ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12705ometendo-12705Research ArticleНаучные исследованияOriginal studiesРиски развития метаболического нездоровья при алиментарно-конституциональном ожиренииRisks for development of metabolic disorders in alimentary constitutional obesityhttps://orcid.org/0000-0003-4784-4107ЛясниковаМ. Б.LyasnikovaM. B.

Лясникова Мария Борисовна - кандидат медицинских наук, доцент; eLibrary SPIN: 2794-6812

Mariya B. Lyasnikova - MD, PhD; eLibrary SPIN: 2794-6812

mashulyasnik@mail.ruhttps://orcid.org/0000-0003-4465-2505БеляковаН. А.BelyakovaN. A.

Белякова Наталья Александровна - доктор медицинских наук, профессор; eLibrary SPIN: 4357-5266.

Тверь, 170100, ул. Советская, д. 4

Nataliya A. Belyakova - MD, PhD, Professor; eLibrary SPIN: 4357-5266.

4 Sovetskay street, 170100 Tver

tverendo@mail.ruhttps://orcid.org/0000-0002-0306-0848ЦветковаИ. Г.TsvetkovaI. G.

Цветкова Инна Геннадьевна - кандидат медицинских наук, доцент; eLibrary SPIN: 1152-8179

 

Inna G. Tsvetkova - MD, PhD; eLibrary SPIN: 1152-8179

inna-zvetkova@mail.ruhttps://orcid.org/0000-0002-7226-772XРодионовА. А.RodionovA. A.

Родионов Андрей Александрович - кандидат медицинских наук; eLibrary SPIN: 8175-4965

 

Andrey A. Rodionov - MD, PhD; eLibrary SPIN: 8175-4965

andrew.rodionov@tvergma.ruhttps://orcid.org/0000-0001-8169-4187МилаяН. О.MilayaN. O.

Милая Наталия Олеговна - кандидат медицинских наук; eLibrary SPIN: 5120-1188

 

nataliya.suslikova.88@mail.ruТверской государственный медицинский университетРоссияTver State Medical UniversiRussian Federation202119022022184406416Copyright © Лясникова М.Б., Белякова Н.А., Цветкова И.Г., Родионов А.А., Милая Н.О., 20222022Лясникова М.Б., Белякова Н.А., Цветкова И.Г., Родионов А.А., Милая Н.О.Lyasnikova M.B., Belyakova N.A., Tsvetkova I.G., Rodionov A.A., Milaya N.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12705Обоснование

Обоснование. Алиментарно-конституциональное ожирение, ввиду его высокой распространенности, является ключевой проблемой современной медицины. Однако не всякое ожирение сопровождается развитием метаболических нарушений, приводящих к ранней инвалидизации и смертности. В связи с этим актуальным является изучение рисков метаболического нездоровья при ожирении.

Цель

Цель. Выявить факторы, повышающие риск развития метаболического нездоровья при алиментарно-конституциональном ожирении.

Методы

Методы. У пациентов с алиментарно-конституциональным ожирением проведены оценка антропометрических данных (индекса массы тела, объемов талии и бедер и их соотношения), уровня артериального давления, результатов лабораторных исследований (глюкоза, инсулин, индексы инсулинорезистентности, лептин, холестерин и фракции, триглицериды, аспартатаминотрансфераза, аланинаминотрансфераза, гамма-глутамилтрансфераза), состава тела методом биоимпеданса, анкетирование по особенностям питания и физической активности.

Результаты

Результаты. В зависимости от метаболического здоровья пациенты были разделены на две группы: основная ­группа — метаболически нездорового ожирения (МНЗО) — 241 человек (средний возраст 41±12,09 года, давность ожирения 12,5±9,51 года), имеющие алиментарно-конституциональное ожирение и 2 и более признака метаболического синдрома (МС), группа сравнения — метаболически здорового ожирения (МЗО) — 120 человек (35,5±10,03 года; p<0,05, 8,0±7,39 года; p<0,05 соответственно) с алиментарно-конституциональным ожирением и одним признаком МС или без них. Анализ изученных факторов риска формирования метаболического нездоровья при алиментарно-конституциональном ожирении показал, что наибольшее значение для развития МНЗО имеет абдоминальное ожирение (увеличение окружности талии у женщин более 88 см и у мужчин более 102 см). При этом МНЗО ассоциировано не только с классическими признаками МС, но и с уровнем инсулина крови, инсулинорезистентностью, нарушениями липидного спектра и функции печени. Наибольший риск появления метаболических нарушений имеют пациенты в возрасте старше 45 лет, со снижением активной клеточной массы в организме менее 45%, давностью ожирения более 10 лет и отягощенной по данной патологии наследственностью. Среди поведенческих факторов (пищевой ­статус) риск метаболического нездоровья при ожирении повышают жирные молочные продукты, а частые перекусы, сладкие безалкогольные напитки, напротив, не влияют на него.

Заключение

Заключение. Формирование МНЗО ассоциировано не только с возрастом пациента, длительностью ожирения, показателями углеводного и липидного обменов, но также со снижением процента метаболически активных тканей организма и поведенческими факторами.

BACKGROUND

BACKGROUND: alimentary-constitutional obesity due to it’s high prevalence, is the key problem of modern healthcare system. However, obesity is not always accompanied with metabolic disorders, leading to early invalidization and mortality. That’s why it is important to study risks of metabolical nonhealth in obesity.

AIM

AIM: to detect factors, increasing risks of development of metabolic disbalance in alimentary-constitutional obesity.

MATERIALS AND METHODS

MATERIALS AND METHODS: In patients with alimentary-constitutional obesity there was performed an examination including anthropometry (body mass index, Waist Circumference, Hip Circumference,waist to hip ratio), blood pressure measurement, laboratory tests – metabolic indexes: glucose, insulin, insulin resistance indexes, leptin, cholesterol, cholesterol of lipoproteins, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamiltransferase), body composition measurement by bioelectrical impedance analysis; patients were also interviewed on their behavior (food habits) and physical activity.

RESULTS

RESULTS: There were formed two groups depending on metabolic health indexes: main group – metabolically non-healthy obesity (MNHO) - 241 persons (aged 41±12,09, duration of obesity 12,5±9,51 years) with alimentary-constitutional obesity and two or more signs of MS, a comparison group – of metabolically healthy obesity (MHO) – 120 persons (aged 35,5±10,03; p<0,05, duration of obesity 8,0±7,39 years; p<0,05) with alimentary-constitutional obesity and one sign of MS or without it. Data analysis of studied risk factors for development of metabolically non-healthy alimentary-constitutional obesity confirmed that most relevant factor in development of MNHO is abdominal fat mass distribution (increasing of Waist Circumference over 88 sm in females and over 102 sm in mails). At the same time MNHO had correlation not only with classical signs of MS, but also with blood insulin level, insulin resistance indexes, fat metabolism disbalance and liver disfunction. More severed risk for appearance of metabolic disorders have patients over 45 years old with decreased active cell mass (less than 45%), duration of obesity above 10 years and obesity-burdened heredity. In food habits risk of development of metabolically non-healthy obesity was increased in taking of fat milk food, and, on the contrary, - frequent snacks, alcohol free sweet drinks didn’t affect it.

CONCLUSION

CONCLUSION: Development of MNHO is associated not only with the age of patient, duration of obesity, carbohydrate and fat metabolism indexes, but also with decreased percentage of metabolically active tissues and some food habits.

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The authors declare that there are no conflicts of interest present.