Endocrinology Unit, Department of Clinical and Molecular Bio-Medicine, University of Catania Medical School, Garibaldi Hospital, Via Palermo 636, 95122, Catania, Italy.
Acta Diabetol. 2013 Jun;50(3):443-9. doi: 10.1007/s00592-013-0460-3. Epub 2013 Feb 28.
The prevalence of very severe obesity has increased progressively and faster than other classes of obesity over the last years. It is unclear whether the prevalence of obesity-related complications and health risks increases progressively or reaches a plateau above a certain degree of obesity. The aim of our study was to investigate whether the severity of obesity was correlated with the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose, impaired glucose tolerance (IGT), metabolic syndrome (MS), and cardiovascular diseases (CVDs) in a large cohort of patients with different degrees of obesity. A cross-sectional study was conducted in 938 obese patients without a previous diagnosis of diabetes. Patients were assigned to different categories of obesity: mild-moderate obesity (BMI 30-39.9 kg/m(2)), morbid obesity (BMI 40-49.9 kg/m(2)), and super-obesity (SO, BMI ≥50 kg/m(2)). The prevalence of IGF, IGT, screen-detected T2DM, MS, and CVD was higher in SO patients than in the other groups. Interestingly, the association between SO and either MS or CVD was independent of glucose tolerance status, indicating that factors other than glucose metabolism also favor cardio-metabolic complications in obese patients. In patients without screen-detected T2DM (n = 807), insulin sensitivity and secretion OGTT-derived indexes indicated that SO patients had the worst glucose homeostasis relative to the other categories of obesity, which was indicated by the most reduced disposition index in these patients, a predictor of future T2DM. In conclusion, SO patients have an extremely high prevalence of glucose metabolism deterioration, and cardio-metabolic complications are more prevalent in these patients compared to less obese patients.
近年来，极重度肥胖的患病率呈逐渐上升趋势，且上升速度快于其他肥胖类别。目前尚不清楚肥胖相关并发症和健康风险的患病率是否会持续上升，还是在达到一定肥胖程度后达到平台期。我们的研究目的是调查在不同程度肥胖的大样本患者中，肥胖的严重程度是否与 2 型糖尿病（T2DM）、空腹血糖受损、葡萄糖耐量受损（IGT）、代谢综合征（MS）和心血管疾病（CVD）的患病率相关。本研究为横断面研究，共纳入 938 例无糖尿病既往史的肥胖患者。患者被分为不同类别的肥胖：轻度至中度肥胖（BMI 30-39.9 kg/m2）、病态肥胖（BMI 40-49.9 kg/m2）和超级肥胖（SO，BMI≥50 kg/m2）。SO 患者的 IGF、IGT、筛查发现的 T2DM、MS 和 CVD 患病率高于其他组。有趣的是，SO 与 MS 或 CVD 之间的关联独立于葡萄糖耐量状态，表明除了葡萄糖代谢以外的其他因素也有利于肥胖患者的心脏代谢并发症。在无筛查发现的 T2DM 患者（n = 807）中，胰岛素敏感性和分泌 OGTT 衍生指标表明，SO 患者的葡萄糖稳态最差，与其他类别的肥胖相比，这些患者的处置指数最低，这是未来发生 T2DM 的预测指标。总之，SO 患者存在极高的葡萄糖代谢恶化发生率，与较不肥胖的患者相比，这些患者更容易发生心脏代谢并发症。
