Nutri 2022
Revisiting
Metabolic Syndrome
The Importance of Weight Management
Dicky L. Tahapary
Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia
Metabolic, Cardiovascular and Aging Research Centre, The Indonesian Medical Education and Research Institute
METABOLIC SYNDROME
is an accumulation/clustering of several disorders,
which together raise the risk of an individual developing
atherosclerotic cardiovascular disease, insulin resistance, and diabetes mellitus,
and vascular and neurological complications such as a cerebrovascular accident.
Cardiometabolic Risk Factors in Indonesia
Cardiometabolic Risk Factors in Indonesia
Obesity
Prediabetes
Dyslipidemia
Hypertension
Metabolic Syndrome
Indonesian Basic Health Research 2018
Obesity – Diabetes – Cardiovascular Complications
From Adiposity-based Chronic Disease
Dysglycaemia-based Chronic Disease
to Cardiometabolic-based Chronic Disease
The Intermediating Roles of Insulin Resistance and Metabolic Syndrome in
Cardiometabolic-Based Chronic Disease
Adiposity-based Chronic Disease (ABCD)
AACE
Dysglycaemia-based Chronic Disease (DBCD)
AACE
Cardiometabolic-Based Chronic Disease (CMBCD):
Adiposity and Dysglycaemia Drivers
AACE
Comprehensive Overview of Cardio-metabolic based Chronic Disease
AACE
ABCD-DBCD-CMBCD
How to intervene?
DBCD
How do you define clinical obesity?
1. Population Medicine (Epidemiologists)
• BMI: On population basis, correlates with body fat and correlates with a host of comorbidities
For Asians2:
Overweight BMI >23 kg/m2 ; Obesity BMI >25 kg/m2
WC 80cm for women; 90cm for men
2. Clinical Medicine
• WHO definition of obesity: “Condition where excess of abnormal body fat may impair health”
• Cut points are used as screening
• Diagnosis = cut-points + health risk assessment
Clinicians use BMI as a screening tool, and the diagnosis of obesity is a clinical diagnosis,
based on excess abnormal body fat that impairs health
1. Jensen et al. J Am Coll Cardiol. 2014;63:2985-3023; 2. WHO/IASO/IOTF guidelines 2000. Available at: http://www.idi.org.au/obesity_report.htm
Diagnosis: Clinical Component – Complications (3M)
Sleep Apnoea
Depression
Metabolic Cardiovascular diseases
• Stroke
Anxiety • Dyslipidaemia
Mechanical • Hypertension
Asthma • Coronary artery disease
• Pulmonary embolism
Mental • HFpEF
NAFLD
Coronary heart failure
GERD Gallstones
Chronic back pain
Cancers* Infertility
Type 2 diabetes
Physical functioning
Prediabetes
Incontinence
Thrombosis
Knee
osteoarthritis Gout
*Including breast, colorectal, endometrial, oesophageal, kidney, ovarian, pancreatic and prostate.
GERD, gastro-oesophageal reflux disease; HFpEF, heart failure with preserved ejection fraction; NAFLD, non-alcoholic fatty liver disease.
Adapted from Sharma AM. Obes Rev 2010;11:808–9; Guh DP et al. BMC Public Health 2009;9:88; Luppino FS et al. Arch Gen Psychiatry 2010;67:220–9; Simon GE et al. Arch Gen Psychiatry 2006;63:824–30;
Church TS et al. Gastroenterology 2006;130:2023–30; Li C et al. Prev Med 2010;51:18–23; Hosler AS. Prev Chronic Dis 2009;6:A48.
Cut Off + Clinical Diagnosis
Grade + Stage
Canada Guidelines 2020
Obesity Diagnosis
Edmonton Obesity Staging System
Cut Off + Clinical Diagnosis
Obesity Grade “X” + Stage “X”
?
?
Weight loss and Health Improvement
Continuum
INSULIN of Cardiometabolic
RESISTANCE Risk
AND TYPE 2 DIABETES
Metabolic adaptation following weight loss
Adaptations that
resist weight loss
Changes in:
• Hormone levels
(↓ satiety hormones;
↑ hunger hormones)
WEIGHT LOSS • Metabolism WEIGHT REGAIN
(↓ energy expenditure)
Fothergill E et al. Obesity (Silver Spring) 2016;24:1612–19; Sumithran P et al. N Engl J Med 2011;365:1597–604.
In people with diabetes,
weight loss can be more difficult to achieve
Fear of hypoglycemia and
Sedentary
compensatory over-eating;
(foot ulcers, neuropathy, heart disease)
Hypoglycemia increases appetite
Reduction in glycosuria Stress burden of diabetes
Medications (insulin, sulfonylureas, TZDs)
TZD, thiazolidinedione
Russell-Jones et al. Diabetes Obes Metab 2007;9:799–812; Van Gaal et al. Diabetes Care 2015;38:1161–72; Pi-Sunyer Diabetes Care 2005;28:1526–7;Krenke et al. Expert Rev Clin Pharmacol 2014;6:171–8.
Terzipatide?
The role of anti-obesity
medications on cardiometabolic
risk management.
Approved Obesity Pharmacotherapy in Indonesia
- Long Term : Orlistat, Liraglutide (Semaglutide in process)
- Short Term : Diethylpropion
Journal of Obesity & Metabolic Syndrome 2019;28:158-166
Summary
• Obesity is the most important determinants of metabolic syndrome (risk
factors for diabetes mellitus and cardiovascular diseases).
• Weight reduction in metabolic syndrome can also improve other
cardiometabolic risk factors, therefore preventing the development of
diabetes mellitus and cardiovascular diseases.
• Multidisciplinary approach is needed to achieve and maintain weight loss.
Thank You
dicky.tahapary@ui.ac.id - @dr.d.tahapary
Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine,
Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine Univesitas Indonesia (RSCM-FKUI);
Metabolic, Cardiovascular, and Aging Cluster, The Indonesian Medical Education and Research Institute (IMERI) – FKUI;
