Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 182

The rising epidemic of obesity is now recognised internationally in both younger and older cohorts and is projected, if it continues, to lead to significant changes in related diseases such as diabetes and also life expectancy. Prevention of excess adiposity is both protective and in some cases therapeutic for many common chronic diseases, offering significant risk reduction in the case of osteoarthritis; cardiovascular disease; gall bladder disease; type 2 diabetes; breast, colon, and endometrial cancer; hypertension; stroke; and vascular impotence, for example. Although generalised obesity is associated with excess mortality, cardiovascular disease, osteoarthritis, mobility impairment, and disability, it is predominantly excess visceral fat that is associated with the derangements of dyslipidaemia, elevated fibrinogen, hyperinsulinaemia, glucose intolerance or diabetes, vascular insulin resistance, hypertension, and cardiovascular disease known as metabolic syndrome or insulin resistance syndrome. Reductions in visceral fat have been shown to improve glucose tolerance and insulin sensitivity in those with and without diabetes, and changes in trunk fat correlate with improved glycaemic control in type 2 diabetes.^77,78 Hence the potential for exercise to impact favourably on the accretion and distribution of adipose tissue, as reviewed below, has enormous significance in that it may reduce the burden of disease expressed in the ageing population.