대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)

  • 제49권3호
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  • Pages.248-255
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  • 2017
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  • 1738-3544(pISSN)
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  • 2288-1662(eISSN)
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)
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대사적으로 건강한 비만남성에서 간 효소의 임상적 의의

The Clinical Implications of Hepatic Enzymes in Metabolically Healthy Obese Men

  • Shin, Kyung-A (Department of Clinical Laboratory Science, Shinsung University)
  • 투고 : 2017.06.29
  • 심사 : 2017.08.03
  • 발행 : 2017.09.30
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초록

대사적으로 건강한 비만인(metabolically healthy obese, MHO)은 대사적 합병증을 동반하지 않으며, 과도한 체지방에도 불구하고 인슐린 감수성을 유지하는 비만의 표현형이다. 이 연구는 20세 이상 70세 이하의 남성을 대상으로 비만과 대사적 이상 유무에 따라 MHNO, MHO와 MAO군으로 분류하여 간 효소의 차이를 알아보고 대사적으로 건강한 비만남성에서 간 효소가 대사적 이상을 예측할 수 있는 지표인지 그 임상적 의의를 확인하고자 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 대상자 9,683명 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 MHO군에서 통계적으로 유의하게 낮았으나(각각 p<0.001), MHO군은 MHNO군보다는 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.

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.

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참고문헌

  1. Karelis AD, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes Metab. 2004;30(6):569-572. https://doi.org/10.1016/S1262-3636(07)70156-8
  2. Messier V, Karelis AD, Robillard ME, Bellefeuille P, Brochu M, Lavoie JM, et al. Metabolically healthy but obese individuals: relationship with hepatic enzymes. Metabolism. 2010;59(1): 20-24. https://doi.org/10.1016/j.metabol.2009.06.020
  3. Messier V, Karelis AD, Prud'homme D, Primeau V, Brochu M, Rabasa-Lhoret R. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women. Obesity (Silver Spring). 2010;18(5):911-917. https://doi.org/10.1038/oby.2009.364
  4. Karelis AD, Faraj M, Bastard JP, St-Pierre DH, Brochu M, Prud'homme D, et al. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab. 2005;90(7):4145-4150. https://doi.org/10.1210/jc.2005-0482
  5. Shea JL, King MT, Yi Y, Gulliver W, Sun G. Body fat percentage is associated with cardiometabolic dysregulation in BMI-defined normal weight subjects. Nutr Metab Cardiovasc Dis. 2012;22(9):741-747. https://doi.org/10.1016/j.numecd.2010.11.009
  6. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, et al. 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. 2008;168(15):1617-1624. https://doi.org/10.1001/archinte.168.15.1617
  7. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-3021. https://doi.org/10.1001/jama.284.23.3015
  8. Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13(5):447-451. https://doi.org/10.1097/00002281-200109000-00018
  9. Frezza EE, Wachtel MS, Chiriva-Internati M. Influence of obesity on the risk of developing colon cancer. Gut. 2006;55(2): 285-291. https://doi.org/10.1136/gut.2005.073163
  10. Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168(15): 1609-1616. https://doi.org/10.1001/archinte.168.15.1609
  11. D'Adamo E, Cali AM, Weiss R, Santoro N, Pierpont B, Northrup V, et al. Central role of fatty liver in the pathogenesis of insulin resistance in obese adolescents. Diabetes Care. 2010;33(8): 1817-1822. https://doi.org/10.2337/dc10-0284
  12. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and metaanalysis. JAMA. 2013;309(1):71-82. https://doi.org/10.1001/jama.2012.113905
  13. Beleigoli AM, Boersma E, Diniz Mde F, Lima-Costa MF, Ribeiro AL. Overweight and class I obesity are associated with lower 10-year risk of mortality in Brazilian older adults: the Bambui Cohort Study of Ageing. PLoS One. 2012;7(12):e52111. https://doi.org/10.1371/journal.pone.0052111
  14. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie ME, Messier V, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes (Lond). 2011;35(7): 971-981. https://doi.org/10.1038/ijo.2010.216
  15. Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM, Sullivan LM, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91(8):2906-2912. https://doi.org/10.1210/jc.2006-0594
  16. 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. 2009;18(2):280-284.
  17. Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EA, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001;86(3): 1020-1025. https://doi.org/10.1210/jc.86.3.1020
  18. Mulhall BP, Ong JP, Younossi ZM. Non-alcoholic fatty liver disease: an overview. J Gastroenterol Hepatol. 2002;17(11):1136-1143. https://doi.org/10.1046/j.1440-1746.2002.02881.x
  19. 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. 2001;285(19):2486-2497. https://doi.org/10.1001/jama.285.19.2486
  20. World Health Organization. The Asia-Pacific Perspective: Redefining obesity and its treatment. Sydney, Australia: Health Communications Australia; 2000. p19-20.
  21. Lynch LA, O'Connell JM, Kwasnik AK, Cawood TJ, O'Farrelly C, O'Shea DB. Are natural killer cells protecting the metabolically healthy obese patient? Obesity (Silver Spring). 2009;17(3):601-605. https://doi.org/10.1038/oby.2008.565
  22. Moon K, Sung SH, Chang YK, Park IK, Paek YM, Kim SG, et al. The association between Apolipoprotein E genotype and lipid profiles in healthy woman workers. J Prev Med Public Health. 2010;43(3):213-221. https://doi.org/10.3961/jpmph.2010.43.3.213
  23. Bluher M. The distinction of metabolically 'healthy' from 'unhealthy' obese individuals. Curr Opin Lipidol. 2010;21(1):38- 43. https://doi.org/10.1097/MOL.0b013e3283346ccc
  24. Calori G, Lattuada G, Piemonti L, Garancini MP, Ragogna F, Villa M, et al. Prevalence, metabolic features, and prognosis of metabolically healthy obese Italian individuals: the Cremona Study. Diabetes Care. 2011;34(1):210-215. https://doi.org/10.2337/dc10-0665
  25. Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012;97(7):2482-2488. https://doi.org/10.1210/jc.2011-3475
  26. Bell JA, Kivimaki M, Hamer M. Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. Obes Rev. 2014;15(6):504-515. https://doi.org/10.1111/obr.12157
  27. Hong HC, Lee JS, Choi HY, Yang SJ, Yoo HJ, Seo JA, et al. Liver enzymes and vitamin D levels in metabolically healthy but obese individuals: Korean National Health and Nutrition Examination Survey. Metabolism. 2013;62(9):1305-1312. https://doi.org/10.1016/j.metabol.2013.04.002
  28. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2010;11(1):11-18. https://doi.org/10.1111/j.1467-789X.2009.00623.x
  29. Hanley AJ, Williams K, Festa A, Wagenknecht LE, D'Agostino RB Jr, Haffner SM. Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study. Diabetes. 2005;54(11):3140-3147. https://doi.org/10.2337/diabetes.54.11.3140
  30. Hanley AJ, Williams K, Festa A, Wagenknecht LE, D'Agostino RB Jr, Kempf J, et al. Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2004;53(10):2623-2632. https://doi.org/10.2337/diabetes.53.10.2623
  31. Stefan N, Kantartzis K, Haring HU. Causes and metabolic consequences of fatty liver. Endocr Rev. 2008;29(7):939-960. https://doi.org/10.1210/er.2008-0009
  32. Thamer C, Tschritter O, Haap M, Shirkavand F, Machann J, Fritsche A, et al. Elevated serum GGT concentrations predict reduced insulin sensitivity and increased intrahepatic lipids. Horm Metab Res. 2005;37(4):246-251. https://doi.org/10.1055/s-2005-861411
  33. Frayn KN. Adipose tissue as a buffer for daily lipid flux. Diabetologia. 2002;45(9):1201-1210. https://doi.org/10.1007/s00125-002-0873-y
  34. Mathews ST, Singh GP, Ranalletta M, Cintron VJ, Qiang X, Goustin AS, et al. Improved insulin sensitivity and resistance to weight gain in mice null for the Ahsg gene. Diabetes. 2002; 51(8):2450-2458. https://doi.org/10.2337/diabetes.51.8.2450
  35. Ix JH, Wassel CL, Kanaya AM, Vittinghoff E, Johnson KC, Koster A, et al. Fetuin-A and incident diabetes mellitus in older persons. JAMA. 2008;300(2):182-188. https://doi.org/10.1001/jama.300.2.182
  36. Stefan N, Hennige AM, Staiger H, Machann J, Schick F, Krober SM, et al. Alpha2-Heremans-Schmid glycoprotein/fetuin-A is associated with insulin resistance and fat accumulation in the liver in humans. Diabetes Care. 2006;29(4):853-857. https://doi.org/10.2337/diacare.29.04.06.dc05-1938
  37. Soriguer F, Gutierrez-Repiso C, Rubio-Martin E, Garcia-Fuentes E, Almaraz MC, Colomo N, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013;98(6):2318-2325. https://doi.org/10.1210/jc.2012-4253
  38. Appleton SL, Seaborn CJ, Visvanathan R, Hill CL, Gill TK, Taylor AW, et al. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care. 2013;36(8):2388-2394. https://doi.org/10.2337/dc12-1971
  39. Yoo HJ. Pathogenesis and clinical implications of metabolically healthy obesity (MHO) and metabolically obese normal weight (MONW) subjects. J Korean Diabetes. 2014;15(1):12-16. https://doi.org/10.4093/jkd.2014.15.1.12
  40. Hong SB, Shin KA, Choi WS. Comparison of echocardiogram and clinical profile between metabolically healthy obese (MHO) and non metabolically healthy obese (Non-MHO) subjects. J Exp Biomed Sci. 2012;18(3):260-267.
  41. Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P. Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr. 2010;64(10):1043-1051. https://doi.org/10.1038/ejcn.2010.114

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