איך למדוד בריאות מטבולית . 1,877 מילים

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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]:

sspg_metabloic_disease

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:

MeasureUnitsCategoryRange menRange womenSourceParticipants
waist-to-hip ratio (WHR)Units lessInsulin 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 lessInsulin resistance< 0.53< 0.54link81 adults (40 women, 41 men; mean (SD) age: 38.4 (17.5) years; 94% Caucasian
TyG (ln(triglycerides * glucose)/2)Conventional unitsInsulin resistance< 4.47< 4.47linkFor 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)/22.5Conventional unitsInsulin resistance< 2.5< 2.5link115 subjects with various degrees of glucose tolerance and insulin sensitivity
steady-state plasma glucose (SSPG)mmol/LInsulin 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
insulinμU/mL or pmol/LInsulin resistance< 6 (μU/mL)
< 42 (pmol/L)
< 6 (μU/mL)
< 42 (pmol/L)
link26 patients with NAFLD and intrahepatic lipid contents of >5% and 5 non‐NAFLD lean control subjects
C-peptideng/mLInsulin resistance< 1.06< 1.06link49 non-obese Japanese men
Blood glocusemmol/L or mg/dLInsulin resistance< 100 (mg/dL)
< 5.5 (mmol/L)
< 100 (mg/dL)
< 5.5 (mmol/L)
linkSixty 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< 5.4linkSixty 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
CRPpg/mLInflammation< 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-6pg/mLInflammation< 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-αpg/mLInflammation< 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)
Ferritinng/mLInflammation< 150< 150link26 patients with NAFLD and intrahepatic lipid contents of >5% and 5 non‐NAFLD lean control subjects
Cortisolμg – excreted over 24h urineInflammation< 75< 75linkThe InCHIANTI study included 1155 participants aged 65 and older.
Lipid hydroperoxidesμmol/LOxidation< 2.55< 2.55linkThirty-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-Tocopherolμmol/LOxidation> 31> 31linkThirty-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-Tocopherolμmol/LOxidation> 72.5> 72.5linkThirty-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/GSSGUnits lessOxidation> 1.3> 1.3linkIn 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],
Adiponectinng/mL orAdipose> 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/LeptinUnits less.
Adiponectin – ng/mL
Leptin – pg/mL
Adipose> 2.5> 2.5linkFifty-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 areacm^2Adipose< 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 acidmmol/lLipids< 0.22< 0.22linkSixty 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
HDLmmol/L or mg/dLLipids> 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
LDLmmol/L or mg/dLLipidsN/AN/AlinkSixty 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
Triglyceridesmmol/L or mg/dLLipids< 0.82 (mmol/L)
< 72 (mg/dL)
< 0.82 (mmol/L)
< 72 (mg/dL)
linkSixty 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
GGTIU/LLiver< 15< 15linkA 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)
ASTIU/LLiver< 18< 18linkA 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)
ALTIU/LLiver< 16< 16linkA 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 pressuremmHgBlood pressure< 120< 120linkA 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 pressuremmHgBlood pressure<75<75linkA 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< 2.3linksubjects (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.
GIPpg/mLGut<15<15linkThe study included 128 subjects with BMI exceeding the normal range (25–40 kg/m2), women and men, aged 25–65 years
GLP-1
eGFRmL/min/1.73 m2Kidney> 95> 95link926 type 2 diabetics (T2D) and 4838 non-diabetic individuals from four independent cohorts
creatininemg/dLKidney< 0.87< 0.87link926 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.

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