Sobrepeso e obesidade no diabetes mellitus do tipo 1: prevalência e fatores relacionados
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Data
2022-11
Autores
Valente, Fernando [UNIFESP]
Orientadores
Dib, Sérgio Atala [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivo: Identificar as características do histórico familiar e os fatores de risco para doença cardiovascular (DCV) associados ao sobrepeso e à obesidade em brasileiros com diabetes tipo 1 (DM1).
Métodos: Realizamos análises antropométricas e laboratoriais transversais em jovens com DM1, divididos segundo o status de IMC em peso normal, sobrepeso ou obesidade, e em controles voluntários sem doenças crônicas e sem história familiar de diabetes.
Resultados: Dos 181 participantes com DM1 (idade média de 23.6 ± 5.5 anos), 87 eram mulheres e 94 homens (64%/78% peso normal, 27%/15% sobrepeso e 9%/7% obesidade). Em relação aos homens com sobrepeso e peso normal, os com obesidade tinham idade maior (29.4±3.7 vs 23.2±5.8 vs 22.5±5.3 anos, p=0.01); eram mais propensos a serem negros (57.1% vs 7.1% vs 7.0%); apresentaram níveis mais elevados de triglicerídeos (180±140 vs 74±34 vs 87±57 mg/dL, p=0.03) e pressão arterial (PA) diastólica (85±8 vs 79±9 vs 73±10 mmHg, p=0.01), menor estimated glucose disposal rate (eGDR) (5.4±1.9 vs 6.8±1.9 vs 7.9 ± 1.7 mg/kg/min, p<0.01) e maior prevalência de parentes de primeiro grau com hipertensão (100% vs 57.1% vs 50.7%, p=0.03) e DCV precoce (28.6% vs 7.1% vs 2.7%, p=0.02). Mulheres com obesidade e sobrepeso eram mais predispostas a ter menor eGDR (5.4±2.4 vs 6.1±2.1 vs 8±2.1 mg/kg/min, p<0.01), e mulheres com obesidade eram mais propensas a ter um parente de primeiro grau com obesidade (62.5% vs 47.8% vs 25.5%, p=0.03). Não houve diferença na adiponectina de alto peso molecular (HMW adipo) e na visfatina entre os grupos de IMC de pessoas com DM1. Os polimorfismos da visfatina e do Fat mass and obesity associated gene (FTO) analisados não foram associados ao excesso de peso no grupo com DM1. Com idade semelhante (23.9±3.5 anos) aos participantes com DM1, os controles tinham menor IMC (21.9±2.3 vs 23.9±4.2 kg/m2, p<0.01) e circunferência abdominal (75.9±8.2 vs 85.5±10.6 cm, p<0.01), menor PA sistólica (102±12 vs 115±15 mmHg, p<0.01) e diastólica (66±8 vs 74±10 mmHg, p<0.01), maior HDL (64±19 vs 55±15 mg/dL, p<0.01), maior HMW adipo (15.66±12.09 vs 10.35±10.79 μg/mL, p<0.01) e visfatina (6.75±3.69 vs 2.76±2.81 ng/mL, p<0.01).
Conclusão: Um terço dos jovens com DM1 apresentava sobrepeso ou obesidade. O excesso de peso foi associado à história familiar de obesidade para mulheres e história familiar de DCV precoce ou hipertensão para homens. O IMC foi relacionado à diminuição da sensibilidade à insulina em ambos os sexos, mas apenas os homens com DM1 apresentaram comprometimento metabólico. Nossos dados destacam a importância de considerar o histórico familiar em indivíduos com DM1.
Aim: To identify family background characteristics and cardiovascular disease (CVD) risk factors linked to overweight and obesity in Brazilian with type 1 diabetes (T1D). Methods: We performed cross-sectional anthropometric and laboratory analyses in young individuals with T1D, divided according to BMI status into normal weight, overweight or obesity, and in volunteer controls without chronic diseases and without a family history of diabetes. Results: Among 181 participants with T1D, mean age of 23.6±5.5 years, 87 were women and 94 were men (64%/78% normal weight, 27%/15% overweight and 9%/7% obese). Compared to overweight and normal weight men, obese men were older (29.4±3.7 vs 23.2±5.8 vs 22.5±5.3 years, p=0.01); were more likely to be Black (57.1% vs 7.1% vs 7.0%); had higher triglyceride levels (180±140 vs 74±34 vs 87±57 mg/dL, p=0.03) and diastolic blood pressure (BP) (85±8 vs 79±9 vs 73±10 mmHg, p=0.01), lower estimated glucose disposal rate (eGDR) (5.4±1.9 vs 6.8±1.9 vs 7.9 ± 1.7 mg/kg/min, p<0.01) and higher prevalence of first-degree relatives (FDR) with hypertension (100% vs 57.1% vs 50.7%, p=0.03) and early CVD (28.6% vs 7.1% vs 2.7%, p=0.02). Obese and overweight women were more likely to have lower eGDR (5.4±2.4 vs 6.1±2.1 vs 8±2.1 mg/kg/min, p<0.01), and obese women were more likely to have FDR with obesity (62.5% vs 47.8% vs 25.5%, p=0.03). There were no differences in High Molecular Weight Adiponectin (HMW adipo) and visfatin between the BMI groups of people with T1D. The visfatin and Fat mass and obesity associated gene (FTO) polymorphisms analyzed were not associated with excess weight in this group with DM1. At a similar age (23.9±3.5 years) to people with T1D, controls had lower BMI (21.9±2.3 vs 23.9±4.2 kg/m2, p<0.01) and waist circumference (75.9±8.2 vs 85.5±10.6 cm, p<0.01), lower SBP (102±12 vs 115±15 mmHg, p<0.01) and DPB (66±8 vs 74±10 mmHg, p<0.01), higher HDL (64±19 vs 55±15 mg/dL, p<0.01), higher HMW adipo (15.66±12.09 vs 10.35±10.79 μg/mL, p<0.01) and visfatin (6.75±3.69 vs 2.76±2.81 ng/mL, p<0.01). Conclusion: One third of young people with T1D were overweight or obese. Excess weight was associated with family history (FH) of obesity for women and FH of early CVD or hypertension for men. BMI was related to decreased insulin sensitivity in both genders, but only men with T1D had metabolic impairment. Our data highlight the importance of considering family background in individuals with T1D.
Aim: To identify family background characteristics and cardiovascular disease (CVD) risk factors linked to overweight and obesity in Brazilian with type 1 diabetes (T1D). Methods: We performed cross-sectional anthropometric and laboratory analyses in young individuals with T1D, divided according to BMI status into normal weight, overweight or obesity, and in volunteer controls without chronic diseases and without a family history of diabetes. Results: Among 181 participants with T1D, mean age of 23.6±5.5 years, 87 were women and 94 were men (64%/78% normal weight, 27%/15% overweight and 9%/7% obese). Compared to overweight and normal weight men, obese men were older (29.4±3.7 vs 23.2±5.8 vs 22.5±5.3 years, p=0.01); were more likely to be Black (57.1% vs 7.1% vs 7.0%); had higher triglyceride levels (180±140 vs 74±34 vs 87±57 mg/dL, p=0.03) and diastolic blood pressure (BP) (85±8 vs 79±9 vs 73±10 mmHg, p=0.01), lower estimated glucose disposal rate (eGDR) (5.4±1.9 vs 6.8±1.9 vs 7.9 ± 1.7 mg/kg/min, p<0.01) and higher prevalence of first-degree relatives (FDR) with hypertension (100% vs 57.1% vs 50.7%, p=0.03) and early CVD (28.6% vs 7.1% vs 2.7%, p=0.02). Obese and overweight women were more likely to have lower eGDR (5.4±2.4 vs 6.1±2.1 vs 8±2.1 mg/kg/min, p<0.01), and obese women were more likely to have FDR with obesity (62.5% vs 47.8% vs 25.5%, p=0.03). There were no differences in High Molecular Weight Adiponectin (HMW adipo) and visfatin between the BMI groups of people with T1D. The visfatin and Fat mass and obesity associated gene (FTO) polymorphisms analyzed were not associated with excess weight in this group with DM1. At a similar age (23.9±3.5 years) to people with T1D, controls had lower BMI (21.9±2.3 vs 23.9±4.2 kg/m2, p<0.01) and waist circumference (75.9±8.2 vs 85.5±10.6 cm, p<0.01), lower SBP (102±12 vs 115±15 mmHg, p<0.01) and DPB (66±8 vs 74±10 mmHg, p<0.01), higher HDL (64±19 vs 55±15 mg/dL, p<0.01), higher HMW adipo (15.66±12.09 vs 10.35±10.79 μg/mL, p<0.01) and visfatin (6.75±3.69 vs 2.76±2.81 ng/mL, p<0.01). Conclusion: One third of young people with T1D were overweight or obese. Excess weight was associated with family history (FH) of obesity for women and FH of early CVD or hypertension for men. BMI was related to decreased insulin sensitivity in both genders, but only men with T1D had metabolic impairment. Our data highlight the importance of considering family background in individuals with T1D.
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VALENTE, Fernando. Sobrepeso e obesidade no diabetes mellitus do tipo 1: prevalência e fatores relacionados. 2023. 132 f. Dissertação (Mestrado em Endocrinologia e Metabologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.