and adiposity by mechanisms yet to be defined (Sartori, 2016). 60 46 36 Girls Women FIGURE 48-2 Prevalence of obesity in girls and women in the United States for 2009-201o4. (Data from Ogden, 201o5.)
FIGURE 48-3 Estimated hazard ratios (95% (I) for death due to cardiovascular disease according to body mass index among 1.46 million white adult men and women. (Data from de Gonzalez, 2010.)
TABLE 48-1 . Criteria for Diagnosis of the Metabolic Syndrome
Patients with three or more of the following:
Elevated triglyceridesb: ::150 mg/dL
Reduced high-density lipoprotein cholesterolb: <50 mg/dL in Elevated blood pressureb: systolicn::130 mm Hg and/or diastolic ::85 mm Hg Elevated fasting glucoseb: ::100 mg/dL country-and population-specific thresholds.
bThose with normal values while taking medications are considered to meet these criteria.
Data from Alberti, 2009.
Generally speaking, visceral adiposity correlates with hepatic fat content (Cornier, 201l). With obesity, excessive fat accumulates in the liver-hepatic steatosis, which is also called nonalcoholic fatty liver disease (NAFLD). In persons with the metabolic syndrome, steatosis can progress to nonalcoholic steatohepatitis (NASH) and cirrhosis, as well as hepatocellular carcinoma. Indeed, one fourth of chronic liver disease cases worldwide are caused by NAFLD (Younossi, 2016). \10reover, NAFLD is strongly associated with both fatal and nonfatal cardiovascular disease (T argher, 2016).
Obese individuals sufer well-known consequences such as glucose intolerance, hypertension, dyslipidemia, and metabolic syndrome. Furthermore, metabolic syndrome and obesity are linked with cardiovascular disease, including myocardial infarction, atrial ibrillation, heart failure, and stroke (Long, 2016). Insulin resistance and metabolic syndrome cause structural cerebral changes and lower executive functioning and memory in adults. Similar consequences are also found in adolescents, suggesting that metabolic syndrome's efects on neurocognitive function are independent of signiicant occlusive vascular disease (Rusinek, 2014).
Obesity is associated with higher rates of all-cause early mortality (Fontaine, 2003; Peeters, 2003). Cardiovascular mortality data from 19 prospective studies are shown in Figure 48-3. In these and other studies, mortality risk from cardiovascular disease and cancer grew proportionally with increasing BM!. Importantly, however, an obesiy paradox-whereby certain groups actually derive a survival advantage from being obese-has been hypothesized (Hainer, 2013). Despite this, the health beneits of weight normalization are well documented (Cheung, 2017).