Kuliah - Obesity - Metabolic Syndrome 2012

8/12/2019 Kuliah - Obesity - Metabolic Syndrome 2012

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OBESITY

ANDMETABOLIC SYNDROME

Fabiola MS A - John MF Adam

Division of Endocrinology and MetabolismDept. of Internal Medicine, Faculty of MedicineHasanuddin University

Makassar 2012


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OBESITY


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Obesity is defined as a condition in whichthere is an excess of fat accumulation inadipose tissue, to the extend that healthmay be impaired (WHO, 2000)

The operational definition of obesity and over-weight are based on Body Mass Index

(BMI), which is closely related with bodyfatness

OBESITY THE DEFINITION


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Regional Office for the Western Pacific of the World Organization, The InternationalAssociation for the Study of Obesity, The International Obesity Task Force. The Asia-Pacificperspective: Redefining obesity and its treatment. WHO Collaborating Centre for theepidemiology of Diabetes and Health Promotion for Noncommunicable Disease, Melbourne2000

PROPOSED CLASSIFICATION of WEIGHT byBMI for ASIAN ADULTS

BMI (kg/m2) Risk of co-morbiditiesClassification

Underweight < 18.5 Low ( but Increased risk

of other clinical problems)

Normal Range 18.5

22.9 AverageOverweight > 23

At Risk 23 - 24.9 Increase

Obese I 25 - 29.9 Moderate

Obese II > 30 Severe

JMFA 7


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OBESITY BODY FAT DISTRIBUTION

It is not the amount of fat but also its

distribution that determines the risk

associated with obesity(WHO, 2000)

Android obesity (abdominal or visceral

or central obesity)Gynoid obesity (gluteal obesity)


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In men, fat distributiontends to accumulate in theupper part of the body or

in the abdominal region(android obesity), while inwomen, it tends toaccumulate in theperipheral part of the body

or gluteofemoral region(gynoid obesity)

Android obesity

Gynoid obesity

OBESITY and BODY FATDISTRIBUTION

JMFA 9


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It is not just the amount of fat,

but the distribution offat

determines the risk of co-morbidities in obese subjects

Large Insulin-ResistantAdipocytes Small Insulin-Sensitive

Adipocytes

AndroidObesity GynoidObesity

JMFA 10


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1. Body Mass Index

BMI =Weight in kg

(Height in meters)2

2. Body Fat Distribution

Android type (central obesity = visceralobesity)

Gineoid type

OBESITY-MEASUREMENT


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MEASUREMENT OF CENTRALOBESITY

Anthropometric

Waist-hip ratio (WHR)Waist circumference

Imaging

Computed tomography scanning (CT-scan)

Magnetic resonance imaging (MRI)Dual energy x-ray absorptiometry (DEXA)


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CT-scanningMRIDEXA

Waist circumferenceWaist-to-hip ratio

MEASUREMENT OF CENTRAL OBESITY


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http://bmj.com/content/vol322/issue7288/images/large/desj3114.f2.jpeg


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Desprs JP, dkk. BMJ 2001;322:716-720

Waist

Hip

20 years

BMI = 35Waist = 100 cmHip = 125 cm

WH Ratio = 0.80

BMI = 24Waist = 80 cmHip =100 cm

WH Ratio = 0.80
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Individual/biological

susceptibility

Dietary and physical

activity patterns

Energy regulation

Intake

Fat

CH

Protein

Activity

TEF

BMR

Expenditure

Body fat stores


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WHY IS OBESITY INCREASE IN THE

DEVELOPING COUNTRIES ?

In the last two decades, obesity is linked to

the adopting of Western lifestyle,

- increased ability of overconsumption ofcheap energy-dense food

- and a shift to decreased physical activity

and more sedentary life


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Fast foodMakassar


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OBESITY -

A DISEASE ?


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There has been a debate if obesity is disease orjust a risk factors for some diseases such asdiabetes, hypertension, dyslipidemia, andcardiovascular disease

In 1985The National Institute of Health in USdecided that obesity is a disease

Even though, clinicians are more interest inthe management of the comorbiditiesrelated

to obesity such as hypertension, diabetesmellitus and dyslipidemia than treatingobesity

OBESITY IS OBESITY A DISEASE ?


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PROPORTION of DISEASE PREVALENCEATTRIBUTABLE to OBESITY

Type 2 diabetes 57%Gallbladder disease 30%

Hypertension 17%Coronary heart disease 17%Osteoarthritis 14%Breast cancer 11%

Ulterine cancer 11%Colon cancer 11%

Men


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Men

Oddsratio

BMI (kg/m2)

6

5

4

3

2

1

022 23 24 25 26 27 28 29 30

Diabetes

Hypertension

Dyslipidemia

Albuminuria

Oddsratio

BMI (kg/m2)

Women6

5

4

3

21

022 23 24 25 26 27 28 29

Diabetes

Hypertension

Dyslipidemia

Albuminuria

BMI and diabetes, hypertension, dyslipidemia and microalbuminuria in China Hongkong. Ko GTC,

Chan JCN, Woo J, Lau E, Yeung VTF, Chow C-C, Wai HPS, LI YKS, So W-Y, Cockram CS. Chinese. Int JObes 1997; 21: 995-1001 2.


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OBESITY

THE TREATMENTShould we treat obesity ??


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2.52

1.51

0.50

Low

Risk

Moderate

RiskHigh

Risk

20 25 30 35Body Mass Index

4

3

2

10

150 170 200 210 220 230 240 250 290

Cholesterol (mg/dl)RelativerRiskofillhealth

54

3

21

Diastolic Blood Pressure

75 80 85 90 95 100 105 110 115 120

Relationship of BMI, cholesterol, and blood pressure to risk of ill health. The vertical lines accepted subdivisions

for low, moderate, and high risk. All three curves show a curvilinear increase with increasing level of risk factor

Bray GA, et al. Handbook of obesity, 1998


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TREATMENT OF OBESITY

Change of lifestyles

- Diet

- Physical activity

Pharmacotherapy

- Orlistat (Xenical)

Surgery


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EXERCISE

Nice try!! But not effective


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OBESITY : TREATMENT GUIDELINES FOR BMI

BMI Treatment

18.5 - 24.9

25.0 - 29.9

- without disease

25.0 - 29.9

- with disease

30.0 - 39.9

> 40

No treatment, diet and exercise to maintain

body weight

Hypocaloric diet and exercise to reducebody weight

Hypocaloric diet and exercise, anti-obesitydrug

Hypocaloric diet and exercise, anti-

obesity drugSurgery

Physicians guide to the management of obesity with Xenical (4)


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Sudden death is more common in thosewho are naturally fat than in the slender

Hippocrates 410 B.C.

Messerli et al Arch Intern Med 1987; 147: 1725 - 1728 JMFA 4


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DEFINITION

Metabolic syndrome is a

constellation of lipid and nonlipidrisk factors of metabolic origin.

This syndrome is closely linked

to a generalized metabolic

disorder called insulin resistancein which the normal actions of

insulin are impaired


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WHO 1999

National Cholesterol Education Program,Adult Treatment Panel III, 2001Modified NCEP-ATP III for Asian, 2001

International Diabetes Federation, 2005

CRITERIAof METABOLIC SYNDROME


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CLINICAL IDENTIFICATION OF THE METABOLIC


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CLINICAL IDENTIFICATION OF THE METABOLICSYNDROME Modified NCEP ATP III 2001for Asian Adults

Metabolic syndrome > 3 risk factors

Risk factor Defining level

Abdominal obesity*(waist circumference)

Men > 90 cmWomen > 80 cm

Triglycerides > 150 mg/dlHigh-density lipoprotein

cholesterol

Men < 40 mg/dlWomen < 50 mg/dlBlood pressure > 130 / > 85 mmHgFasting glucose > 110 mg/dl


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IDF Criteriaof Metabolic Syndrome

> 150 mg/dl

< 40 mg/dl

< 50 mg/dl> 130 / > 85 mmHg

> 115 mg/dl

Abdominal obesity*

(waist circumference)

Men

Women

Plus two of the following :

Triglycerides

HDL chol Men

WomenBlood pressure

Fasting plasma glucose

> 90 cm

> 80 cm


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CENTRAL OBESITY ANDMETABOLIC SYNDROME

Hypertension

Diabetes mellitus /Impaired glucose tolerance

Dyslipidaemia(HyperTG, low HDL-C)

CentralObesity

JMFA 27


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PREVALENCE OF METABOLIC SYNDROME

USA 22% of adult population, 47 million

In Asian countries as well as other developingcountries metabolic syndrome suggest to be higher

In Makassar,

Adriansjah and Adam (2003) 30,8% among males

Adam and Adriansjah (2003) difference betweentwo criteria 24,2% NCEP-ATP III, 35,7%modified NCEP-ATP III

A S ifi P l f th M t b li S d


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Prevalence(%

)

20

20-29 30-39 40-49 50-59 60-69 >70

10

40

30

50

0

Ford ES et al. JAMA 2002; 287: 356-359

Age-Specific Prevalence of the Metabolic SyndromeAmong 8,814 US Adults (Age > 20 Years)

(NHANES III, 1988-1994)

WomenMen

Mean SE


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Subjects with metabolic syndrome are high risk for:

- diabetes mellitus

- cardiovascular diseaseFor these reasons, patients with MetS should be treated

Treatment modalities:

- lifestyle modification, diet and exercise- treating the risk factors, lipid abnormalities,

hypertension, hyperglycemia

WHY IS METABOLIC SYNDROMEIMPORTANT?


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TREATMENT OFMETABOLIC SYNDROME


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Diabetes MellitusMetformin, Thiozolidinedione

TREATMENT OF METABOLIC SYNDROME

DyslipidemiaStatins, Fibrates

Hypertension

ACE

inhibitor, ARB, Ca

Channel blocker, HCT


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Kuliah - Obesity - Metabolic Syndrome 2012

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