Dual energy Xray absortiometry DEXA A

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method used to estimate total body fat and percent of body fat. Potential disadvantages include whole body radiation and the long time required for scanning while the subject lies on a hard table.

Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis.

Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial.

Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs.

Energy deficit: A state in which total energy intake is less than total energy need.

Ephedrine: A sympathomimetic drug that stimulates thermogenesis in laboratory animals and humans. Animal studies show that it may reduce fat content and, therefore, body weight by mechanisms that probably involve increased expenditure and reduced food intake.

Extreme obesity: A body mass index > 40.

Femoxetine: A selective serotonin reuptake inhibitor drug used in obese patients for weight loss.

Fenfluramine: A serotonin agonist drug used in the treatment of obesity. FDA approval has been withdrawn.

Fibrinogen: A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions. Fibrin is responsible for the semisolid character of a blood clot.

Fluoxetine: An antidepressant drug used to promote weight loss whose action is mediated by highly specific inhibition of serotonin reuptake into presynaptic neurons. Serotonin acts in the brain to alter feeding and satiety by decreasing carbohydrate intake, resulting in weight reduction.

Framingham Heart Study: Study begun in 1948 to identify constitutional, environmental, and behavioral influences on the development of cardiovascular disease. Framingham data show that increased relative weight and central obesity are associated with elevated levels of risk factors (e.g., cholesterol, blood pressure, blood glucose, uric acid), increased incidence of cardiovascular disease, and increased death rates for all causes combined.

Gallstones: Constituents in the gallbladder that are not reabsorbed, including bile salts and lipid substances such as cholesterol that become highly concentrated. They can cause severe pain (obstruction and cramps) as they move into the common bile duct. Risk factors for cholesterol gallstone formation include female gender, weight gain, overweight, high energy intake, ethnic factors (Pima Indians and Scandinavians), use of certain drugs (clofibrate, estrogens, and bile acid sequestrants), and presence of gastrointestinal disease. Gallstones sometimes develop during dieting for weight reduction. There is an increased risk for gallstones and acute gallbladder disease during severe caloric restriction.

Gastric banding: Surgery to limit the amount of food the stomach can hold by closing part of it off. A band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.

Gastric bubble/balloon: A free-floating intragas-tric balloon used in the treatment of obesity.

Gastric bypass: A surgical procedure that combines the creation of small stomach pouches to restrict food intake and the construction of bypasses of the duodenum and other segments of the small intestine to cause food malabsorption. Patients generally lose two-thirds of their excess weight after 2 years.

Gastric exclusion: Same as gastric partitioning and Roux-en Y bypass. A small stomach pouch is created by stapling or by vertical banding to restrict food intake. A Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum.

Gastric partitioning: See gastric exclusion.

Gastroplasty: See also jejuno-ileostomy. A surgical procedure that limits the amount of food the stomach can hold by closing off part of the stomach. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.

Genotype: The entire genetic makeup of an individual. The fundamental constitution of an organism in terms of its hereditary factors. A group of organisms in which each has the same hereditary characteristics.

Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 2M hours after ingestion.

Hemoglobin Aic : One of the fractions of glycosylated hemoglobin A. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal concentration. Generally, complications are substantially lower among patients with HbA1c levels of 7 percent or less than in patients with HbA1C levels of 9 percent or more.

Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarct-ed), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue.

Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones.

High-density lipoproteins (HDL): Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels are inversely correlated with coronary heart disease risk.

Hirsutism: Presence of excessive body and facial hair, especially in women; may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of an endocrine disorder. Apert's hir-sutism is caused by a virilizing disorder of adrenocortical origin. Constitutional hirsutism is mild-to-moderate hirsutism present in individuals exhibiting otherwise normal endocrine and reproductive functions; it appears to be an inheritable form of hirsutism and commonly is an expression of an ethnic characteristic. Idiopathic hirsutism is of uncertain origin in women, who may exhibit menstrual abnormalities and sterility. Some authorities believe the hirsutism reflects hypersecretion of adrenocorti-cal androgens.

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