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Background & objectives: Although insulin resistance (IR) is a known complication in obesity, the physiological mechanisms linking IR with cardiometabolic risks in obesity have not been well studied. This study was conducted to assess the difference in cardiovascular (CV) risk profile in IR and non-IR (NIR) conditions, and contribution of IR to cardiometabolic risks in pre-obese and obese individuals. Methods: Basal CV, blood pressure variability, autonomic function test and cardiometabolic parameters were recorded in pre-obese (n=86) and obese (n=77) individuals during 2012 and 2015. The association of altered cardiometabolic parameters with homeostatic model for IR (HOMA-IR) in pre-obese and obese groups and with baroreceptor sensitivity (BRS) in IR and NIR groups was calculated by appropriate statistical analysis. Results: Decreased BRS, a known CV risk and cardiometabolic parameters were significant in IR (pre-obese and obese) group compared to the NIR group. Sympathovagal imbalance in the form of increased sympathetic and decreased parasympathetic activities was observed in individuals with IR. There was no significant difference in the level of independent contribution of HOMA-IR to cardiometabolic parameters in pre-obese and obese groups. Adiponectin and inflammatory markers had an independent contribution to BRS in IR group. Interpretation & conclusions: Findings of the present study demonstrated that the intensity of cardiometabolic derangements and CV risk were comparable between IR, pre-obese and obese individuals. Pro-inflammatory state, dyslipidaemia and hypoadiponectinaemia might contribute to CV risk in these individuals with IR. IR could possibly be the link between altered metabolic profile and increased CV risks in these individuals independent of the adiposity status.
ABSTRACT
Introducción: la Medicina Preventiva enfatiza la detección de preenfermedades como la prediabetes mellitus, prehipertensión arterial, preobesidad y prehiperuricemia con el propósito de intervenir oportunamente en el desarrollo de estas afecciones. Objetivos: investigar la prevalencia de preenfermedades en pacientes adultos del Servicio de Consultas de Medicina Interna del Hospital Nacional. Materiales y métodos: estudio observacional descriptivo, de corte transverso, prospectivo, realizado en varones y mujeres, mayores de edad, del Servicio de Consultas de Medicina Interna del Hospital Nacional de noviembre 2012 a noviembre 2013. Fueron medidas variables demográficas, clínicas y laboratoriales. Resultados: ingresaron al estudio 267 sujetos, siendo 64 varones con edad media 52±18 años y 203 mujeres con edad media 53±20 años (p 0,62). Se detectaron las sgtes. preenfermedades: prediabetes mellitus 31%, prehipertensión arterial sistólica 32%, prehipertensión arterial diastólica 46%, preobesidad 36%, prehipercolesterolemia 36%, prehipertrigliceridemia 15% y prehiperuricemia 60%. Conclusiones: las preenfermedades más frecuentes fueron la prehiperuricemia y la prehipertensión arterial diastólica.
Introduction: Preventive Medicine emphasizes the detection of pre-diseases like pre-diabetes mellitus, pre-arterial hypertension, pre-obesity and pre-hyperuricemia with the purpose of intervening opportunely in the development of these diseases. Objectives: To investigate the prevalence of pre-diseases in adult patients of the Consultation Service of Internal Medicine of the National Hospital. Materials and methods: cross-sectional prospective observational descriptive study performed in adult men and women in the Consultation Service of Internal Medicine of the National Hospital from November 2012 to November 2013. Demographic, clinical and laboratory variables were measured. Results: Two hundred sixty seven subjects participated in the study; 64 were men with a mean age of 52±18 years old and 203 women with a mean age of 53±20 (p = 0.62). The following pre-diseases were detected: pre-diabetes mellitus 31%, pre-systolic arterial hypertension 32%, pre-diastolic arterial hypertension 46%, pre-obesity 36%, pre-hypercholesterolemia 36%, pre-hypertriglyceridemia 15% and pre-hyperuricemia 60%. Conclusion: The most frequent pre-diseases were pre-hyperuricemia and pre-diastolic arterial hypertension.
ABSTRACT
<p><b>OBJECTIVE</b>Central obesity is considered to be a central component of metabolic syndrome. Waist circumference (WC) has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese.</p><p><b>METHODS</b>The study involved 923 subjects aged 40-65 years. The metabolic risk factors were defined according to the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and ⋝90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and ⋝85 cm were used as cut-off values of central pre-obesity and central obesity in females.</p><p><b>RESULTS</b>First, WC values corresponding to body mass index (BMI) 24 kg/m2 and visceral fat area (VFA) 80 cm2 were 88.55 cm and 88.51 cm in males, and 81.46 cm and 82.51 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females (81.75 cm). Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels.</p><p><b>CONCLUSION</b>WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors.</p>