Gli obesi metabolicamente normali dovrebbero essere trattati?

  • Raquel Cristina Lopes Assis Universidade Federal de Viçosa (UFV), Viçosa-MG, Brasil.
  • Saulo Moreira Coelho Instituto Nacional do Seguro Social
Parole chiave: Obesità, Obesi metabolicamente normali, Rischio cardiovascolare, Rischio di mortalità

Abstract

La presenza di disordini metabolici varia ampiamente tra gli individui obesi. Un sottogruppo della popolazione obesa sembra essere protetto o più resistente allo sviluppo di anomalie metaboliche associate all'obesità. Questi individui, nonostante l'eccesso di grasso corporeo, hanno un profilo metabolico caratterizzato da una migliore sensibilità all'insulina, assenza di ipertensione e profilo lipidico e ormonale favorevole. Tuttavia, studi recenti indicano che questo profilo metabolico più sano non si traduce in un minor rischio di mortalità. Il rischio cardiovascolare degli individui obesi metabolicamente normali è superiore a quello degli individui eutrofici e sono ancora soggetti alle complicanze non metaboliche dell'obesità. Si conclude che gli interventi mirati al controllo del peso corporeo sono indicati per tutti i soggetti obesi.

Biografie autore

Raquel Cristina Lopes Assis, Universidade Federal de Viçosa (UFV), Viçosa-MG, Brasil.

Médica graduada pela Universidade Federal de Minas Gerais, pós-graduanda em Endocrinologia e Metabologia, mestranda em Ciência da Nutrição na Universidade Federal de Viçosa.

Saulo Moreira Coelho, Instituto Nacional do Seguro Social

Médico perito do Instituto Nacional do Seguro Social, tí­tulo de especialista em Medicina do Trabalho, graduação em Medicina na Universidade Federal de Minas Gerais

Riferimenti bibliografici

-Aguilar-Salinas, C.A.; Garcia, E.G.; Robles, L.; Riano, D.; Ruiz-Gomez, D.G.; Garcia-Ulloa, A.C.; et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. Vol. 93. 2008. p. 4075-4079.

-Arnlov, J.; Ingelsson, E.; Sundstrom, J.; Lind, L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-agedmen. Circulation. Vol. 121. p. 230-236. 2010.

-Chen, P.C.; Sung, F.C.; Su, T.C.; Chien, K.L.; Hsu, H.C.; Lee, Y.T. Two-year change in body mass index and subsequent risk of hypertension among men and women in a Taiwan community. J Hypertens. Vol. 27. p. 1370-1376. 2009.

-Despres, J.P.; Cartier, A.; Cote, M.; Arsenault, B.J. The concept of cardiometabolic risk: bridging the fields of diabetology and cardiology. Ann Med. Vol. 40. p. 514-523. 2008a.

-Despres, J.P.; e colaboradores. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. Vol. 28. p. 1039-1049. 2008b.

-Elisha, B.; Karelis, A.D.; Imbeault, P.; Rabasa-Lhoret, R. Effect of acute hyperinsulinemia on total and high molecular weight adiponectina concentration in metabolically healthy but obese postmenopausal women: a Montreal Ottawa New Emerging Team study (MONET). Diabetes Metab. Vol. 36. p. 319-321. 2010.

-Flegal, K.M.; Carroll, M.D.; Ogden, C.L.; Curtin, L.R. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. Vol. 303. p. 235-241. 2010.

-Genelhu, V.A.; Celoria, B.M.; Duarte, S.F.; Cabello, P.H.; Francischetti, E.A. Not all obese subjects of multiethnic origin are at similar risk for developing hypertension and type-2 diabetes. Eur J Intern Med. Vol. 20. p. 289-295. 2009.

-Guh, D.P.; Zhang, W.; Bansback, N.; Amarsi, Z.; Birmingham, C.L.; Anis, A.H. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health. Vol. 9. p. 88. 2009.

-Hahn, K.M.E.; Bondy, M.L.; Selvan, M.; Lund, M.J.; Liff, J.M.; Flagg, E.W.; Brinton, L.A.; Porter, P.; Eley, J.W.; Coates, R.J. Factors associated with advanced disease stage at diagnosis in a population-based study of patientswith newly diagnosed breast cancer.Am J Epidemiol. Vol. 166. p. 1035-1044. 2007.

-Hammoud, A.O.; Walker, J.M.; Gibson, M.; Cloward, TV.; Hunt, S.C.; Kolotkin, R.L.; Adams, T.D.; Meikle, A.W. Sleep Apnea, Reproductive Hormones and Quality of Sexual Life in Severely Obese Men. Obesity. Vol. 19. p. 1118-1123. 2011.

-Hayes, L.; Pearce, M.S.; Firbank, M.J.; Walker, M.;Taylor, R.; Unwin, N.C. Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study. BMC Public Health. Vol. 10. p. 723. 2010.

-Hozawa, A.; e colaboradores. Relationship between BMI and all-cause mortality in Japan: NIPPON DATA80. Obesity (Silver Spring). Vol. 16. p. 1714-1717. 2008.

-Joseph, F.P.; Michael, J.P.; Christopher, J.O.D.; Philip, A.W.; Ralph, D.A. Abstract 1012: Added Value of the Common and Internal Carotid Intima-media Thickness (IMT) for the Prediction of Cardiovascular Events: The Framingham Offspring Study. Circulation. Vol. 120. p. S425. 2009.

-Karelis, A.D. Metabolically healthy but obese individuals. Lancet. Vol. 372. p. 1281-1283. 2008.

-Karelis, A.D.; e colaboradores. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab. Vol. 90. p. 4145-4150. 2005.

-Kim,C.S.; e colaboradores. Circulating levels of MCP-1 and IL-8 are elevated in human obese subjects and associated with obesity-related parameters. Int J Obes (London). Vol. 30. p. 1347-1355. 2006.

-Knudson, J.D.; Dincer, U.D.; Zhang, C.; Swafford, A.N.; Koshida, R.; PicchiA, F.M.; Dick, G.M.; Tune, J.D. Leptin receptors are expressed in coronary arteries, and hyperleptinemia causes significant coronary endothelial dysfunction. Am J Physiol Heart Circ Physiol. Vol. 289. Núm. 1. p. 48-56. 2005.

-Kuk, J.F.; Ardern, C.I. Are Metabolically Normal but Obese Individuals at Lower Risk for All-Cause Mortality? Diabetes Care. Vol. 32. p. 2297-2299. 2009.

-Lakoski, S.G.; Cushman, M.; Siscovick, D.S.; Blumenthal, R.S.; Palmas, W.; Burke, G.; Herrington, D.M. The relationship between inflammation, obesity and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis (MESA). Journal of Human Hypertension. Vol. 25 . p. 73-79. 2011.

-Lihn, A.S.; Bruun, J.; He, G.; Pedersen, S.B.; Jensen P.F.; Richelsen B. Lower expression of adiponectin mRNA in visceral adipose tissue in lean and obese subjects. Mol Cell Endocrinol. Vol. 219. p. 9-15. 2004.

-Magkos, F.; Fabbrini, E.; Mohammed, B.S.; Patterson, B.W.; Klein, S. Increased whole-body adiposity without a concomitant increase in liver fat is not associated with augmented metabolic dysfunction. Obesity (Silver Spring). Vol. 18. p. 1510-1515. 2010.

-Mattace-Raso, F.U.; Van der Cammen, T.J.; Hofman, A.; Van Popele, N.M.; Bos, M.L.; Schalekamp, M.A.; Asmar, R.; Reneman, R.S.; Hoeks, A.P.; Breteler, M.M.; Witteman, J.C. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. Vol.113. 5. p. 657-663. 2006.

-Matsuo, T.; Sairenchi, T.; Suzuki, K.; Tanaka, K.; Muto, T. Long-term stable obesity increases risk of hypertension. International Journal of Obesity. Vol. 35. p. 1056-1062. 2011.

-Marini, M.A.; e colaboradores. Metabolically healthy but obese women have an intermediate cardiovascular risk profile between healthy nonobese women and obese insulin-resistant women. Diabetes Care. Vol. 30. p. 2145-2147. 2007.

-Marzullo,P.; e colaboradores. The relationship between active ghrelin levels and human obesity involves alterations in resting energy expenditure. J Clin Endocrinol Metab. Vol. 89. p. 936-939. 2004.

-Meigs, J.B.; e colaboradores. Body mass index, metabolic syndrome, and risk of type-2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. Vol. 91. p. 2906-2912. 2006.

-Park, J.; e colaboradores. Obesity phenotype and cardiovascular changes. Journal of Hypertension. Vol. 29. p. 1765-1772. 2011.

-Peelman, F.; Waelput, W.; Iserentant, H.; Lavens, D.; Eyckerman, S.; Zabeau, L.; Tavernier, J. Leptin: linking adipocyte metabolism with cardiovascular and autoimmune diseases. Prog Lipid Res. Vol. 43. 4. p. 283-301. 2004.

-Percik, R.; Stumvoll, M. Obesity and cancer. Exp Clin Endocrinol Diabetes. Vol. 117. 10. p. 563-566. 2009.

-Petry, N.M.; Barry, D.; Pietrzak, R.H.; Wagner, J.A. Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine. Vol. 70. p. 288-297. 2008.

-Primeau, V.; Coderre, L.; Karelis, A.D.; Brochu, M.; Lavoei, M.E.; Messier, V.; Sladek, R.; Rabasa-Lhoret, R. Characterizing the profile of obese patients who are metabolically healthy. International Journal of Obesity. Vol. 35. p. 971-981. 2011

-Puhl, R.; Brownell ,K.D. Bias, discrimination, and obesity. Obesity. Vol. 9. p. 788-805. 2001.

-Reijman, M.; Pols, H.A.J.; Bergink, A.P.; Hazes, J.M.W, Belo, J.N.; Lievense, A.M.; Bierma S.M.A. Body mass index associated with onset and progression of osteoarthritis of the kneebut not of the hip: The Rotterdam Study. Ann Rheum Dis. Vol. 66. p. 158-162. 2007.

-Rider, J.O.; Francis, J.M.; Mohammed, K.A.; Robinson, M.; Neubauer,S. Left ventricular structural changes in subjects with severe uncomplicated obesity are reversible with significant weight loss. A one year follow up study. Journal of Cardiovascular Magnetic Resonance. Vol. 10. Suppl 1. p. A319. 2008a.

-Rider,J.O.;Francis,J.M.;Mohammed,K.A.;Robinson, M.;Neubauer,S. Weight loss reverses aortic distensibility changes in subjects with severe uncomplicated obesity. a one year follow up study. Journal of Cardiovascular Magnetic Resonance. Vol. 10. Suppl 1. p.A6. 2008b.

-Robinson, M.R.; Freestone, M.S.; Leeson, P.; Channon, K.M.; Clarke, K.; Neubauer, S.; Wiesmann, F. Uncomplicated obesity is associated with abnormal aortic function assessed by cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance. Vol.10. p. 10-18. 2008.

-Schafer, K.; Halle, M.; Goeschen, C.; Dellas, C.; Pynn, M.; Loskutoff, D.J.; Konstantinides, S.Leptin promotes vascular remodeling and neointimal growth in mice. Arterioscler Thromb Vasc Biol. Vol. 24. 1. p. 112-117. 2004.

-Singhal, A.; Farooqi, I.S.; Cole, T.J.; O'Rahilly, S.; Fewtrell, M.; Kattenhorn, M.; Lucas, A, Deanfield, J.Influence of leptin on arterial distensibility: a novel link between obesity and cardiovascular disease? Circulation. Vol. 106. 15. p. 1919-1924. 2002.

-Shin, M.J.; Hyun, Y.J.; Kim, O.Y.; Kim, J.Y.; Jang, Y.; Lee, J.H. Weight loss effect on inflammation and LDL oxidation inmetabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women. IntJ Obes (London). Vol. 30. p. 1529-1534. 2006.

-Shuger, S.L.; Sui, X.; Church, T.S.; Meriwether, R.A.; Blair, S.N. Body mass index as a predictor of hypertension incidence among initially healthy normotensive women. Am J Hypertens. Vol. 21. p. 613-619. 2008.

-St-Pierre DH.; e colaboradores. Association of acylated and nonacylated ghrelin with insulin sensitivity in overweight and obese postmenopausal women. J Clin Endocrinol Metab. Vol. 92. p. 264-269. 2007.

-Stefan N.; e colaboradores. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. Vol. 168. p. 1609-1616. 2008.

-Succurro, E.; e colaboradores. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals. Obesity (Silver Spring). Vol. 16. p. 1881-1886.2008.

-Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. Vol. 106. p.3143-3421.2002.

-Yamauchi, T.; e colaboradores. Cloning of adiponectin receptors that mediate antidiabeticmetaboliceffects. Nature. Vol. 423. p. 762-769. 2003.

-Wildman, R.P.; Mackey, R.H.; Bostom, A.; Thompson, T.; Sutton-Tyrrell, K. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension. Vol. 42. Núm. 4. p. 468-473. 2003.

-Wildman, R.P.; e colaboradores. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes amongthe US population (NHANES 1999-2004). Arch Intern Med. Vol. 168. p. 1617-1624. 2008.

Pubblicato
2012-05-03
Come citare
Lopes Assis, R. C., & Coelho, S. M. (2012). Gli obesi metabolicamente normali dovrebbero essere trattati?. Giornale Brasiliano Di obesità, Nutrizione E Perdita Di Peso, 6(31). Recuperato da https://www.rbone.com.br/index.php/rbone/article/view/12
Fascicolo
V. 6 N. 31 (2012)
Sezione
Articoli Scientifici - Original

Gli autori che pubblicano in questa rivista accettano i seguenti termini:

Gli autori mantengono i diritti d'autore e concedono alla rivista il diritto di prima pubblicazione, con l'opera contemporaneamente concessa in licenza con una licenza di attribuzione Creative Commons BY-NC che consente la condivisione dell'opera con riconoscimento della paternità dell'opera e pubblicazione iniziale in questa rivista.
Gli autori sono autorizzati ad assumere ulteriori contratti separatamente, per la distribuzione non esclusiva della versione dell'opera pubblicata su questa rivista (es. da pubblicare in un repository istituzionale o come capitolo di libro), con riconoscimento della paternità e pubblicazione iniziale in questa rivista .
Gli autori sono autorizzati e incoraggiati a pubblicare e distribuire il loro lavoro online (ad es. in archivi istituzionali o sulla loro pagina personale) in qualsiasi momento prima o durante il processo editoriale, poiché ciò può generare cambiamenti produttivi, nonché aumentare l'impatto e la citazione del pubblicato lavoro (Vedi L'effetto dell'accesso aperto).