Efekti redukcije telesne mase na promene androgenog statusa, metaboličkog i opstruktivnog apneja sindroma u izrazito gojaznih muškaraca

Abstract

Uvod: Prevаlencijа gojаznosti se drаmаtično povećаvа poslednjih 30 godinа, kаko u rаzvijenim zemljаmа, tаko i u zemljаmа u rаzvoju. Novije studije sve više ukаzuju dа je u gojаznih muškаrаcа snižen ne sаmo ukupni (T), nego i slobodni testosteron (FT) proporcionаlno stepenu gojаznosti. Poslednjih godina sve više naučne pažnje se posvećuje interakciji hipogonadizma, gojaznosti, metaboličkog sindroma (MetS), insulinske rezistencije i diabetes mellitus-a tip 2 u muškaraca. Dаnаs se sve više govori o opstruktivnom аpnejа sindromu (OSAS), kаo jednom od rаzlogа snižene koncentracije testosteronа u gojаznih muškаrаcа. Redukcija telesne mase (TT) je zajednički imenitelj terapije hipoandrogenizma, MetS, insulinske rezistencije i OSAS u gojaznih muškaraca. Cilj ove doktorske disertacije je bio ispitivanje povezanosti koncentracije testosterona u serumu, MetS, insulinske rezistencije i OSAS, kao i ispitivanje uticaja redukcije telesne mase higijensko dijetetskim režimom na koncentraciju testosterona u serumu, MetS, insulinsku rezistenciju i OSAS u uzorku izrazito gojaznih muškaraca. Materijal i metode: U prospektivnu eksperimentalnu studiju sprovedenu na Klinici za endokrinologiju, dijabetes i bolesti metabolizma, KCS su bili uključeni izrazito gojazni muškaraci, indeksa telesne mase (BMI)≥35kg/m2 i starosti između 20 i 60godina. U terapijski program koji se sastojao od naizmenične veoma nisko kalorijske dijete (VLCD) u bolničkim uslovima i nisko kalorijske dijete (LCD) uz doziranu svakodnevnu fizičku aktivnost u vanbolničkim uslovima su učestvovala 82 izrazito gojazna muškarca. Na prijemu su mereni antropometrijski parametri, krvni pritisak, koncentracija lipida i polnih hormona. Rađen je test oralnog opterećenja glukozom u cilju izračunavanja insulinske rezistencije i insulinske senzitivnosti. Svim ispitanicima je rađena polisomnografija. Uslov za ponovno testiranje po istom protokolu je bila redukcija TT za najmanje 10% u odnosu na početnu...

Introduction: Obesity has increased dramatically worldwide over the past 30 years, in both developing and developed countries. Recent studies indicate that obese men have not only low testosterone (T) but also low free testosterone (FT), in proportion to degree of obesity. Many recent reviews pay attention to the link between hypogonadism, obesity, metabolic syndrome (MetS), insuline resistance and type 2 diabetes in male. Obstructive sleep apnea syndrome (OSAS) is emerging as new area of interest that can help to explain low testosterone in obese male. The weight loss have been demonstrated to play a cardinal role in significant improving not only testosterone concentration but also MetS, insulin resistance and OSAS in obese men. The aim of this doctoral dissertation was to analyze the relationship between MetS, serum sex hormone concentrations, OSAS and to evaluate the influence of non-surgical weight reduction on sex hormone levels, MetS and OSAS in severely obese men. Material and methods: This was a prospective clinical study at the Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, which included 20-60 year old severely obese men with Body Mass Index (BMI)≥35kg/m2. Eighty-two extremely obese men, started the therapeutic program, which consisted of two alternating phases: very low calorie diet (VLCD) in hospital conditions and the low calorie diet (LCD) with dosed physical activity in outpatient conditions. Anthropometric parameters, blood pressure, lipid profile and reproductive hormones were measured. Subjects were underwent an oral glucose tolerance test and insulin resistance/sensitivity was evaluated by the homeostasis model assessment and the oral glucose insulin sensitivity. All patients were subjected to polysomnography. After weight reduction by at least 10%, all mentioned assessments were repeated. Results: The prevalence of obesity-related comorbidities in the study population was as following: OSAS 95.12%, MetS 75.61%, type 2 diabetes 23.2%. Total testosterone was subnormal in 40.24% and free testosterone in 12.2% of the subjects. There was significant correlation between abdominal obesity and MetS score (p=0.01), severity of OSAS (p<0.001), T levels (p<0.001), as well as FT levels (p=0.001)...