Obesita’ e sindrome metabolica
S. Bernasconi
Dipartimento età evolutiva Clinica Pediatrica
Università di Parma
sbernasconi@ao.pr.it
Obesita’ e sindrome metabolica
0 500 1000 1500 2000 2500
2008 2 anni
3 anni
PUBMED
:Obesity
Ultimo anno Ultimi due Ultimi tre Inglese 0-18 anni
Obesita’ e sindrome metabolica
Perché tanto interesse ?
Annals of Human Biology 2008; 35(4): 439–448
Annals of Human Biology 2008; 35(4): 439–448
….In detail, 9% of the women were underweight (n=20), 40% normal
weight (n=91), 34% overweight
(n=77), and 16% obese (n=36)…..
N Engl J Med 2006
N Engl J Med 2007
Obesita’ e sindrome metabolica
Rapporto con la sindrome metabolica
OBESITA’
METABOLIC SYNDROME
(IFG or IGT or diabetes) and/or IR + 2 or more of :
• Waist-hip ratio > 0.85 (F) or >0.9 (M) and/or BMI >30Kg/m2
• Triglycerides ≥150 mg/dl and/or
HDL- C<35 mg/dl (F) or <39 mg/dl (M)
• Blood pressure ≥140/90 mmHg
• Microalbuminuria: urinary albumin excretion rate ≥20µg/min or
albumin/creatinine ratio ≥ 20 mg/g
WHO (1998)
3 or more of:
• Abdominal obesity: waist circumference
> 88 cm (F) or 102 cm (M)
• Triglycerides ≥ 150 mg/dl
• HDL cholesterol < 50 mg/dl (F) or
< 40 mg/dl (M)
• Blood pressure ≥ 130/85 mmHg
• Fasting plasma glucose ≥110 mg/dl
NCEP ATP III (2001)
The Metabolic Syndrome
Proposed definitions
METABOLIC SYNDROME
YES NO
insulinaemia HDL-C
Obesity
OMS NO ATP III
YES glycemia
triglycerids
HDL-C
METABOLIC SYNDROME Summary of concerns :
• Criteria are ambiguous or incomplete. Rationale for thresholds are ill defined
• Value of including diabetes in the definition is questionable
• Insulin resistance as the unifying etiology is uncertain
• No clear basis for including/excluding other CVD risk factors
• CVD risk value is variable and dependent on the specific risks factor present
Joint Statement American Diabetes Asociation and
European Association for the Study of Diabetes
METABOLIC SYNDROME
• The CVD risk associated with the
“syndrome” appears to be no greater the the sum of its parts
• Treatment of the syndrome is no different than the treatment for each of its
components
• The medical value of diagnosing the syndrome is unclear
Diabetes Care 2005
METABOLIC SYNDROME
….rather than discussing the pros and cons of the various definition, I believe it more useful to cease debating their relative
benefits, focusing in the future on
adressing the many unresolved issues concerning the role of insulin resistance and associated abnormalities in human disease…
G.Reaven Circulation 2005
METABOLIC SYNDROME
METABOLIC SYNDROME
METABOLIC SYNDROME
Current concepts of the metabolic syndrome represent the
confluence of two merging streams of research. On the one hand, the metabolic syndrome is viewed by some investigators as
representing largely the metabolic complications of obesity. Without doubt, obesity itself is a major underlying risk factor for both CVD and type 2 diabetes.
It is accompanied by a variety of metabolic aberrations (risk factors)
that more directly produce these two clinical outcomes.
METABOLIC SYNDROME
Another view holds that insulin resistance
is the major underlying risk factor for the
metabolic syndrome.
METABOLIC SYNDROME
METABOLIC SYNDROME
Consensus Group IDF Ped Diab 2007
13.9%
NECP/ATP III Calcaterra, 2007
6.9%
Weiss, 2004
11.6%
Cook, 2003
35.3%
Rodriguez-Moran, 2004 41.3%
Boney, 2004
24.8%
Viner, 2005
7.3%
Invitti, 2006
14.5%
Druet, 2006
Prevalence of MS in Italy with
different
criteria
METABOLIC SYNDROME
Adipose tissue
Adiponectine
Estrogen
IGF-1 IGF-BP3
Adipsine
Interleukins TGF ß
FGF Bone morphogenic IL-6
protein
Resistin
Unknown factors Fatty acids Lysophospholipid
Lactate Adenosine Prostaglandine
Glutamine
Retinol PAI-1
Leptin ASP
ANG-II
Angiotensin TNF α
CRP
Agouti
protein
METABOLIC SYNDROME
METABOLIC SYNDROME
METABOLIC SYNDROME
METABOLIC SYNDROME
Nontraditional Cardiovascular Risk Factors in Pediatric Metabolic Syndrome
Retnakaran R et al, J Pediatr 2006 The non traditional risk factors CRP, adiponectin, leptin and apoB:apoA1 were
strongly correlated with the traditional cardiovascular risk factors
METABOLIC SYNDROME
METABOLIC SYNDROME
As to the fate of metabolic
syndrome, whether it will continue
to dominate our thinking or will be laid to “requiescat in pace”, only time will tell.
E. Goodman J Pediatr 2006
BMJ 2008
JCEM
First published ahead of print September 9, 2008
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
G. P. August et al
JCEM
First published ahead of print
September 9, 2008
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
G. P. August et al
METABOLIC SYNDROME
THANK YOU
JCEM
First published ahead of print September 9, 2008
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
G. P. August et al
JCEM
First published ahead of print September 9, 2008
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
G. P. August et al
9,9 5,7 30,1
43,5
24,5
17,1
11,8 38,7
35,5
26,4 24,9
43,8
10,9 32,1
0 10 20 30 40 50
Tan ner
NCHS
Rolland-Cach era
Must
CDC
Cole
Cacci ari
Obesi (%)
M F
(Valerio G. et al., J Pediatr Endocrinol Metab, 2003)
Prevalenza dell’obesità in scolari napoletani:
confronto tra metodi
IBW%
BMI 95°
BMI 30 BMI 97°
Obesita’ e sindrome metabolica
• 1) Epidemiologia
Obesita’ e sindrome metabolica
1. Definizione
2. Epidemiologia 3. Eziopatogenesi
4. Rapporto con la sindrome metabolica
OBESITA’
Obesita’ e sindrome metabolica
1. Definizione
2. Epidemiologia 3. Eziopatogenesi
4. Rapporto con la sindrome metabolica
OBESITA’
Obesita’ e sindrome metabolica
Obesita’ e sindrome metabolica
• 1) Epidemiologia dell’obesità
• 2) EZIOLOGIA
NATURE 2006
