Escolar Documentos
Profissional Documentos
Cultura Documentos
New Perspectives on
Obesity
Virend K. Somers MD, PhD
Obesity
Defined by the WHO/NIH as an excess of
body fat percentage of :
> 25% men
> 35% women
BMI
Weight
height2
increased BMI
(> 30 kg/m2)
Background
Obesity Definition
BMI
BMI Advantages
BMI Disadvantages
Obesity Paradox
General
Population
CAD
Population
Results
Interpretation.
Possible Explanations
Low BMI:
Older patients
Cancer and other co-morbidities
Low lean mass and high body fat
Elevated BMI:
Younger
Better treatment?
Preserved or increased lean mass rather than
excess in body fat
Conclusions
Mechanisms underlying this apparently
Objective
Assess the diagnostic performance of
BMI in detecting excess in BF% in
patients with CAD *.
> 25 % in men.
> 35 % in women.
Diagnostic Performance: Sensitivity,
Specificity, correlation coefficients between
BMI and both, BF % and LM.
* BF % estimated using air displacement plethysmography
Methods
A cross-sectional design of 13,601 subjects
Conclusions
Obesity defined as a BMI > 30 kg/m2 misses
Conclusions
Variability of BF%
in People with
BMI 25 kg/m2
(n = 54)
(n = 54)
~55%
~20%
~62%
~18%
Hypotheses
Definitions
Metabolic Syndrome
ATP III criteria
Prevalence of NWO
57.5% in men and 53.5% in women
70.4%
61.4%
61.4%
53.2%
Weighted prevalences
Dose Response
WOMEN
Body fat < 30%
Body fat < 20%
Discussion
Main Findings
~ 45 million Americans
Central
vs.
Non-central obesity
8-weeks
Visit 2
Sleep study
Blood draw
Body composition
8-weeks
Visit 3
Sleep study
Blood draw
Body composition
Image at baseline
5 min
15-30 sec
(image acquisition)
Cuff inflation
Cuff deflation
p = 0.003
p = 0.07
10
8
6
4
2
0
Baseline
Fat gain
Recovery
Case Example
27 yr male, BMI 24.5 kg/m2
Weight gainer
Baseline
Follow-up
Visceral
Adipose Tissue
Subcutaneous
Adipose Tissue
p < 0.0001
p = 0.006
4.5
3.5
p = 0.05
2.5
1.5
0.5
-0.5
-1.5
< 8 cm2
8 16.5 cm2
Potential Mechanisms
Visceral fat accumulation may cause
FREE-FATTY
ACIDS
PRO-INFLAMMATORY
CYTOKINES
Pretest questions:
Who are these innovators
who have transformed
society? What, if anything, do
they have to do with the
obesity epidemic?
McKnight-Eily, JAMA 2008; Krueger Am. J. Epidemiol 2009; Sleep in America 2002; Aguiar
National Bureau of Economic Research 2006
Short sleep
duration and
obesity
Epidemiologic
evidence
1984
1987
NHANES I
Gangswisch, Sleep 2005;
Patel, Am J Epidemiology
2006
1992
HUNGER
5.5
AFTER 2 DAYS OF
4-H BEDTIME
3.5
AFTER 2 DAYS OF
10-H BEDTIME
52
GLOBAL
APPETITE
42
32
22
9
HUNGER (cms)
GLOBAL APPETITE (cms)
11
13 15 17 19
CLOCK TIME
6.0 0.5
39.7 3.0
21
7.2 0.4
47.7 3.4
p level
<0.01
0.010
% change
+24%
+23%
SCREEN
1 d/1 n
1 week
home
actigraphy
ACCLIMATION
3 d/3n
EXPERIMENTAL
8 d/8 n
RECOVERY
4 d/3 n
P=NS
Pretest questions:
Who are these innovators
who have transformed
society? What, if anything, do
they have to do with the
obesity epidemic?
Tim Berners-Lee
(html and www)
2011 MFMER | slide-64
Results
Mean BMI = 31 13 kg/m2 - documented in 14%
83% overweight, 55% obese, 8% morbidly obese
For BMI 30, only 20% had obesity documented
as PMH, current medical problem or final
diagnosis
Results
CanJohnnycomeoutandeat?
Acknowledgements
Francisco Lopez-Jimenez, M.D.
Prachi Singh, Ph.D.
Fatima H. Sert-Kuniyoshi, Ph.D.
Thais Coutinho
Abel Romero-Corral, M.D.
Diane E. Davison, R.N.
Michael D. Jensen, M.D.
Andy Calvin, M.D.
Naima Covassin, Ph.D.
Virend K. Somers, M.D., Ph.D.
Funding: National Institutes of Health
American Heart Association
Thank you