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Obesity and Metabolic syndrome

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  1. Obesity and Metabolic syndrome FarhadHosseinpanah, M.D. Obesity Research Center Research Institute for Endocrine sciences ShahidBeheshti University of Medical Science 14th January, 2013 Tehran

  2. Outline • Contributing factors • BMI and prevalence of metabolic syndrome • Subphenotypes of obesity • Obesity vs. metabolic syndrome in predicting CVD • Importance of fat distribution • Conclusion

  3. Factors influencing prevalence of metabolic syndrome • Age • Sex • Ethnicity • Fat mass and fat distribution • Nutrition • Physical activity • Birth weight • Genetics • Endocrine factors Endocrinol Metab Clin N Am 33 (2004) 267-282

  4. ARCH INTERN MED/VOL 163, FEB 24, 2003

  5. ARCH INTERN MED/VOL 163, FEB 24, 2003

  6. ARCH INTERN MED/VOL 163, FEB 24, 2003

  7. Multivariable Adjusted ORs for the Metabolic Syndrome Men (n = 5227) ARCH INTERN MED/VOL 163, FEB 24, 2003

  8. Multivariable Adjusted ORs for the Metabolic Syndrome Women (n = 5591) ARCH INTERN MED/VOL 163, FEB 24, 2003

  9. Prevalence of metabolic syndrome among adults 20 years ofage and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006 • Overweight males and females were found, respectively, to be more than 6 and 5.5 times as likely to meet the criteria for MetS compared to underweight and normal weight individuals. • In obese males and females compared to underweight and normal weight individuals these figures spiked to 32 and 17 times, respectively Natl Health Stat Report 2009, 13:1-7

  10. BMI specific prevalence of MS in TLGS (unpublished data) % BMI

  11. A total of 2309 (aged 25-75 years) adults were evaluated during a hospital based cross sectional design in Tehran from November 2004 to January 2008 Archives of Medical Research 39 (2008) 803-808

  12. Obesity= MS

  13. Prevalence of overweight and obesity l N = 8647 ( aged 20-70 years ) F.Azizi et al, Eastern Mediterranean Health Journal(2004), Vol. 10, No. 6

  14. Twin Epidemics in Iran • There is an epidemic of both metabolic syndrome and obesity that has been ongoing in Iran • It's estimated that approximately 6o%of Iranian adults are either overweight or obese. But 30% of them have MS. The prevalence of obesity and overweight is exceeding that of the metabolic syndrome

  15. Obesity is not the only underlying RF for MS Obesity Insulin resistance Genetic Metabolic syndrome

  16. J Clin Endocrinol Metab, February 2007, 92(2):399–404

  17. Subphenotypes of obesity • Metabolically obese normal-weight (MONW) • Metabolically healthy obese (MHO) DIABETES, VOL. 47, MAY 1998

  18. In a cohort of 71 healthy non obese women (21–35 years old), we identified MONW women based on cut points for insulin sensitivity DIABETES, VOL. 48, NOVEMBER 1999

  19. DIABETES, VOL. 48, NOVEMBER 1999

  20. Key points • Higher body fat percentage • Higher subcutaneous and visceral abdominal adiposity • Lower physical activity energy expenditure • No difference in cardiorespiratory fitness was noted between group • Higher predisposition to CAD ?

  21. FACTORS CONTRIBUTING TO METABOLIC OBESITY IN MONW • Central obesity • low VO2 max • Inactivity DIABETES, VOL. 47, MAY 1998

  22. MHO J Clin Endocrino Metab 89: 2569–2575, 2004)

  23. Less visceral fat in MHO J Clin Endocrinol Metab, 2001,86:1020–1025

  24. Obesity as an independent risk factor for CVD ? ObesityCVD Standard RFs Emerging RFs Standard RFs : Blood pressure, total cholesterol HDL cholesterol, and diabetes Emerging RFs: Atherogenic dyslipidemia, insulin resistance, proinflammatory state, prothrombotic state,….. Circulation 2002;105:2696-2698

  25. 26 -Year Incidence of Coronary Heart Disease in Men Incidence/1,000 BMI Levels Adapted from Hubert HB et al. Circulation 1983;67:968-977. Metropolitan Relative Weight of 110 is a BMI of approximately 25.

  26. 26 -Year Incidence of Coronary Heart Disease in Women Incidence/1,000 BMI Levels Adapted from Hubert HB et al. Circulation 1983;67:968-977. Metropolitan Relative Weight of 110 is a BMI of approximately 25.

  27. Overweight Adjusted for age, sex, smoking, and physical activity

  28. Overweight Additionally adjusted for blood pressure and cholesterol

  29. Obesity Adjusted for age, sex, smoking, and physical activity

  30. Obesity Additionally adjusted for blood pressure and cholesterol

  31. VS Metabolic syndrome Body Mass Index CVD DM

  32. A community-based, longitudinal study of 2902 people (55% women, mean age 53 yr) without diabetes or CVD in 1989–1992 followed for up to 11 yr J Clin Endocrinol Metab 91: 2906–2912, 2006

  33. Results • Overall, of 2902 subjects, 2.6% were normal weight with MetS (resembling the MONW phenotype), and 8.1% were obese without MetS (resembling the MHO phenotype). • Among normal-weight subjects, 7.1% had MetS, and among obese subjects, 37.0% did not have MetS

  34. The presence of metabolic risk factors typically associated with obesity augmented risk for incident CVD, regardless of obesity status

  35. The presence of metabolic risk factors typically associated with obesity augmented risk for incident DM, regardless of obesity status

  36. Ann Nutr Metab. 2011;58(2):126-32

  37. The overall prevalence of MS increased from 2.3% and 4.0% in phase I and phase II to 9.6% in phase III

  38. Key message • There was a dramatic 4-fold increase in the prevalence of MS in Tehranian normal weight adult population

  39. Deign: prospective cohort study Participants: 6,215 subjects aged >30 years ,free of cardiovascular disease (CVD) stratified by body mass index and dysmetabolic status Length of F/U : A mean of 8.1 years Outcome: CVD Am J Cardiol 2011;107:412–416

  40. Results • The prevalence of dysmetabolic status in normal-weight, overweight , and obese participants was 12.5%, 47.1%, and 76%,respectively • Overall, of 6,215 subjects, 3.5% and 6.5% Had MNOW and MHO phenotypes respectively

  41. Key message • Normal-weight subjects with dysmetabolic status had higher risk for future CVD compared to healthy obese subjects