Fazla Kilolu ve Obez Bireylerde Kardiyovasküler Risk Faktörlerinin Kontrolünde Diyetin Etkinliği

Öz

Amaç: Bu çalışmanın amacı, fazla kilolu ve obez bireylerde uygulanan standardize edilmiş, kişiye uyarlanmış diyet müdahalesinin kardiyovasküler risk faktörleri ve Framingham risk skoru ile hesaplanan 10 yıllık kardiyovasküler hastalık (KVH) riski ile ilişkisini değerlendirmektir. Gereç ve Yöntem: Prospektif ve müdahale temelli olarak planlanan bu çalışma, Ocak–Ağustos 2013 tarihleri arasında bir üniversite hastanesinin aile hekimliği kliniğinde yürütülmüştür. Çalışmaya vücut kitle indeksi ≥25 kg/m² olan 205 birey (178 kadın, 27 erkek) dahil edilmiştir. Katılımcılara altı ay süreyle standardize edilmiş, kişiye uyarlanmış diyet programı uygulanmıştır. Müdahale öncesi ve sonrasında vücut kitle indeksi (VKİ), bel çevresi, kan basıncı, açlık kan şekeri, Hemoglobin A1c (HbA1c), total kolesterol, LDL, HDL ve trigliserid düzeyleri değerlendirilmiştir. On yıllık KVH riski Framingham risk skoru kullanılarak hesaplanmıştır. Diyet öncesi ve sonrası ölçümler eşleştirilmiş gruplarda paired-samples t testi ile karşılaştırılmıştır. Bulgular: Diyet müdahalesi sonrasında VKİ, bel çevresi, kan basıncı, glisemik ve lipit parametrelerinde istatistiksel olarak anlamlı olmayan ancak klinik açıdan olumlu kabul edilebilecek iyileşme eğilimleri izlenmiştir. Kadınlarda HbA1c ≥6,5 oranı %25’ten %10’a, erkeklerde %50’den %40,9’a gerilemiştir. Evre 1 hipertansiyon oranı kadınlarda %22,5’ten %7,3’e, erkeklerde %33,3’ten %11,1’e düşmüştür. En belirgin ve istatistiksel olarak anlamlı bulgu, Framingham risk skorundaki azalmadır (p<0,05). Kadınlarda en belirgin düşüş 60–64 yaş grubunda (%−2,4), erkeklerde 65–69 yaş grubunda (%−2,8) saptanmıştır. Başlangıçta tüm katılımcıların üçte birinde (%33,2) kronik hastalık, %27,8’inde aktif sigara kullanımı mevcuttu; bu risk faktörleri Framingham skorlamasında belirleyici olmuştur. Sonuç: Bu çalışmada, standardize edilmiş ve kişiye uyarlanmış diyet müdahalesi sonrasında kardiyometabolik risk göstergelerinde değişim eğilimleri ve Framingham risk skorunda anlamlı bir azalma ile ilişki saptanmıştır. Ancak kontrol grubunun bulunmaması nedeniyle gözlenen değişikliklerin yalnızca diyet müdahalesine atfedilmesi mümkün değildir. Bulgular, fazla kilolu ve obez bireylerde beslenme temelli müdahalelerin kardiyovasküler risk profilinde iyileşme eğilimi ile ilişkili olabileceğini düşündürmektedir. Bu alanda nedensel ilişkilerin ortaya konulabilmesi için kontrollü ve uzun süreli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• obezite
• kalp ve damar hastalıkları
• risk faktörleri
• diyet

Destekleyen Kurum

Bu araştırma herhangi bir fonlama kuruluşu/sektöründen hibe almamıştır.

Etik Beyan

Çalışma, Mersin Üniversitesi Tıp Fakültesi Tıbbi Araştırmalar Etik Kurulu’nun 19.07.2012 tarihli ve 2012/256 numaralı onayı ile yürütüldü. Çalışma yapılırken Helsinki Bildirgesi ilkelerine uygun hareket edilmiştir.

Teşekkür

Yazarlar, Mersin Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı çalışanlarına araştırma sürecindeki destekleri için teşekkür etmektedir.

Effectiveness of Diet in Controlling Cardiovascular Risk Factors in Overweight and Obese Individuals

Öz

Objective: The objective of this study is to evaluate the relationship between a standardized, individualized dietary intervention applied to overweight and obese individuals and cardiovascular risk factors and the 10-year cardiovascular disease (CVD) risk calculated using the Framingham risk score. Materials and Methods: This prospective, intervention-based study was conducted at a university hospital's family medicine clinic between January and August 2013. A total of 205 individuals (178 women, 27 men) with a body mass index (BMI) ≥25 kg/m² were included in the study. Participants were assigned to a standardized, personalized diet program for six months. Body mass index (BMI), waist circumference, blood pressure, fasting blood glucose, hemoglobin A1c (HbA1c), total cholesterol, LDL, HDL, and triglyceride levels were assessed before and after the intervention. Ten-year CVD risk was calculated using the Framingham risk score. Pre- and post-diet measurements were compared in matched groups using the paired-samples t-test. Results: Following dietary intervention, trends toward improvement were observed in BMI, waist circumference, blood pressure, glycemic, and lipid parameters, which were not statistically significant but could be considered clinically favorable. The proportion of women with HbA1c ≥6.5 decreased from 25% to 10%, and in men from 50% to 40.9%. The prevalence of stage 1 hypertension decreased from 22.5% to 7.3% in women and from 33.3% to 11.1% in men. The most prominent and statistically significant finding was the decrease in the Framingham risk score (p<0.05). The most significant decrease was observed in the 60–64 age group in women (−2.4%) and in the 65–69 age group in men (−2.8%). At baseline, one-third of all participants (33.2%) had chronic disease, and 27.8% were active smokers; these risk factors were decisive in the Framingham scoring. Conclusion: In this study, trends in changes in cardiometabolic risk indicators and a significant decrease in the Framingham risk score were found to be associated with standardized and personalized dietary interventions. However, due to the absence of a control group, it is not possible to attribute the observed changes solely to the dietary intervention. The findings suggest that nutrition-based interventions may be associated with an improvement trend in the cardiovascular risk profile of overweight and obese individuals. Controlled and long-term studies are needed to establish causal relationships in this area.

Anahtar Kelimeler

• obesity
• cardiovascular diseases
• risk factors
• diet

Destekleyen Kurum

This research has not received any grants from any funding organization/sector.

Etik Beyan

The study was conducted with the subscription of Mersin University Faculty of Medicine Medical Research Ethics Committee dated 19.07.2012 and numbered 2012/256.

Teşekkür

The authors would like to thank the staff of Mersin University Faculty of Medicine, Department of Family Medicine, for their support during the research process.

Kaynakça

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