Prädisposition – Phänotyp der Adipositas

 

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Zusammenfassung

Adipositas stellt eines der fünf wesentlichen Gesundheitsrisiken moderner Gesellschaften dar und ist mit einer Prävalenz von ca. 20 % in der deutschen Normalbevölkerung eine sehr häufige Erkrankung. Adipositas erhöht das Risiko für Typ 2 Diabetes, Erkrankungen des Herz-Kreislaufsystems, des Stütz- und Bewegungsapparats, der Psyche und andere Organsysteme. Obwohl der Zusammenhang zwischen Adipositas Stoffwechsel- oder Herz-Kreislauf-Folgeerkrankungen epidemiologisch gut belegt ist, scheinen 10–20 % der Personen mit ausgeprägter Adipositas vor diesen Begleiterkrankungen geschützt zu sein. Diese Gruppe metabolisch gesunder Menschen mit Adipositas zeichnet sich gegenüber den Adipositas-Patienten mit hohem Risiko für Stoffwechsel- und Gefäßerkrankungen durch eine erhaltene Insulinsensitivität, geringere Leberverfettung, niedrigere viszerale Fettmasse und normale Fettgewebsfunktion aus. Personen mit metabolisch gesunder Adipositas können durch eine Gewichtsreduktion ihr Adipositas-assoziiertes Risiko nicht deutlich senken. Die bisher in der Klinik noch wenig etablierte Unterscheidung zwischen (metabolisch) gesunder und Hochrisiko-Adipositas ist für eine Stratifizierung der Adipositas-Behandlung wichtig, um Patienten zu identifizieren, die von einer frühzeitigen Lebensstil, pharmakologischen oder chirurgischen Intervention am meisten profitieren würden.

Abstract

Obesity belongs to the five most important health burdens in modern societies and reaches with ~20 % prevalence in Germany epidemic proportions. Obesity significantly increases the risk of developing metabolic (e. g. type 2 diabetes), cardiovascular, orthopaedic, psychologic and other disorders. Despite the well established epidemiologic relationship between obesity and these co-morbidities, there is a subgroup of metabolically healthy obese patients, which seems to be protected against metabolic and cardiovascular obesity related disorders. Compared to metabolically unhealthy or high risk obese patients, metabolically healthy obese individuals are characterized by preserved insulin sensitivity, lower liver fat content, lower visceral fat mass, as well as normal adipose tissue function. Noteworthy, metabolically healthy obese individuals do not significantly improve their obesity-associated risk for the development of type 2 diabetes and vascular diseases. Therefore, distinction between metabolically healthy from high-risk obese phenotypes will facilitate the identification of the obese person who will benefit the most from early lifestyle, pharmacological or bariatric surgery interventions. A stratified treatment approach considering these different obesity phenotypes should be introduced into clinical management of obese patients.

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