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In a time when famine was commonplace and social hierarchies were often brutally enforced, food was an important marker of social status in a way that has no equivalent today in most developed countries. As each level of society imitated the one above it, innovations from international trade and foreign wars from the 12th century onward gradually disseminated through the upper middle class of medieval cities. Chronic alcohol abuse taxes the liver, causing accumulation of fatty deposits, which become inflamed, leading to alcoholic hepatitis. Food and Drug Administration of Thailand. Before hops became popular as an ingredient, it was difficult to preserve this beverage for any time, and so, it was mostly consumed fresh. Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease.
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Abdominal swelling and tenderness, loss of appetite and nausea may characterize alcoholic liver disease. Obesity, high cholesterol, high blood pressure and type 2 diabetes are risk factors for non-alcoholic steatohepatitis.
The disorder generally follows the same course as alcoholic liver disease, however patients may be non-drinkers. The National Digestive Diseases Information Clearinghouse advises that many people with NASH do not have symptoms of fatigue and upset stomach until liver damage is advanced. Losing weight, eating a healthy diet and getting regular exercise can help you manage NASH.
Regular medical care is also needed to control the effects of this disease. The entire family of cholesterol-lowering medications known as statins can damage your liver. Regular blood tests can detect changes and avoid the development of an associated muscle wasting condition known as rhabdomyolysis.
Symptoms may include stiffness, swelling and tenderness in the large muscles of the legs and back, dark urine, rapid heart rate, fever, nausea and vomiting.
Liver impairment or failure can also result from long-term use or high doses of other medications, including over the counter pain relievers, such as acetaminophen. Toxic effects of these medications can cause jaundice, fatigue, nausea, vomiting, diarrhea and loss of appetite. Video of the Day. What Does High Enzymes Mean? Elevated Liver Enzymes in Babies. Symptoms of Slightly Elevated Liver Enzymes. Elevated Glucose and Liver Enzymes. How to Get Liver Enzymes Down. Normal Levels for Liver Enzymes.
Abdominal obesity , also known as central obesity , occurs when excessive abdominal fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health. There is a strong correlation between central obesity and cardiovascular disease. Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes. Visceral fat , also known as organ fat or intra-abdominal fat , is located inside the peritoneal cavity , packed in between internal organs and torso, as opposed to subcutaneous fat , which is found underneath the skin , and intramuscular fat , which is found interspersed in skeletal muscle.
Visceral fat is composed of several adipose depots including mesenteric , epididymal white adipose tissue EWAT and perirenal fat. An excess of visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped", in which fat is deposited on the hips and buttocks.
Researchers first started to focus on abdominal obesity in the s when they realized it had an important connection to cardiovascular disease , diabetes , and dyslipidemia. Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity.
In the late s and early s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-abdominal fat and subcutaneous fat.
Central obesity is associated with a statistically higher risk of heart disease , hypertension , insulin resistance , and Diabetes Mellitus Type 2 see below. Central obesity can be a feature of lipodystrophies , a group of diseases that is either inherited , or due to secondary causes often protease inhibitors , a group of medications against AIDS.
Central obesity is a symptom of Cushing's syndrome  and is also common in patients with polycystic ovary syndrome PCOS. Central obesity is associated with glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver.
The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.
Recent validation has concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio-vascular risk. There are numerous theories as to the exact cause and mechanism in Type 2 Diabetes. Central obesity is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance.
But adiponectin which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in Type 2 diabetes mellitus. Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air. Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease.
Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear. Based on logistic regression analyses, it was found that obesity was associated with an almost fold increase risk of Alzheimer's disease.
The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination. Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity ,  is related to the excessive consumption of fructose.
Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein. Visceral fat cells will release their metabolic by-products in the portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there.
In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'. Hypercortisolism, such as in Cushing's syndrome , also leads to central obesity. Many prescription drugs, such as dexamethasone and other steroids, can also have side effects resulting in central obesity,  especially in the presence of elevated insulin levels. The prevalence of abdominal obesity is increasing in western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.
It is recommended to use both standards. BMI will illustrate the best estimate of your total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease.
A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women. Excluding energy under-reporters slightly attenuated these associations. After controlling for energy under-reporting, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants — but not in the small number of female participants 2.
Further study is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol. In those with a BMI under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat.
BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. For this reason, it is recommended to use both methods of measurements. While central obesity can be obvious just by looking at the naked body see the picture , the severity of central obesity is determined by taking waist and hip measurements.
A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating. In the cohort of 15, people participating in the National Health and Nutrition Examination Survey NHANES III , waist circumference explained obesity-related health risk better than the body mass index or BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant.
In other words, excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI. The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman review. This parameter has been used in the study of metabolic syndrome   and cardiovascular disease. When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women.
Central obesity is positively associated with coronary heart disease risk in women and men. It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk.
There are sex-dependent differences in regional fat distribution. In women, estrogen is believed to cause fat to be stored in the buttocks , thighs , and hips. Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences.
Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women. A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity.
Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine , although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the United States ,  the UK ,  the EU ,  Australia ,  Canada ,  Hong Kong ,  Thailand ,  Egypt and Mexico.
A study published in the International Journal of Sport Nutrition and Exercise Metabolism ,  suggests that combining cardiovascular aerobic exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat.
An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol , a hormone that leads to more belly fat deposits.
Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics. In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat. As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer.
Specifically it's the deepest layer of belly fat the fat you cannot see or grab that poses health risks, as these "visceral" fat cells produce hormones that can affect health e. The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity.
For example, fat next to the liver drains into it, causing a fatty liver , which is a risk factor for insulin resistance, setting the stage for Type 2 diabetes. In the presence of diabetes mellitus type 2 , the physician might instead prescribe metformin and thiazolidinediones rosiglitazone or pioglitazone as antidiabetic drugs rather than sulfonylurea derivatives.
Thiazolidinediones may cause slight weight gain but decrease "pathologic" abdominal fat visceral fat , and therefore may be prescribed for diabetics with central obesity. Low-fat diets may not be an effective long-term intervention for obesity: The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.
This difference from baseline between control and intervention groups diminished over time, but a significant difference in weight was maintained through year 9, the end of the study. There is a common misconception that spot exercise that is, exercising a specific muscle or location of the body most effectively burns fat at the desired location, but this is not the case. Spot exercise is beneficial for building specific muscles, but it has little effect, if any, on fat in that area of the body, or on the body's distribution of body fat.
The same logic applies to sit-ups and belly fat. Sit-ups , crunches and other abdominal exercises are useful in building the abdominal muscles , but they have little effect, if any, on the adipose tissue located there. Several colloquial terms used to refer to central obesity, and to people who have it, refer to beer drinking. However, there is little scientific evidence that beer drinkers are more prone to central obesity, despite its being known colloquially as "beer belly", "beer gut", or "beer pot".