Palabras clave
Obesidad
insulinorresistencia
síndrome metabólico
obesos metabólicamente enfermos
obesos metabólicamente sanos
insulinorresistencia
síndrome metabólico
obesos metabólicamente enfermos
obesos metabólicamente sanos
Cómo citar
González Clavijo, A. M., Fierro Maya, L. F., Caminos, J. E., Carreño, J. A., & Garcés, M. F. (2018). No existe la obesidad metabólicamente sana. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 5(3), 11–18. https://doi.org/10.53853/encr.5.3.429
Resumen
Introducción: La expresión Obesidad Metabólicamente Sana (ObMS) hace referencia a un subgrupo de pacientes obesos que no presentan síndrome metabólico y, por consecuencia, parecen tener menos complicaciones cardiovasculares(1).
Objetivo: Describir cuáles son las características bioquímicas y antropométricas por composición corporal que diferencian a los obesos metabólicamente sanos de los obesos metabólicamente enfermos.
Materiales y métodos: Es un estudio de corte transversal con sujetos hombres obesos con edades entre 18 y 30 años, a quienes se les midió porcentaje de grasa total, androide y ginecoide por composición corporal, niveles plasmáticos de Colesterol total, HDL, LDL, VLDL, triglicéridos, glucemia, PCR, insulina, leptina, adiponectina, galanina, testosterona total y estradiol en ayunas y se les practicó una prueba de tolerancia a la glucosa oral (PTOG) para medición de glucemia, insulina y galanina y se les determinó el índice de insulinorresistencia por HOMA-IR.
Resultados: Se encontraron 16 pacientes con ObMS y 14 pacientes ObME. Se observó hiperinsulinismo basal y HOMA- IR elevado entre los sujetos con ObMS, aunque en menor magnitud que en el grupo de ObME (p=0,009).
También se encontraron niveles elevados de leptina, galanina y proteína C reactiva entre los ObMS, equiparables a los de los ObME y niveles reducidos de adiponectina, en la misma magnitud entre ambos grupos de sujetos.
Conclusiones: Encontramos que la insulina basal, el HOMA- IR, la leptina, la galanina, el PCR y la adiponectina se encuentran alterados entre los sujetos ObMS, en la misma magnitud que entre los ObME, sugiriendo que las alteraciones bioquímicas son hallazgos mucho más tempranos que los cambios en las variables clínicas que definen al síndrome metabólico.
Citas
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2. Análisis de situación de salud. A s i s [Internet].. Available from: https://www.minsalud.gov.co/salud/Paginas/An%C3%A1lisisdeSalud.aspx.
3. Fundación Colombiana de Obesidad FUNCOBES. Guías colombianas para el manejo cientifico de la obesidad y sobrepeso. 2012;1-82. Available from: http://academia.utp.edu.co/medicinadeportiva/files/2012/04/GUIAS-COLOMBIANAS-PARA-MANEJO-CIENTIFICO-OBESIDAD.pdf
4. Lavie CJ, Sharma A, Alpert MA, Schutter A De, et al. Update on Obesity and Obesity paradox in Heart Failure. Prog Cardiovasc Dis [Internet]. 2015; Available from: http://dx.doi.org/10.1016/j.pcad.2015.12.003
5. Matthews, D. R. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412-9 (1985).
6. Alberti, K.G.; Eckel, R.H.; Grundy, S.M.; et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesit Circulation 2009, 120, 1640-1645. [PubMed]
7. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-1607.
8. Cook S1, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003 Aug;157(8):821-7.
9. Robinson Ramírez-Vélez , Jorge Enrique Correa-Bautista, Alejandra Sanders-Tordecilla 1. Percentage of Body Fat and Fat Mass Index as a Screening Tool for Metabolic Syndrome Prediction in Colombian University Students. Nutrients 2017, 9, 1009; doi:10.3390/nu9091009
10. H. Bryan Brewer, Jr.Increasing HDL Cholesterol levels. N Engl J Med 2004; 350:1491-1494 DOI: 10.1056/NEJMp048023
11. Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001; 50:1499± 1504. https://doi.org/10.1053/meta.2001.27213 PMID: 11735101
12. Meigs JB, Wilson PWF, Fox CS, Vasan RS, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006; 91:2906±2912. https://doi.org/10.1210/jc.2006-0594 PMID: 16735483
13. Ortega FB, Lee D-C, Katzmarzyk PT, Ruiz JR, Sui X, Church TS, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013; 34:389± 397. https://doi.org/10.1093/eurheartj/ehs174 PMID: 22947612.
14. J. A. Bell, M. Kivimaki and M. Hamer. Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. obesity reviews (2014) 15, 504-515.
15. Eckel N, Meidtner K, Kalle-Uhlmann T, Stefan N, Schulze MB. Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016; 23: 956±966. https://doi. org/10.1177/2047487315623884 PMID: 26701871
16. Doumatey AP, Bentley AR, Zhou J, Huang H, et al. Paradoxical hyperadiponectinemia is associated with the metabolically healthy obese (MHO) phenotype in African Americans. J Endocrinol Metab. 2012;2(2):51-65.
17. Aguilar-Salinas CA, García EG, Robles L, et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008;93(10):4075-4079.
18. Morrison JA, Glueck CJ, Daniels S, et al. Paradoxically high adiponectin and the healthy obese phenotype inobese black and white 16-year-old girls. Transl Res. 2010;156(5):302-308.
19. Scott Ahl, Mitchell Guenther, Shi Zhao et al. Adiponectin Levels Differentiate Metabolically Healthy vs Unhealthy Among Obese and Nonobese White Individuals. J Clin Endocrinol Metab. 2015, 100(11):4172-4180.
20. IN1, L. The role of galanin in metabolic disorders leading to type 2 diabetes mellitus. Drug News Perspect. 18, 173-7 (2005).
21. Sandoval-Alzate HF, Agudelo-Zapata Y, González-Clavijo AM, et al Serum Galanin Levels in Young Healthy Lean and Obese Non Diabetic Men during an Oral GlucoseTolerance Test. Sci Rep. 2016 Aug 23;6:31661. doi: 10.1038/srep31661
22. Iglesias Molli AE, Penas Steinhardt A, López AP, et al. Metabolically healthy obese individuals present similar chronic inflammation level but less insulin-resistance than obese individuals with metabolic syndrome. PLoS ONE. 2017; 12(12): e0190528. https://doi.org/10.1371/journal.pone.0190528
23. Martínez-Larrad MT, Corbatón Anchuelo A, Del Prado N, et al. Profile of Individuals Who Are Metabolically Healthy Obese Using Different Definition Criteria. A Population-Based Analysis in the Spanish Population. PLoS ONE. 2014; 9(9): e106641. https://doi.org/10.1371/journal.pone.0106641
24. Van Wijk DF1, Boekholdt SM2, Arsenault BJ3, et al. C-Reactive Protein Identifies Low-Risk Metabolically Healthy Obese Persons: The Europe- an Prospective Investigation of Cancer-Norfolk Prospective Population Study. J Am Heart Assoc. 2016 Jun 3;5(6). pii: e002823. doi: 10.1161/ JAHA.115.002823
25. Lillioja S, Mott DM, Spraul M, et al. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med 1993, 329:1988-1992.
26. Park BH, Yoon JM, Kim JH, Moon JH, et al. Pathologic Impact of Insulin Resistance and Sensitivity on the Severity of Liver Histopathology in Pediatric Non-Alcoholic Steatohepatitis. Yonsei Med J. 2017 Jul;58(4):756-762. doi: 10.3349/ymj.2017.58.4.756
27. Uppalakal B1, Karanayil LS2 Incidence of Metabolic Syndrome in Patients Admitted to Medical Wards with ST Elevation Myocardial In- farction. J Clin Diagn Res. 2017 Mar;11(3):OC17-OC20. doi: 10.7860/ JCDR/2017/24803.9481.
28. Simental-Mendía L.E, Rodríguez-Morán M, Guerrero-Romero F. Product of Fasting Glucose and Triglycerides As Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects. Metabolic Syndrome and Related Disorders. 2008; 6(4).DOI: 10.1089/met.2008.0034
29. Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism Nature. 2001 Dec 13;414(6865):799-806.
30. Franco-Bourland RE, Mendez-Sanchez N. The liver is the key organ for the evelopment of metabolic syndrome. Ann Hepatol 2011;10:216-217.
31. Biddinger SB, Kahn CR. From mice to men: insights into the insulin resistance syndromes. Annu Rev Physiol 2006;68:123-158.
2. Análisis de situación de salud. A s i s [Internet].. Available from: https://www.minsalud.gov.co/salud/Paginas/An%C3%A1lisisdeSalud.aspx.
3. Fundación Colombiana de Obesidad FUNCOBES. Guías colombianas para el manejo cientifico de la obesidad y sobrepeso. 2012;1-82. Available from: http://academia.utp.edu.co/medicinadeportiva/files/2012/04/GUIAS-COLOMBIANAS-PARA-MANEJO-CIENTIFICO-OBESIDAD.pdf
4. Lavie CJ, Sharma A, Alpert MA, Schutter A De, et al. Update on Obesity and Obesity paradox in Heart Failure. Prog Cardiovasc Dis [Internet]. 2015; Available from: http://dx.doi.org/10.1016/j.pcad.2015.12.003
5. Matthews, D. R. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412-9 (1985).
6. Alberti, K.G.; Eckel, R.H.; Grundy, S.M.; et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesit Circulation 2009, 120, 1640-1645. [PubMed]
7. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-1607.
8. Cook S1, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003 Aug;157(8):821-7.
9. Robinson Ramírez-Vélez , Jorge Enrique Correa-Bautista, Alejandra Sanders-Tordecilla 1. Percentage of Body Fat and Fat Mass Index as a Screening Tool for Metabolic Syndrome Prediction in Colombian University Students. Nutrients 2017, 9, 1009; doi:10.3390/nu9091009
10. H. Bryan Brewer, Jr.Increasing HDL Cholesterol levels. N Engl J Med 2004; 350:1491-1494 DOI: 10.1056/NEJMp048023
11. Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001; 50:1499± 1504. https://doi.org/10.1053/meta.2001.27213 PMID: 11735101
12. Meigs JB, Wilson PWF, Fox CS, Vasan RS, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006; 91:2906±2912. https://doi.org/10.1210/jc.2006-0594 PMID: 16735483
13. Ortega FB, Lee D-C, Katzmarzyk PT, Ruiz JR, Sui X, Church TS, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013; 34:389± 397. https://doi.org/10.1093/eurheartj/ehs174 PMID: 22947612.
14. J. A. Bell, M. Kivimaki and M. Hamer. Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. obesity reviews (2014) 15, 504-515.
15. Eckel N, Meidtner K, Kalle-Uhlmann T, Stefan N, Schulze MB. Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016; 23: 956±966. https://doi. org/10.1177/2047487315623884 PMID: 26701871
16. Doumatey AP, Bentley AR, Zhou J, Huang H, et al. Paradoxical hyperadiponectinemia is associated with the metabolically healthy obese (MHO) phenotype in African Americans. J Endocrinol Metab. 2012;2(2):51-65.
17. Aguilar-Salinas CA, García EG, Robles L, et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008;93(10):4075-4079.
18. Morrison JA, Glueck CJ, Daniels S, et al. Paradoxically high adiponectin and the healthy obese phenotype inobese black and white 16-year-old girls. Transl Res. 2010;156(5):302-308.
19. Scott Ahl, Mitchell Guenther, Shi Zhao et al. Adiponectin Levels Differentiate Metabolically Healthy vs Unhealthy Among Obese and Nonobese White Individuals. J Clin Endocrinol Metab. 2015, 100(11):4172-4180.
20. IN1, L. The role of galanin in metabolic disorders leading to type 2 diabetes mellitus. Drug News Perspect. 18, 173-7 (2005).
21. Sandoval-Alzate HF, Agudelo-Zapata Y, González-Clavijo AM, et al Serum Galanin Levels in Young Healthy Lean and Obese Non Diabetic Men during an Oral GlucoseTolerance Test. Sci Rep. 2016 Aug 23;6:31661. doi: 10.1038/srep31661
22. Iglesias Molli AE, Penas Steinhardt A, López AP, et al. Metabolically healthy obese individuals present similar chronic inflammation level but less insulin-resistance than obese individuals with metabolic syndrome. PLoS ONE. 2017; 12(12): e0190528. https://doi.org/10.1371/journal.pone.0190528
23. Martínez-Larrad MT, Corbatón Anchuelo A, Del Prado N, et al. Profile of Individuals Who Are Metabolically Healthy Obese Using Different Definition Criteria. A Population-Based Analysis in the Spanish Population. PLoS ONE. 2014; 9(9): e106641. https://doi.org/10.1371/journal.pone.0106641
24. Van Wijk DF1, Boekholdt SM2, Arsenault BJ3, et al. C-Reactive Protein Identifies Low-Risk Metabolically Healthy Obese Persons: The Europe- an Prospective Investigation of Cancer-Norfolk Prospective Population Study. J Am Heart Assoc. 2016 Jun 3;5(6). pii: e002823. doi: 10.1161/ JAHA.115.002823
25. Lillioja S, Mott DM, Spraul M, et al. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N Engl J Med 1993, 329:1988-1992.
26. Park BH, Yoon JM, Kim JH, Moon JH, et al. Pathologic Impact of Insulin Resistance and Sensitivity on the Severity of Liver Histopathology in Pediatric Non-Alcoholic Steatohepatitis. Yonsei Med J. 2017 Jul;58(4):756-762. doi: 10.3349/ymj.2017.58.4.756
27. Uppalakal B1, Karanayil LS2 Incidence of Metabolic Syndrome in Patients Admitted to Medical Wards with ST Elevation Myocardial In- farction. J Clin Diagn Res. 2017 Mar;11(3):OC17-OC20. doi: 10.7860/ JCDR/2017/24803.9481.
28. Simental-Mendía L.E, Rodríguez-Morán M, Guerrero-Romero F. Product of Fasting Glucose and Triglycerides As Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects. Metabolic Syndrome and Related Disorders. 2008; 6(4).DOI: 10.1089/met.2008.0034
29. Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism Nature. 2001 Dec 13;414(6865):799-806.
30. Franco-Bourland RE, Mendez-Sanchez N. The liver is the key organ for the evelopment of metabolic syndrome. Ann Hepatol 2011;10:216-217.
31. Biddinger SB, Kahn CR. From mice to men: insights into the insulin resistance syndromes. Annu Rev Physiol 2006;68:123-158.
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