RELAÇÃO ENTRE ÍNDICES ANTROPOMÉTRICOS E RESISTÊNCIA À INSULINA EM PACIENTES COM OBESIDADE GRAUS 2 E 3
Palavras-chave:
Obesidade, Resistência à insulina, Antropometria, Circunferência abdominalResumo
Introdução: A resistência à insulina (RI) tem papel central na fisiopatologia da obesidade e doenças associadas, porém não há método universalmente aceito para avaliá-la na prática clínica. Como a RI é associada à composição corporal, é possível estimá-la por meio de índices antropométricos. Objetivo: Correlacionar medidas antropométricas e o índice de adiposidade visceral (IAV) com o modelo de avaliação da homeostase de resistência à insulina (HOMA-IR) em pacientes com obesidade graus 2 e 3. Métodos: Estudo transversal que avaliou pacientes adultos no pré-operatório, que foram submetidos a cirurgia bariátrica no período de 2013 a 2018, no Serviço de Endocrinologia e Metabologia do HU-UFSC, excluindo-se os que faziam uso de insulina. Foram analisadas as correlações do HOMA-IR com o índice de massa corporal (IMC), a circunferência abdominal (CA), a relação cintura estatura (RCE), o índice de conicidade (ICO) e o IAV. Resultados: Foram incluídos 131 pacientes, 81% do sexo feminino, 95% com obesidade grau 3 e 32% com diabetes mellitus tipo 2 (DM2). Os índices que tiveram correlação com o HOMA-IR foram CA e ICO (p < 0,01) e IAV (p = 0,04), sendo que a CA apresentou o maior coeficiente (r = 0,293). Não houve correlação com RCE e IMC. Os indicadores de obesidade central e o HOMA-IR foram maiores nos pacientes com DM2. Conclusões: Os índices CA, ICO e IAV apresentaram correlação significativa com o HOMA-IR. A CA foi superior e configura uma medida simples e sem custo, o que reforça seu uso rotineiro na prática clínica.
Referências
Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Grossman A, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 [cited 2021 Oct 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK279167/
Obesity and overweight [Internet]. [cited 2021 Oct 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Mapa da obesidade [Internet]. Abeso. [cited 2021 Oct 6]. Available from: https://abeso.org.br/obesidade-e-sindrome-metabolica/mapa-da-obesidade/
Freeman AM, Pennings N. Insulin Resistance. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2021 Oct 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507839/
Neeland IJ, Ross R, Després J-P, Matsuzawa Y, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin B, Zambon A, Barter P, Fruchart J-C, Eckel RH, International Atherosclerosis Society, International Chair on Cardiometabolic Risk Working Group on Visceral Obesity. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019 Sep;7(9):715–25.
Tchernof A, Després J-P. Pathophysiology of human visceral obesity: an update. Physiol. Rev. 2013 Jan;93(1):359–404.
Bastien M, Poirier P, Lemieux I, Després J-P. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog. Cardiovasc. Dis. 2014 Feb;56(4):369–81.
Phillips LK, Prins JB. The link between abdominal obesity and the metabolic syndrome. Curr. Hypertens. Rep. 2008 Apr;10(2):156–64.
Vasques AC, Rosado L, Rosado G, Ribeiro R de C, Franceschini S. Indicadores Antropométricos de Resistência à Insulina. :10.
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A. Visceral Adiposity Index. Diabetes Care. 2010 Apr;33(4):920–2.
Minist�rio da Sa�de [Internet]. [cited 2022 Apr 21]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt0424_19_03_2013.html
Geloneze B, Vasques ACJ, Stabe CFC, Pareja JC, Rosado LEFP de L, Queiroz EC de, Tambascia MA. HOMA1-IR and HOMA2-IR indexes in identifying insulin resistance and metabolic syndrome: Brazilian Metabolic Syndrome Study (BRAMS). Arq. Bras. Endocrinol. Metabol. Sociedade Brasileira de Endocrinologia e Metabologia; 2009 Mar;53:281–7.
Geloneze B, Repetto EM, Geloneze SR, Tambascia MA, Ermetice MN. The threshold value for insulin resistance (HOMA-IR) in an admixtured population IR in the Brazilian Metabolic Syndrome Study. Diabetes Res. Clin. Pract. 2006 May;72(2):219–20.
Vasques ACJ, Rosado LEFPL, Alfenas R de CG, Geloneze B. Análise crítica do uso dos índices do Homeostasis Model Assessment (HOMA) na avaliação da resistência à insulina e capacidade funcional das células-beta pancreáticas. Arq. Bras. Endocrinol. Metabol. Sociedade Brasileira de Endocrinologia e Metabologia; 2008 Feb;52:32–9.
WHO Consultation on Obesity (1999: Geneva S, Organization WH. Obesity : preventing and managing the global epidemic : report of a WHO consultation [Internet]. World Health Organization; 2000. Available from: https://apps.who.int/iris/handle/10665/42330
Consensus statements [Internet]. [cited 2022 Apr 3]. Available from: https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome.html
Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int. J. Food Sci. Nutr. 2005 Aug;56(5):303–7.
Valdez R. A simple model-based index of abdominal adiposity. J. Clin. Epidemiol. 1991;44(9):955–6.
Pitanga FJG, Lessa I. Sensibilidade e especificidade do índice de conicidade como discriminador do risco coronariano de adultos em Salvador, Brasil. Rev. Bras. Epidemiol. Associação Brasileira de Saúde Coletiva; 2004 Sep;7:259–69.
Kelles SMB, Diniz M de FHS, Machado CJ, Barreto SM. [The profile of patients undergoing bariatric surgery in the Brazilian Unified National Health System: a systematic review]. Cad. Saude Publica. 2015 Aug;31(8):1587–601.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724–37.
Rao RS, Yanagisawa R, Kini S. Insulin resistance and bariatric surgery: Insulin resistance and bariatric surgery. Obes. Rev. 2012 Apr;13(4):316–28.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J. Am. Coll. Cardiol. 2014 Jul 1;63(25, Part B):2985–3023.
Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H. European Guidelines for Obesity Management in Adults. Obes. Facts. Karger Publishers; 2015;8(6):402–24.
Vasques ACJ, Rosado LEFP de L, Rosado GP, Ribeiro R de CL, Franceschini S do CC, Geloneze B, Priore SE, Oliveira DR de. Habilidade de indicadores antropométricos e de composição corporal em identificar a resistência à insulina. Arq. Bras. Endocrinol. Metabol. 2009 Feb;53(1):72–9.
Barazzoni R, Gortan Cappellari G, Semolic A, Ius M, Zanetti M, Gabrielli A, Vinci P, Guarnieri G, Simon G. Central adiposity markers, plasma lipid profile and cardiometabolic risk prediction in overweight-obese individuals. Clin. Nutr. 2019 Jun 1;38(3):1171–9.
Huang L-H, Liao Y-L, Hsu C-H. Waist circumference is a better predictor than body mass index of insulin resistance in type 2 diabetes. Obes. Res. Clin. Pract. 2012 Oct 1;6(4):e314–20.
Bonneau GA, Pedrozo WR, Berg G. Adiponectin and waist circumference as predictors of insulin-resistance in women. Diabetes Metab. Syndr. Clin. Res. Rev. 2014 Jan 1;8(1):3–7.
Nkwana MR, Monyeki KD, Lebelo SL. Body Roundness Index, A Body Shape Index, Conicity Index, and Their Association with Nutritional Status and Cardiovascular Risk Factors in South African Rural Young Adults. Int. J. Environ. Res. Public. Health. 2021 Jan 1;18(1):E281.
Andrade MD, Freitas MCP de, Sakumoto AM, Pappiani C, Andrade SC de, Vieira VL, Damasceno NRT. Association of the conicity index with diabetes and hypertension in Brazilian women. Arch. Endocrinol. Metab. 2016 Oct;60(5):436–42.
Milagres LC, Martinho KO, Milagres DC, Franco FS, Ribeiro AQ, Novaes JF de. Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population. Ciênc. Saúde Coletiva. ABRASCO - Associação Brasileira de Saúde Coletiva; 2019 May 2;24:1451–61.
Ghosh A, Bose K, Das Chaudhuri AB. Association of food patterns, central obesity measures and metabolic risk factors for coronary heart disease (CHD) in middle aged Bengalee Hindu men, Calcutta, India. Asia Pac. J. Clin. Nutr. 2003;12(2):166–71.
Mantzoros CS, Evagelopoulou K, Georgiadis EI, Katsilambros N. Conicity index as a predictor of blood pressure levels, insulin and triglyceride concentrations of healthy premenopausal women. Horm. Metab. Res. Horm. Stoffwechselforschung Horm. Metab. 1996 Jan;28(1):32–4.
Martínez-Sánchez FD, Vargas-Abonce VP, Rocha-Haro A, Flores-Cardenas R, Fernández-Barrio M, Guerrero-Castillo AP, Meza-Arana CE, Gulias-Herrero A, Gómez-Sámano MÁ. Visceral adiposity index is associated with insulin resistance, impaired insulin secretion, and β-cell dysfunction in subjects at risk for type 2 diabetes. Diabetes Epidemiol. Manag. 2021 Apr 1;2:100013.
Ballesteros-Pomar MD, Diez Rodriguez R, Calleja Fernández A, Vidal Casariego A, Calleja Antolin S, Cano Rodríguez I, Olcoz Goñi JL. PP223-MON VISCERAL ADIPOSITY INDEX IN SEVERELY OBESE PATIENTS: RELATIONSHIP TO INSULIN RESISTANCE, INFLAMMATORY PARAMETERS AND OBESITY TREATMENT. Clin. Nutr. 2013 Sep 1;32:S205.
Lechner K, Lechner B, Crispin A, Schwarz PEH, von Bibra H. Waist-to-height ratio and metabolic phenotype compared to the Matsuda index for the prediction of insulin resistance. Sci. Rep. 2021 Dec;11(1):8224.
Jabłonowska-Lietz B, Wrzosek M, Włodarczyk M, Nowicka G. New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese. Kardiol. Pol. 2017;75(11):1185–91.
Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes. Rev. Off. J. Int. Assoc. Study Obes. 2012 Mar;13(3):275–86.
Ho S-Y, Lam T-H, Janus ED. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann. Epidemiol. 2003 Nov;13(10):683–91.
Abbasi F, Malhotra D, Mathur A, Reaven GM, Molina CR. Body mass index and waist circumference associate to a comparable degree with insulin resistance and related metabolic abnormalities in South Asian women and men. Diab. Vasc. Dis. Res. 2012 Oct;9(4):296–300.
Janghorbani M, Amini M. Comparison of body mass index with abdominal obesity indicators and waist-to-stature ratio for prediction of type 2 diabetes: The Isfahan diabetes prevention study. Obes. Res. Clin. Pract. 2010 Jan 1;4(1):e25–32.
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