Morbid obez hastalarda kilo kaybının insulin direnci, bazal metabolizma hızı, antropometrik ölçümler ve tiroid fonksiyonlarına etkisi

Year 2019, Volume: 1 Issue: 4, 99 - 104, 22.09.2019

Şenay Durmaz Ceylan Şuuri Ahsen Ceylan Fatih Eker Aşkın Güngüneş

https://doi.org/10.38053/agtd.586008

Abstract

Giriş ve Amaç: Obez
kişilerde tiroid fonksiyonlarında değişiklik olduğu gösterilmesine rağmen kilo
kaybının tiroid fonksiyonlarına olan etkisi açık değildir. Bu çalışmanın amacı
morbid obeziteli kişilerde kilo kaybının tiroid fonksiyonlarına, antropometik
ölçümlere, bazal metabolizma hızına ve metabolik sendrom parametrelerine olan
etkilerini araştırmaktır.

Gereç ve Yöntem: Çalışmamızda  morbid obezite (BMI≥40 kg/m²) nedeni
ile başvuran kilo verme programına uygun olarak ilk 6 ay içinde kilo kaybı
sağlanan 107 kişinin hastane sisteminde kayıtlı verileri retropektif olarak değerlendirildi.
İlk başvuru sırasında ve ilk 6 ay içinde kilo kaybı sağlandıktan sonra biyoelektriksel
impedans ile antropometrik ölçümleri, bel çevresi, kan basınçları, serbest T3
(FT3), serbest T4 (FT4), TSH, Tiroid ultrasonu, total kolesterol,
LDL-kolesterol, HDL-kolesterol, trigliserid, HOMAIR, glukoz ve  insulin düzeyleri  obesite polikliniğindeki hasta verilerinden kaydedildi.

Bulgular: Morbid
obezli kişilerde kilo kaybı sonrası yağ
kitlesinde (p=0.001), yağ yüzdesinde p=0.001, bazal metabolizma hızında (p=0,01), bel çevresinde (p=0.001) ve BMI (p=0.001) değerlerinde belirgin azalma
sağlandı;kas kitlesi, yağsız vücut kitlesi ve kemik kitlesinde ise değişiklik
saptanmadı; FT4 düzeyinde istatistiksel olarak artma saptanırken (1.23± 0.18
vs. 1.29±0.21 ng/dL, p=0.01), TSH ve FT3 düzeyinde ise anlamlı bir farklılık
bulunmamıştır. Morbid obezitesi olan hastaların kilo kaybı sonrası açlık plazma
glukozunda anlamlı bir farklılık olmazken, açlık plazma insulin düzeyleri (p=0,001)
ve HOMA-IR (p=0,004) değeri anlamlı olarak azaldı. Total kolesterol (p=0,014)
ve HDL kolesterolde (p=0,003) azalma meydana geldi, sistolik kan basıncı
(p=0.0001) ve diastolik kan basıncı da anlamlı olarak azaldı (p=0.001).

Sonuçlar: Bizim
verilerimize göre morbid obeziteli kişilerde kilo kaybı tiroid fonksiyonlarında
yanlızca FT4 düzeyinde artışa neden olmuştur ancak bu minimal artışın klinik
bir önemi bulunmamaktadır. Hastalarımızda kan basıncı azalması, total
kolesterolde azalma, bel çevresinde ve insulin direncinde azalma sağlanmış olup,
kilo kaybı sonrası morbid obeziteleri devam etse bile metabolik sendrom parametrelerinde
ilk 6 ay içinde düzelme olmuştur.

 

Keywords

Morbid obezite, tiroid fonksiyon testleri, kilo kaybı, metabolik sendrom

The effect of weight loss on insulin resistance, basal metabolic rate, anthropometric measurements and thyroid functions in patients with morbid obesity

Abstract

Introduction and Aim: Although the changes in thyroid
functions have been demonstrated in obese subjects, the effect of weight loss
on thyroid functions is not clear in morbid obesity. The aim of this study is
to investigate the effects of weight loss on thyroid functions, anthropometric
measurements, basal metabolic rate and metabolic syndrome parameters in
patients with morbid obesity.

Material and Method: In our study, 107 patients who had lost
weight in the first 6 months in accordance with the weight loss program applied
for morbid obesity (BMI≥40 kg/m²) were evaluated retrospectively.
Anthropometric measurements with bioelectrical impedance, waist circumference,
blood pressures, free T3 (FT3), free T4 (FT4), TSH, thyroid ultrasound, total
cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, Homeostatic Model
Assessment Insulin Resistance (HOMA-IR), glucose and insulin levels
were recorded from patient records in obesity department.

Results: After
weight loss, there were significant decrease in fat mass (p=0.001), fat
percentage (p=001, basal metabolic rate (p=0.01), waist circumference
(p=0.001), and BMI (p=0.001). however, there were no change in muscle mass,
lean body mass and bone mass; there were a statistically significant increase
in mean FT4 level (1.23±0.18 vs. 1.29±0.21 ng / dL, p=0.01), but no significant
differences were found in mean TSH and FT3 levels. There was no significant
difference in fasting plasma glucose after weight loss in patients with morbid
obesity, whereas fasting plasma insulin levels (p=0.001) and HOMA-IR (p=0.004)
decreased significantly. Total cholesterol (p=0.014) and HDL cholesterol
(p=0.003) decreased, systolic blood pressure (p=0.0001) and diastolic blood
pressure decreased significantly (p=0.001)

Conclusions:
According to our data, weight loss in patients with morbid obesity caused an
increase in thyroid function only in FT4 levels, but this minimal increase of FT4
levels does not have clinical significance. Our patients have decreased blood
pressure, total cholesterol, waist circumference, and insulin resistance, and
improved metabolic syndrome parameters within the first 6 months, even if
morbid obesity persisted after weight loss.

Keywords

Morbid obesity, thyroid function tests, weight loss, metabolic syndrome

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