SAQUITON, Ma. Frances B.

Section 9

A Case Study on Lipid Metabolism

1. Determine her BMI and interpret the results in relation to health risk.

According to a study conducted by Ranasinghe et al. (2013), body mass index

(BMI) is utilized in measuring overweight and obesity whereby too much body fats

can predispose risks to an individual’s health. BMI is calculated from height and

weight, and it has its own classification namely underweight, healthy weight,

overweight, and obesity (Dwyer, 2015). The patient’s BMI is 30.8 which indicates

that she has Obesity Class 1. Health risks include hypertension which can lead to

cardiovascular disease and stroke, type 2 diabetes, gallstones, kidney failure,

difficulty in breathing, and bone and joint problems. The patient might also suffer

from poor self-esteem or depression. In line with this, the health risks associated

with obesity may be inclined on the patient’s family health history.

2. Identify possible causes of the patient’s elevated levels of TAGs and cholesterol.

Based on a study conducted by Cox (n.d.), low-density lipoprotein or “bad”

cholesterol and high-density lipoprotein or “good” cholesterol are the two kinds

of lipoproteins that carries cholesterol in the blood. Both LDL and HDL increase
the risks for cardiovascular diseases since excess cholesterol in the blood will be

confined in the artery walls causing a build-up called plaque which in return,

hardens the arteries. The blood then will bring insufficient oxygen and nutrients

to the heart muscle. There is also a higher risk for heart attack since the release

of cholesterol and fats such as triglycerides into the bloodstream will block blood

flow through the artery causing blood clot. The possible causes of the patient’s

elevated levels of TAGs and cholesterol include familial hypercholesterolemia

(FH), unhealthy diet, certain medical conditions such as metabolic syndrome,

medications that include corticosteroids or estrogen therapy, involving in a poor

lifestyle like smoking, and lack of physical activities. First, FH is inherited and

present from birth so even an individual with a healthy lifestyle will not be able

to control their LDL from elevating since a defect on their chromosome 19 makes

their body unable to remove bad cholesterol from the blood, but consistent low

diet may be an initial treatment for it. Second, an unhealthy diet or consuming

foods high in saturated fats and trans-fatty acids also elevates cholesterol levels

as both saturated fats from red meat and trans-fat from processed foods can

increase LDL levels. At the same time, trans-fat lowers HDL levels. Third,

metabolic syndrome increases the risk of an individual into having diabetes,

cardiovascular disease, or stroke since it often occurs with an abnormal

triglyceride and cholesterol levels. It can only be prevented by lowering blood

pressure, cholesterol intake, and improving insulin resistance. Fourth,

 medications such as blood pressure medicines can influence the triglyceride

levels while beta-blockers and growth hormones may increase LDL levels,

whereby this side effect is often correlated with individuals who smoke. Lastly,

physical inactivity or lack of exercise contributes to obesity and will only worsen

the condition as LDL or bad cholesterol in the blood stay elevated.

3. The patient was recommended a change in diet to help manage her weight.

Weight loss is usually achieved through caloric restriction. Explain how restricting

the patient’s calories can lead to weight loss and a decrease in her TAGs and

cholesterol levels.

Caloric restriction is a dietary intervention used to continuously reduce

average daily caloric intake. It is considered as a preventative approach against

obesity and metabolic disorders. An individual that practices caloric restriction

will not suffer from malnutrition or nutrient deficiency since it does not

completely mean starvation. They are only strictly avoiding foods that contain

trans-fatty acids and high amounts of glycemic. Thus, TAGs and LDL cholesterol

levels were decreased while HDL cholesterol levels and blood glucose levels were

increased. Weight loss that resulted from caloric restriction also requires less

energy to sustain the reduced body mass so combining it with exercising will

balance the energy and will protect both bone density and muscle mass (Makris,

2011).
4. On top of a change in diet, the patient was also advised to increase her physical

activity. How does exercise affect the role of our body’s metabolism in weight

management?

Exercising or partaking in physical activities daily positively affects an

individual’s metabolism since there is an increased production of several enzymes

that acts in the reverse cholesterol transport whereby the removal of excess

cholesterol from the tissues out of the body is enhanced. Metabolites are the

substances produced during metabolism and individuals that are physically active

use more fats as a helper fuel and as a source of adenosine triphosphate (ATP).

An increased in the intensity of the exercise only means that there will be a

demand for greater energy in which the muscles that are working will also need

more ATP. In line with this, glycogen replenishment also aids in burning extra

calories in the body. It is known that excess post-exercise oxygen consumption

(EPOC) and an increased lean body mass is what helps people to lose weight (Cox,

2017).

5. Statins are a class of drugs often prescribed by doctors to help lower cholesterol

levels in the blood. By lowering the levels, they help prevent heart attacks and

stroke. Explain the mechanism of action of this drug.

 According to a study conducted by Sizar (2021), statins are risk-reducing

drugs that aids to lower triglyceride, cholesterol, and LDL concentrations while

increasing HDL concentrations. Statins have the ability to suppress cholesterol

biosynthesis in the liver. It regulates lipid metabolism caused by statins inhibitory

effect on hydroxymethylglutaryl-CoA (HMG-CoA) reductase, an enzyme for

cholesterol and isoprenoid. Upregulation of LDL receptors from the bloodstream

and increased hepatic absorption of LDL cholesterol transpires once hepatic

cholesterol synthesis is reduced. Also, statins have antiatherosclerotic properties

that counteract plaque build-up in an individual’s arteries, also called

atherosclerosis. Statins antiatherosclerotic effects are proportional with the

percent reduction in LDL cholesterol thus, its hypolipidemic or lipid-lowering

action. Statins lowers the risk of adverse cardiac events from occurring and its

hypolipidemic properties are also beneficial in impeding tumor growth.

6. The dietician advised the patient to include fruits in her diet. Avocado oil is high

in monounsaturated oleic acid, a heart-healthy fatty acid, compute the net ATP

yield of oleic acid.

7. What does the total cholesterol/HDL ratio mean? Is a high total cholesterol/HDL

ratio a good or bad indicator of health? Explain.

Based on a study conducted by Kunutsor (2017), an individual’s cholesterol

ratio is significant because this will be the basis of the physician to determine

whether he or she is at risk of cardiovascular diseases. It can be calculated by

dividing total blood cholesterol by high-density lipoprotein (HDL). A high good

cholesterol level must be greater than 60 milligrams per deciliter (mg/dL) whereby

it is a good indicator of health because it aids in absorbing other forms of cholesterol

in the bloodstream back to the liver. Then, the liver will disintegrate the cholesterol

converting it to bile salts in which the excess cholesterol will be eliminated out of
 the body, and is considered as a waste product. Thus, high HDL ratio aids in the

removal of LDL or bad cholesterol.

References:

Cox, R. (n.d.). Cholesterol, triglycerides, and associated lipoproteins. Retrieved April 26,

2021, from https://www.ncbi.nlm.nih.gov/books/NBK351/

Cox C. E. (2017). Role of Physical Activity for Weight Loss and Weight

Maintenance. Diabetes spectrum: a publication of the American Diabetes

Association, 30(3), 157–160. https://doi.org/10.2337/ds17-0013

Dwyer, J. (2015, February 28). Table 4, classification of Weight status by body mass Index

(bmi) - Endotext - Ncbi bookshelf. Retrieved April 26, 2021, from

https://www.ncbi.nlm.nih.gov/books/NBK278991/table/diet-treatment-

obes.table4clas/

Kunutsor, S. K., Zaccardi, F., Karppi, J., Kurl, S., & Laukkanen, J. A. (2017). Is High Serum

LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death?

Findings from the KIHD Study. Journal of atherosclerosis and thrombosis, 24(6),

600–608. https://doi.org/10.5551/jat.37184
Makris, A., & Foster, G. D. (2011). Dietary approaches to the treatment of obesity. The

Psychiatric clinics of North America, 34(4), 813–827.

https://doi.org/10.1016/j.psc.2011.08.004

Ranasinghe, C., Gamage, P., Katulanda, P., Andraweera, N., Thilakarathne, S., & Tharanga,

P. (2013, September 03). Relationship between body mass index (BMI) and body fat

PERCENTAGE, estimated By BIOELECTRICAL IMPEDANCE, in a group of Sri Lankan

adults: A cross sectional study. Retrieved April 26, 2021, from

https://doi.org/10.1186/1471-2458-13-797

Sizar, O. (2021, January 03). Statin medications. Retrieved April 26, 2021, from

https://www.ncbi.nlm.nih.gov/books/NBK430940/