Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ Άσκηση και Παχυσαρκία Η παχυσαρκία ως επιβαρυντικός παράγοντας στην υγεία – Συνοδές ασθένειες Σακκάς Γεώργιος PhD Τμήμα Επιστήμης Φυσικής Αγωγής και Αθλητισμού

Άδειες Χρήσης Το παρόν εκπαιδευτικό υλικό υπόκειται σε άδειες χρήσης Creative Commons. Για εκπαιδευτικό υλικό, όπως εικόνες, που υπόκειται σε άλλου τύπου άδειας χρήσης, η άδεια χρήσης αναφέρεται ρητώς.

Χρηματοδότηση Το παρόν εκπαιδευτικό υλικό έχει αναπτυχθεί στα πλαίσια του εκπαιδευτικού έργου του διδάσκοντα. Το έργο «Ανοικτά Ακαδημαϊκά Μαθήματα Πανεπιστημίου Θεσσαλίας» έχει χρηματοδοτήσει μόνο τη αναδιαμόρφωση του εκπαιδευτικού υλικού. Το έργο υλοποιείται στο πλαίσιο του Επιχειρησιακού Προγράμματος «Εκπαίδευση και Δια Βίου Μάθηση» και συγχρηματοδοτείται από την Ευρωπαϊκή Ένωση (Ευρωπαϊκό Κοινωνικό Ταμείο) και από εθνικούς πόρους.

Σκοποί ενότητας Η απόκτηση γνώση για τις σχετιζόμενες με την παχυσαρκία συνοδές ασθένειες και πως αυτές επηρεάζουν το προσδόκιμο ζωής των ατόμων αυτών.

Περιεχόμενα ενότητας - Contents Associated Comorbidities (συνοδές ασθένειες) Cardiovascular Disease Respiratory Complication Stroke Autonomic Nervous System Diabetes Dyslipidemia Gastroesophageal Reflex Arthritis Urinary Incontinence Non-alcoholic Liver Disease Psychological Disorders

What is Obesity – What is the risk Overweight is BMI of 25 to 29.9 Kg/m2 Obesity is BMI anything above 30 Kg/m2

Obesity - Metabolic Syndrome (MetS) MetS composed of: Insulin resistance Abnormal fasting glucose levels Increased cholesterol (total, LDL) and TG Increased blood pressure Increased WHR or central adiposity (visceral fat) MetS is associated with Obesity & Diabetes CardioVascular Disease (CVD) Optimal BMI for a healthy life from age 18 to 85 is the 23 to 25 (23-30 African American)

Obesity - Metabolic Syndrome (MetS) The life-shortening effect of obesity rises if (obese) young people stay obese until the middle and older ages compared to if they become obese into an older age.

MetS affects the whole body

Obesity and Cardiovascular Disease Studies have shown that adolescence obesity predicts mortality (θνησιμότητα) rates by 80% in male and 100% in female patients the risk of death is independent of adult BMI but dependent of “since when” the adult was obese Obesity is associated with reduced life expectancy (προσδόκιμο ζωής)!

Cardiovascular Impact of Increased Fat Mass Adipose Tissue Circulation Increased Adipose tissue leads to edema Adipose tissue has an extensive capillary network Resting blood flow is 2-3ml/min/100g fat Increased after meal to 20ml/min/100g fat In obesity, perfusion is reduced in 1.5ml/min/100g fat meaning that the water between the fat cells (interstitial space) is not accessible leading to increased edema In addition, 30% of the circulated IL6 (Interleukin-6) comes from the adipose tissue IL6 modulates CRP – marker of chronic inflammation – that can trigger acute coronary syndrome

Left Ventricular Hypertrophy (υπερτροφία της αριστερής κοιλίας) At any given level of activity, the cardiac workload and peripheral resistance are greater for obese subjects Due to increased left ventricular filling pressure and volume – chamber dilation – there is a high risk for Left Ventricular Hypertrophy (LVH) In weight reduction a decrease in central blood volume gives relief from edema and dyspnea

Lipid Deposition in Organs Lipid deposition can impair tissue or organ function in three ways: Fat around organs can modify function due to increased pressure (compression) periorgan fat cells secreting various acting molecules Lipids accumulation may lead to cell dysfunction or cell death – known as Lipotoxicity Fat deposition in cardiac muscle (epicardial fat) could lead to cardiomyopathy

Vascular Disease in Obesity Venous Stasis (φλεβική στάση), lower leg edema and cellulitis (κυτταρίτιδα) due to venous valvular incompetence Venous thrombosis and pulmonary embolism – 2.5 times more risk with waist circumference >100 cm Abnormal endothelial function due to decrease NO (nitric oxide) meaning increased oxidative stress Decrease in NO function leads to increased vasoconstriction and increased vascular resistance

What is Hypertension? Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure.

What is Hypertension?

Hypertension in Obesity (υπέρταση) The majority of hypertensive patients are overweight Hypertension is 6 times more frequent in obese than in lean subjects Weight gain in a previously lean subject is a potent risk for developing hypertension

Hypertension in Obesity A 10 kg increase in body weight is associated with 3 mmHg higher systolic and 2.3mmHg higher diastolic blood pressure This is translated into 12% risk for Coronary Heart Disease (CHD) and 24% for stroke Blood Pressure = Cardiac Output * Systemic Vascular Resistance C.O. is increased due to oxygen demand from the excess fat tissue, SVR is increased due to endothelial dysfunction (NO etc)

Obesity is considered a “low-grade systemic inflammation” Peripheral Vascular Resistance in Obesity (περιφερεική αγγειακή αντίσταση) Obesity is associated with inflammation Strong correlation between IL6, CRP and obesity IL6 stimulates CRP from the liver Increased IL6 is correlated with systolic and diastolic blood pressure Obesity is considered a “low-grade systemic inflammation”

Respiratory Complications in Obesity (αναπνευστικές διαταραχές) Obese subjects have Increase demand for ventilation Increased breathing workload Respiratory muscle inefficiency Decreased functional reserve capacity and expiratory reserve volume Closure of peripheral lung units Ventilation-Perfusion mismatch (supine position) Obesity is a classic cause of alveolar hypoventilation (κυψελιδικός υποαερισμός)

Apnea in Obesity (υπνική άπνοια) Obesity is by far the most important risk factor for sleep disorders Sleep Apnea – repeated episodes of obstructive apnea and hypopnea during sleep, together with daytime sleepiness or altered cardiopulmonary function Hypertension rises with sleep disorders Sleep apnea is associated with increased levels of CRP Sleep Apnea – Hypertension – Atherosclerosis

Pulmonary Hypertension in Obesity (πνευμονική υπέρταση) 15-20% of Sleep Apnea patients suffer from Pulmonary Hypertension MetS is associated with Pulmonary Hypertension Mechanism: Obesity relates to sleep apnea – relates to alveolar hypoventilation – relates to alveolar hypoxia = pulmonary vasoconstriction

Stroke & Obesity (εγκεφαλικό επεισόδιο) Many studies have shown association between BMI – WHR – Stroke Obesity is a potential risk factor for stroke independently from cholesterol levels, hypertension & diabetes Overweighted men (25 – 29.9 BMI) had 1.32 times higher risk for Total Stroke, 1.25 for Hemorrhagic Stroke and 1.35 for Ischemic Stroke If your BMI increases by 1 unit your risk increases by 4% for Ischemic Stroke 6% for Hemorrhagic Stroke

Coronary Artery Disease in Obesity (στεφανιαία νόσο) Obesity is associated with advanced atherosclerosis in the Right Coronary Artery & Abdominal Aorta

Coronary Artery Disease in Obesity Central adiposity is more important for atherosclerosis than total body fat The levels of HDL , LDL, hypertension, diabetes, smoking and glycohemoglobin accounted for the 15% of atherosclerosis found in obese patients…the rest is explained by central fat (visceral fat)

Arrhythmias in Obesity (αρρυθμίες) “Sudden death is more common in those who are naturally fat than in the lean” Hippocrates Obese subjects have an increased risk of arrhythmias and sudden death even in the absence of cardiac dysfunction Abnormal prolonged QT interval found in obese patients QT abnormalities are associated with central adiposity or insulin resistance

Autonomic Nervous System & Obesity (αυτόνομο νευρικό σύστημα) ANS regulates cardiovascular system and energy expenditure 10% increase in body weight = decline in parasympathetic tone = increase in resting heart rate Increase of resting HR is associated with high mortality rates 10% reduction in body weight in severely obese subject resulted improvement in cardiac function

Diabetes in Obesity (διαβήτης) More than 95% type 2 diabetes is attributed to obesity The risk of type 2 diabetes increases with weight gain With weight loss, type 2 diabetes and insulin resistance is improved, diabetes medication is reduced

Dyslipidemia in Obesity (δυσλιπιδαιμία) Obesity is associated with increased total cholesterol, increased LDL, decrease HDL and increased TG levels With weight loss, lipidemia is improved by 40% and stays there until weight is regained

Gastroesophageal Reflux in Obesity (γαστρο-οισοφαγική παλινδρόμηση) Obesity is a major risk factor for gastrointestinal reflux disease (γαστρο- οισοφαγική παλινδρόμηση) Improvement of these symptoms have been found in the majority of the patients who lost weight

Degenerative Joint Disease in Obesity (ασθένειες του κολλαγόνου) Obesity is clearly a cause of large joint degeneration (ασθένειες του κολλαγόνου) and arthritis With weight loss, obese patients have found relief from pain in hips, knees, feet and lower back Arthroplasty is safe when the patients are within the normal weight range

Urinary Incontinence in Obesity (ακράτεια ούρων) Obesity appears to be an important etiologic factor in stress urinary incontinence (ακράτεια ούρων), probably through the mechanism of increased abdominal pressure With weight loss, studies have shown decrease in intra-abdominal pressure, decrease in sagittal abdominal diameter and decrease in stress urinary incontinence

Non-alcoholic Steatohepatitis in Obesity (μη αλκοολική στεατοηπατίτιδα) Nonalcoholic Liver Disease and Nonalcoholic SteatoHepatitis are strongly associated with obesity and type 2 diabetes NASH may result in cases of cirrhosis and liver failure Deposition of fat in the liver is the primary suspect but the pathophysiology is unknown

Psychiatric and Social Disorders in Obesity (ψυχιατρικές διαταραχές) The morbidly obese frequently suffer from poor self-image and social stigmatization They are at special risk for affective disorders, anxiety and substance abuse (drugs) Repeated diets could lead to depression, anxiety and food preoccupation After weight loss, patients have been shown to have better mood, self-esteem and to become more socially active

Summary Obesity is always followed by something else… From metabolic syndrome and urinary incontinence to psychiatric disorders The years that somebody has been obese, highly related to the risk of death Reduction of body mass (kg) results in a significant improvement in total health The combination of exercise and diet is the optimal way to loose weight and keep it away

ΠΑΝΕΠΙΣΤΗΜΙΟ ΘΕΣΣΑΛΙΑΣ Τέλος Ενότητας