Fisiopatologia

Nutrizione

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

Underweight <18.5 Increased

Normal 18.5-24.9 Normal

Overweight 25.0-29.9 Increased

Obesity I 30.0-34.9 High

II 35.0-39.9 Very high

Extreme Obesity III ≥40.0 Extremely high

Data from National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-The evidence
report. Obes Res 6 (suppl 2):515, 1998.

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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 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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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 may
play a role in modulating insulin resistance in peripheral tissues. Excess FFA and resistin are associated with insulin
resistance; in contrast, adiponectin, whose levels are decreased in obesity, is an insulin-sensitizing adipokine. Leptin
is also an insulin-sensitizing agent, but it acts via central receptors (in the hypothalamus). The PPAR is an adipocyte
nuclear receptor that is activated by a class of insulin-sensitizing drugs called thiazolidinediones (TZDs). The
mechanism of action of TZDs may eventually be mediated through modulation of adipokine and FFA levels that
favor a state of insulin sensitivity.
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 Medical Complications Associated with Obesity
Gastrointestinal Gallstones, pancreatitis, abdominal hernia, NAFLD (steatosis, steatohepatitis, and cirrhosis), and possibly GERD

Endocrine/meta Metabolic syndrome, insulin resistance, impaired glucose tolerance, type II diabetes mellitus, dyslipidemia, polycystic ovary
bolic syndrome

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

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

Musculoskeleta Osteoarthritis, gout, low back pain

l

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

Postoperative Atelectasis, pneumonia, deep vein thrombosis, pulmonary embolus

events

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 Effetti della dieta:

•Grassi insaturi
•Sodio
•Fibre
•Frutta e verdura
•Carni
•Restrizione 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 lipidi

Strutturali

•Vitamine e minerali

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Malnutrizione primaria: uno solo o la totalita’
di questi componenti vengono a mancare nella dieta

Malnutrizione secondaria: l’apporto di nutrienti e’

adeguato e la malnutrizione puo’ derivare da
malassorbimento, alterazzione dei processi di
utilizzazione e immagazzinamento delle sostanze
nutritizie, da una perdita eccessiva di nutrienti o da
un aumento del fabbisogno nutrizionale.

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