Water and sodium retention obesity

Introduction After obesity is determined, it can be combined with medical history, body film and laboratory data to identify simple secondary depression. If you have high blood pressure, central obesity, purple streak, amenorrhea, etc. with 24-hour urine 17-hydroxysteroids, you should consider hypercortisolism. Those with low metabolic rate should further check T3, T4 and TSH. test. In addition, it is often necessary to pay attention to the presence of diabetes, coronary heart disease, atherosclerosis, gout, cholelithiasis and other concomitant diseases. If you regularly consume too much neutral fat and sugar, it will accelerate the synthesis of fat and become an external cause of obesity, often in the case of too little activity, such as stopping physical exercise, reducing physical labor or bed rest during bed recovery. Obesity occurs after childbirth recuperation.

Cause

1. Internal cause: Obesity caused by disorder of fat metabolism in the human body.

(1) genetic factors

Epidemiological surveys have shown that some of the simple obesity have a family predisposition. Both parents are obese, and those who are born with simple obesity are 5 to 8 times more likely than those born to both parents. Vanllallie conducted a longitudinal survey of 1,333 children born between 1965 and 1970 and found that one parent was obese, and their children's children's odds increased as they grew older. Obese children aged 1 to 2 years old are 1.3 in early adult obesity, 4.7 in 3 to 5 years old, 8.8 in 6 to 9 years old, 22.3 in 10 to 14 years old, and 17.5 in 15 to 17 years old.

(2) Neuropsychiatric factors

It is known that there are two pairs of nerve nuclei associated with feeding behavior in the hypothalamus of humans and various animals. One pair is the contralateral contralateral nucleus (VMH), also known as the satiety center; the other pair is the ventrolateral nucleus (LHA), also known as the hunger center. When the center is full of excitement, there is a feeling of fullness and refusal to eat. When it is destroyed, the appetite increases greatly. When the hunger center is excited, the appetite is strong, and when it is destroyed, it is anorexia and refuses to eat. The two regulate each other, restrict each other, and are in a state of dynamic equilibrium under physiological conditions, so that the appetite is regulated in a normal range and maintains a normal body weight. When the hypothalamus develops lesions, whether it is a sequela of inflammation (such as meningitis, encephalitis), trauma, tumors and other pathological changes, such as ventral medial nucleus destruction, the ventrolateral nucleus function is relatively phlegm and then gluttony, causing obesity. Conversely, when the ventrolateral nucleus is destroyed, the ventromedial nucleus functions relatively sputum and then anorexia, causing weight loss. In addition, the area has a close anatomical connection with higher-grade neural tissue, which can also regulate the feeding center to a certain extent. The blood-brain barrier at the hypothalamus is relatively weak. This anatomical feature makes it easy for many biologically active factors in the blood to migrate to the place, thus affecting the feeding behavior. These factors include: glucose, free fatty acids, norepinephrine, dopamine, serotonin, insulin, and the like. In addition, mental factors often affect appetite, and the function of the prey center is controlled by mental state. When mental stress is excessive and sympathetic stimulation or adrenergic nerve stimulation (especially receptor predominance), appetite is inhibited; when vagus nerve is excited When insulin secretion increases, appetite often increases. The ventromedial nucleus is the sympathetic center, and the ventrolateral nucleus is the parasympathetic center. Both play an important role in the pathogenesis of this disease.

(3) hyperinsulinemia

In recent years, the role of hyperinsulinemia in the pathogenesis of obesity has attracted attention. Obesity often coexists with hyperinsulinemia, but it is generally believed that hyperinsulinemia causes obesity. People with hyperinsulinemia obesity have about three times the amount of insulin released from normal people.

Insulin has a significant role in promoting fat accumulation. It is believed that insulin can be used as an indicator of total lipid content and, in a certain sense, as a monitoring factor for obesity. Some people think that plasma insulin concentration has a significant positive correlation with total lipid.

(4) Abnormal brown adipose tissue

Brown adipose tissue is an adipose tissue that has been discovered in recent years and corresponds to white adipose tissue that is mainly distributed under the skin and around the internal organs. The distribution of brown adipose tissue is limited, and it is only distributed between the scapula, the neck and back, the armpit, the mediastinum and the kidney. The tissue appearance is light brown and the cell volume changes relatively little.

White adipose tissue is a form of energy storage. The body stores excess energy in the form of neutral fat. When the body needs energy, the neutral fat is hydrolyzed in the fat cells. The volume of white fat cells varies with release energy and storage energy.

Brown adipose tissue is functionally a thermogenic organ, that is, when the body is ingested or stimulated by cold, the fat in the brown fat cells burns, thereby determining the energy metabolism level of the body. The above two conditions are called feeding-induced heat production and cold-induced heat production.

Of course, the function of this particular protein is influenced by many factors. It can be seen that the brown adipose tissue, the heat-producing tissue, directly participates in the total regulation of heat in the body, and dissipates excess heat in the body to the outside, so that the body's energy metabolism tends to balance.

(5). Other

Eating too much can produce excessive intestinal inhibitory peptide (GIP) by stimulating the small intestine, and GIP stimulates islet beta cells to release insulin. In the lower pituitary function, especially the reduction of growth hormone, gonads and thyroid dysfunction caused by decreased gonads and thyroid stimulating hormones, special types of obesity may occur, which may be related to decreased fat mobilization and increased synthesis. Clinically, obesity is more common in women, especially in women who are maternal or menopausal or oral contraceptives, suggesting that estrogen is associated with fat anabolism. When the adrenal cortex is hyperactive, cortisol secretion increases, promotes gluconeogenesis, increases blood sugar, stimulates insulin secretion, and thus increases fat synthesis, while cortisol promotes fat breakdown.

2. External causes: Too much activity due to excessive diet.

When the calorie intake exceeds the energy required for consumption, it is almost completely converted into fat, stored in the whole body fat storehouse, except for storage in the form of liver and muscle glycogen, which is mainly triglyceride. Due to limited glycogen storage, Therefore, fat is the main storage form of human body heat energy. If you regularly consume too much neutral fat and sugar, it will accelerate the synthesis of fat and become an external cause of obesity, often in the case of too little activity, such as stopping physical exercise, reducing physical labor or bed rest during bed recovery. Obesity occurs after childbirth recuperation.

an examination

Related inspection

CT scan body mass index

The diagnosis of obesity is mainly based on excessive accumulation and/or abnormal distribution of fat in the body.

1. Body Mass Index (BMI): is a more commonly used measure. Body mass index (BMI) = weight (kg) / height (m) 2. WHO proposes that BMI 25 is overweight and 30 is obese. The Asia-Pacific Diabetes and Overweight Diagnostic Criteria Symposium is based on the fact that Asians tend to have abdominal or visceral obesity when they have a relatively low BMI and show a significant increase in the risk of hypertension, diabetes, hyperlipemia and proteinuria. Therefore, BMI 23 is considered to be overweight, and BMI 25 is obese.

2. Ideal weight: ideal weight (kg) = height (cm) -105; or height minus 100 and then multiplied by 0.9 (male) or 0.85 (female). Those who actually weigh more than 20% of their ideal body weight are obese; more than 10% of the ideal body weight and less than 20% are overweight.

3. Distribution characteristics of body fat: It can be measured by waist circumference or waist-to-hip ratio (WHR). The waist circumference is the distance from the midpoint between the rib line of the midline and the anterior superior iliac spine; the hip circumference is the distance measured by the most bulging part of the buttocks, and the waist-to-hip ratio (WHR) is the ratio of the waist circumference to the hip circumference. Waist male 90cm, female 80cm; waist-to-hip ratio WHR> 0.9 (male) or > 0.8 (female) can be regarded as central obesity.

4. Degree of subcutaneous fat accumulation: It can be estimated from the thickness of sebum. The average thickness of scapular sebum in normal 25-year-old is 12.4mm, and the fat accumulation is more than 14mm. The thickness of triceps in the triceps is 10.4mm. The average is 17.5mm.

5. Visceral fat: can be measured by B-mode ultrasound, dual-energy X-ray absorptiometry, CT scan or magnetic resonance. After determining obesity, it should be identified as simple obesity or secondary obesity.

Differential diagnosis

After obesity is determined, it can be combined with medical history, body film and laboratory data to identify simple secondary depression. If you have high blood pressure, central obesity, purple streak, amenorrhea, etc. with 24-hour urine 17-hydroxysteroids, you should consider hypercortisolism. Those with low metabolic rate should further check T3, T4 and TSH. test. In addition, it is often necessary to pay attention to the presence of diabetes, coronary heart disease, atherosclerosis, gout, cholelithiasis and other concomitant diseases.

Simple obesity: Obesity is the main manifestation in the clinic. There is no obvious changes in the morphology and function of the nervous and endocrine systems, but it is accompanied by disorders in the regulation of fat and glucose metabolism. This type of obesity is the most common. Diagnosis can be made according to signs and weight.

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