ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet2015210-13ometendo-6580Research ArticleОбзор литературыReviewРоль инсулина, лептина и адипонектина в формировании структурно-функциональных изменений миокарда при ожирении и их динамика на фоне снижения массы тела: литературный обзор.The role of insulin, leptin, adiponectin in forming of structural and functional changes of myocardium in obesity and their dynamics in weight loss.ПостоеваАнна ВикторовнаPostoevaAnna Viktorovna

Assistant at the Department of Therapy, endocrinology and ambulance services

ann-primak@yandex.ruДворяшинаИрина ВладимировнаDvoryashinvaIrina Vladimirovna

профессор, д.м.н., заведующая кафедрой терапии, эндокринологии и скорой медицинской помощи

Professor, MD, PhD, Head of the Department of Therapy, endocrinology and ambulance services

dvoryashinva@yandex.ruСеверный государственный медицинский университетРоссияNorthern State Medical UniversityRussian Federation2015090320151221013Copyright © Постоева А.В., Дворяшина И.В., 20152015Постоева А.В., Дворяшина И.В.Postoeva A.V., Dvoryashinva I.V.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/6580

Целью данной работы явилось обобщение литературных данных о возможных взаимосвязях между уровнями инсулина, лептина и адипонектина и формированием структурно-функциональных изменений миокарда при ожирении, а также их динамики на фоне снижения массы тела. Произведен анализ исследований, найденных по ключевым словам «insulin, adiponectin, leptin, left ventricular hypertrophy» в международных базах данных Pubmed, Medline и Cochrane. Результаты многих работ свидетельствуют о положительных связях гиперинсулинемии и гиперлептинемии с массой и индексом массы миокарда левого желудочка.  Инсулинорезистентность может выступать независимым предиктором субклинической диастолической дисфункции. Вклад адипонектина в развитие сердечно-сосудистых заболеваний широко исследуется: многие авторы получали результаты, указывающие на его протективное действие на миокард. При похудении наблюдается снижение уровней инсулина и лептина крови, однако снижение уровня лептина, по данным отдельных авторов, происходило только при уменьшении массы тела на величину, превышающую 7% от исходной. Результаты измерения уровня адипонектина у пациентов с ожирением на фоне снижения массы тела остаются противоречивыми: одни авторы получали увеличение концентрации данного белка в крови, другие отмечали отсутствие динамики.

The aim of this work was a review of literature data on the possible relationships between the levels of insulin, leptin, and adiponectinand the formation of structural and functional changes in the myocardium in obesity, as well as their dynamics due to body weight reduction.We analyzed the studies found by keywords «insulin, adiponectin, leptin, left ventricular hypertrophy» in international databasesPubmed, Medline and Cochrane. Results of many studies suggest a positive association with hyperinsulinemia and hyperleptinemia massindex and left ventricular mass. Insulin resistance can act as an independent predictor of subclinical diastolic dysfunction. Contributionof adiponectin in the development of cardiovascular diseases has been investigated extensively: many authors have obtained results thatindicate its protective effect on the myocardium. Weight reduction is associated with decrease in levels of blood insulin and leptin, butleptin reduction, according to some authors, there was only seen in a decrease in body weight by an amount exceeding 7% of the original.The results of measuring the level of adiponectin in obese patients on the background of weight loss remains controversial: some authorshave obtained an increase in the concentration of this protein in the blood, while others pointed out the lack of any dynamics.

лептинадипонектининсулинлевый желудочекinsulinadiponectinleptinleft ventricular massReferencesWorld Health Organization http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/overweight/atlas.htmlWorld Health Organization http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/overweight/atlas.htmlMesserli FH. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Archives of Internal Medicine. 1987;147(10):1725–8. PMID:2444173 doi:10.1001/archinte.147.10.1725Messerli FH. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Archives of Internal Medicine. 1987;147(10):1725–8. PMID:2444173 doi:10.1001/archinte.147.10.1725Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity. Obesity Research. 2002;10(8):767–73. doi:10.1038/oby.2002.104Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity. Obesity Research. 2002;10(8):767–73. doi:10.1038/oby.2002.104Philip-Couderc P. Uncomplicated human obesity is associated with a specific cardiac transcriptome: involvement of the Wnt pathway. The FASEB Journal. 2004. doi:10.1096/fj.03-1242fjePhilip-Couderc P. Uncomplicated human obesity is associated with a specific cardiac transcriptome: involvement of the Wnt pathway. The FASEB Journal. 2004. doi:10.1096/fj.03-1242fjeLugo M, Putong PB. Metaplasia. An overview. Arch Pathol Lab Med. 1984;108(3):185–9. PMID:6546503Lugo M, Putong PB. Metaplasia. An overview. Arch Pathol Lab Med. 1984;108(3):185–9. PMID:6546503Unger RH. Lipotoxic Diseases. Annual Review of Medicine. 2002;53(1):319–36. PMID:11818477 doi:10.1146/annurev.med.53.082901.104057Unger RH. Lipotoxic Diseases. Annual Review of Medicine. 2002;53(1):319–36. PMID:11818477 doi:10.1146/annurev.med.53.082901.104057Unger RH, Scherer PE. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends in Endocrinology & Metabolism. 2010;21(6):345–52. doi:10.1016/j.tem.2010.01.009Unger RH, Scherer PE. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends in Endocrinology & Metabolism. 2010;21(6):345–52. doi:10.1016/j.tem.2010.01.009Sasson Z, Rasooly Y, Bhesania T, Rasooly I. Insulin resistance is an important determinant of left ventricular mass in the obese. Circulation. 1993;88(4):1431–6. doi:10.1161/01.CIR.88.4.1431Sasson Z, Rasooly Y, Bhesania T, Rasooly I. Insulin resistance is an important determinant of left ventricular mass in the obese. Circulation. 1993;88(4):1431–6. doi:10.1161/01.CIR.88.4.1431Urbina EM, Gidding SS, Bao W, Elkasabany A, Berenson GS. Association of fasting blood sugar level, insulin level, and obesity with left ventricular mass in healthy children and adolescents: The Bogalusa Heart Study. American Heart Journal. 1999;138(1):122–7. doi:10.1016/S0002-8703(99)70256-5Urbina EM, Gidding SS, Bao W, Elkasabany A, Berenson GS. Association of fasting blood sugar level, insulin level, and obesity with left ventricular mass in healthy children and adolescents: The Bogalusa Heart Study. American Heart Journal. 1999;138(1):122–7. doi:10.1016/S0002-8703(99)70256-5Sharp SD, Williams RR. Fasting Insulin and Left Ventricular Mass in Hypertensives and Normotensive Controls. Cardiology. 1992;81(4–5):207–12. doi:10.1159/000175806Sharp SD, Williams RR. Fasting Insulin and Left Ventricular Mass in Hypertensives and Normotensive Controls. Cardiology. 1992;81(4–5):207–12. doi:10.1159/000175806Verdecchia P, Reboldi G, Schillaci G, Borgioni C, Ciucci A, Telera MP, et al. Circulating Insulin and Insulin Growth Factor-1 Are Independent Determinants of Left Ventricular Mass and Geometry in Essential Hypertension. Circulation. 1999;100(17):1802–7. doi:10.1161/01.CIR.100.17.1802Verdecchia P, Reboldi G, Schillaci G, Borgioni C, Ciucci A, Telera MP, et al. Circulating Insulin and Insulin Growth Factor-1 Are Independent Determinants of Left Ventricular Mass and Geometry in Essential Hypertension. Circulation. 1999;100(17):1802–7. doi:10.1161/01.CIR.100.17.1802Ilercil A, Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, et al. Associations of Insulin Levels With Left Ventricular Structure and Function in American Indians : The Strong Heart Study. Diabetes. 2002;51(5):1543–7. doi:10.2337/diabetes.51.5.1543Ilercil A, Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, et al. Associations of Insulin Levels With Left Ventricular Structure and Function in American Indians : The Strong Heart Study. Diabetes. 2002;51(5):1543–7. doi:10.2337/diabetes.51.5.1543Galvan AQ, Galetta F, Natali A, Muscelli E, Sironi AM, Cini G, et al. Insulin Resistance and Hyperinsulinemia : No Independent Relation to Left Ventricular Mass in Humans. Circulation. 2000;102(18):2233–8. doi:10.1161/01.CIR.102.18.2233Galvan AQ, Galetta F, Natali A, Muscelli E, Sironi AM, Cini G, et al. Insulin Resistance and Hyperinsulinemia : No Independent Relation to Left Ventricular Mass in Humans. Circulation. 2000;102(18):2233–8. doi:10.1161/01.CIR.102.18.2233Malmqvist K, Isaksson H, Östergren J, Kahan T. Left ventricular mass is not related to insulin sensitivity in never-treated primary hypertension. Journal of Hypertension. 2001;19(2):311–7. doi:10.1097/00004872-200102000-00019Malmqvist K, Isaksson H, Östergren J, Kahan T. Left ventricular mass is not related to insulin sensitivity in never-treated primary hypertension. Journal of Hypertension. 2001;19(2):311–7. doi:10.1097/00004872-200102000-00019Rider OJ, Francis JM, Ali MK, Byrne J, Clarke K, Neubauer S, et al. Determinants of left ventricular mass in obesity; a cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance. 2009;11(1):9. doi:10.1186/1532-429X-11-9Rider OJ, Francis JM, Ali MK, Byrne J, Clarke K, Neubauer S, et al. Determinants of left ventricular mass in obesity; a cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance. 2009;11(1):9. doi:10.1186/1532-429X-11-9Muscerlli E, Camastra S, Kozakova M et al. Insulin resistance is an independent predictor of early diastolic myocardial dysfunction in uncomplicated obesity. International journal of obesity, abstracts supplement, 2008; S133.Muscerlli E, Camastra S, Kozakova M et al. Insulin resistance is an independent predictor of early diastolic myocardial dysfunction in uncomplicated obesity. International journal of obesity, abstracts supplement, 2008; S133.Cittadini A, Stromer H, Katz SE, Clark R, Moses AC, Morgan JP, et al. Differential Cardiac Effects of Growth Hormone and Insulin-like Growth Factor1 in the Rat: A Combined In Vivo and In Vitro Evaluation. Circulation. 1996;93(4):800–9. doi:10.1161/01.CIR.93.4.800Cittadini A, Stromer H, Katz SE, Clark R, Moses AC, Morgan JP, et al. Differential Cardiac Effects of Growth Hormone and Insulin-like Growth Factor1 in the Rat: A Combined In Vivo and In Vitro Evaluation. Circulation. 1996;93(4):800–9. doi:10.1161/01.CIR.93.4.800Epstein FH, Reaven GM, Lithell H, Landsberg L. Hypertension and Associated Metabolic Abnormalities — The Role of Insulin Resistance and the Sympathoadrenal System. New England Journal of Medicine. 1996;334(6):374–82. doi:10.1056/NEJM199602083340607Epstein FH, Reaven GM, Lithell H, Landsberg L. Hypertension and Associated Metabolic Abnormalities — The Role of Insulin Resistance and the Sympathoadrenal System. New England Journal of Medicine. 1996;334(6):374–82. doi:10.1056/NEJM199602083340607Pladevall M, Williams K, Guyer H, Sadurní J, Falces C, Ribes A, et al. The association between leptin and left ventricular hypertrophy. Journal of Hypertension. 2003;21(8):1467–73. doi:10.1097/00004872-200308000-00009Pladevall M, Williams K, Guyer H, Sadurní J, Falces C, Ribes A, et al. The association between leptin and left ventricular hypertrophy. Journal of Hypertension. 2003;21(8):1467–73. doi:10.1097/00004872-200308000-00009Perego L, Pizzocri P, Corradi D, Maisano F, Paganelli M, Fiorina P, et al. Circulating Leptin Correlates with Left Ventricular Mass in Morbid (Grade III) Obesity before and after Weight Loss Induced by Bariatric Surgery: A Potential Role for Leptin in Mediating Human Left Ventricular Hypertrophy. The Journal of Clinical Endocrinology & Metabolism. 2005;90(7):4087–93. doi:10.1210/jc.2004-1963Perego L, Pizzocri P, Corradi D, Maisano F, Paganelli M, Fiorina P, et al. Circulating Leptin Correlates with Left Ventricular Mass in Morbid (Grade III) Obesity before and after Weight Loss Induced by Bariatric Surgery: A Potential Role for Leptin in Mediating Human Left Ventricular Hypertrophy. The Journal of Clinical Endocrinology & Metabolism. 2005;90(7):4087–93. doi:10.1210/jc.2004-1963Barouch LA. Disruption of Leptin Signaling Contributes to Cardiac Hypertrophy Independently of Body Weight in Mice. Circulation. 2003;108(6):754–9. doi:10.1161/01.CIR.0000083716.82622.FDBarouch LA. Disruption of Leptin Signaling Contributes to Cardiac Hypertrophy Independently of Body Weight in Mice. Circulation. 2003;108(6):754–9. doi:10.1161/01.CIR.0000083716.82622.FDRaju SVY, Zheng M, Schuleri KH, Phan AC, Bedja D, Saraiva RM, et al. Activation of the cardiac ciliary neurotrophic factor receptor reverses left ventricular hypertrophy in leptin-deficient and leptin-resistant obesity. Proceedings of the National Academy of Sciences. 2006;103(11):4222–7. doi:10.1073/pnas.0510460103Raju SVY, Zheng M, Schuleri KH, Phan AC, Bedja D, Saraiva RM, et al. Activation of the cardiac ciliary neurotrophic factor receptor reverses left ventricular hypertrophy in leptin-deficient and leptin-resistant obesity. Proceedings of the National Academy of Sciences. 2006;103(11):4222–7. doi:10.1073/pnas.0510460103Schwartz MW, Woods SC, Porte DJr et al. Central nervous system control of food intake. Nature. 2000;404:661–671.Schwartz MW, Woods SC, Porte DJr et al. Central nervous system control of food intake. Nature. 2000;404:661–671.Haynes WG, Sivitz WI, Morgan DA, Walsh SA, Mark AL. Sympathetic and Cardiorenal Actions of Leptin. Hypertension. 1997;30(3):619–23. doi:10.1161/01.HYP.30.3.619Haynes WG, Sivitz WI, Morgan DA, Walsh SA, Mark AL. Sympathetic and Cardiorenal Actions of Leptin. Hypertension. 1997;30(3):619–23. doi:10.1161/01.HYP.30.3.619Rajapurohitam V. The Obesity-Associated Peptide Leptin Induces Hypertrophy in Neonatal Rat Ventricular Myocytes. Circulation Research. 2003;93(4):277–9. doi:10.1161/01.RES.0000089255.37804.72Rajapurohitam V. The Obesity-Associated Peptide Leptin Induces Hypertrophy in Neonatal Rat Ventricular Myocytes. Circulation Research. 2003;93(4):277–9. doi:10.1161/01.RES.0000089255.37804.72Xu FP. Leptin Induces Hypertrophy via Endothelin-1-Reactive Oxygen Species Pathway in Cultured Neonatal Rat Cardiomyocytes. Circulation. 2004;110(10):1269–75. doi:10.1161/01.CIR.0000140766.52771.6DXu FP. Leptin Induces Hypertrophy via Endothelin-1-Reactive Oxygen Species Pathway in Cultured Neonatal Rat Cardiomyocytes. Circulation. 2004;110(10):1269–75. doi:10.1161/01.CIR.0000140766.52771.6DTajmir P, Ceddia RB, Li R-K, Coe IR, Sweeney G. Leptin Increases Cardiomyocyte Hyperplasia via Extracellular Signal-Regulated Kinase- and Phosphatidylinositol 3-Kinase-Dependent Signaling Pathways. Endocrinology. 2004;145(4):1550–5. doi:10.1210/en.2003-1128Tajmir P, Ceddia RB, Li R-K, Coe IR, Sweeney G. Leptin Increases Cardiomyocyte Hyperplasia via Extracellular Signal-Regulated Kinase- and Phosphatidylinositol 3-Kinase-Dependent Signaling Pathways. Endocrinology. 2004;145(4):1550–5. doi:10.1210/en.2003-1128Shibata R, Sato K, Pimentel DR, Takemura Y, Kihara S, Ohashi K, et al. Adiponectin protects against myocardial ischemia-reperfusion injury through AMPK- and COX-2–dependent mechanisms. Nature Medicine. 2005;11(10):1096–103. doi:10.1038/nm1295Shibata R, Sato K, Pimentel DR, Takemura Y, Kihara S, Ohashi K, et al. Adiponectin protects against myocardial ischemia-reperfusion injury through AMPK- and COX-2–dependent mechanisms. Nature Medicine. 2005;11(10):1096–103. doi:10.1038/nm1295Iacobellis G, Sharma AM. Obesity and the heart: redefinition of the relationship. Obesity Reviews. 2007;8(1):35–9. doi:10.1111/j.1467-789X.2006.00257.xIacobellis G, Sharma AM. Obesity and the heart: redefinition of the relationship. Obesity Reviews. 2007;8(1):35–9. doi:10.1111/j.1467-789X.2006.00257.xTsatsanis C, Zacharioudaki V, Androulidaki A et al. Adiponectin and pro-inflammatory stimuli. International journal of obesity, abstracts supplement. 2008. S121.Tsatsanis C, Zacharioudaki V, Androulidaki A et al. Adiponectin and pro-inflammatory stimuli. International journal of obesity, abstracts supplement. 2008. S121.Geldszus R, Mayr B, Horn R, Geisthovel F, von zur Muhlen A, Brabant G. Serum leptin and weight reduction in female obesity. European Journal of Endocrinology. 1996;135(6):659–62. doi:10.1530/eje.0.1350659Geldszus R, Mayr B, Horn R, Geisthovel F, von zur Muhlen A, Brabant G. Serum leptin and weight reduction in female obesity. European Journal of Endocrinology. 1996;135(6):659–62. doi:10.1530/eje.0.1350659Havel PJ, Kasim-Karakas S, Mueller W, Johnson PR, Gingerich RL, Stern JS. Relationship of plasma leptin to plasma insulin and adiposity in normal weight and overweight women: effects of dietary fat content and sustained weight loss. The Journal of Clinical Endocrinology & Metabolism. 1996;81(12):4406–13. doi:10.1210/jcem.81.12.8954050Havel PJ, Kasim-Karakas S, Mueller W, Johnson PR, Gingerich RL, Stern JS. Relationship of plasma leptin to plasma insulin and adiposity in normal weight and overweight women: effects of dietary fat content and sustained weight loss. The Journal of Clinical Endocrinology & Metabolism. 1996;81(12):4406–13. doi:10.1210/jcem.81.12.8954050Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine. 2011;365(17):1597–604. doi:10.1056/NEJMoa1105816Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine. 2011;365(17):1597–604. doi:10.1056/NEJMoa1105816Nasseri E, Hosseini M, Dorosti MA et al. Impact of weight loss on inflammatory proteins in obese women. International journal of obesity, abstracts supplement. 2008. S108.Nasseri E, Hosseini M, Dorosti MA et al. Impact of weight loss on inflammatory proteins in obese women. International journal of obesity, abstracts supplement. 2008. S108.Leichman JG, Aguilar D, King TM, Mehta S, Majka C, Scarborough T, et al. Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery. Surgery for Obesity and Related Diseases. 2006;2(6):592–9. doi:10.1016/j.soard.2006.09.005Leichman JG, Aguilar D, King TM, Mehta S, Majka C, Scarborough T, et al. Improvements in systemic metabolism, anthropometrics, and left ventricular geometry 3 months after bariatric surgery. Surgery for Obesity and Related Diseases. 2006;2(6):592–9. doi:10.1016/j.soard.2006.09.005

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