Información del artículo
La obesidad se define como un aumento de la grasa corporal aunque en la práctica clínica utilizamos el índice de masa corporal (IMC) para identificar a los pacientes con obesidad. Se dice que hay obesidad abdominal cuando la grasa intraabdominal es igual o superior a 130 cm2; sin embargo, en la práctica clínica, la definición de la obesidad central se basa en el perímetro de la cintura ya que existe una buena correlación entre el perímetro de la cintura y la grasa intraabdominal. Aunque no hay un consenso definitivo sobre los puntos de corte, los valores más utilizados son los propuestos por el NCEP-ATP-III.
La obesidad central tiene más trascendencia clínica que la obesidad periférica ya que el tejido adiposo intraabdominal es metabólicamente más activo que el periférico. Así, libera ácidos grasos y citocinas que son la causa de las alteraciones en el metabolismo lipídico y de los hidratos de carbono, lo que facilita la resistencia insulínica. La obesidad central es un componente esencial del síndrome metabólico y un factor de riesgo para el desarrollo de la diabetes mellitus tipo 2 y de la enfermedad cardiovascular.
Palabras clave:
Obesidad central
Diabetes mellitus
Dislipemia
Riesgo cardiometabólico
Obesity is defined as a pathologic increase in the body's adipose content. In clinical practice, obesity is usually estimated by calculating the body mass index (BMI). Central (or abdominal) obesity is defined as an intraabdominal fat area of = 130 cm2, but in clinical practice calculation is based on waist perimeter, which has been shown to correlate with intraabdominal fat area. Although agreement is lacking on cut-off points, the most widely used criteria are those of the NCEP-ATP-III.
Central obesity is clinically more important than peripheral obesity, because intraabdominal fat is more metabolically active than peripheral fat. Intraabdominal fat releases free fatty acids and adipokines, which cause lipid and carbohydrate metabolism disorders, facilitating insulin resistance and chronic inflammation. Central obesity is an essential component of the metabolic syndrome and a major risk factor for the development of both type 2 diabetes mellitus and cardiovascular disease.
Key words:
Central obesity
Diabetes mellitus
Dyslipemia
Cardiometabolic risk
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Bibliografía
[1.]
G. Bray.
Contemporary diagnosis and management of obesity.
Handbooks in HealthCare Co, (1998),
[2.]
G.W. Strain, B. Zumoff.
The relationship of weight-height indices of obesity to body fat content.
J Am Coll Nutr, 11 (1992), pp. 715-718
[3.]
D.C. Frankenfield, W.A. Rowe, R.N. Cooney, J.S. Smith, D. Becker.
Limits of body mass index to detect obesity and predict body composition.
Nutrition, 17 (2001), pp. 26-30
[4.]
T.A. Welborn, M.W. Knuiman, H.T. Vu.
Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton health study.
Int J Obes Relat Metab Disord, 24 (2000), pp. 108-115
[5.]
J.C. Wells, W.A. Coward, T.J. Cole, P.S. Davies.
The contribution of fat and fat-free tissue to body mass index in contemporary children and the reference child.
Int J Obes Relat Metab Disord, 26 (2002), pp. 1323-1328
[6.]
National Institutes of Health. National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The evidence report. Bethesda, June 1999.
[7.]
M.C. Pouliot, J.P. Despres, S. Lemieux, S. Moorjani, C. Bouchard, A. Tremblay, et al.
Waist circumference and abdominal sagital diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women.
Am J Cardiol, 73 (1994), pp. 460-468
[8.]
A. Onat, G.S. Avci, M.M. Barlan, H. Uyarel, B. Uzunlar, V. Sansoy.
Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk.
Int J Obes Relat Metab Disord, 28 (2004), pp. 1018-1025
[9.]
R.P. Stolk, O. Wink, P.M. Zelissen, R. Meijer, A.P. Van Gils, D.E. Grobbee.
Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue.
Int J Obes Relat Metab Disord, 25 (2001), pp. 1346-1351
[10.]
R.P. Stolk, R. Meijer, W.P. Mali, D.E. Grobbee, Y. Van der Graaf.
Secondary manifestations of arterial disease study group. Ultrasound measurements of intraabdominal fat estimate the metabolic syndrome better than do measurements of waist circumference.
Am J Clin Nutr, 77 (2003), pp. 857-860
[11.]
L. Concepción, L. Martí-Bonmatí, R. Aliaga, F. Delgado, C. Morillas, A. Hernández.
Estudio de la grasa abdominal mediante resonancia magnética: comparación con parámetros antropométricos y de riesgo cardiovascular.
Med Clin (Barc), 117 (2001), pp. 366-369
[12.]
J.P. Despres, B. Lamarche.
Low-intensity endurance exercise trainning, plasma lipoproteins and the risk of coronary heart disease.
J Intern Med, 236 (1994), pp. 7-22
[13.]
Examination Committee of Criteria for Obesity Disease in Japan.
New criteria for obesity disease in Japan.
Circ J, 66 (2002), pp. 987-992
[14.]
T.S. Han, G. McNeill, J.C. Seidell, M.E. Lean.
Predicting intra-abdominal fatness from anthropometric measures: the influence of stature.
Int J Obes Relat Metab Disord, 21 (1997), pp. 587-593
[15.]
T. Rankinen, S.Y. Kim, L. Perusse, J.P. Despres, C. Bouchard.
The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis.
Int J Obes Relat Metab Disord, 23 (1999), pp. 801-809
[16.]
J.K. Snell-Bergeon, J.E. Hokanson, G.L. Kinney, D. Dabelea, J. Ehrlich, R.H. Eckel, et al.
Measurement of abdominal fat by CT compared to waist circumference and BMI in explaining the presence of coronary calcium.
Int J Obes Relat Metab Disord, 28 (2004), pp. 1594-1599
[17.]
World Health Organization.
Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity.
WHO, (1998),
[18.]
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 (2001), pp. 2486-2497
[19.]
K.G. Alberti, P. Zimmet, J. Shaw, IDF Epidemiology Task Force Consensus Group.
The metabolic syndrome a new worldwide definition.
Lancet, 366 (2005), pp. 1059-1062
[20.]
E.S. Ford, A.H. Mokdad, W.H. Giles.
Trends in waist circumference among US adults.
Obes Res, 11 (2003), pp. 1223-1231
[21.]
E.E. Alvárez León, L. Ribas Barba, L. Serra Majem.
Prevalencia del síndrome metabólico en la población de la Comunidad Canaria.
Med Clin (Barc), 120 (2003), pp. 172-174
[22.]
T.L. Visscher, J.C. Seidell.
Time trends (1993-1997) and seasonal variation in body mass index and waist circumference in the Netherlands.
Int J Obes Relat Metab Disord, 28 (2004), pp. 1309-1316
[23.]
A.D. Liese, A. Doring, H.W. Hense, U. Keil.
Five year changes in waist circumference, body mass index and obesity in Augsburg, Germany.
Eur J Nutr, 40 (2001), pp. 282-288
[24.]
P.T. James, N. Rigby, R. Leach.
International Obesity Task Force. The obesity epidemic, metabolic syndrome and future prevention strategies.
Eur J Cardiovasc Prev Rehabil, 11 (2004), pp. 3-8
[25.]
B. Balkau, M. Vernay, L. Mhamdi, M. Novak, D. Arondel, S. Vol, DESIR Study Group, et al.
The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French DESIR study.
Diabetes Metab, 29 (2003), pp. 526-532
[26.]
A.J. Scheen.
From obesity to diabetes: why, when and who?.
Acta Clin Belg, 55 (2000), pp. 9-15
[27.]
P.Z. Zimmet.
Challenges in diabetes. Epidemiology from West to the rest.
Diabetes Care, 15 (1991), pp. 232-252
[28.]
E. Ravussin.
Energy metabolism in obesity studies in the Pima Indians.
Diabetes Care, 16 (1993), pp. 232-238
[29.]
P. Bjorntorp.
Abdominal obesity and the metabolic syndrome.
Ann Med, 24 (1994), pp. 465-468
[30.]
B. Larsson.
Obesity and prospective risk of associated diseases.
Metabolic Complications of the Human Obesities, pp. 21-29
[31.]
J.M. Chan, M.J. Stampfer, E.B. Rimm, W.C. Willett, G.A. Colditz.
Obesity, fat distribution and weight gains as risk factors for clinical diabetes in man.
Diabetes Care, 17 (1994), pp. 961-969
[32.]
P.L. De Pablos-Velasco, F.J. Martínez-Martín, F. Rodríguez-Pérez.
Prevalence of obesity in a Canarian community. Association with type 2 diabetes mellitus: the Guia Study.
Eur J Clin Nutr, 56 (2002), pp. 557-560
[33.]
P.L. De Pablos-Velasco, F.J. Martínez-Martín, F. Rodríguez-Pérez, B.J. Ania, A. Losada, P. Betancor.
Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population -comparison of the 1997 ADA and the 1985 WHO criteria. The Guia Study.
Diabet Med, 18 (2001), pp. 235-241
[34.]
J.P. Despres, S. Moorjani, P.J. Lupien, A. Tremblay, A. Nadeau, C. Bouchard.
Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease.
Arteriosclerosis, 10 (1990), pp. 497-511
[35.]
A. Tchernof, B. Lamarche, D. Prud’Homme, A. Nadeau, S. Moorjani, F. Labrie, et al.
The dense LDL phenotype. Association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men.
Diabetes Care, 19 (1996), pp. 629-637
[36.]
V. Large, P. Amer.
Regulation of lipolysis in humans. Pathophysiological modulation in obesity, diabetes, and hyperlipidaemia.
Diabetes Metab, 24 (1998), pp. 409-418
[37.]
P. Amer, J. Bolinder, P. Engfeldt, J. Hellrner, J. Ostman.
Influence of obesity on the antilipolytic effect of insulin in isolated human fat cells obtained before and after glucose ingestion.
J Clin Invest, 73 (1984), pp. 673-680
[38.]
R. Taylor.
Intramuscular triglyceride and muscle insulin sensitivity: evidence for a relationship in nondiabetic subjects.
Metabolism, 45 (1996), pp. 947-950
[39.]
J.A. Simoneau, J.H. Veerkamp, L.P. Turcotte, D.E. Kelley.
Markers of capacity to utilize fatty acids in human skeletal muscle: relation to insulin resistance and obesity and effects of weight loss.
FASEB J, 13 (1999), pp. 2051-2060
[40.]
G.F. Gibbons, K. Islam, R.J. Pease.
Mobilization of triacylglycerol stores.
Biochem Biophys Acta, 1483 (2000), pp. 37-57
[41.]
F. Lonnqvist, A. Thorne, K. Nilsell, J. Hoffstedt, P. Arner.
A pathogenetic role of visceral α-adrenoreceptors in obesity.
Clin Invest, 95 (1995), pp. 1109-1116
[42.]
R. Rosell, E. Belfrage.
Blood circulation in adipose tissue.
Physiol Rev, 59 (1979), pp. 1078-1104
[43.]
J.L. Campra, T.B. Reynolds.
The hepatic circulation.
The liver: biology and pathobiology, pp. 627-645
[44.]
A. Misra, A. Garg, N. Abate, R.M. Peshock, J. Stray-Gundersen, S.M. Grundy.
Relationship of anterior and posterior subcutaneous abdominal fat to insulin sensitivity in nondiabetic men.
Obes Res, 5 (1997), pp. 93-99
[45.]
G.S. Hotamisigil, P. Arner, J.F. Caro, R.L. Atkinson, B.M. Spiegelman.
Increased adipose tissue expression of tumor necrosis factor in human obesity and insulin resistance.
J Clin Invest, 95 (1995), pp. 2409-2415
[46.]
J.S. Flier.
The missing link with obesity?.
Nature, 409 (2001), pp. 307-312
[47.]
A. Gavrila, J.L. Chan, N. Yiannakouris, M. Kontogianni, L.C. Miller, C. Orlova, et al.
Serum adiponectin levels are inversely associated with overall and central fat distribution but are not directly regulated by acute fasting or leptin administration in humans: cross-sectional and interventional studies.
J Clin Endocrinol Metab, 88 (2003), pp. 4823-4831
[48.]
K. Ohashi, N. Ouchi, S. Kihara, T. Funahashi, T. Nakamura, S. Sumitsuji, et al.
Adiponectin I164T mutation is associated with the metabolic syndrome and coronary artery disease.
J Am Coll Cardiol, 43 (2004), pp. 1195-1200
[49.]
H. Waki, T. Yamauchi, J. Kamon, Y. Ito, S. Uchida, S. Kita, et al.
Impaired multimerization of human adiponectin mutants associated with diabetes. Molecular structure and multimer formation of adiponectin.
J Biol Chem, 278 (2003), pp. 40352-40363
[50.]
M. Rebuffe-Scrive, B. Anderson, L. Olbe, P. Bjorntorp.
Metabolism of adipose tissue in introabdominal depots in severely obese men and women.
Metabolism, 39 (1990), pp. 1021-1025
[51.]
V. Large, P. Arner.
Regulation of lipolysis in humans. Pathophysiological modulation in obesity, diabetes, and hyperlipidaemia.
Diabetes Metab, 24 (1998), pp. 409-418
[52.]
G.F. Lewis, A. Carpentier, K. Adeli, A. Giacca.
Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes.
Endocr Rev, 23 (2002), pp. 201-229
[53.]
A.N. Peiris, R.A. Mueller, G.A. Smith, M.F. Struve, A.H. Kissebah.
Splanchnic insulin metabolism in obesity: Influence of body fat distribution.
J Clin Invest, 78 (1986), pp. 1648-1657
[54.]
A.N. Peiris, M.F. Struve, R.A. Mueller, M.B. Lee, A.H. Kissebah.
Glucose metabolism in obesity: influence of body fat distribution.
J Clin Endocrinol Metab, 67 (1988), pp. 760-767
[55.]
E.E. Calle, M.J. Thun, J.M. Petrelli, C. Rodriguez, C.W. Heath Jr.
Body-mass index and mortality in a prospective cohort of US adults.
N Engl J Med, 341 (1999), pp. 1097-1105
[56.]
J.E. Manson, W.C. Willett, M.J. Stampfer, G.A. Colditz, D.J. Hunter, S.E. Hankinson, et al.
Body weight and mortality among women.
N Engl J Med, 333 (1995), pp. 677-685
[57.]
D.B. Allison, K.R. Fontaine, J.E. Manson, J. Stevens, T.B. VanItallie.
Annual deaths attributable to obesity in the United States.
JAMA, 282 (1999), pp. 1530-1538
[58.]
P.W. Wilson, R.B. D’Agostino, L. Sullivan, H. Parise, W.B. Kannel.
Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.
Arch Intern Med, 162 (2002), pp. 1867-1872
[59.]
A. Peeters, J.J. Barendregt, F. Willekens, J.P. Mackenbach, A. Al Mamun, L. Bonneux.
NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis.
Ann Intern Med, 138 (2003), pp. 24-32
[60.]
K.M. Rexrode, V.J. Carey, C.H. Hennekens, E.E. Walters, G.A. Colditz, M.J. Stampfer, et al.
Abdominal adiposity and coronary heart disease in women.
JAMA, 280 (1998), pp. 1843-1848
[61.]
S. Yusuf, S. Hawken, S. Ounpuu, T. Dans, A. Avezum, F. Lanas, et al.
INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
Lancet, 364 (2004), pp. 937-952
[62.]
S. Yusuf, S. Hawken, S. Ounpuu, L. Bautista, M.G. Franzosi, P. Commerford, et al.
INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.
Lancet, 366 (2005), pp. 1640-1649
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