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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The abdominal fat can be seen subjectively. But this is another good opportunity to use a tape measure to be more objective. Loss of fat tissue from the buttocks and thighs will result in loosening of the overlying skin in these regions. See Table 7.4 for a full physical examination to evaluate fat mass.
Pathophysiology of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With type 2 diabetes mellitus, there is inadequate secretion of insulin. Early in the disease, insulin levels are commonly very high. This situation may continue later on in disease development. Peripheral insulin resistance and the increased production of glucose by the liver cause levels of insulin to be insufficient to normalize levels of plasma glucose. Insulin production becomes reduced, and the hyperglycemia worsens. Type 2 diabetes usually develops in adults and is more common with continued aging. Plasma glucose levels spike higher following meals in older adults compared to younger adults. This is most common following high carbohydrate loads. The levels require a longer period of time to return to normal. This is partly due to increased accumulation of visceral and abdominal fat, plus decreased muscle mass. Type 2 diabetes has become more common than ever in children. Childhood obesity has now reached epidemic levels of prevalence. About 40%–50% of new pediatric cases are type 2 diabetes, and more than 90% of adults with diabetes have this form. Genetic factors are clear, influencing the prevalence of type 2 diabetes ethnic groups such as Hispanics, American Indians, and Asians. Several genetic polymorphisms have been discovered, but no individual causative gene has been identified.
The menopause
Published in Myra Hunter, Melanie Smith, Managing Hot Flushes and Night Sweats, 2020
Weight gain is often a concern for women during and after the menopause. Will I put on weight and develop ‘middle-age spread’?The steady weight gain of about 0.5 kg annually amongst women is largely due to age and associated lifestyle factors such as diet and lack of exercise (Davis et al. 2012). However, reduced oestrogen levels during menopause can lead to the redistribution of body fat. Women tend to find that their body shape may change as ‘childbearing’ fat moves from their hips and thighs, where it is no longer needed, to their stomach and middle. Abdominal fat is less healthy than fat on the hips, though, another reason for adopting a healthy diet and regular exercise. This does not seem to happen to everyone, and while some women do not like this change, others welcome it. I was always a typical pear shape and couldn’t get jeans to look good on me. But now I can so this has been a bonus for me but some of my friends complain about having more fat around the waist.For breast cancer patients, there are additional challenges as chemotherapy can lead to weight gain due to reduced activity levels and fatigue; medications such as steroids can lead to metabolic and appetite changes, cravings and comfort eating (American Society of Clinical Oncology 2019).
Effects of aerobic exercise on waist circumference, VO2 max, blood glucose, insulin, and lipid index in middle-aged women: A meta-analysis of randomized controlled trials
Published in Health Care for Women International, 2022
Aerobic exercise increases fat breakdown through oxidation of fat during exercise through aerobic metabolism (Horowitz and Klein, 2000), so it lowers triglycerides and low-density lipoproteins and increases high-density lipoproteins (Kraus, et al., 2002; Galvao et al., 2011). As a result, it helps to reduce abdominal fat and improve cardiopulmonary function (Takeshima et al., 2004; Tang et al., 2013). In addition, aerobic exercise improves insulin resistance (Williams & Franklin, 2007). The reason is that insulin resistance is lowered and insulin sensitivity is increased by increasing the absorption of blood glucose into the muscle by increasing affinity with the insulin receptor substrate through regular and continuous muscle contraction (Dohm, 2002). As the amount of glycogen in the muscle increases to 50–65% of the maximum oxygen consumption, and at 85%, the amount of glycogen in the muscle doubles (Romijn, et al., 1993), it helps to improve insulin resistance (O'Donovan et al., 2005).
Role of endometriosis in defining cardiovascular risk: a gender medicine approach for women’s health
Published in Human Fertility, 2022
Michela Cirillo, Maria Elisabetta Coccia, Felice Petraglia, Cinzia Fatini
According to the WHO criteria, underweight was defined when the Body Mass Index (BMI) was <18.5 Kg/m2, normal weight when BMI was ≥18.5 and <25 Kg/m2, and overweight when BMI was ≥25 Kg/m2. Anthropometric parameters were also measured in order to evaluate abdominal fat. Waist circumference was measured midway between the inferior margin of the lowest rib and the iliac crest in the horizontal plane at the end of normal expiration; hip circumference was measured at the widest point over the buttocks. A waist circumference of ≥80 cm was considered a marker of increased cardiovascular risk according to Alberti et al. (2005); waist to hip ratio (WHR) was obtained by dividing the waist circumference by hip circumference, and values ≥0.80 were considered a marker of increased cardiovascular risk (Lear et al., 2010). Self-reported physical activity grade was investigated and sedentary behaviour was defined as absent or light (i.e. either occasional walking or recreational activity only).
Sex differences in cardiovascular risk may be related to sex differences in diet patterns: a narrative review
Published in Annals of Human Biology, 2021
A. M. Tindall, V. A. Stallings
Fatty acid metabolism can affect the distribution of fat deposits (Comitato et al. 2015). Adipose in the visceral compartment has a higher contribution to fatty acid delivery to the liver compared to adipose from subcutaneous leg fat (Reaven and Bernstein 1978; Mittendorfer et al. 2003; Nielsen et al. 2004). Although men typically have greater energy needs due to, on average, more body mass, women generally have a larger proportion of body mass as fat, and are more likely to deposit fat subcutaneously, vs. viscerally, and on their lower extremities, and men are more likely to deposit fat in the abdominal region (Power and Schulkin 2008). Abdominal fat and visceral fat increase the risk of cardiovascular disease (Scheuer et al. 2015; Lee et al. 2020). Oestrogen plays a role in body composition as post-menopausal women transition to storing fat in the abdominal region, similar to men (Freitas et al. 2021).