Obesita e sindrome metabolica

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1 Obesita e sindrome metabolica S. Bernasconi Dipartimento età evolutiva Clinica Pediatrica Università di Parma sbernasconi@ao.pr.it

2 Obesita e sindrome metabolica 2500 PUBMED : 2000 Obesity 1500 Ultimo anno Ultimi due Ultimi tre Inglese 0-18 anni anni 3 anni

3 Obesita e sindrome metabolica Perché tanto interesse?

4 Annals of Human Biology 2008; 35(4):

5 Annals of Human Biology 2008; 35(4): In detail, 9% of the women were underweight (n=20), 40% normal weight (n=91), 34% overweight (n=77), and 16% obese (n=36)..

6 N Engl J Med 2006

7 N Engl J Med 2007

8

9 Obesita e sindrome metabolica OBESITA Rapporto con la sindrome metabolica

10 METABOLIC SYNDROME

11 The Metabolic Syndrome Proposed definitions WHO (1998) (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/m 2 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 3 or more of: NCEP ATP III (2001) 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

12 METABOLIC SYNDROME glycemia triglycerids HDL-C ATP III YES OMS NO insulinaemia HDL-C Obesity NO YES

13 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

14 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

15 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

16 METABOLIC SYNDROME

17 METABOLIC SYNDROME

18 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.

19 METABOLIC SYNDROME Another view holds that insulin resistance is the major underlying risk factor for the metabolic syndrome.

20 METABOLIC SYNDROME

21 METABOLIC SYNDROME Consensus Group IDF Ped Diab 2007

22 Prevalence of MS in Italy with different criteria 41.3% Boney, % NECP/ATP III Calcaterra, % Weiss, % Invitti, % Cook, % Rodriguez-Moran, % Viner, % Druet, 2006

23 METABOLIC SYNDROME

24 Adiponectine Estrogen IGF-1 IGF-BP3 Bone morphogenic protein Resistin Adipsine ANG-II TNF α Angiotensin Adipose tissue Interleukins TGF ß FGF IL-6 ASP Leptin Fatty acids Lysophospholipid Lactate Adenosine Prostaglandine Glutamine PAI-1 Retinol Unknown factors Agouti protein CRP

25

26 METABOLIC SYNDROME

27 METABOLIC SYNDROME

28 METABOLIC SYNDROME

29 METABOLIC SYNDROME

30 Nontraditional Cardiovascular Risk Factors in Pediatric Metabolic Syndrome The non traditional risk factors CRP, adiponectin, leptin and apob:apoa1 were strongly correlated with the traditional cardiovascular risk factors Retnakaran R et al, J Pediatr 2006

31 METABOLIC SYNDROME

32 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

33 BMJ 2008

34 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

35 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

36 METABOLIC SYNDROME THANK YOU

37 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

38 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

39 Obesi (%) Prevalenza dell obesità in scolari napoletani: confronto tra metodi ,7 32,1 IBW% 30,1 35,5 43,543,8 BMI 97 26,4 24,5 BMI 95 17,1 24,9 M F 11,810,9 BMI 30 9,9 5,7 0 Tanner NCHS Rolland-Cachera Must CDC Cole Cacciari (Valerio G. et al., J Pediatr Endocrinol Metab, 2003)

40 Obesita e sindrome metabolica 1) Epidemiologia

41 Obesita e sindrome metabolica OBESITA 1. Definizione 2. Epidemiologia 3. Eziopatogenesi 4. Rapporto con la sindrome metabolica

42 Obesita e sindrome metabolica OBESITA 1. Definizione 2. Epidemiologia 3. Eziopatogenesi 4. Rapporto con la sindrome metabolica

43 Obesita e sindrome metabolica

44 Obesita e sindrome metabolica 1) Epidemiologia dell obesità 2) EZIOLOGIA

45 NATURE 2006

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