Dyslipidemia
May Be An Indicator for Trend of Body Weight
.........................................................................................................................
Mehmet Rami Helvaci*, Cihangir Akdemir**,
Hasan Kaya***, Cahit Ozer****
*Medical Faculty of the Mustafa Kemal University,
Antakya, Assistant Professor of Internal Medicine,
M.D.
**Medical Faculty of the Dumlupinar University,
Kütahya, Assistant Professor of Parasitology,
Ph.D.
***Medical Faculty of the Mustafa Kemal University,
Antakya, Associated Professor of Internal Medicine,
M.D.
****Medical Faculty of the Mustafa Kemal University,
Antakya, Assistant Professor of Family Medicine,
M.D.
Correspondence
to:
Mehmet Rami Helvaci, M.D.
Hospital of the Mustafa Kemal University
31100, Antakya, Turkey
Tel: +903262140649
Fax: +903262148214
Email:mramihelvaci@hotmail.com
.........................................................................................................................
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ABSTRACT
Background:
Prevalence of excess weight is increasing
with a high cost on health worldwide.
Methods:
The study was performed in the Internal
Medicine Polyclinic on routine check up
patients, and consecutive patients at
and above the age of 20 years were studied
to permit growth of height in youngers.
Results:
The study included 1068 cases (628 females)
totally. There were only 19 (1.7%) cases
with underweight and 307 (28.7%) with
normal weight, so 69.4% (742) of cases
at and above the age of 20 years had excess
weight. The prevalence of excess weight
increased from 28.7% (52) in the third
to 63.6% (100) in the fourth decades (p<0.001),
and decreased from 87.0% (94) in the seventh
to 78.5% (84) in the eighth decades (p<0.05).
Similarly, prevalences of hyperbetalipoproteinemia,
hypertriglyceridemia, and dyslipidemia
showed similar patterns of tendency with
the excess weight, by increasing in the
fourth and decreasing in the eighth decades
of life (p<0.05 in all).
Conclusion:
Prevalence of excess weight and dyslipidemia
are increasing by decades, particularly
in the fourth decade, and this increase
turns to a decrease in the eighth decade
of life. So 30th and 70th years of age
may be the breaking points of life, both
for dyslipidemia and body weight, and
dyslipidemia may be a pioneer sign for
tendency of body weight. Probably decreased
physical and mental stresses after the
age of 30th years and debility and comorbid
disorders induced restrictions after the
age of 70th years may be the major causes
for the changes.
Key
words: Dyslipidemia, excess weight.
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Excess weight is a disorder
characterized by increased mass of adipose tissue,
and its prevalence is increasing all over the
world, but it is well recognized that it causes
a high cost on physical health. Main physical
consequences of excess weight are impaired glucose
tolerance (IGT) or type 2 diabetes mellitus
(DM), white coat hypertension (WCH) or hypertension
(HT), dyslipidemia, and coronary heart disease
(CHD)(1-3). For example, persons with excess
weight have a higher prevalence of elevated
blood pressure (BP) than lean persons, and well-known
complications of HT are left ventricular hypertrophy,
CHD, heart failure, chronic renal failure, and
stroke(4). In addition to above, excess weight
is accompanied by some other medical complications
including fatty liver, cholesterol gallstones,
sleep apnea, osteoarthritis, and polycystic
ovary disease, and the majority of people with
excess weight have a clustering of these risk
factors. Furthermore, excess weight is highly
correlated with dietary intake of increased
calories and fat, both of which have been linked
to several types of cancer including breast,
colon, and prostate(5). So the risk of death
from all causes including cardiovascular diseases,
cancers, or other diseases increases throughout
the range of moderate and severe excess weight
both for men and women in all age groups(6, 7).
On the other hand, atherogenic dyslipidemia
is commonly seen in cases with excess weight,
and it is characterized by increased levels
of triglycerides (TG) and/or low density lipoprotein
cholesterol (LDL-C), or a decreased level of
high density lipoprotein cholesterol (HDL-C)
in serum(1). We tried to understand whether
or not there is a close relationship between
dyslipidemia and body weight.
The study was performed in
the Internal Medicine Polyclinic of the Dumlupinar
University on routine check up patients between
August 2006 and March 2007. Consecutive patients
at and above the age of 20 years were studied
to permit growth of height in youngers. Their
medical histories including smoking habit, dyslipidemia,
and already used medications were learnt, and
a routine check up procedure including TG, HDL-C,
and LDL-C was performed. Current daily smokers
at least for a period of last 12-month and cases
with a history of at least five pack-years smoked,
were accepted as smokers. Patients with devastating
illnesses including type 1 DM, malignancies,
acute or chronic renal failure, chronic liver
diseases, hyper- or hypothyroidism, and heart
failure were excluded to avoid their possible
effects on weight. Body Mass Index (BMI) of
each case was calculated by the measurements
of the same physician instead of verbal expressions.
Weight in kilograms is divided by height in
meters squared, and underweight is defined as
a BMI of lower than 18.5, normal weight as 18.5-24.9,
overweight as 25-29.9, and obesity as a BMI
of 30.0 kg/m(2) or greater(1). Additionally
patients with dyslipidemia were detected, and
we used the National Cholesterol Education Program
Expert Panel's recommendations for defining
dyslipidemic subgroups(1). Dyslipidemia is
diagnosed when LDL-C is 160 or higher and/or
TG is 200 or higher and/or HDL-C is lower than
40 mg/dL. Eventually, patients with underweight,
normal weight, overweight, obesity, hyperbetalipoproteinemia,
hypertriglyceridemia, and dyslipidemia were
detected in each decade, and prevalence was
compared between the decades. Comparison of
proportions was used as the method of statistical
analysis.
The study included 1068 cases (628 females
and 440 males) totally. But due to the small
number of cases in the ninth decade, 20 cases
only, they were not included in the comparison.
There were only 19 (1.7%) cases with underweight
and 307 (28.7%) with normal weight, so as a
very high prevalence 69.4% (742) of cases at
and above the age of 20 years had excess weight.
The prevalence of cases with normal weight was
64.6% (117 cases) in the third decade, and decreased
gradually but significantly until the seventh
decade of life (p<0.05 nearly in all steps).
Then it increased from 12.9% (14 cases) of the
seventh to 20.5% (22 cases) in the eighth decades
of life (p<0.05) (Table 1). In other words,
the prevalence of excess weight increased from
28.7% (52 cases) in the third to 63.6% (100
cases) in the fourth decade (p<0.001), and
decreased from 87.0% (94 cases) in the seventh
to 78.5% (84 cases) in the eighth decades of
life (p<0.05). On the other hand, when we
looked at the prevalence of hyperbetalipoproteinemia,
hypertriglyceridemia, and dyslipidemia, all
three health parameters showed similar patterns
of tendency with the excess weight by increasing
in the fourth and decreasing in the eighth decades
of life significantly (p<0.05) in all (Table
2). So the 30th and 70th years were the breaking
points for both lipid disorders and body weight.
|
Table 1: Characteristic features
of the study cases |
|
Variables |
Third
decade |
p-value |
Fourth
decade |
p-value |
Fifth
decade |
p-value |
Sixth
decade |
p-value |
Seventh
decade |
p-value |
Eighth
decade |
|
Number |
181 |
|
157 |
|
246 |
|
249 |
|
108 |
|
107 |
Prevalence
of
smoking |
11.0%
(20) |
p<0.001 |
32.4%
(51) |
ns* |
28.8%
(71) |
ns |
31.7%
(79) |
ns |
23.1%
(25) |
ns |
23.3%
(25) |
|
Prevalence
of underweight |
6.6%
(12) |
p<0.05 |
1.9%
(3) |
ns |
0.4%
(1) |
ns |
0.0%
(0) |
ns |
0.0%
(0) |
ns |
0.9%
(1) |
|
Prevalence
of normal weight |
64.6%
(117) |
p<0.001 |
34.3%
(54) |
P<0.001 |
21.1%
(52) |
ns |
16.8%
(43) |
ns |
12.9%
(14) |
P<0.05 |
20.5%
(22) |
|
Prevalence
of overweight |
24.3%
(44) |
p<0.001 |
42.0%
(66) |
ns |
45.9%
(113) |
p<0.05 |
39.3%
(98) |
ns |
46.2%
(50) |
ns |
40.1%
(43) |
|
Prevalence
of obesity |
4.4%
(8) |
p<0.001 |
21.6%
(34) |
p<0.001 |
32.5%
(80) |
p<0.001 |
43.7%
(109) |
ns |
40.7%
(44) |
ns |
38.3%
(41) |
*Nonsignificant
|
Table 2: Associated disorders of
the study cases |
| Variables |
Third
decade |
p-value |
Fourth
decade |
p-value |
Fifth
decade |
p-value |
Sixth
decade |
p-value |
Seventh
decade |
p-value |
Eighth
decade |
| Number |
181 |
|
157 |
|
246 |
|
249 |
|
108 |
|
107 |
| Prevalence
of excess weight |
28.7%
(52) |
<0.001 |
63.6%
(100) |
<0.001 |
78.4%
(193) |
ns |
83.1%
(207) |
ns |
87.0%
(94) |
<0.05 |
78.5%
(84) |
| Prevalence
of hyper-betalipoproteinemia |
1.6%
(3) |
<0.001 |
12.7%
(20) |
ns* |
15.8%
(39) |
ns |
19.6%
(49) |
ns |
23.1%
(25) |
<0.05 |
14.0%
(15) |
| Prevalence
of hyper-triglyceridemia |
5.5%
(10) |
<0.001 |
15.2%
(24) |
<0.05 |
20.3%
(50) |
<0.05 |
25.7%
(64) |
ns |
24.0%
(26) |
<0.01 |
11.2%
(12) |
| Prevalence
of dyslipidemia |
6.6%
(12) |
<0.001 |
26.7%
(42) |
ns |
31.7%
(78) |
<0.05 |
38.9%
(97) |
ns |
39.8%
(43) |
<0.001 |
20.5%
(22) |
*Nonsignificant
Excess weight leads to
both structural and functional abnormalities
of many systems of body, and it is important
in medical terms to specify the excess weight
not only as one of the risk factors, but as
'obesity disease'. For example, individuals
with excess weight will have an increased circulating
blood volume as well as an increased volume
of cardiac output, thought to be the result
of increased oxygen demand of the extra body
tissue. The prolonged increase in circulating
blood volume can lead to myocardial hypertrophy
and decreased compliance, in addition to the
common comorbidity of HT. Similarly, the relationship
between the excess weight and HT is also described
under the heading of the metabolic syndrome,
and clinical manifestations of the syndrome
include abdominal obesity, dyslipidemia, HT,
insulin resistance, and proinflammatory as well
as prothrombotic states. In addition to the
HT, the prevalence of high FPG, high serum total
cholesterol, and low HDL-C, and their clustering
were all raised with increases in BMI(8). Combination
of these cardiovascular risk factors will eventually
lead to an increase in left ventricular stroke
with a higher risk of arrhythmias, cardiac failure,
or even sudden cardiac death. So the above prospective
cohort study showed that the BMI is one of the
independent risk factors for stroke and CHD(8). Similarly, the incidences of CHD and stroke,
especially ischemic stroke, have increased with
an elevated BMI in other studies(9). Eventually,
the risk of death from all causes increases
with excess weight in all age groups(7). On
the other hand, dyslipidemia comes with excess
weight, HT, type 2 DM, CHD, and stroke-like
health problems in front of us in future. Similarly,
we observed that excess weight, hyperbetalipoproteinemia,
hypertriglyceridemia, and dyslipidemia showed
highly significant increases in prevalence during
passage to the fourth decade of life (p<0.001
in all), and interestingly while the prevalence
of excess weight was decreasing in the eighth
decade significantly, the prevalence of hyperbetalipoproteinemia,
hypertriglyceridemia, and dyslipidemia decreased,
too (p<0.05 in all). So dyslipidemia may
be a pioneer sign for tendency of body weight
either to increase or decrease.
Some studies revealed that the increase in
body weight by age has been found to be lower
among smokers(10), and smoking in humans and
nicotine administration in animals are associated
with a decreased body weight(11). In another
study, there was a relationship between being
overweight and nicotine dependence among men
but not among women(12). Whereas in our study,
prevalence of smoking also increased in parallel
to the increasing prevalence of excess weight
in the fourth decade, and its prevalence was
11.0% and 32.4% in the third and fourth decades
respectively (p<0.001). So both the smoking
and excess weight showed a nearly three-fold
increase in the fourth decade of life. Then
it remained nearly constant in the rest of life
and it changed between 32.4% and 23.1% nonsignificantly.
Actually, smoking may be associated with post-cessation
weight gain, but evidence suggests that the
risk of weight gain is the highest during the
first year after quitting and declines over
the years(13). This might be interpreted as
a response to smoking cessation, whereas the
long-term increase in BMI has been attributed
to more stable characteristics such as gender(14). Similarly, smoking females have not gained
weight after cessation compared to never smoking
women(15). Actually, the apparent body weight
increase after smoking cessation in males seems
to be due to decreased weight during smoking
plus a transient weight increase after quitting.
As a conclusion, although the already known
consequences of excess weight and dyslipidemia
on health, prevalence is increasing by decades
particularly in the fourth decade, and this
increase turns to a decrease in the eighth decade
of life. So 30th and 70th years of age may be
the breaking points of life both for dyslipidemia
and body weight, and dyslipidemia may be a pioneer
sign for tendency of body weight. Probably decreased
physical and mental stresses after the age of
30 years and debility and comorbid disorders
induced restrictions after the age of 70 years
may be the major causes for the changes.
- Third Report
of the National Cholesterol Education
Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment
Panel III) final report. Circulation 2002;
17:106: 3143-3421.
- Helvaci MR, Kaya H, Seyhanli M, Cosar
E. White Coat Hypertension Is Associated
with a Greater All-cause Mortality. J
Health Sci 2007; 53: 156-160.
- Helvaci MR, Kaya H, Yalcin A, Kuvandik
G. Prevalence of white coat hypertension
in underweight and overweight subjects.
Int Heart J 2007 (in press).
- Chobanian AV, Bakris GL, Black HR,
Cushman WC, Green LA, Izzo JL Jr, et al.
Seventh report of the Joint National Committee
on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure.
Hypertension 2003; 42: 1206-1252.
- Calle EE, Rodriguez C, Walker-Thurmond
K, Thun MJ. Overweight, obesity, and mortality
from cancer in a prospectively studied
cohort of U.S. adults. N Engl J Med 2003;
348: 1625-1638.
- Adams KF, Schatzkin A, Harris TB,
Kipnis V, Mouw T, Ballard-Barbash R, et
al. Overweight, obesity, and mortality
in a large prospective cohort of persons
50 to 71 years old. N Engl J Med 2006;
355: 763-778.
- Calle EE, Thun MJ, Petrelli JM, Rodriguez
C, Heath CW Jr. Body-mass index and mortality
in a prospective cohort of U.S. adults.
N Engl J Med 1999; 341: 1097-1105.
- Zhou B, Wu Y, Yang J, Li Y, Zhang
H, Zhao L. Overweight is an independent
risk factor for cardiovascular disease
in Chinese populations. Obes Rev 2002;
3: 147-156.
- Zhou BF. Effect of body mass index
on all-cause mortality and incidence of
cardiovascular diseases--report for meta-analysis
of prospective studies open optimal cut-off
points of body mass index in Chinese adults.
Biomed Environ Sci 2002; 15: 245-252.
- Rasmussen F, Tynelius P, Kark M. Importance
of smoking habits for longitudinal and
age-matched changes in body mass index:
a cohort study of Swedish men and women.
Prev Med 2003; 37: 1-9.
- Grunberg NE, Greenwood MR, Collins
F, Epstein LH, Hatsukami D, Niaura R,
et al. National working conference on
smoking and body weight. Task Force 1:
Mechanisms relevant to the relations between
cigarette smoking and body weight. Health
Psychol 1992; 11: 4-9.
- John U, Meyer C, Rumpf HJ, Hapke U.
Relationships of psychiatric disorders
with overweight and obesity in an adult
general population. Obes Res 2005; 13:
101-109.
- Froom P, Melamed S, Benbassat J. Smoking
cessation and weight gain. J Fam Pract
1998; 46: 460-464.
- Perkins KA. Effects of tobacco smoking
on caloric intake. Br J Addict 1992; 87:
193-205.
- John U, Hanke M, Rumpf HJ, Thyrian
JR. Smoking status, cigarettes per day,
and their relationship to overweight and
obesity among former and current smokers
in a national adult general population
sample. Int J Obes (Lond) 2005; 29: 1289-1294.
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