Department of Surgery, Donald W. Reynolds Cardiovascular Clinical Research Center, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
Metab Syndr Relat Disord. 2007 Spring;5(1):3-12. doi: 10.1089/met.2006.0016.
Severe obesity is increasingly common in the United States. Very obese persons are at increased risk for the metabolic consequences of obesity. A common multidimensional risk condition associated with obesity is the metabolic syndrome. It is accompanied by increased risk for cardiovascular disease and type 2 diabetes. Clinical manifestations of the metabolic syndrome can vary among obese individuals depending on ethnicity and gender. This study was carried out to determine the pattern of metabolic risk factors in very obese women who were considered candidates for bariatric surgery. Twenty-eight women of this type were compared to 28 nonobese women. Among the former, 11 had categorical hyperglycemia (type 2 diabetes), and 26 had metabolic syndrome by current criteria. Both those with and without diabetes had higher triglycerides and lower high-density lipoprotein (HDL) cholesterol levels than nonobese, but their levels were not categorically abnormal. These changes may have been related to observed lower postheparin lipoprotein lipase activities and higher hepatic lipase activities. In spite of lipid changes, apolipoprotein B levels were only marginally higher in very obese women. In contrast to small changes in lipoprotein metabolism, the obese women were severely insulin resistant, as indicated by hyperglycemia and elevated insulin levels. In addition, they had very high C-reactive protein levels. Thus, the metabolic syndrome, which appears to be typical of very obese women, is characterized by insulin resistance, glucose intolerance and a proinflammatory state. Atherogenic dyslipidemia as a metabolic risk factor in contrast is relatively mild. This pattern is more likely to lead to type 2 diabetes prior to development of clinically evident cardiovascular disease.
在美国，严重肥胖症越来越普遍。非常肥胖的人患肥胖相关代谢并发症的风险增加。与肥胖相关的一种常见多维风险状况是代谢综合征。它伴随着心血管疾病和 2 型糖尿病风险的增加。代谢综合征的临床表现在肥胖个体中因种族和性别而异。这项研究旨在确定被认为是减肥手术候选者的非常肥胖女性的代谢风险因素模式。将 28 名此类女性与 28 名非肥胖女性进行比较。其中 11 人有明确的高血糖（2 型糖尿病），26 人根据当前标准患有代谢综合征。有糖尿病和没有糖尿病的人都有更高的甘油三酯和更低的高密度脂蛋白（HDL）胆固醇水平，比非肥胖者高，但他们的水平并没有明确异常。这些变化可能与观察到的肝脂酶活性升高和肝素后脂蛋白脂肪酶活性降低有关。尽管血脂发生变化，但非常肥胖的女性的载脂蛋白 B 水平仅略高。与脂蛋白代谢的微小变化相反，肥胖女性表现出严重的胰岛素抵抗，表现为高血糖和胰岛素水平升高。此外，她们的 C 反应蛋白水平非常高。因此，代谢综合征似乎是非常肥胖女性的典型特征，其特征是胰岛素抵抗、葡萄糖耐量受损和促炎状态。相反，作为代谢风险因素的动脉粥样硬化性血脂异常相对较轻。这种模式更有可能导致 2 型糖尿病，而不是在出现明显心血管疾病之前。
