בפוסט בדיקות דם ובריאות אופטימלית דיברתי על הבעיות שיש בטווחים שמוגדרים כתקינים בבדיקות השלנו. הטווח של מדדי בדיקות הדם מגיעים מהממוצע באוכלוסיה (עבור הרוב המוחלט של המדדים) כאשר רצף הערכים בין הערך התחתון לעליון מייצגים 95% מהערכים שיש באוכלוסיה, זה חישוב פשוט של ממוצע +- שתי סטיות תקן (בהתפלגות נורמלית 2 סטיות תקן נותן 95%) בלי קשר לפיזיולוגיה או המשמעות של המדד [1-2]. כאשר הבעיה המרכזית היא שהרוב המוחלט של האוכלוסיה אינה בריאה מטבולית ולכן ההתפלגות והטווחים מוטים [3].
רמת הפוסט: מתחיל.
אדם בריא מטבולית
כיצד נראה אדם בריא מטבולית? מה המדדים שלו? בדיקות הדם? מדדים אחרים? אם נידע את התשובות לשאלות האלה נוכל להשוות את עצמינו לאותם אנשים ולקבל מושג האם אנחנו בכיוון הנכון בתזונה קטוגנית.
לשם כך אספתי נתונים ממחקרים שבהם מתוארים אנשים בריאים מטבולית ויצרתי טווחים תקינים מהנתונים במחקרים. הכלל המנחה שלי היה ״חוק השליש״. חוק השליש הוא חוק שהמצאתי ממחקר [4] המתואר בפוסט מה הסיכון בתנגודת אינסולין? בו אנו רואים שאנשים בשליש התחתון של התנגודת אינסולין באוכלוסיה הרבה יותר בריאים וללא מחלות מאשר השלישים האחרים.
חלוקה לשלישים על פי תנגודת אינסולין והסיכון למחלות מתוך [4]:
מדדים של אדם בריא מטבולית
עבור כל מדד מצויין הטווח האידיאלי ועל סמך מה הוא נקבע (המקור בספרות). קישור חי נמצא למצוא כאן (Google Sheets). המדדים מחולקים לתנגודת אינסולין, דלקתיות, עומס מחמצן, כבד, שומנים, לחץ דם, מעי ורקמת השומן.
גרסה זמנית:
| Measure | Units | Category | Range men | Range women | Source | Participants |
| waist-to-hip ratio (WHR) | Units less | Insulin resistance | < 0.86 | < 0.82 | [1] – link [2] – link |
[1] – peripheral insulin sensitivity was examined in 10 healthy men [2] – The residents of southern communities in China from June to October 2012 were selected for cross-sectional screening ( n = 2142). The participants were divided into male and female groups, and men and women were divided into 4 groups according to the quartile of waist-to-hip ratio |
| waist-to-height ratio (WHtR) | Units less | Insulin resistance | < 0.53 | < 0.54 | link | 81 adults (40 women, 41 men; mean (SD) age: 38.4 (17.5) years; 94% Caucasian |
| TyG (ln(triglycerides * glucose)/2) | Conventional units | Insulin resistance | < 4.47 | < 4.47 | link | For this analysis, 2004 individuals of both genders ≥18 years old with basal insulin determination and triglycerides < 500 mg/dl were evaluated |
| HOMA-IR (glocuse*insulin)/22.5 | Conventional units | Insulin resistance | < 2.5 | < 2.5 | link | 115 subjects with various degrees of glucose tolerance and insulin sensitivity |
| steady-state plasma glucose (SSPG) | mmol/L | Insulin resistance | < 4.4 | < 4.47 | [1] – link [2] – link |
[1] – Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity [2] – 208 apparently healthy, nonobese (body mass index < 30 kg/m2) individuals |
| insulin | μU/mL or pmol/L | Insulin resistance | < 6 (μU/mL) < 42 (pmol/L) |
< 6 (μU/mL) < 42 (pmol/L) |
link | 26 patients with NAFLD and intrahepatic lipid contents of >5% and 5 non‐NAFLD lean control subjects |
| C-peptide | ng/mL | Insulin resistance | < 1.06 | < 1.06 | link | 49 non-obese Japanese men |
| Blood glocuse | mmol/L or mg/dL | Insulin resistance | < 100 (mg/dL) < 5.5 (mmol/L) |
< 100 (mg/dL) < 5.5 (mmol/L) |
link | Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| HbA1c | % | Insulin resistance | < 5.4 | < 5.4 | link | Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| CRP | pg/mL | Inflammation | < 1 | < 1 | [1] – link [2] – link |
[1] – Fifty-three men aged 34 to 55 years were recruited in four groups in a cross sectional study: sedentary (n = 11), obesity (n = 11), obesity and glucose intolerance (n = 16), and highly trained endurance active (n = 15). [2] – Forty‐eight normal‐weight and 40 obese (20 without MetS; 20 with MetS) |
| IL-6 | pg/mL | Inflammation | < 1 | < 1 | [1] – link [2] – link |
[1] – Fifty-three men aged 34 to 55 years were recruited in four groups in a cross sectional study: sedentary (n = 11), obesity (n = 11), obesity and glucose intolerance (n = 16), and highly trained endurance active (n = 15). [2] – Forty‐eight normal‐weight and 40 obese (20 without MetS; 20 with MetS) |
| TNF-α | pg/mL | Inflammation | < 5 | < 5 | [1] – link [2] – link |
[1] – Fifty-three men aged 34 to 55 years were recruited in four groups in a cross sectional study: sedentary (n = 11), obesity (n = 11), obesity and glucose intolerance (n = 16), and highly trained endurance active (n = 15). [2] – Forty‐eight normal‐weight and 40 obese (20 without MetS; 20 with MetS) |
| Ferritin | ng/mL | Inflammation | < 150 | < 150 | link | 26 patients with NAFLD and intrahepatic lipid contents of >5% and 5 non‐NAFLD lean control subjects |
| Neutrophils | 10^9/L | Inflammation | < 4 | < 4 | [1] – link [2] – link |
[1] -From 2006 until 2011, 1054 diabetic patients were admitted to the Department of Endocrinology at Lu He hospital in Beijing. According to the diagnostic criteria of the American Diabetes Association, 946 had type-2 diabetes and were eligible for analysis. |
| Lymphocytes | 10^9/L | Inflammation | < 2.2 | < 2.2 | link | Ninety-six patients and 40 healthy controls were included in this study. |
| White Blood Cells | 10^9/L | Inflammation | < 2 | < 2 | link | Ninety-six patients and 40 healthy controls were included in this study. |
| Cortisol | μg – excreted over 24h urine | Inflammation | < 75 | < 75 | link | The InCHIANTI study included 1155 participants aged 65 and older. |
| Lipid hydroperoxides | μmol/L | Oxidation | < 2.55 | < 2.55 | link | Thirty-six healthy volunteers with a mean (±SEM) age of 47 ± 2 y and body mass index (BMI; in kg/m2) of 25 ± 1 (range: 19–32) |
| α-Tocopherol | μmol/L | Oxidation | > 31 | > 31 | link | Thirty-six healthy volunteers with a mean (±SEM) age of 47 ± 2 y and body mass index (BMI; in kg/m2) of 25 ± 1 (range: 19–32) |
| δ-Tocopherol | μmol/L | Oxidation | > 72.5 | > 72.5 | link | Thirty-six healthy volunteers with a mean (±SEM) age of 47 ± 2 y and body mass index (BMI; in kg/m2) of 25 ± 1 (range: 19–32) |
| GSH/GSSG | Units less | Oxidation | > 1.3 | > 1.3 | link | In healthy subjects (n = 10) and non-insulin-dependent (type II) diabetics (n = 10) matched for age [43.1 & 2.2 vs. 41 t 4.4 yr, P = not significant (NS)], body mass index (25.1 t 1.1 vs. 26 k 0.8 kg/m”, P = NS), gender ratio [ 5 males (M)/5 females (F) vs. 5M/5F], |
| Adiponectin | ng/mL or | Adipose | > 4800 | > 8800 | [1] – link [2] – link |
[1] – Fifty-three men aged 34 to 55 years were recruited in four groups in a cross sectional study: sedentary (n = 11), obesity (n = 11), obesity and glucose intolerance (n = 16), and highly trained endurance active (n = 15). [2] – Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| Adiponectin/Leptin | Units less. Adiponectin – ng/mL Leptin – pg/mL |
Adipose | > 2.5 | > 2.5 | link | Fifty-three men aged 34 to 55 years were recruited in four groups in a cross sectional study: sedentary (n = 11), obesity (n = 11), obesity and glucose intolerance (n = 16), and highly trained endurance active (n = 15). |
| Visercal fat area | cm^2 | Adipose | < 130 | < 120 | [1] – link [2] – link |
[1] – Cross-sectional study with 191 adults and elderly of both sexes. [2] – Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| Free fatty acid | mmol/l | Lipids | < 0.22 | < 0.22 | link | Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| HDL | mmol/L or mg/dL | Lipids | > 1.5 (mmol/L) > 58 (mg/dL) |
> 1.5 (mmol/L) > 58 (mg/dL) |
[1] –link [2] – link |
[1] – Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity [2] – A total of 5,989 Korean subjects (age ≥20 years) who were participants in an in-depth health checkup program at the Gangnam Severance Hospital Health Promotion Center from January 2008 to February 2015, were included in the study |
| LDL | mmol/L or mg/dL | Lipids | N/A | N/A | link | Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| Triglycerides | mmol/L or mg/dL | Lipids | < 0.82 (mmol/L) < 72 (mg/dL) |
< 0.82 (mmol/L) < 72 (mg/dL) |
link | Sixty morbidly obese (45 ± 1.3% kg/m2) but otherwise healthy Caucasian women (n = 40) and men (n = 20) were matched for BMI, percent body fat, age, and sex into groups of IS (n = 30) and IR (n = 30) obesity |
| GGT | IU/L | Liver | < 15 | < 15 | link | A cross-sectional study was conducted in 113 non-obese, non-diabetic individuals classified as overweight (BMI 25–29.9 kg/m2) or lean (BMI 19.5–24.9 kg/m2) |
| AST | IU/L | Liver | < 18 | < 18 | link | A cross-sectional study was conducted in 113 non-obese, non-diabetic individuals classified as overweight (BMI 25–29.9 kg/m2) or lean (BMI 19.5–24.9 kg/m2) |
| ALT | IU/L | Liver | < 16 | < 16 | link | A cross-sectional study was conducted in 113 non-obese, non-diabetic individuals classified as overweight (BMI 25–29.9 kg/m2) or lean (BMI 19.5–24.9 kg/m2) |
| Hepatic Triglycerides | % | Liver | < 2 | < 2 | [1] – link [2] – link |
[1] – A cross-sectional study was conducted in 113 non-obese, non-diabetic individuals classified as overweight (BMI 25–29.9 kg/m2) or lean (BMI 19.5–24.9 kg/m2) [2] – A total of 5,989 Korean subjects (age ≥20 years) who were participants in an in-depth health checkup program at the Gangnam Severance Hospital Health Promotion Center from January 2008 to February 2015, were included in the study |
| Systolic blood pressure | mmHg | Blood pressure | < 120 | < 120 | link | A total of 5,989 Korean subjects (age ≥20 years) who were participants in an in-depth health checkup program at the Gangnam Severance Hospital Health Promotion Center from January 2008 to February 2015, were included in the study |
| Diastolic blood pressure | mmHg | Blood pressure | <75 | <75 | link | A total of 5,989 Korean subjects (age ≥20 years) who were participants in an in-depth health checkup program at the Gangnam Severance Hospital Health Promotion Center from January 2008 to February 2015, were included in the study |
| Endotoxin (LPS, Lipopolysaccharide) | log EU/ml (geometric mean) | Gut | < 2.3 | < 2.3 | link | subjects (BMI 23.6 ± 1.5 kg/m2, age 45.7 ± 7.5 yr, n = 23 female) and obese ND subjects (BMI 32.51 ± 4.0 kg/m2, age 46.8 ± 11.0 yr, n = 16, female:male 4:1) during elective abdominal surgery. |
| GIP | pg/mL | Gut | <15 | <15 | link | The study included 128 subjects with BMI exceeding the normal range (25–40 kg/m2), women and men, aged 25–65 years |
| GLP-1 | ||||||
| Gut permeability (lactulose/mannitol) | % | Gut | < 0.003 | < 0.003 | link | Fifteen healthy volunteers (8 males, average age 36 ± 6 years, range 23-46 years) were submitted to the intestinal permeability test to establish control values. Twenty-two celiac disease patients (11 males, average age 41 ± 14 years, range 19-74 years) who were diagnosed at least 1 year previously and were asymptomatic after 1 year of a gluten-free diet constituted the second group. The third group was comprised of 31 Crohn’s disease patients (18 males, average age 37 ± 7 years, range 19-54 years) in remission as defined by the Crohn’s disease activity index (4) |
| Gut permeability mannitol | % | Gut | < 0.07% | < 0.07% | link | Fifteen healthy volunteers (8 males, average age 36 ± 6 years, range 23-46 years) were submitted to the intestinal permeability test to establish control values. Twenty-two celiac disease patients (11 males, average age 41 ± 14 years, range 19-74 years) who were diagnosed at least 1 year previously and were asymptomatic after 1 year of a gluten-free diet constituted the second group. The third group was comprised of 31 Crohn’s disease patients (18 males, average age 37 ± 7 years, range 19-54 years) in remission as defined by the Crohn’s disease activity index (4) |
| Zonulin | ng/mg protein | Gut | < 0.3 | < 0.3 | link | Using a serum zonulin ELISA, we measured serum zonulin levels in both CD and T1D patients, their relatives, and age and sex-matched healthy controls |
| eGFR | mL/min/1.73 m2 | Kidney | > 95 | > 95 | link | 926 type 2 diabetics (T2D) and 4838 non-diabetic individuals from four independent cohorts |
| creatinine | mg/dL | Kidney | < 0.87 | < 0.87 | link | 926 type 2 diabetics (T2D) and 4838 non-diabetic individuals from four independent cohorts |
מקורות
[1] – Establishing Reference Intervals for Clinical Laboratory Test Results: Is There a Better Way? David W. Seccombe, MD, PhD, 2010. link.
[2] – Should We Maintain the 95 Percent Reference Intervals in the Era of Wellness Testing? A Concept Paper, Per Hyltoft Petersen, 2004. link.
[3] – Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016, Joana Araújo, 2019. link.
[4] –Insulin Resistance as a Predictor of Age-Related Diseases, Francesco S. Facchin, 2001. Link.