Metabolic Syndrome Definition

Transcription

1 5 Models of Osteopathic Patient Care in Obesity January 27, 2017 Mark Thai, D.O. Metabolic Syndrome Definition Per NCEP: 3 or more of the 5 risk factors 1 Central Obesity Dyslipidemia Hyperglycemia Hypertension Large Waistline High TG level Low HDL High Fasting blood sugar High blood pressure (M) >40 in (F) > 35 in 150mg/dl or Rx (M) <40 mg/dl (F) < 50 mg/dl or Rx 100 mg/dl or Rx 130/ 85 mmhg or Rx 1

2 Life Expectancy at Birth (in Years) 1/28/2017 Oklahoma State s Health Report 2 Health disease deaths - Leading causing of death in OK - In 2012, 1 in 4 Oklahoma deaths were due to heart disease - In 2010, OK had 3 rd highest death rate for heart disease in nation Life Expectancy Trends OK vs US US Women OK Women US Total OK Total US Men OK Men US Women US Total OK Women US Men OK Total OK Men U.S. NCHS. Oklahoma: OSDH, Health Care Information 2

3 America s Health Rankings Oklahoma - Obesity ** In Oklahoma 888,000 adults are obese Almost 1 in 3 adult Oklahomans are obese * Copyright 2012 United Health Foundation Oklahoma State s Health Report 2 Obesity - OK 6 th most obese state in nation - Rate of obesity increased from 1 in 7 adults in 1993 to 1 in 3 adults in In 2013, 12% OK youth were obese and 15% were overweight 3

4 America s Health Rankings Oklahoma Sedentary Lifestyle * * In Oklahoma 891,000 adults are sedentary An important indicator of future obesity rates * Copyright 2012 United Health Foundation Oklahoma State s Health Report 2 No Physical Activity - OK ranks 44 th least active state in the nation - In 2012, more than a quarter OK adults were not physically active - Greatest in southeast region of OK 4

5 Oklahoma State s Health Report 2 Limited Activity Days - In 2012, OK adults ranked 44 th in nation in average number of limited activity days per month - OK report average of 3 limited activity days each month due to poor health Oklahoma State s Health Report 2 Poor Physical Health Days - In 2012, OK adults ranked 43 th in nation in poor physical health days - 2/3rds OK counties report more days poor physical health compared to nation 5

6 Oklahoma State s Health Report 2 Tulsa County - Heart disease, cancer, and chronic lower respiratory disease were leading causes of death Oklahoma State s Health Report 2 Tulsa County - Ranked among ten best counties for lowest rate physically inactive adults - 1 in 5 adults reported 3+ days of limited activity in past month - 1 in 4 adults 4+ days of poor physical health 6

7 Physical Activity Recommendations 3 Minimum 30 mins of moderate intensity aerobic physical activity (brisk walking) five days each week or Minimum 20 mins of vigorous intensity aerobic physical activity (jogging) three days each week or Combination of moderate and vigorous intensity Equivalent to minimum goal of MET min/week Light < 3.0 METS Moderate METS Vigorous > 6.0 METS 7

8 5 Osteopathic Models I know I am obese but I m too stressed! My body hurts! I can t breathe! I can t find the motivation! I m too tired! 8

9 Biomechanical/Postural Structure Broader and thicker structural features in calves, ankles, feet and toes Obese children have an externally rotated lower limb Obese adolescents have more compressive forces in the medial compartment of the knee that can result in tibia vara Lower medial longitudinal arch that can increase midfoot contact and pronation Strength Biomechanical/Postural Function Obese children have similar or greater absolute strength of the trunk and upper extremities Reduced knee extensor and elbow flexor strength Decrease power and strength when required to move their mass against gravity No differences in intrinsic strength may be due to reduced activation of motor units which is associated with lower level of physical activity and muscle deconditioning. May limit their ability to perform everyday tasks like rising to standing position 9

10 Biomechanical/Postural Gait Function Reduction in step length and step frequency Longer single support and double support phase durations along with a shorter swing phase Normal static balance under normal conditions Impaired performance and greater postural sway under difficult conditions Difficulty with mediolateral stability during gait Biomechanical/Postural Pain Neck, Lower back, knees, ankles and feet Nonspecific musculoskeletal pain 48% of obese children experience MSK pain more than other types of pain such as headache or abdominal pain Odds of having joint pain increased by 10% for every 10 kg increase in weight and an increase in 3% for every unit increase in BMI Children link their pain with levels of activity whereas parents associated activity with child s weight Child: more active = more pain Parents: higher BMI = less active 10

11 Respiratory/Circulatory Metabolic/Energy Significantly greater energy expenditure during resting state Higher metabolic cost associated with walking Mechanical difference in gait style Anterior tilt of upper body Altered step frequency Greater vertical displacement of center of mass Extraneous movements of limbs 11

12 Respiratory/Energy 6 Respiratory/Energy 5 12

13 Respiratory/Energy 5 I have really poor aerobic capacity! WOW! Autonomic/Nervous System Fig. 6. Potential mechanisms contributing to sympathetic nervous system activation in obesity (Davy and Hall, 2004). AGT = angiotensinogen; Ang II = angiotension II; ACTH = adrenocorticotropin hormone. Used with permission from Davy and Hall (2004). 13

14 Model of the metabolic syndrome caused by a central nervous deregulation 7 Felix Kreier et al. Diabetes 2003;52: by American Diabetes Association Autonomic/Nervous System 14

15 Behavioral Social isolation Loneliness and low self esteem Depression and anxiety Linked with poor cardiorespiratory fitness MSK pain is correlated with diminished quality of life. Obesity Dyslipidemia Hyperglycemia Physical Activity Cardiorespiratory Fitness CVD Risk Hypertension 15

16 How much PA is enough? 8 Per 1 MET increase in exercise capacity: 10 25% reduction in mortality risk in both men and women Marked reduction in mortality risk by 3-10 mins moderate PA per day Lower risk of all cause and CVD mortality with slow jogging (<6mi/hr) 5 10 min/day 7 Exercising just over 5 METs can achieve similar or even greater reduction in risk than by statin therapy alone. How much PA is enough? Exercise - + Diet - Weight Gain min/week Mod-vigorous PA Possible weight loss Reduce risk of future weight gains Greater reduction total fat mass Improved CRF + Sign. Weight loss Potential CV benefits Sign. Weight loss Improved CRF 16

17 1 mile vs 26.2 miles 9 5 Models of Osteopathic Patient Care Towards Physical Activity 17

18 References 1. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, et al. (2010) The Metabolic Syndrome and Cardiovascular RiskA Systematic Review and Meta-Analysis. Journal of the American College of Cardiology 56: State of the State s Health. Oklahoma State Department of Health 3. Haskell, William L, Lee, I-Min, et al. (2007) Physical Activity and Public Health: Updated Recommendation for Adults from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise pg Swift DL, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis.2014;56(4): Volpe Ayub B, Bar-Or O. Energy cost of walking in boys who differ in adiposity but are matched for body mass. Med Sci Sports Exerc 2003; 35: Maffeis, C., Y.Y. Schutz, F. Schena, M. Zaffanello, and L Pinelli. Energy expenditure during walking and running in obese and nonobese prepubertal children. J. Pediatr. 123: , Kreier F, et al. Hypothesis: Shifting the equilibrium from activity to food leads to autonomic unbalance and the metabolic syndrome. Diabetes. 2003;52(11). 8. Myers J, et al. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: Their independent and interwoven importance to health status.. Progress in Cardiovascular Diseases 57 (2015) Lee, Duck-chul, et al. Leisure time running reduces all cause and cardiovascular mortality risk. Journal of the American College of Cardiology Vol 64. No5. 18