Sunday, 22 May 2011

Lipodystrophy and Autonomic Neuropathy

If you start Googling the subject you will find hundreds of articles and scientific papers but not a great deal of evidence in the sort of language that 'ordinary' people can understand. Swollen abdomens are a long-feared possiblity amongst HIV patients but mainly amongst those who started treatment a long time ago and were given certain drugs. These days it seems to be less of an issue but not for patients with autonomic neuropathy. An increase in abdominal fat build up, leading to a swollen abdomen, is a recognised feature of autonomic neuropathy. The link between the two has been recognised but I can't find an article which explains it simply. So far as I can see, the abnormal fat distribution (and loss) is as a result of disrupted neurological signals which is the same reason given for the problem in autonomic neuropathy. Increased Triglycerides seem to play a large role too (see earlier post).

Is anyone able to throw more light on this subject?

This short summary below is from the University of Amsterdam and is very technical for anyone browsing the blogs over their Sunday breakfast. If you read it carefully, the general idea becomes clear but easy it ain't!




White adipose tissue: getting nervous.

E Fliers, F Kreier, P J Voshol, L M Havekes, H P Sauerwein, A Kalsbeek, R M Buijs, J A Romijn

Academic Medical Center of the University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam, The Netherlands. e.fliers@amc.uva.nl

Neuroendocrine research has altered the traditional perspective of white adipose tissue (WAT) as a passive store of triglycerides. In addition to fatty acids, WAT produces many hormones and can therefore be designated as a traditional endocrine gland actively participating in the integrative physiology of fuel and energy metabolism, eating behaviour and the regulation of hormone secretion and sensitivity. WAT is controlled by humoral factors, para- and intracrine factors and by neural regulation. Sympathetic nerve fibres innervate WAT and stimulate lipolysis, leading to the release of glycerol and free fatty acids. In addition, recent research in rats has clearly shown a functional parasympathetic innervation of WAT. There appears to be a distinct somatotopy within the parasympathetic nuclei: separate sets of autonomic neurones in the brain stem innervate either the visceral or the subcutaneous fat compartment. We therefore propose that the central nervous system (CNS) plays a major role in the hitherto unexplained regulation of body fat distribution. Parasympathectomy induces insulin resistance with respect to glucose and fatty acid uptake in the innervated fat depot and has selective effects on local hormone synthesis. Thus, the CNS is involved not only in the regulation of hormone production by WAT, but also in its hormone sensitivity. The developments in this research area are likely to increase our insights in the pathogenesis of metabolic disorders such as hypertriglyceridemia, diabetes mellitus type 2 and lipodystrophy syndromes.th respect to glucose and fatty acid uptake in the innervated fat depot and has selective effects on local hormone synthesis. Thus, the CNS is involved not only in the regulation of hormone production by WAT, but also in its hormone sensitivity. The developments in this research area are likely to increase our insights in the pathogenesis of metabolic disorders such as hypertriglyceridemia, diabetes mellitus type 2 and lipodystrophy syndromes.

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