Graisse totale, graisse viscérale Aspects cliniques et épidémiologiques

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Graisse totale, graisse viscérale Aspects cliniques et épidémiologiques. Jean-Michel OPPERT Service de Nutrition, GH Pitié-Salpêtrière (AP-HP) Université Pierre et Marie Curie-Paris 6 INSERM U 557 Epidémiologie de la nutrition PARIS. Séminaire NSFA, Mars 2010. Questions. - PowerPoint PPT Presentation

Transcript of Graisse totale, graisse viscérale Aspects cliniques et épidémiologiques

  • Graisse totale, graisse viscraleAspects cliniques et pidmiologiques

    Jean-Michel OPPERT

    Service de Nutrition, GH Piti-Salptrire (AP-HP)Universit Pierre et Marie Curie-Paris 6INSERM U 557 Epidmiologie de la nutritionPARISSminaire NSFA, Mars 2010

  • Questions

    Phnotypes dobsit risque (cardiovasculaire) ?Graisse totale ? Corpulence, IMCGraisse viscrale ?Rpartition du tissu adipeux, dpts spcifiquesPhnotypes dynamiques ?

    Indicateurs ?Signification biologique ?Implications ?

  • 3 notions :Composition corporelleRpartition du tissu adipeuxDpts adipeux spcifiques

  • MasseGrasse(triglycrides stocks dans adipocytes)LiquidesExtraCellulaires(plasma et interstitiel)Masse cellulaireactiveSolides ExtracellulairesMassegrassemasse maigre

    Masse non grasse et non osseuseContenu Minral osseuxMassegrasse Masse non grasse(FFM)

    Masse maigre4 (rfrence) 3 2Composition corporelle GLOBALEModles physiologiques

  • Composition corporelle REGIONALE1 Tte2 Tronc3 Mb sup4 Mb infs

    HAUTBAS

  • Diffrents types de dpts graisseuxSous-cutanFmoralAbdominalIntra-abdominalIntra-pritonal = viscralRtro-pritonal

    Autres dpts Foie, cur, muscle

  • MthodesMG totaleMG rgionale

    Anthropomtrie IMCOUI Circonfrences, ratiosOUI Plis cutansOUIOUIImpdanceOUIDEXAOUIOUIDensitomtrieOUIImagerie+/-OUI

    Composition corporelle

  • Masse grasse totaleCorpulenceIMC

  • Dfinition internationale de lobsit et du surpoids chez ladulte (OMS)IMC : Indice de Masse CorporellePoids (en kg)Taille2 (en m2)WHO Report of a WHO Consultation on obesity : preventing and managing the global epidemic. WHO, Geneva, 3-5 June 1998

    Classification

    IMC (kg/m2)

    Maigreur

    < 18,5

    Normal

    18,5 24,9

    Surpoids

    25,0 29,9

    Obsit

    30,0 34,9

    Obsit svre

    Obsit massive

    35,0 39,9

    ( 40,0

    Classification

    IMC (kg/m2)

    Maigreur

    < 18,5

    Normal

    18,5 24,9

    Surpoids

    25,0 29,9

    Obsit

    30,0 34,9

    Obsit svre

    Obsit massive

    35,0 39,9

    ( 40,0

  • Risque de mortalitIMC (Poids/taille2)IMC et mortalit18,52530

  • Body-mass index and cause-specific mortality in 900 000 adults: Prospective Studies Collaborationbaseline BMI versus mortality in 57 prospective studies 894 576 participants, mostly in western Europe and North America 61% [n=541 452] malemean recruitment age 46 [SD 11] yearsmedian recruitment year 1979 [IQR 197585]mean BMI 25 [SD 4] kg/m2analyses adjusted for age, sex, smoking status, and study. first 5 years of follow-up excluded, 66 552 deaths of known cause mean of 8 (SD 6) further years of follow-up (mean age at death 67[SD 10] years)30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 otherPSC Lancet 2009; 373: 1083-96

  • Obsit - Coronaropathie Nurses Health StudyRR Evnements coronariens(IDM non mortels et dcs coronariens) IMC 29 vs IMC
  • Masse grasseIMC (Poids/taille2)IMC et masse grasse corporeller ~ 0,80

  • In: Oppert et al. Obesity phenotypes. 2008

  • Composition corporelle rgionaleRpartition de la masse grasseRTH et autres

  • Indicateurs rgionaux1947 : Vague (Presse Med)RAMTF1956 : Vague (Am J Clin Nutr)1984 : Gteborg - Bjrntorp (BMJ)RTH1984 : Kissebah (JCEM)RTH1983 : Borkan (Am J Clin Nutr)GAV-scan1985 : Park (Diabetes)GAV1992 : Krauss (Metabolism)GCUISSE1995 : Lean (Br Med J)TT1998 : IOTF (WHO)TT seuils2001 : Lissner (Am J Clin Nutr) TH2005 : Interheart (Lancet)RTH, TT, TH

  • Masse grasse tronc et extrmitsRelations avec ALAT Etude prospective entre 1997 et 2002 sur 1155 femmes vus en Nutrition (Htel-Dieu)Critres inclusion- surpoids ou obsit : IMC 25 kg/m2- ge de 18 75 ans- consommation dalcool < 20 g/j ladmission

    Perlemuter et al. Liver Int 2008

  • PercentileTrunk Fat MassALT > NAdj OR 95 % CI 10th12.89 (7.8)1.00> 10th and 25th> 12.8 and 17.726 (14.9)2.140.84 5.42> 25th and 50th> 17.7 and 23.645 (15.6)3.381.35 8.48> 50th and 75th> 23.6 and 32.048 (16.6)3.941.42 10.94> 75th and 90th> 32.0 and 40.225 (14.5)5.301.60 17.55> 90th> 40.222 (19.1)7.611.99 29.05

    Variables included in the model : age, height, blood glucose, HDL-cholesterol, apolipoprotein-B, triglycerides, trunk fat mass and leg fat mass. P for linear trend < 0.005DXA-assessed trunk fat mass and ALTPerlemuter et al. Liver Int 2008

  • DXA-assessed leg fat mass and ALTPerlemuter et al. Liver Int 2008PercentileTrunk Fat MassALT > NAdj OR 95 % CI 10th10.614 (12.2)1.00> 10th and 25th> 10.6 and 13.236 (20.7)1.610.73 3.51> 25th and 50th> 13.2 and 17.245 (15.6)0.860.38 1.92> 50th and 75th> 17.2 and 22.548 (16.6)0.860.34 2.15> 75th and 90th> 22.5 and 27.824 (13.9)0.470.15 1.44> 90th> 27.88 (7)0.140.03 0.58

    Variables included in the model : age, height, blood glucose, HDL-cholesterol, apolipoprotein-B, triglycerides, trunk fat mass and leg fat mass. P for linear trend < 0.005

  • Dpts adipeux spcifiquesGraisse viscraleTour de taille et autres

  • Oppert Charles et al. Am J Clin Nutr 2002Intra-abdominal fat and mortality

    middle-aged men, PPS1 15-y follow-up

  • Oppert, Charles et al. Am J Clin Nutr 2002Muscle mass and mortality

  • Oppert, Charles et al. Am J Clin Nutr 2002Predicted adjusted 15-year cancer death rates

  • Phnotypes dynamiquesGain de poids (adulte)Fluctuations pondralesPerte de poids

  • 505152535455565712345MesuresPoids (kg)Tendancecalcule partir de largressionVariationsde poidsRMSE =( Erreurs)Sn - pn = nombre dobservations, p = nombre de paramtresFrom Vergnaud AC & Czernichow S

  • Weight fluctuations and risk of MetS SUVIMAX studyVergniaud et al. Int J Obes 2008n=3558Adj age, sex and BMI at age 20 yearsaccording to median weight-slope specific tertiles of weight-RMSE

  • SOS study Causes de dcsChirurgieTmoins(n=2010)(n=2037)Totaldcs 101129

    Non cardiovasculaire 5876 -Tumeur 2948 Cancer 29 47 Mningiome 0 1 -Infection 123 -Thromboembolique 5 (EP 4)7 (EP 7)-Autres 23Sjstrm et al. N Engl J Med 2007

  • SOS study Causes de dcsChirurgieTmoins(n=2010)(n=2037)Totaldcs 101129

    Cardiovasculaire 4353-Cardiaque 3544 Infarctus 13 25 Ins. cardiaque 2 5 Mort subite 20 14-AVC 6 6-Autres 1218Sjstrm et al. N Engl J Med 2007

  • Evolution de la composition corporelle globale aprs bypass gastriqueabaabbcdb,cccdCiangura et al. Obesity 2009

    Chart2

    12361.557.415.215.27.87.810.710.7

    102.854.545.214.214.27.47.49.69.6

    93.352.937.313.313.36.66.69.19.1

    85.951.731.413.813.86.76.79.79.7

    poids

    masse maigre

    masse grasse

    (kg)

    Sheet1

    preopratoire3 mois6 mois12 mois

    123102.893.385.9

    61.554.552.951.7

    57.445.237.331.4

    Sheet1

    00015.215.27.87.810.710.7

    00014.214.27.47.49.69.6

    00013.313.36.66.69.19.1

    00013.813.86.76.79.79.7

    poids

    masse maigre

    masse grasse

    (kg)

    Evolution de la composition corporelle globale aprs bypass

    Sheet2

    Sheet3

  • Changement de la composition corporelle globale aprs bypass gastriqueCiangura et al. Obesity 2009

    03 mois36 mois612 moisn424242Poids (kg/mois)6.4 1.8a3.2 1.7 b1.2 1.0 cIMC (kg/m/mois)2.4 0.7 a1.2 0.6 b0.4 0.3 cMM (kg/mois)2.3 1.2 a0.5 0.7 b0.2 0.4 bMG (kg/mois)4.1 1.7 a2.6 1.4 b1.0 0.7 c

  • Quelques conclusionsImplicationsRhabiliter lIMCDmystifier le tour de taillePenser globalPhnotypage de qualit

  • Oppert JM et al. 2002