Visceralna gojaznost i metabolički sindrom kod bolesnika sa kolorektalnim adenomima

Abstract

Uvod: Globalno, karcinom debelog creva (CRC) se prema incidenciji nalazi na trećem mestu svih malignih bolesti, a prema mortalitetu povezanim sa malignitetom nalazi se na drugom mestu. Većina slučajeva CRC nastaje progresijom polipa debelog creva. Kod osoba sa umerenim rizikom, ova progresija se odigrava sporo, što omogućava otkrivanje i uklanjanje polipa na vreme. Najčešći put prelaska polipa u CRC je adenom-karcinom sekvenca. Faktori rizika za nastanak CRC i kolorektalnih adenoma (CRA) su: pozitivna porodična anamneza na prisustvo CRC, zapaljenske bolesti creva, pušenje cigareta, sedentarni način života, gojaznost. Literaturni podaci pokazuju da su visceralna gojaznost i metabolički sindrom (MetS) udruženi sa češćom pojavom CRA i CRC. Pacijenti sa MetS i gojazni imaji niži nivo adiponektina, što se može dovesti u vezu sa zapaljenjem i proliferacijom ćelija i samim tim učestvovati u nastanku karcinoma. Izmene životnih i navika u ishrani mogu biti važne u prevenciji malignih bolesti, koje su među glavnim uzročnicima morbiditeta i mortaliteta i u našoj zemlji. Ciljevi: 1) Utvrditi razliku između količine visceralnog masnog tkiva kod pacijenata sa i bez CRA. 2) Utvrditi koja metoda za procenu količine visceralnog masnog tkiva (antropometrijska merenja, bioelektrična impedancija (BIA) ili ultrasonografija (USG)) bolje korelira sa postojanjem CRA. 3) Utvrditi razliku između nivoa serumskog adiponektina i prisustva MetS kod pacijenata sa i bez CRA. 4) Utvrditi da li postoji povezanost između veličine, broja, lokalizacije i patohistoloških karakteristika CRA i MetS i količine visceralnog masnog tkiva. Materijal i metode: Istraživanje je sprovedeno kao studija preseka, a obuhvatila je ispitanike kojima je u periodu od januara 2022. godine do januara 2023. godine na Klinici za gastroenterologiju i hepatologiju Univerzitetskog kliničkog centra Vojvodine urađena totalna kolonoskopija. Ispitivanu grupu činilo je 60 pacijenata, starosti od 40 do 75 godina, kod kojih su endoskopski i histološki utvrđeni CRA. Kontrolnu grupu činilo je 60 pacijenata, starosti od 40 do 75 godina, sa urednim nalazom kolonoskopije. Svi ispitanici u obe grupe popunili su unapred kreirani upitnik i odgovorili na pitanja o: starosti, polu, pušenju cigareta, konzumaciji alkoholnih pića, porodičnoj anamnezi, korišćenju acetilsalicilne kiseline i nesteroidnih antiinflamatornih lekova, fizičkoj aktivnosti, povišenom krvnom pritisku, šećernoj bolesti, sniženom HDL holesterolu, povišenim trigliceridima, lekovima koje koriste. Određivani su sledeći parametri iz seruma ispitanika: koncentracija glukoze, triglicerida, HDL holesterola i adiponektina. Ispitanicima je izmeren krvni pritisak, telesna visina, telesna masa, obim struk, obim kuka, a zatim su izračunati indeks telesne mase i odnos obim struka/obim kuka. Debljina visceralne masti (VFT) merena je ultrazvučno, a za granice visceralnog masnog tkiva uzete su linea alba i prednji zid aorte. Površina visceralne masti (VFA) merena je BIA metodom. Rezultati: VFT merena ultrazvučno je statistički značajno veća kod pacijenata sa CRA u odnosu na pacijente kontrolne grupe, dok razlike u obimu struka, odnosu obim struka/obim kuka i VFA merene BIA metodom između te dve grupe nisu značajne. Nije dobijena statistički značajna razlika u nivou adiponektina u serumu između pacijenata koji imaju CRA i pacijenata kontrolne grupe. MetS je u statistički značajno većoj meri zastupljen kod ispitanika sa CRA nego u kontrolnoj grupi. MetS je statistički značajan prediktor za prisustvo CRA. Osobe koje imaju MetS imaju 2,6 puta veću šansu da imaju i CRA. Nije dobijena statistički značajna razlika u broju, karakteristikama i distribuciji polipa kod pacijenata sa MetS u poređenju sa pacijentima koji nemaju MetS, a razlika ne postoji ni kod pacijenata sa većim obimom struka, većom VFA merenom BIA metodom i većom VFT merenom ultrazvučno u poređenju sa kontrolnom grupom. Zaključak: Rezultati ovog istraživanja su ukazali na značaj visceralne gojaznosti i MetS kod prisustva CRA, ali su ukazali i na potrebu da istraživanja ovog tipa obuhvate veći broj ispitanika, uz dodatne metode procene visceralne gojaznosti i uz određivanje i drugih adipokina, a u cilju bolje kontrole rizika od CRC.

Introduction: Globally, colorectal carcinoma (CRC) ranks third in terms of incidence among all malignancies, and it is the second leading cause of malignancy-related mortality. The majority of CRC cases arise through the progression of colorectal polyps. In individuals with moderate risk, this progression occurs slowly, allowing for the detection and removal of polyps in a timely manner. The most common pathway for the transformation of polyps into CRC is the adenoma-carcinoma sequence. Risk factors for the development of CRC and colorectal adenoma (CRA) include positive family history of CRC, inflammatory bowel diseases, cigarette smoking, sedentary lifestyle, and obesity. Literature data show that patients with metabolic syndrome (MetS) also have an elevated risk of CRC and CRA. Patients with MetS and obesity have lower levels of adiponectin, which can be linked to inflammation and cell proliferation, thus potentially contributing to the development of carcinomas. Changes in lifestyle and dietary habits can be important in the prevention of malignancies, which are among the main contributors to morbidity and mortality in our country. Aims: 1) To determine the difference in the amount of visceral adipose tissue between patients with and without CRA. 2) To establish which method for assessing the quantity of visceral adipose tissue (anthropometric measurements, bioelectrical impedance analysis (BIA), or ultrasonography (USG)) correlates better with the presence of CRA 3) To ascertain the difference in serum adiponectin levels and the presence of MetS in patients with and without CRA. 4) To determine whether there is an association between the size, number, localisation, and histopathological characteristics of CRA, MetS, and the quantity of visceral adipose tissue. Materials and Methods: The study was conducted as a cross-sectional study and included participants who underwent total colonoscopy at the Clinic for Gastroenterology and Hepatology of the University Clinical Center of Vojvodina from January 2022 to January 2023. The study group consisted of 60 patients, aged 40 to 75 years, with endoscopically and histologically confirmed CRA. The control group consisted of 60 patients, aged 40 to 75 years, with normal colonoscopy findings. All participants in both groups completed a pre designed questionnaire and answered questions about their age, gender, cigarette smoking, alcohol consumption, family history, use of aspirin and nonsteroidal anti inflammatory drugs, physical activity, elevated blood pressure, diabetes mellitus, low HDL cholesterol, elevated triglycerides, and medication they use. The following serum parameters were measured in participants: concentration of glucose, triglycerides, HDL cholesterol, and adiponectin. Blood pressure, height, weight, waist circumference, hip circumference were measured for the participants, and the body mass index and waist-to-hip ratio (WHR) were subsequently calculated. Visceral fat thickness (VFT) was measured using ultrasound, while the linea alba and anterior wall of the aorta were chosen as the boundaries of visceral fat tissue. Visceral fat area (VFA) was measured using BIA. Results: 1) VFT measured by ultrasound is statistically significantly higher in patients with CRA compared to patients in the control group, while differences in waist circumference, WHR, and VFA measured by BIA between these two groups are not significant. 2) There is no statistically significant difference in serum adiponectin levels between patients with CRA and the control group. 3) MetS is significantly more prevalent in subjects with CRA compared to the control group. MetS is a statistically significant predictor for the presence of CRA. Individuals with MetS have a 2.6 times higher chance of also having CRA. 4) There is no statistically significant difference in the number, characteristics, and distribution of polyps in patients with MetS compared to patients without MetS. There is also no difference in patients with larger waist circumference, higher VFA measured by BIA, and higher VFT measured by ultrasound compared to the control group. Conclusion: The results of this study have indicated the significance of the presence of MetS and visceral obesity in patients with CRA. However, they have also highlighted the need for further research with a larger number of participants, additional methods for assessing visceral obesity, and determination of levels of other adipokines, in order to better control the risk of CRC.