Obesity is a common, preventable and ubiquitous disease of

Obesity is a common,  preventableand ubiquitous disease of clinical and public health importance. It is often amajor risk factor for the development of several non-communicable diseases,significant disability and premature deathObesity is defined as a condition of abnormal or excessive fataccumulation in adipose tissue, to the extent that health is impairedUntil recently the relation between obesity andcoronary heart disease was viewed as indirect, ie, through covariates relatedto both obesity and coronary heart disease risk, including hypertension; dyslipidemia,particularly reductions in HDL cholesterol (abnormal lipid profile); andimpaired glucose tolerance or non–insulin-dependent diabetes mellitus.

Insulinresistance and accompanying hyperinsulinemia are typically associated withthese comorbidities. Althoughmost of the comorbidities relating obesity to coronary artery disease increaseas BMI increases, they also relate to body fat distribution. Long-termlongitudinal studies, however, indicate that obesity as such not only relatesto but independently predicts coronary atherosclerosis. This relation appears to exist forboth men and women with minimal increases in BMI.Body Mass Index (BMI) is a simple index of weight-for-height that iscommonly used to classify underweight, overweight and obesity in adults. The Body Mass Index (BMI) is widelyused for the determination of nutritional status or body composition.

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It is thevalue obtained when the weight in kilograms is divided by the square of theheight in meters. Nutritional status is determined through BMI cut-offs valuesas recommended by the World Health Organization (WHO) however, in recent yearssome scientists in the Asia- Pacific region made recommendations that thecriteria values be modified to fit the Asian body composition, which is claimedto be different compared to the American or European body composition. Thus the”Asian criteria” for the determination of nutritional status based onthe BMI was born. The cold pressor test is a widely used experimentaltechnique for human pain or stress induction, involving immersion of the hand orforearm in cold water. First documented as a test of cardiovascular stressreactivity, its application in investigation of pain perception, mechanisms,and treatment is due to a gradually mounting painful sensation of mild tomoderate intensity. As water temperatures used are within the range considerednoxious (below 15°C), nociceptors (pain receptors) are activated and transmitan aversive signal to the CNS. While nociception-transduction ion channelsinvolved have been identified, the exact mechanisms of cold pain are not fullyelucidated.

Chronic imbalance of the autonomic nervous system isprevalent and potent risk factor for adverse cardiovascular events includingmortality.Any factor that lead to inappropriate activation of the sympatheticnervous system.Any factor that lead to inappropriate activation of thesympathetic nervous system can be expected to have an adverse effect on this measures.Any factor that augments vagal tone tends to improve outcome. Factors linkingobesity to increase BP and blood volume and cardiac output that is caused byincreased metabolic demand.