Tuesday, October 13, 2009

Cardiometabolic Health Congress 2009: Some Important Lessons Learned

I just returned from Boston after attending the Cardiometabolic Health Congress 2009 and thought I would quickly share with my readers some of the important take home messages from the meeting. I will keep adding information to this post as and when I remember additional information that I learned at the conference. So, keep coming back for more and also I would really appreciate any comments or questions.

• Obesity and Central adiposity are the leading drivers of Cardiometabolic risk. Intra-abdominal obesity is now emerging as a new therapeutic target in cardiometabolic risk management.

• What is causing the epidemic of obesity and why is it so difficult to treat obesity? The reason is that the weight is controlled by a feedback system and so the plateau is caused by compensation ia parts of the system we can’t control.

• Important biomarkers to measure- CRP, triglycerides, LDL, HDL, HbA1c, blood pressure, waist circumference.

• High waist circumference is associated with several cardiovascular risk factors. High waist circumference is an easy measure of intra-abdominal obesity, which is characterized by accumulation of fat around and inside abdominal organs.

• Fat cells (adipocytes), especially in the abdomen are metabolically active endocrine organs, and not just an inert fat storage. Excess adipose tissue leads to increased expression of some hormones, suppression of others, thereby causing inflammation and disease.

• Excess adipose tissue in the abdomen attracts and activates macrophages, which leads to chronic inflammation and adipocyte insulin resistance.

• Adipose tissue products cause insulin resistance and inflammation. Adiponectin, which has been characterized to have anti-inflammatory properties, its levels are reduced in obesity; PAI-1 levels are increased in diabetes; CRP levels are increased in diabetics.

• Peptide hormones are known to have a physiological role in regulating energy balance. For example, Ghrelin in stomach; GIP, GLP-1, Somatostatin in intestine; Insulin, Glucagon, Amylin and Pancreatic Polypeptide in Pancreas; Leptin and Adiponectin in Adipose tissue.

• Standard small molecule oral therapies of type 2 diabetes are always associated with significant side effects and weight gain. Some newer peptide hormone analogues and combinations were shown to offer better future therapies for type 2 diabetes.

• Hypertension is a major component of cardiometabolic risk and Beta-Adrenergic –blocking drugs might have some important role in management of patients with hypertension. At the meeting some data was presented showing that beta-blockers with vasodilating properties have advantages over traditional beta-blockers in terms of less side effects.

• Diabetes prevention: We can do better by…Maintaining awareness of diabetes risk and also by developing strategies to more efficiently and effectively applying therapeutic lifestyle interventions.

• Answer to obesity related problems is Prevention and Lifestyle modification. It is important to understand the importance of physical activity, and how much and what type of exercise provides benefit. Location and measure of fat may have implication for impact of exercise training.

• Which is a better measure of risk- Waist circumference or Waist/ Hip ratio? Waist circumference is better predictor of overall risk and a better marker to monitor weight loss, especially in women because when they lose weight, they lose it both in waist and hip, so for this reason Waist/Hip ratio does not work as a sensitive predictor.

• What should be the Physician’s role in obesity management, especially in children? Physicians should track BMI in children and talk to their parents; recommend prevention plan that includes diet with more fruits and vegetables, diet rich in calcium and fiber, less consumption of energy dense foods, daily breakfast, reduced TV and other screen times; actively engage parents in the prevention and management program; recommend maintaining weekly goal cards to monitor progress.

• Few additional recommendations:
o Limit eating out in restaurants and no fast food.
o Encourage family meals meaning parents and children eat together.
o Use fast food trade off information sheets to find healthy alternatives.
o Limit portion sizes.
o Limit sweetened drinks.
o Promote physical activity at least 60 minutes per day.
o Use pedometers to monitor daily walking (should be close to 10, 000 steps every day).

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