ÖZGE KÜÇÜKERDÖNMEZ, MERVE ŞEYDA KARAÇİL ERMUMCU, Selda SEÇKİNER, EDA KÖKSAL

Tip 2 Diyabetli Bireylerde Abdominal Obezite/Adipozite ve Aterojenik Belirteçlerin Değerlendirilmesi

Amaç: Bu çalışmada tip 2 diabetes mellituslu (DM) bireylerde insülin direnciyle ilişkili olan abdominal obezite/adipozite göstergeleri ile aterojenik indeksin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Bu kesitsel çalışmaya yaşları 18-65 yıl arasında değişen tip 2 DM’li yetişkin 100 gönüllü birey dahil edilmiştir. Bireylere ait genel ve sağlık bilgileri anket formu aracılığıyla alınmıştır. Bireylerin antropometrik ve vücut bileşim ölçümleri araştırmacılar tarafından kurallarına uygun şekilde yapılmıştır. Biyokimyasal bulgularından açlık glukoz, açlık insülin, glukozillenmiş hemoglobin (HbA1c), kan lipit parametreleri alınmıştır. Abdominal obezitenin değerlendirilmesinde bel kalça oranı ve bel boy oranı, abdominal adipozitenin değerlendirilmesinde viseral adipozite indeksi (VAİ) ile koniklik indeksi (Kİ) hesaplanmıştır. Ayrıca vücut adipozite indeksi (BAİ) hesaplanmıştır. Ateroskleroz risk değerlendirilmesinde serum aterojenik indeksi (Aİ) kullanılmıştır. Bireylerin insülin direnci değerlendirilmesinde homeostaz model değerlendirmesi (HOMA-IR) hesaplanmıştır. Bulgular: Çalışmaya dahil edilen erkek (%91.2) ve kadın (% 98.5) bireylerin tamamına yakınının şişman olduğu saptanmıştır. Bel boy oranına göre kadınların (%100) tamamının erkeklerin ise %94.1’inin hastalık riskinin yüksek olduğu belirlenmiştir. Aterojenik indeks sınıflamasına göre erkeklerin %85.3’ü, kadınların ise %83.3’ü yüksek riskli ateroskleroz grubundadır. Bireylerin insülin direnciyle Beden Kütle İndeksi (BKİ) (r=0.212, p=0.035), bel çevresi (r=0.222, p=0.027), VAİ (r=0.323, p=0.001), Aİ (r=0.318, p=0.001), viseral yağlanma % (r=0.201, p=0.044), HbA1c (r= 0.297, p=0.003) ve trigliserit düzeylerinin (r=0.289, p=0.004) pozitif ilişkili olduğu saptanmıştır. Bireylerin aterojenik indeks ile abdominal obezite/adipozite göstergeleri arasındaki ilişki değerlendirildiğinde ise erkeklerde Aİ, yaş (r=0.414, p=0.015) ve VAİ (r=0.778, p=0.000) ile kadınlarda ise bel kalça oranı (r=0.250, p=0.043), bel boy oranı (r=0.264, p=0.032), VAİ (r=0.708, p=0.000) ve açlık insülin değeriyle (r=0.271, p=0.006) pozitif ilişkili bulunmuştur. Sonuç: Artmış Aİ tip 2 DM riskinde artışla ilişkili olup kardiyovasküler hastalık gelişimini olumsuz etkilemektedir. Buna bağlı olarak Aİ tip 2 DM’li bireylerde kardiyovasküler hastalık risk tahmininde objektif bir gösterge olarak kullanılabilir. Ancak tip 2 DM bireylerde kardiyovasküler hastalıklar açısından en iyi risk tahminini bulmak için daha ileri çalışmalara gereksinme vardır.

Evaluation of Abdominal Obesity/Adiposity and Atherogenic Predictors in Individuals with Type 2 Diabetes

Aim: This study aimed to evaluate atherogenic index with abdominal obesity/adiposity indicators associated with insulin resistance in individuals with type 2 diabetes mellitus (DM). Subjects and Methods: This cross-sectional study was conducted on 100 patients with type 2 DM aged 18-65 years. The general and health information of individuals was obtained by a questionnaire. Anthropometric and body composition measurements of individuals were applied by the researchers in accordance with its rules. Biochemical findings (fasting glucose, fasting insulin, glycated haemoglobin (HbA1c), and blood lipid parameters) were taken. Waist hip ratio and waist to height ratio were calculated for evaluating abdominal obesity. Visceral adiposity index (VAI) and conicity index (CI) were calculated for evaluating abdominal adiposity and body adiposity index (BAI) was also calculated. Serum atherogenic index (AI) was used for assessment of atherosclerosis risk. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated for evaluation of insulin resistance. Results: Almost all of the men (91.2%) and women (98.5%) were obese. Accordingly depending on waist to height ratio, all of women (100%) and 94.1% of men had high risk of disease. Overall 85.3% of men and 83.3% of women were in high atherosclerosis risk group according to atherogenic index classification. There was a positive correlation between insulin resistance and BMI (r: 0.212; p: 0.035), waist circumference (r=0.222; p=0.027), VAI (r=0.323; p=0.001), AI (r=0.318; p=0.001), visceral adiposity (r=0.201, p=0.044), HbA1c (r=0.297, p=0.003) and triglyceride levels (r=0.289, p= 0.004). There was a positive correlation between AI and age (r=0.414, p=0.015), VAI (r=0.778; p=0.000) in males and waist to hip ratio (r=0.250, p=0.043), waist to height ratio (r=0.264, p=0.032), VAI (r=0.708, p=0.000) and fasting insulin value (r=0.271, p=0.006) in females. Conclusion: Increased AI is associated with increased risk of type 2 DM and it adversely affects the development of cardiovascular disease. AI can be used as an objective indicator in predicting cardiovascular disease risk in individuals with type 2 DM. However, further studies are needed to find the best risk prediction for cardiovascular diseases in individuals with type 2 DM.

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