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Underweight

2. 2. Agenda. What is underweight?BMIThe real issue: abdominal fatThe U shape of the mortality curveSpecial cases in the adultElderlyEating disordersFAT a.k.a Female Athlete TriadSpecial cases in the child. 3. 3. Agenda. What is underweight?BMIThe real issue: abdominal fatThe U shape of the mortality curveSpecial cases in the adultElderlyEating disordersFAT a.k.a Female Athlete TriadSpecial cases in the child.

Samuel
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Underweight

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    1. Underweight AHOU APRIL 2010

    2. 2

    3. 3 Agenda What is underweight? BMI The real issue: abdominal fat The U shape of the mortality curve Special cases in the adult Elderly Eating disorders FAT a.k.a Female Athlete Triad Special cases in the child

    4. 4 So there must be a right weight, right? Right ? average ? standard ? ideal The key: at what weight for your height is the mortality the lowest?

    5. 5 Underweight A.k.a. skinny Epidemiologic definition: Body Mass Index <18.5 BMI <13 not compatible with survival in Males FAO considers BMI <18.5 as epidemiological evidence of chronic energy deficiency

    6. 6 Agenda What is underweight? BMI The real issue: abdominal fat The U shape of the mortality curve Special cases in the adult Elderly Eating disorders FAT a.k.a Female Athlete Triad Special cases in the child

    7. 7 Body Mass Index Ideally translate your body shape and composition into one easily calculated number One of many ways to get to ideal weight [see for instance the not so famous Mohamed formula: ideal weight=0.032 x (height in inches squared)] Weight in kg/(height in meters squared) Simple if you use the metric system, otherwise use on line calculators Does it work? Yes…sort of

    8. 8 Whaddya mean “sort of”? Correlates with body fat, but not perfect correlation Less correlation with central adiposity Problem with bodybuilders (BMI too high relative to body fat) Problem with “slim” bone structure (for instance some south-east Asians) What do you expect? It’s an epidemiological measure Issues are more for overweight than underweight

    9. 9 BMI Illustration

    10. 10 BMI Visual Range

    11. 11 BMI Distribution- Applicant Sample

    12. 12 What do we do with them?

    13. 13 Men vs. Women

    14. 14 BMI Shift

    15. 15 BMI Shift

    16. 16 BMI Distribution - Men by Race

    17. 17 BMI Distribution - Women by Race

    18. 18 BMI Adjustment by Race/Ethnicity For the same amount of body fat in a American Caucasian, BMI is: 1.9/1.9 (women/men) more in American Black 3.9/4.1 more in Polynesian 0.0/1.0 less in Chinese 5.9/7.6 less in Thai 8.8/6.7 less in Indonesian

    19. 19 Agenda What is underweight? BMI The real issue: abdominal fat The U shape of the mortality curve Special cases in the adult Elderly Eating disorders FAT a.k.a Female Athlete Triad Special cases in the child

    20. 20 So what?

    21. 21 The Fat Cell a.k.a. the Adipocyte

    22. 22 Some are good things and some are bad things Adipocytes release many physiologically active substances (adipokines). List as of 9/09: • 14-3-3-eta • A20 • ASP • ADAM9 • ADAM12 • ADAM17 • ADAMTS5 • adhesion-regulating molecule 1 • ADF • adiponectin • Adipsin • Adrenomedullin •aFGF • Agouti • Alpha-1-acid glycoprotein 1 • Alpha-2-Macroglobulin • alpha-MSH • AMF • ANF • angiogenin • angiopoietin-1 • angiopoietin-2 • angiopoietin-like-4 • angiotensin-2 • Angiotensinogen • ANT3 • Apelin • BAG-3 • BCL2 • Beta-IG-H3 • bFGF • BIRC1 • BIRC3 • BNIP3 • Calcitonin gene-related peptide • calcitonin receptor-like receptor • cardiotrophin-1 • Cartducin • cathepsin S • CCDC80 • CCL2 • CCL3 • • CCL5 • CCL6 • CCL7 • CCL9 • CCL11 • CD9 • CD14 • CD16 • CD18 • • CD39L1 • CD40 • CD44 • CD49e • CD51 • CD53 • CD68 • CD71 • CD83 • CD85j • CD87 • CD95 • CD105 • CD106 • CD157 • Chemerin • CIDE-A • CKLFSF3 • collagen type 4 • collagen type 6 • complement factor B • complement factor Bb • complement factor • complement factor H • Corticotropin releasing hormone • CRP • CTGF • CTRP1 • CTRP5 • CXCL1 • CXCL2 • CXCL10 • CXCL12 • CXCL14 • cyclophilin A • cyclophilin C • Cystatin C • DAPK2 • DLC1 • Endocan • endothelin-1 • Epimorphin • Epiregulin • FADD • ferritin • Fetuin-A • FGF-10 • FGF-19 • FGF-21 • FGFR1 • FGFR2 • FGFR2c • fibronectin • Galectin-1 • galectin-12 • gelsolin • Glypican • granulin • haptoglobin • HCNP • HGF • hsp47 • hsp70 • HVEM • ICAM-2 • ID2 • IGF-1 • IGFBP3 • IGFBP4 • IL1-alpha • IL1-beta • IL1F5 • IL1ra • IL1RAP • IL1 receptor-like-1 • IL6 • IL8 • IL10 • IL17 • IL18 • IL18 • IL25 • IL33 • insulin receptors (CD220, INSR) • insulysin • laminin-8 • • LIF • lipocalin-2 • Lumican • M-CSF • Metallothionein-1 • Metallothionein-2 • MFG-E8 • MIC1 • MIF • MMP-1 • MMP-2 • MMP-3 • MMP-9 • MMP-10 • MMP-11 • MMP-12 • MMP-15 • MMP-19 • Neuromedin B (NMB, ranatensin) • neuropeptide Y • neuropilin-1 • neuropilin-2 • Neuropoietin • OKL38 • Oncostatin M • Orexin A receptors • Orexin B receptors • osteocalcin • osteopontin • PACAP • PAI-1 • PD-ECGF • PDGF-A • PEA-15 • PEDF • Pentraxin-• peptide • periostin • Pref-1 • procollagen C-proteinase enhancer protein • Prohibitin • Protein S • PUMA-G • Reelin • resistin • retinol binding protein • S100 • S100A1 • S100A4 • S100A11 • SAA3 • Semaphorin 3A • SOCS3 • SPARC • stanniocalcin 1 • STAT1 • STAT3 • STAT5 • STAT6 • stress-70 • TDAG51 • TGF-alpha • TGF-beta • Thrombospondin-1 • Thymosin-beta-• TIARP• TIMP-• Tissue • TLR-2 • TLR-4 • TNF-alpha • TNFRSF25 • TSG-6 • tyro3 • VEGF-120 • VEGF-• VEGF-188 • • WISP-2 • ZAG Reality: Fat cells do Things

    23. 23 U/J Shape of Mortality Curve

    24. 24 Relative Risk for Men by Race

    25. 25 Relative Risk for Men by Race

    26. 26 Relative Risk for Women by Race

    27. 27 Relative Risk for Women by Race

    28. 28 Relative Risk by Age for Men

    29. 29 Relative Risk by Age for Men

    30. 30 Relative Risk by Age for Men

    31. 31 Relative Risk by Age for Men

    32. 32 Relative Risk by Age for Men

    33. 33 Relative Risk by Age for Women

    34. 34 RR by gender, age class & follow-up

    35. 35 RR by gender, age class & follow-up

    36. 36 RR by gender, age class & follow-up

    37. 37 Latest data still show a U! Following slides are from a recently published large Canadian study

    38. 38 RR By age

    39. 39 RR by Gender

    40. 40 Because of smoking

    41. 41 Relative Risk for Men by Smoking

    42. 42 Relative Risk for Men by Smoking

    43. 43 Relative Risk for Women by Smoking

    44. 44 Hazard Ratio by Smoking Men 50-71

    45. 45 Hazard Ratio by Smoking Women 50-71

    46. 46 RR by Smoking Status

    47. 47 Because of preexisting disease

    48. 48 Relative Risk for Men by Follow-Up

    49. 49 Relative Risk for Women by Follow-Up

    50. 50 Relative Risk for Men by Preexisting Chronic Disease

    51. 51 Relative Risk for Women by Preexisting Chronic Disease

    52. 52 Causes of mortality The reaper by August Schmiemann

    53. 53 Mortality by Cause for Men

    54. 54 Mortality by Cause for Women

    55. 55 Suicide by BMI for Men

    56. 56 Causes of mortality Respiratory Stroke Suicide – at least for men Not cancer for women Not (much) CAD for men

    57. 57 Agenda What is underweight? BMI The real issue: abdominal fat The U shape of the mortality curve Special cases in the adult Elderly Eating disorders FAT a.k.a Female Athlete Triad Special cases in the child

    58. 58 Special cases in Adults HIV/AIDS Drugs Diabetes mellitus Gastro The elderly Eating disorders Female Athlete Triad

    59. 59 The Elderly

    60. 60 Combination Factors in the Elderly Sarcopenia Malnutrition Frailty

    61. 61 Attempt at illustrating sarcopenia

    62. 62 Sarcopenia Starts at age 30, increases after 60 Loss of muscle mass Loss of muscle “quality” and strength Reduces value of BMI: more fat/less lean mass for the same BMI Some synergy with obesity: sarcopenic obesity for “younger old”

    63. 63 The frailty cycle in older age

    64. 64 Flags in the Elderly Frailty Low BMI Change in weight over time, especially if already low BMI or weight loss is recent Low pulmonary function Falls Social habits/ eating habits

    65. 65 Mortality after 1 year weight loss Of 10lbs in the last year Intentional: HR 0.52 Unintentional: HR 1.84 In this group lowest mortality was for obese class I (BMI 30-34.9)! 47% of underweight had unintentional weight loss vs. 17% for obese class I

    66. 66 Eating disorders Especially prevalent in the young/middle aged adult female Anorexia nervosa SMR 6.2 Still elevated 20 years after first hospitalization “Orthorexia”: obsession with eating right “Diabulimics” Underdosing insulin to lose weight in type I diabetics (18% in female diabetic teenagers)

    67. 67 Disordered eating Amenorrhea Osteoporosis Caloric deficiency Low estrogen Consequences: Cardiovascular? Osteoporosis Female Athlete Triad

    68. 68 Agenda What is underweight? BMI The real issue: abdominal fat The U shape of the mortality curve Special cases in the adult Elderly Eating disorders FAT a.k.a Female Athlete Triad Special cases in the child

    69. 69 Special cases in Children Eating disorder Malnutrition Type 1 Diabetes Abuse: could not find proof of correlation with underweight

    70. 70 Conclusion Look at the build pattern Malnutrition-more for elderly Respiratory issues

    71. 71 Conclusion Look at the build pattern Malnutrition-more for elderly Respiratory issues

    72. 72

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