대사적으로 건강한 비만남성에서 간 효소의 임상적 의의
The Clinical Implications of Hepatic Enzymes in Metabolically Healthy Obese Men
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
대사적으로 건강한 비만인(metabolically healthy obese, MHO)은 대사적 합병증을 동반하지 않으며, 과도한 체지방에도 불구하고 인슐린 감수성을 유지하는 비만의 표현형이다. 이연구는 20세 이상 70세 이하의 남성을 대상으로 비만과 대사적이상 유무에 따라 MHNO, MHO와 MAO군으로 분류하여 간 효소의 차이를 알아보고 대사적으로 건강한 비만남성에서 간 효소가 대사적 이상을 예측할 수 있는 지표인지 그 임상적 의의를확인하고자 하였다. Executive Summary of The Third Report of The National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) 진단기준으로 대사적 이상을 평가하였으며, 비만 진단기준은 WHO에서 제시하는 아시아인의 기준을 따라 세 군으로 분류하였다. 최종 연구 대상자9,683명 중 대사적으로 건강한 정상체중군(metabolically healthy non obese, MHNO) 2,878명, 대사적으로 건강한 비만군(metabolically healthy obese, MHO) 5,427명, 대사적으로 이상이 있는 비만군(metabolically abnormal obese, MAO) 1,378명 이었다. AST, ALT, GGT는 MAO군보다 MHO군에서통계적으로 유의하게 낮았으나(각각 p＜0.001), MHO군은MHNO군보다는 간 효소치가 높게 나타났다(각각 p＜0.001). 또한 간 효소는 대사증후군 위험요인과 관련이 있으며, 허리둘레, 공복혈당, 총콜레스테롤, 중성지방, HDL-C은 AST, ALT, GGT에 영향을 미치는 위험요인으로 나타났다. 결론적으로 대사적으로 건강한 비만남성에서 간 효소가 대사적 이상을 예측할 수 있는 지표인 것을 확인하였다.
Abstract
Increased hepatic enzymes are associated with insulin resistance, metabolic complications, and type 2 diabetes mellitus. Metabolically healthy obese (MHO) phenotype is not accompanied by metabolic complications and maintains insulin sensitivity, despite excessive body fat. The purpose of this study was to evaluate the clinical implications of hepatic enzymes in MHO men. The diagnostic criteria for MHO were based on NCEP-ATP III and obesity in adults was defined using WHO Asian-Pacific criteria. We used the data from 9,683 obese men aged between 20 and 70 years. The subjects were divided into three groups according to the diagnostic criteria: The metabolically healthy non-obese (MHNO, N=2,878), metabolically healthy obese (MHO, N=5,427), and metabolically abnormal obese (MAO, N=1,378). Obesity criteria were classified according to the standards set forth by WHO Asia-Pacific Criteria. AST, ALT, and GGT were significantly lower in the MHO group than in the MAO group (p＜0.001, respectively). However, the hepatic enzyme levels were higher in the MHO group than in the MHNO group (p＜0.001). Liver enzymes were associated with metabolic syndrome risk factors. Waist circumference, fasting glucose, total cholesterol, triglyceride, and HDL-C were risk factors for metabolic syndrome affecting liver enzymes. In conclusion, hepatic enzymes were found to predict metabolic abnormalities in metabolically healthy obese men.
참고문헌 (41)
- Karelis AD, "Can we identify metabolically healthy but obese individuals (MHO)?", Diabetes Metab, 30(6), pp.569~572 (2004)
- Messier V, "Metabolically healthy but obese individuals:relationship with hepatic enzymes", Metabolism, 59(1), pp.20~24 (2010)
- Messier V, "Identifying metabolically healthy but obese individuals in sedentary postmenopausal women", Obesity (Silver Spring), 18(5), pp.911~917 (2010)
- Karelis AD, "The metabolically healthy but obese individual presents a favorable inflammation profile", J Clin Endocrinol Metab, 90(7), pp.4145~4150 (2005)
- Shea JL, "Body fat percentage is associated with cardiometabolic dysregulation in BMI-defined normal weight subjects", Nutr Metab Cardiovasc Dis, 22(9), pp.741~747 (2012)
- Wildman RP, "The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004)", Arch Intern Med, 168(15), pp.1617~1624 (2008)
- Peppard PE, "Longitudinal study of moderate weight change and sleep-disordered breathing", JAMA, 284(23), pp.3015~3021 (2000)
- Sowers M, "Epidemiology of risk factors for osteoarthritis: systemic factors", Curr Opin Rheumatol, 13(5), pp.447~451 (2001)
- Frezza EE, "Influence of obesity on the risk of developing colon cancer", Gut, 55(2), pp.285~291 (2006)
- Stefan N, "Identification and characterization of metabolically benign obesity in humans", Arch Intern Med, 168(15), pp.1609~1616 (2008)
- D'Adamo E, "Central role of fatty liver in the pathogenesis of insulin resistance in obese adolescents", Diabetes Care, 33(8), pp.1817~1822 (2010)
- Flegal KM, "Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and metaanalysis", JAMA, 309(1), pp.71~82 (2013)
- Beleigoli AM, "Overweight and class I obesity are associated with lower 10-year risk of mortality in Brazilian older adults: the Bambuí Cohort Study of Ageing", PLoS One, 7(12), pp.e52111~ (2012)
- Primeau V, "Characterizing the profile of obese patients who are metabolically healthy", Int J Obes (Lond), 35(7), pp.971~981 (2011)
- Meigs JB, "Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease", J Clin Endocrinol Metab, 91(8), pp.2906~2912 (2006)
- Lee K, "Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans:characteristics and health behaviors", Asia Pac J Clin Nutr, 18(2), pp.280~284 (2009)
- Brochu M, "What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women?", J Clin Endocrinol Metab, 86(3), pp.1020~1025 (2001)
- Mulhall BP, "Non-alcoholic fatty liver disease:an overview", J Gastroenterol Hepatol, 17(11), pp.1136~1143 (2002)
- Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, "Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)", JAMA, 285(19), pp.2486~2497 (2001)
- World Health Organization, "The Asia-Pacific Perspective:Redefining obesity and its treatment", pp.19~20 (2000), Health Communications Australia
- Lynch LA, "Are natural killer cells protecting the metabolically healthy obese patient?", Obesity (Silver Spring), 17(3), pp.601~605 (2009)
- 문기은, "건강한 여성 근로자에서 Apolipoprotein E와 혈중 지질 농도와의 관련성", 예방의학회지, 43(3), pp.213~221 (2010), 대한예방의학회
- Blüher M, "The distinction of metabolically 'healthy' from 'unhealthy'obese individuals", Curr Opin Lipidol, 21(1), pp.38~43 (2010)
- Calori G, "Prevalence, metabolic features, and prognosis of metabolically healthy obese Italian individuals: the Cremona Study", Diabetes Care, 34(1), pp.210~215 (2011)
- Hamer M, "Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality", J Clin Endocrinol Metab, 97(7), pp.2482~2488 (2012)
- Bell JA, "Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies", Obes Rev, 15(6), pp.504~515 (2014)
- Hong HC, "Liver enzymes and vitamin D levels in metabolically healthy but obese individuals: Korean National Health and Nutrition Examination Survey", Metabolism, 62(9), pp.1305~1312 (2013)
- Ibrahim MM, "Subcutaneous and visceral adipose tissue: structural and functional differences", Obes Rev, 11(1), pp.11~18 (2010)
- Hanley AJ, "Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study", Diabetes, 54(11), pp.3140~3147 (2005)
- Hanley AJ, "Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study", Diabetes, 53(10), pp.2623~2632 (2004)
- Stefan N, "Causes and metabolic consequences of fatty liver", Endocr Rev, 29(7), pp.939~960 (2008)
- Thamer C, "Elevated serum GGT concentrations predict reduced insulin sensitivity and increased intrahepatic lipids", Horm Metab Res, 37(4), pp.246~251 (2005)
- Frayn KN, "Adipose tissue as a buffer for daily lipid flux", Diabetologia, 45(9), pp.1201~1210 (2002)
- Mathews ST, "Improved insulin sensitivity and resistance to weight gain in mice null for the Ahsg gene", Diabetes, 51(8), pp.2450~2458 (2002)
- Ix JH, "Fetuin-A and incident diabetes mellitus in older persons", JAMA, 300(2), pp.182~188 (2008)
- Stefan N, "Alpha2-Heremans-Schmid glycoprotein", fetuin-A is associated with insulin resistance and fat accumulation in the liver in humans, 2006, pp.29(4), 853~857
- Soriguer F, "Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study", J Clin Endocrinol Metab, 98(6), pp.2318~2325 (2013)
- Appleton SL, "Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study", Diabetes Care, 36(8), pp.2388~2394 (2013)
- Yoo HJ, "Pathogenesis and clinical implications of metabolically healthy obesity (MHO) and metabolically obese normal weight (MONW) subjects", J Korean Diabetes, 15(1), pp.12~16 (2014)
- 홍승복, "Comparison of Echocardiogram and Clinical Profile between Metabolically Healthy Obese (MHO) and Non Metabolically Healthy Obese (Non-MHO) Subjects", 대한의생명과학회지, 18(3), pp.260~267 (2012), 대한의생명과학회
- Velho S, "Metabolically healthy obesity: different prevalences using different criteria", Eur J Clin Nutr, 64(10), pp.1043~1051 (2010)