内臓脂肪
内臓脂肪としては腸間膜脂肪と呼ばれる胃や腸の周辺にあるものが代表的である。
通常時は中性脂肪を合成してエネルギーを蓄えているが、エネルギー不足の状態では門脈を通じて遊離脂肪酸などの形でエネルギーを送る役割を果たす。
このように内臓脂肪は皮下に存在する皮下脂肪に比べて代謝が活発に行われる脂肪組織である。
また、内臓脂肪は様々なアディポサイトカインを分泌する巨大なホルモン産生器官であることが明らかになった。
普通体重時の脂肪細胞
普通体重時では脂肪細胞はアディポネクチンと呼ばれる善玉のアディポサイトカインを分泌する。
アディポネクチンにはインスリン抵抗性改善作用や動脈壁に対する直接作用で動脈硬化を抑制して血管の損傷も修復する役割がある。
肥満体重時の脂肪細胞
肥満体重時では脂肪細胞が大型化してTNF-αやアンジオテンシノーゲンなどの悪玉アディポサイトカインを分泌するようになる。悪玉アディポサイトカインは善玉アディポサイトカインであるアディポネクチンぼ分泌を抑制する。
TNF-αにはインスリン抵抗性増強作用があり血糖値上昇を引き起こす。また、インスリン抵抗性が増強されるとLPL(リポタンパク質リパーゼ)の活性が低下するため、この影響でトリグリセリド値が上昇してHDL-Cが減少する。このときにLDL-Cはあまり影響を受けない。
アンジオテンシノーゲンによって血圧が上昇する。
メタボリックシンドローム
内臓脂肪蓄積によりアディポサイトカイン分泌異常が生じた結果として起こる病態がメタボリックシンドローム(内臓脂肪症候群)である。内臓脂肪蓄積に随伴する危険因子(高血圧・高血糖・脂質異常症)により動脈硬化が促進して心筋梗塞や脳梗塞を発症しやすくなる。
メタボリックシンドロームの診断基準
メタボリックシンドロームの基礎の大前提として内臓脂肪の蓄積があるため、必須項目としてウエスト周囲経で内臓脂肪蓄積を確認する必要がある。
厳密には腹部CTで内臓脂肪面積を算出して100㎠以上になると内臓脂肪蓄積と判定することができるのだが、全ての人に行うことができないのでウエスト周囲径で男性:85cm以上、女性:90cm以上のときに内臓脂肪面積が概ね100㎠となることを用いている。
これに加えて、内臓脂肪蓄積に随伴する動脈硬化の危険因子を2個以上認めた場合に心筋梗塞や脳梗塞といった動脈硬化疾患を発症する危険性の高いメタボリックシンドロームだと診断される。
メタボリックシンドロームは完全に高血圧となったり、糖尿病になる前の患者さんも早期治療をすることを目的としている。
このため、危険因子としての血圧の診断基準が[収縮期血圧:130mmHgかつ・または拡張期血圧:85mmHg]と設定されており、正常血圧120/80mmHgとⅠ度高血圧140~159/90~99mmHgの下限の中間で高値血圧130~139/80~89mmHgの範囲内に下限が位置するようになっている。
また、危険因子としての血糖の診断基準が[空腹時血糖値:110mg/dL以上]と設定されており、これは糖尿病の境界型[早朝空腹時血糖値110~125mg/dL]の範囲内に下限が位置するように設定されている。
危険因子としての脂質異常症の診断基準にLDL-Cが含まれていないのは、「内臓脂肪蓄積→インスリン抵抗性」によるLPL活性低下はTG増加・HDL-C減少を引き起こすもののLDL-Cは影響をあまり受けないためである。それに加えて、LDLコレステロールは動脈硬化因子としては別格なのでメタボリックシンドロームの診断基準とは別格に扱っているということもある。
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Fortunately, leg exercises don’t need to be difficult to be effective—and they don’t have to require any
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No weight-training plan is complete, nonetheless, without no much
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ground. If you’re used to only utilizing barbells in your leg workouts, you would possibly surprise tips on how to do leg exercises with
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You can use a barbell, dumbbells, or kettlebells for weights.
The key to this exercise, as it’s with many workout routines, is to prioritize form
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in the bottom of the motion. Your adductors are muscle teams made up of
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Skipping leg day won’t just damage your legs; it will
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Maintain the kettlebell or dumbbell earlier than your chest
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While such enthusiasm is admirable, you could want to build
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then holding the toes to stretch the hamstrings. Whereas there could be
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