Pahwa Roma, Adams-Huet Beverley, Jialal Ishwarlal
California North-state University College of Medicine, Elk Grove, Sacramento, CA, USA.
Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Diabetes Complications. 2017 May;31(5):810-813. doi: 10.1016/j.jdiacomp.2017.02.010. Epub 2017 Feb 27.
The effect of BMI defined obesity on cardio-metabolic features and biomarkers of oxidative stress and inflammation in patients with nascent metabolic Syndrome (MetS) is poorly defined. Hence the aim of this study was to examine the effect of increasing obesity on the cardio metabolic risk profile, pro-oxidant state and pro-inflammatory features in nascent MetS patients without Diabetes or CVD. MetS was diagnosed by ATPIII criteria using waist circumference (WC) as the measure of adiposity. Patients (n=58) were stratified into overweight, obese and extreme obesity groups using BMI cut offs of 25-29.9, 30-39.9kg/m and ≥40kg/m and cardio-metabolic features, circulating and cellular biomarkers of oxidative stress and inflammation were determined and correlated with BMI. None of the main cardio-metabolic features including blood pressure, blood glucose, HDL-cholesterol, triglycerides, HOMA-IR, free fatty acids were increased with increasing BMI. Also none of the biomarkers of oxidative stress (ox-LDL, nitrotyrosine and monocyte superoxide anion release) were increased with increasing BMI. However, significant increase in hsCRP, the soluble TNFR1 and sTNFR2 and leptin, were observed with increasing adiposity. Other inflammatory bio-mediators (IL-1β, IL-6, IL-8, MCP-1, Toll-like receptors 2-4), endotoxin, LBP, sCD14 and HMGB1, adiponectin, and chemerin did not show significant increases with increasing BMI. Leptin, hsCRP, sTNFR1, and sTNFR2 correlated significantly with BMI. In conclusion, capturing the cardio-metabolic cluster of MetS that predisposed to both increased risk of diabetes and CVD, using waist circumference, as one of the 5 diagnostic criteria is sufficient and BMI does not appear to afford any major incremental benefit on the cardio-metabolic risk factors, increased oxidative stress and the majority of both cellular and circulating biomarkers of inflammation.
体重指数（BMI）定义的肥胖对初发代谢综合征（MetS）患者心脏代谢特征以及氧化应激和炎症生物标志物的影响尚不明确。因此，本研究旨在探讨肥胖程度增加对无糖尿病或心血管疾病（CVD）的初发MetS患者心脏代谢风险状况、促氧化状态和促炎特征的影响。采用ATPIII标准，以腰围（WC）作为肥胖指标来诊断MetS。将58例患者根据BMI分为超重、肥胖和极度肥胖组，BMI临界值分别为25 - 29.9、30 - 39.9kg/m²和≥40kg/m²，并测定其心脏代谢特征、氧化应激和炎症的循环及细胞生物标志物，并与BMI进行相关性分析。随着BMI升高，包括血压、血糖、高密度脂蛋白胆固醇、甘油三酯、胰岛素抵抗指数（HOMA-IR）、游离脂肪酸在内的主要心脏代谢特征均未增加。同样，随着BMI升高，氧化应激生物标志物（氧化型低密度脂蛋白、硝基酪氨酸和单核细胞超氧阴离子释放）也未增加。然而，随着肥胖程度增加，观察到高敏C反应蛋白（hsCRP）、可溶性肿瘤坏死因子受体1（sTNFR1）和可溶性肿瘤坏死因子受体2（sTNFR2）以及瘦素显著增加。其他炎症生物介质（白细胞介素-1β、白细胞介素-6、白细胞介素-8、单核细胞趋化蛋白-1、Toll样受体2 - 4）、内毒素、脂多糖结合蛋白（LBP）、可溶性CD14和高迁移率族蛋白B1（HMGB1）、脂联素和趋化素并未随BMI增加而显著升高。瘦素、hsCRP、sTNFR1和sTNFR2与BMI显著相关。总之，将腰围作为五项诊断标准之一来确定易患糖尿病和CVD风险增加的MetS心脏代谢簇就足够了，BMI似乎并未给心脏代谢风险因素、氧化应激增加以及大多数细胞和循环炎症生物标志物带来任何重大的额外益处。
