Ty p I ( i n i c i ja l )i z o l a t e dm a c r o p h a g e sa n d f o a m c e l ls .Ty p I I ( f a t y l in e sI n t r a c e l u l a rA c u m u l a ti o n o f l i p i d s

I n f i r s td e c a d e

Ty p I I I( i n t e r m e d i j a r )d i f fe r e n t t y p I Ic e l l sa n d s m a la c c u m u l a t io n o f e k s t r a c e l l u l a rl i p i d s

k l i n i k is i l e n t

Ty p I V ( a t e r o m a )d i f fe r e n t t y p I Ic e l l sa n d b i g e s ta c c u m u l a t io n o f e k s t r a c e l l u l a rl i p i d s

g r o w t h f ro ml ip ida c c u m u l a t i o n

I n t h i r dd e c a d e

Ty p V( f i b r o a t e r o m a )L i p id s g r o w t h a n df ib r o s e w a l l w i t hm o r e c a l c i fi c a c i e s

B i g e r s m o o t hM m u s c u l u sa n d c o l a g e n

Ty p V I( c o m p l i c a t e d )S u r f a c e s d e f e c t s ,H a e m o r h a g ie a n dt h r o m b i

t h r o m b o s i sc h e m a t o m e s

I nf o u r t hd e c a d e

C l i n i c a l ys i l e n t o re v i d e n t i c a l

I

I I

I I I

I V

V

V I


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P at h omorp h ological aterosklerotic aorte disturbances :mild, midle, strong (Apollo lipids, Edu. sci, 2005)


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Clasters and syndroms with hight atherogenic potential


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Prevalence of atherogenic risico factors in patient with syndrom X (Stern M, Ferrarini E, 1991)


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Dijagnostic criteria of varies syndroms with Insulin resistance Bloomgarden TZ,2004


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Link beetwen insulin resistane, growth hormon and somatostatin in answer to stresss (Dilmjan V,1974)


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Stress, symphatoadrenal axis and Hy pothlamo-hypophyeo-medular axis


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Criteriums of stage of nutrition (WHO, 1997)


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1. IS index - hyperglicaemic ins. slamp2. Minimod IS index-hyperglicaemic ins. slamp=G old standard for all form of IR, specially for IR withpathomorphological basis, but problem is a lot of samples and difficult count

Q ualification of insulin sensitivity

IR in Syndrom X - linked with elevatedvisceral fat and general obesity

1.

2. IS-FFM indeks (uzima u obzir veli inu mr avetelesne mase i kon. Triglicerida u plazmi)IS (FFM) = e

[ 2,63 0,28x(log. ins. na te 0,31 (fasting

TG )]

O ther indexes of insulinsensitivity1. H O MA indeksHI=[log(Io)+log(Go)]

22,5fasting insulin ( IU/L)

fasting glucose ( mmol/L)2. Ln H O MA index3.Benet index

QU ICKI INDEKS (Katz,2000)Q I= _____1__ _______

[log(Io) + log(Go)]


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Aterogeniq potential and compositionof lipoprotein bodies


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Structure of lipoproteinbody (Biomerieux,1987)

Differences in amount of cholesterol and triglyceridesin hylomicrones and in HDLbodies

(Biomerieux,1987)


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Syndrom X (SY X) risico factors:

Up today known risico factors resposible forS yndrom X are:1. O veraeting generaly (biger caloric intake),2. O verconsumption of carbochydrates and

or saturated fat generaly ,3. Abdominal obesity,4. Disturbancies of diurnal rhitmus ( WR O NG

DIETARY S TYLE AND LIFE S TYLE),5. LO WERED DEILY PHY S ICAL ACTIVITY,6. Alckohol consumtion7. EFFECT S O F S UBCHR O NIC S TRE SSO R S


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1 . REGULATED FORM OF KEEPING AMOUNT OF FAT BODY MASS

2. NON REGULATED FORM OF KEEPING AMOUNT OF FAT BODY MASS

ADAPTIVE MECHANISMUS FORSTABILE BODY WEIGH


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Regulation of energetic homeostasis and Apetit control - Modern concepts

NARC (nukleus arkuatus), apety control

Hypothalamic nuclei of sekcija korona

Central kontrol of a apety

Perifern kontrol of apety

Regulation of energetic methabolism and apetit control go with neurohormonal circuits, and concept of isolated centers is now past (Wynne Katty, 2005)


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Sinergy ! Univer Univers sit ity iny in Beograd Beograd Abbrevations :NPY,-neuropeptid gama; GHS-R, receptor sekretagoga hormona rasta; MSH, melanostimuliraju i hormon;

AgRP- aguti relatirani peptid,CART- cocain, amfetamin relatirani transkript

Hypothlamic nuclei of sectia korona (Wynne K, 2005).

Eminencija mediana


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Apetit control, NARC (nukleus arcuatus),(Wynne K, 2005)

Abbrevations: MSH ,-melano-stimuliraju i hormon; GHS-R, receptor sekretagoga hormona rasta; BDNF- mo dano neurotropni faktor (eng.brain-derived neurotrophic factor);CRH -kortikotropni rilizing faktor (eng.-corticotrophin-releasing hormone; MCH, melanosti-muliraju i hormon(melanin-concentrating hormone);ME,eminencija medijana (eng. medianeminence); PFA, periforni-kalna zona (eng. perifornical area);TRH,tirotropin osloba aju i hormon (eng. thyrotropin-releasing hormon),

Tre akomora


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Central control of apetit (Wynne K, 2005)

Abbrevations: :-AP, area postrema ; ME: eminencija medijana (eng. median eminence);NAC , nukleus akumbiens (eng. nucleus accumbens);PFA, perifornikalna area (eng. perifornical area)NTS , nukleus traktus solitarius(eng. nucleus tractus solitarius)


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Periferal apetit control, (Wynne K, 2005)

abbreviations

1. GH-relin2. Adiponektin3. Leptin4. Rezistin5. Insulin6. Peptid-y

7. YY3-36


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Hypothalamus, neuroendocrine regulation and homeostsis of energo-methabolic spending (Diagnostic Systems Laboratory, Inc.)


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Bodily source of glucolysis1. Egzogenic glucose with food 2. Endogenic source of glucose

DISTURBANCIES OF HOMEOSTASIS of ENERGO-METABOLIC BALANCE AND ETHIOPTHOGENESIS OF SYNDROM X

Posibility of glucose methabolismus -Energo-methabolic utilisation of glucozea) oxidation of glucozeb) transfering in lipides

c) transfering in other carbo-hydrates andnonesentional fatty acids


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Lipid apsorbcion and production of chylomicrones(Biomerieux, inc)


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Liver secret HDL-lp and they get cholesterol fromarthery walls and transfer it trought bllader in colonand excrete them. (but cholesterol, can be recycled if

the bod has more need for them

ANTIATHEROGENIC EFEKTS OF HDL-LP


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Patways of cholesterol: excrecion trought goldbllader in digestive

liver

goldbllader

HDL transport of intracelular holesterol

Illeus,colon


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Secretion of VLDL from liver: cholesterol go on arthery waals but tryglicerides from blood go in visceral and other fat depos

Tryglicerides goin abdominal fat depoes

liver

VLDL-LP

LDL-LP i IDL REMNANT S

Cholesterol is transport on arthery walls


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S CAT(subcutaneusadipose tissue)

1. preadipociti have bigerkapacy of diferencijation

2. They can go in VAT tissue

3. estrogen ga promovi e(glutealno, posebno)

4. produce leptin5. Has protect role in proces of

insulin resistance IR

Functional and morphologyc diferences of cells of subcutaneus and visceral intraabdominal fat

( Freedland SE, 2004 i Wajcenberg BI,2000)

VAT (visceral adipose tisue)1. Main predictor of Syndrom of IR2. No answer on insulinogenic

adipogenic efects3. Easy go in lypolysis

4. portal drenage5. It can to elevate lipolysis of S CAT

6. It produce more inhibitorplazminogena aktivator and IL-6

7. Has more glukokortikoid

receptors8. The density of androgenicreceptor is biger


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Cholesteril ester transfer protein (ECTP) and his Importance for activyty of HDL lipoproteins


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Methabolismus of hepatal lipids and Methabolismus of hepatal lipids and lipogenesis " DE NOVO lipogenesis " DE NOVO (Donnelly KL et al., 2005).(Donnelly KL et al., 2005).

DNL"


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li . t i r l i t i i lir i-

t ij i l j i li i l i tti t r li r

Insulin and glucose influence on sintesis of aktivators of " lipogenesis de novo " (DNL), which give elevated

production of triglicerides in liver and insulin resistance

(Tamura S, 2005)


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i dorzalnih gangliona ki mene m o dine

Dorsal, motor nucleusof nervus X

parasimpat.Nervous system

Intra-abdom.depot of fat

parasimpat.

S ubcutaneous fat tissue

ELEVATEDF F T

S celetalmuscules Dorzal. Radix of

spine neurona

Endotelsplaques

Athero sklerosis Neuropatyae Insulin resistance

LIPOLYSIS LIPOLYSIS

Liver

Influence of Free Faty Acids (FFA) on neuroendokrine regulation and deposit of lipids on predilektion places: in liver, in muscules, on endotel of blood vesels waal or on dorsal ganglion of spine


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Etiological clasification of obesity (Bray G,1989)

1 . Alimentarna gojaznostusled navika u ishrani I shrana b o gata mastimaKa f eterija ishrana

3. Neuroendokrina gojaznostDe f icit h o rm o na rasta I nsulin o m i hi p erinsulinizam

hi po talamusni sindr o mM. CushingHipo tire o idizam

PCO (Stein Leventhal) sindr o mPrimarni hi po g o nadizam

2. Gojaznost usled fizi keneaktivnosti

po st op erativna iliim o bilizaci o na p rof esi o nalnastarenje

3. Jatrogeni tipovi gojaznosti

lek o vi ( p sih o tr op ni,ko rtik o ster o idi)hiru ke intervencije nahi po talamusu

5. Genetski (dismorfi ni) oblici aut o s o mn o recesivna

u vezi sa h o rm o n. po reme ajimahr o m o zo mska


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Morphologic characteristic and funkcional klasificationof elevated fat-body mass accord. Claude Boushard

tip 1: Generally overweit body mass,f at tissue is generally over

tip 2: Android typ of obesity,ellevated subcutane ous f at

p redilecti on is u pp er ch oulder, back ( S CAT )

tip 3: Abdominal-visceral type,elevated f atis in visceral de po ts ( omentum majus,ommentum misus ie. ligg. abd ominalis, eng. visceraladi po se tissue ( VAT ))

tip 4: Gynoid typ of obesity predominant elevated glute of em o ral f at .


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Elimination of tresch intraabdominal fat and keeping of insulin sensitivity


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Main reactions of neuroendocrine sistemin alarm phase


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Integrated prescription for physical activity for health and cardiorespyrthory fitnness

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Sy x Engl-ubacivati Ispravke