Endocrinologists diagnose abdominal obesity, when accumulation of excess fat tissue is concentrated in the abdominal and abdominal areas.
This type of obesity can also be called android obesity (due to the distribution of body fat deposits on the male type), central or visceral. That is, for medical professionals these definitions are synonymous, although there are differences between visceral and abdominal obesity: in Latin, abdomen means "belly", and viscera means "insides". It turns out that in the first case anatomical localization of fat is characterized, and in the second it is emphasized that the fat is not subcutaneous, but internal and is located in the region of the omentum, fat depots of the mesentery and around the visceral organs themselves.
In physiologically normal amounts, this fatty tissue serves as a protection for them, but its excess volumes - abdominal obesity - affect health negatively.
According to some estimates, almost 2.3 billion adults in the world are overweight, and in three decades their number has increased more than 2.5 times. For example, in the US, at least 50% of men aged 50 to 79 and about 70% of women in this age group are obese. And obesity in combination with diabetes was diagnosed in 38.8 million Americans - with a margin of 0.8% in "men's favor." Approximately 32% of the US adult population (47 million) have a metabolic syndrome.
The number of Canadians over 18 who have been obese increased dramatically, although most BMIs do not exceed 35, that is, obesity of the first degree.
Children's endocrinologists in Brazil claim that 26.7% of Brazilian boys aged 7-10 years and 34.6% of girls of the same age have either excessive body weight or some degree of obesity, most often abdominal.
The number of obese patients has increased in Australia, Mexico, France, Spain, Switzerland; 27% of diagnoses of obesity concern men, 38% - of women.
Among the British, the level of obesity has increased about fourfold over the past 30 years, reaching 22-24% of the total population of the United Kingdom.
Causes of the abdominal obesity
Key exogenous causes of abdominal obesity are associated with a violation of the physiological proportionality of caloric intake and the consumption of energy received - with a significant excess of consumption. With a sedentary lifestyle, unused energy in the form of triglycerides accumulates in adipocytes (cells of white adipose tissue). By the way, leads to obesity is not so much excessive consumption of fat as food rich in carbohydrates, because excess glucose under the influence of insulin is easily transformed into triglycerides. So, there are no doubts about such risk factors for obesity, as malnutrition and lack of motor activity.
One of the obvious reasons for abdominal obesity in men is alcohol. The so-called "beer belly" appears due to the fact that alcohol (including beer) gives a lot of calories without real nutritional value, and when these calories are not burned, the fat reserves in the abdominal cavity increase.
Disturbance of eating behavior is also among the reasons for being overweight: many people are accustomed to "reward themselves with food," that is, "jam" stress and any surge of emotions (the pathogenesis of this phenomenon will be discussed below).
Endogenous causes of abdominal obesity are associated with the development of a number of protein-peptide and steroid hormones, neuropeptides and neurotransmitters (catecholamines), as well as their interaction, the level of sensitivity of the conjugated receptors and the regulatory reaction of the sympathetic nervous system. Enough enough endocrine problems are genetically determined.
As noted by endocrinologists, abdominal obesity in men (who initially have more visceral fat than women) is due to a decrease in testosterone (dihydrotestosterone). Reducing the production of sex steroids, as it turned out, contributes to an increase in the number of their receptors in the tissues, but the receptor sensitivity in this case is significantly reduced, therefore, the signal transmission to the neuro receptor of the hypothalamus, which regulates the majority of endocrine processes in the body, is distorted.
Abdominal obesity in women develops, usually after the onset of menopause, and is explained by the rapid decline in the synthesis of estradiol in the ovaries. As a result, not only the catabolism of brown adipose tissue changes, but also its distribution in the body. In this case, abdominal obesity with a normal BMI (that is, with a body mass index of no more than 25) is often observed. Promotes obesity polycystic ovary, which reduces the level of female sex hormones. In addition, the risk factors for visceral obesity in women include hypothyroidism - thyroid hormone thyroid hormone deficiency and thyroid-stimulating hormone (synthesized by the pituitary gland), which play an important role in the overall metabolism.
Abdominal obesity in women after childbirth threatens those who gain more kilos during pregnancy than they should (this is typical for about 43% of pregnant women). Promotes obesity and increased weight before pregnancy, especially against a background of high levels of the prolactin hormone in the blood (which is produced during lactation and stimulates the conversion of glucose into fat). The development of abdominal obesity after childbirth can be one of the consequences of Shihan's syndrome, associated with a strong loss of blood during labor, which leads to damage to the pituitary cells.
Among the endocrine pathological changes, the following risk factors for fat accumulation in the abdominal cavity are distinguished:
an increase in the synthesis of adrenocorticotropic hormone (ACTH) by the pituitary gland and a decrease in the production of somatotropin, beta and gamma-lipotropins;
excess production of glucocorticoids (steroid hormones) with functional disorders of the adrenal cortex;
an increase in the synthesis of insulin by the pancreas, while reducing the production of the hormone glucagon (stimulating lipolysis - the cleavage of triglycerides in fat cells).
In fact, the combination of these factors causes abdominal obesity in the metabolic syndrome. Abdominal obesity is part of the symptomatic complex of the metabolic syndrome and is directly related to both increased tissue resistance to insulin, the development of hyperinsulinemia and an increase in glucose from the blood, and hyperlipidemia, a high level of triglycerides in the blood and low levels of high-density lipoprotein (HDL). At the same time, according to clinical studies, in 5% of cases the metabolic syndrome is present at normal body weight, in 22% - at excess weight and in 60% of patients with abdominal obesity.
Accumulation of visceral fat in the abdominal cavity can occur with Cushing's syndrome (Isenko-Cushing's disease); with alcohol-induced pseudo-Cushing syndrome; with a benign pancreas tumor (insulinoma); with inflammatory, traumatic or radiation damage to the hypothalamus, as well as in patients with rare genetic syndromes (Lawrence-Moon, Cohen, Carpenter, etc.).
Abdominal obesity may develop in children and adolescents with neuroendocrine Fröhlich syndrome (adiposogenital dystrophy), which is the result of birth craniocerebral injuries, cerebral infestations or infectious brain damage in meningitis or encephalitis.
Obesity can lead to some medications, for example, steroids and drugs used in mental illness.
Violations of the neuroendocrine regulation of fat metabolism determine the pathogenesis of abdominal obesity. Depending on its characteristics, the types of obesity are conditionally divided into endocrine and cerebral.
So, despite the fact that when obesity is marked increase in the level of the protein hormone suppressing the appetite of leptin (synthesized by adipocytes), the hunger is quenched, the person does not feel and continues to eat. And here either the frequent mutations of the leptin gene (LEP) are guilty, as a result of which the receptors in the nucleus of the hypothalamus (regulating the feeling of hunger) are simply not perceived, and the brain does not receive the desired signal. Either - in parallel with an increase in insulin production by the pancreas - resistance develops in leptin.
In addition, the regulation of food saturation may be impaired due to functional insufficiency of leptin with a decrease in the level of estrogens in the blood. And the pathogenesis of "stress seizure" (referred to above) is due to the release of cortisol into the blood, suppressing the activity of leptin. In general, the lack of this hormone or the indifference of its receptors leads to an uncontrolled feeling of hunger and constant overeating.
With a decrease in the synthesis of estrogen, there is also a decrease in the production in the pituitary gland of the neuropeptide hormone melanocortin (α-melanocyte-stimulating hormone), which inhibits lipolysis in adipocytes. To the same result leads to a reduction in the synthesis of the pituitary hormone of somatotropin and the hormone of the adrenal cortex of glucagon.
Increased food intake and abdominal obesity of tissues causes more intensive synthesis in the intestine and hypothalamus of the neuropeptide NPY (regulatory hormone of the autonomic nervous system).
The transformation of carbohydrates into triglycerides and their accumulation in cells of white adipose tissue is induced by hyperinsulinemia.
The main symptoms of abdominal obesity: the deposition of fat in the abdomen and increased appetite, which provokes a feeling of heaviness in the stomach.
And the first signs with obesity of the initial degree (BMI 30-35) are manifested by an increase in waist circumference. Read more about what are the levels of obesity
Experts refer to the nonspecific symptomatology of excessive amount of visceral fat, the appearance of burping, increased intestinal gas formation (flatulence) and arterial pressure, dyspnea even with insignificant physical exertion, increased heart rate, swelling and sweating.
In addition, the blood levels of triglycerides, LDL and fasting glucose increase.
Fat, surrounding the abdominal cavity, shows significant metabolic activity: it releases fatty acids, inflammatory cytokines and hormones, which ultimately produces serious consequences and complications.
Central obesity is associated with a statistically higher risk of cardiovascular disease, arterial hypertension, insulin resistance and the development of non-insulin-dependent diabetes mellitus (type 2 diabetes).
Obstructive sleep apnea and asthma development are associated with abdominal obesity (obesity reduces lung volume and narrows the airways).
Abdominal obesity in women provokes disorders of the menstrual cycle and causes infertility. And the absence of an erection is one of the consequences of abdominal obesity in men.
Recent studies have confirmed the fact that large volumes of visceral fat, regardless of the total weight, are associated with smaller brain volumes and an increased risk of developing dementia and Alzheimer's disease.
Diagnostics of the abdominal obesity
Diagnosis of abdominal obesity begins with anthropometry, that is, measurement of the waist circumference and thigh of the patient.
Commonly accepted criteria for abdominal obesity: in men, the waist circumference is more than 102 cm (the ratio of the waist circumference to the hip circumference is 0.95); in women, 88 cm (and 0.85), respectively. Many endocrinologists measure only the circumference of the waist, because this indicator is more accurate and easily controlled. Some specialists carry out an additional measurement of the amount of fat in the intestinal region (sagittal abdominal diameter).
Weighed and determined BMI (body mass index), although it does not reflect the distribution of fat in the body. Therefore, to measure the amount of visceral fat, instrumental diagnostics - ultrasound-densitometry, computer or magnetic resonance imaging - is needed.
Necessary blood tests: on the levels of triglycerides, glucose, insulin, cholesterol, adiponectin and leptin. Urine is being analyzed for cortisol.
Differential diagnosis and additional examinations are designed to distinguish visceral obesity from ascites, bloating, hypercorticism, and also to identify problems with the thyroid gland, ovaries, pituitary gland, adrenals, hypothalamus and pituitary gland.
Treatment of the abdominal obesity
The main treatment for abdominal obesity is a diet to reduce calories from the diet and exercise to burn already accumulated energy fat stores.
Some medications are used in drug therapy. To reduce fat absorption, Orlistat (Orlimax) is used - 1 capsule (120 mg) three times a day (during meals). Contraindicated in urolithiasis, pancreatic inflammation and fermentopathies (celiac disease, cystic fibrosis); side effects include nausea, diarrhea, flatulence.
Lirahlutid (Viktoza, Saksienda) lowers a level of a glucose in a blood; is prescribed in a daily dosage of a dose of not more than 3 mg. May cause headaches, nausea and vomiting, problems with the intestines, inflammation of the gallbladder and pancreas, kidney failure, tachycardia, depressive condition.
Alternative treatment of obesity includes such tools for reducing appetite, like bee pollen, fresh plantain leaves, stellate grass (Stellaria media) and burdock root large. Plantain and stellate are recommended to be added to salads; from the root of the mug, prepare a decoction (a tablespoon of dry root for 250 ml of water); take 10 g of pollen twice a day.
Practiced with abdominal obesity and herbal treatment. Seeds of fenugreek hay (Trigonella Foenum-graecum) - plants of the family of legumes - are taken orally powdered. Contained in it saponins, hemicellulose, tannins and pectin help to lower the level of low density cholesterol, deducing it with bile acids through the intestine. And isoleucine helps to reduce the rate of absorption of glucose in the intestines, which leads to a decrease in blood sugar in patients with type 2 diabetes mellitus.
The effect of the malignant tea (Camellia sinensis) for weight reduction is provided by epigallocatechin-3-gallate. Promote weight loss: water extract of Cissus quadrangularis ( Cissus q uadrangularis ), elderberry black (Sambucus n igra), fruits of Garcinia dark green (Garcinia a troviridis), infusion or decoction of leaves and stems of Ephedra Chinese (Ephedra sinica) and white mulberry (Morus alba), decoction of the root of the skullcap of the Baikal ( Scutellaria baicalensis ) and the flowers and leaves of the bell of large color (Platycodon grandiflor is).
With any type of obesity, surgical treatment requires special indications and can be performed when all attempts to reduce weight have not yielded results.
Today, bariatric surgery uses operations that modulate the volume of the stomach by: inserting a balloon into the cavity of the stomach (with its subsequent pumping up to the established size), bandaging, shunting, and vertical (tubular) plastic.
Diet for abdominal obesity
What should be the food for abdominal obesity, is detailed in the previously published material - Diet for obesity, which lists the food for abdominal obesity (recommended and contraindicated).
In adults who continue to gain more than 2.5-3 kg per year, the risk of developing metabolic syndrome rises to 45%. In advanced cases, the complications that accompany abdominal obesity reduce the overall life expectancy by an average of six to seven years.
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