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Lifestyle Management of Adult Obesity

Laboratory Data


Table 1: Key laboratory values drawn after a 12-hour fast
Parameter Value Normal Range
Blood glucose 211 mg/dl 80-120 mg/dl
Cholesterol 242 mg/dl < 200 mg/dl
Triglycerides 211 mg/dl < 150 mg/dl
High density lipoprotein 39 mg/dl 40 - 60 mg/dl
Low density lipoprotein 151 mg/dl < 100 mg/dl
Hemoglobin 14.9 mg/dl 13-16 mg/dl
Hematocrit 42% 36-44%
TSH (thyroid stimulating hormone) 1.6 MCIU/ML 0.35-5.50
Free thyroxine 1.09 ng/dl 0.89-1.76
Serum iron 119 mg/dl 40-140 mg/dl
Hemoglobin A1c* 8.4% 4.8-6.3%
Uric acid 7.4 (3.5-7.8)

*Hemoglobin A1c is a measure of the percentage of hemoglobin bound to red blood cells and reflects the previous 2-3 month mean blood glucose levels.

Remaining blood work was within normal limits, including kidney and liver function, muscle enzymes, electrolytes, etc. Urinalysis revealed elevated glucose.

The lab data is remarkable for elevated blood glucose, elevated cholesterol, triglycerides, and low density lipoprotein (LDL) and low high density lipoprotein (HDL). Repeat measurements done 48 hours later were similar. These results indicate DM and dyslipidemia. Fasting blood glucose on repeat measurements of > 125 mg/dl are abnormal and indicative of DM. [51]

Additionally, recently published National Cholesterol Education Program Guidelines III (NCEPIII), cholesterol, LDL, HDL, and triglycerides all suggest borderline risk for CVD. [50] Her blood pressure of 146/94 mm Hg suggests she has Stage 1 hypertension. [52]

This patient has multiple risk factors for CVD including DM, borderline high cholesterol, LDL and triglycerides, as well as low HDL, Stage 1 obesity (BMI 30 to < 35), hypertension, and sedentary lifestyle. She has five of the six American Heart Association major risk factors for CVD: hypertension, diabetes, high cholesterol, overweight, and sedentary life style; she does not have tobacco use. She also is post-menopausal. From Framingham data, her risk for future CHD would be 4% over the next 10 years. [53] Although this is a highly validated risk prediction instrument, neither physical inactivity, obesity, or diabetes are included in the risk calculation. Considering that all three of these are major, independent risk factors for CVD by the American Heart Association, her risk is likely greater than predicted by this instrument. [54] [55] [56]

In addition, virtually all of these risk factors are obesity-related disorders and are amenable to modification through increased physical activity, improved nutrition habits, and weight loss.


Pertinent information

Borderline abnormal lipids, insulin, glucose intolerance, physical inactivity, Stage 1 obesity, Stage 1 hypertension, high risk for CVD.

Consider

Primary prevention for dyslipidemia, hypertension, platelet aggregation, DM, CVD; diet/exercise control of DM.



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Last Update: March 6 2013