RU2163087C1 - Method for evaluating adipose deposits of men with ischemic heart disease - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves measuring by means of calipers the thickness of fat-and-skin fold at side and stomach regions on the basis of product of them, with 407.7 sq.mm being taken as critical value of this product. Value exceeding 407.7 sq.mm is indicative of excessive adipose deposits for patients with ischemic heart disease. EFFECT: simplified method and provision for obtaining precise data. 1 dwg, 2 tbl, 2 ex

Description

 The invention relates to medicine, namely to cardiology.

 Overweight (BMI) is traditionally regarded as one of the important risk factors for coronary heart disease (CHD). However, BMI among people with already developed coronary heart disease occurs 3 times more often than in the general population. Moreover, it not only does not lose its pathogenic role, but also significantly complicates the course and prognosis of the disease, contributing to a more rapid progression of hemodynamic and metabolic disorders and an increase in mortality.

 The mechanisms of this effect are quite complex and diverse, but to a large extent they are due to excessive accumulation of adipose tissue in the body.

 On the contrary, a decrease in BMI leads to predictable and adequate favorable morphofunctional shifts. The foregoing makes it relevant to determine the severity of fat deposition in patients with coronary artery disease in the clinic.

Currently, there are the following methods for assessing the severity of fat deposition:
1. Instrumental methods for direct assessment of the amount of adipose tissue in the body (computed tomography, densitometry, underwater weighing, isotopic dilution, absorption of fat-soluble gases, NMR imaging). However, these methods currently cannot be widely used in clinical practice because of their high cost and laboriousness.

 2. Determination of mass-growth or growth-volume ratios.

 For a quantitative assessment of body mass (MT), more than 50 indirect (based on the relationship between an increase in total MT with an increase in fat deposition) mass and growth indicators (Kegle index, Brock index, mass-height index, Sheldon ponderal index, Davenport, Breitman indicators , Borngardt, etc.), as well as tables and nomograms, to varying degrees, taking into account the gender and type of human constitution.

At present, one of the most common mass growth indicators is the Ketle index (IR, body mass index in kg / m ² ). With its value in men less than 25.0 MT is usually defined as normal, with a value of 25.0-29.9 - as borderline, with a value of more than 29.9 - as excess.

 However, mass-growth ratios inherently do not accurately reflect the amount of fat in the body. It is obvious, for example, that IR as an estimated indicator of MT does not take into account its structure, namely, the ratio of fat and muscle components, i.e. true fat deposition, especially with a slight excess. So, MT can be increased not only due to fat, but also due to muscle tissue. On the contrary, in patients with coronary artery disease, partial atrophy of skeletal muscles is often observed, associated with both age and limited physical activity. As a result, the mass-growth index may be normal, despite excessive fat deposition. Fluid retention in the patient's body is also capable of influencing the value of IR. These factors are very significant for patients with coronary artery disease, as people of the older age groups prevail among them, moreover, they are prone to the development of congestive heart failure. It should also be noted that the sensitivity of various mass growth indicators depends on gender and age, and they are more applicable to young people.

 3. Determination of the fat component of body weight (MMT) using caliperometry. This method consists in measuring with a caliper the thickness of skin-fat folds (QLC) of 8-10 different areas of the body, allows you to get an idea of the composition of body weight in accordance with its two-component model (MMT and fat-free MT) and is the prototype of the proposed method for assessing fat deposition in patients with coronary artery disease . Caliperometry makes it possible to quite reliably evaluate individual fat deposition both in the clinical and in the preclinical stage of obesity. The measurement results correlate with the data of soft tissue radiography and densitometry, as well as sectional studies. The advantages of the caliperometry method include simplicity, low cost, high reproducibility.

 However, caliperometry of 8-10 skin-fat folds with the aim of calculating the BMI is rarely used in traditional clinical practice, as it is undoubtedly less convenient than estimating body weight by IR and especially by Brock's index. The choice for these purposes of a limited number of KZhS should be justified for this contingent of subjects. At the same time, the measurement of individual CLS in mass studies of an epidemiological nature, as a rule, is explained by the authors only by the availability of selected areas of the body, as well as ethical considerations.

 It should also be noted that the range of MMC values accepted by various authors as normal is very wide: from 11.0 to 24.9%, and in women up to 32.0% (!). At the same time, there are practically no works devoted to the study of this indicator specifically in patients with already formed coronary heart disease, and the above standards of MMT were applied to patients of different ages and with various diseases or when examining healthy individuals.

The author proposes to use the following method for assessing fat deposition in men with coronary heart disease: measurement with a caliper (with a constant pressure of 10 g / mm ² and an accuracy of 0.1 mm) of the thickness of the QOL on the side (vertically along the right middle axillary line at the navel) and on the stomach (3 cm to the right at the navel level), taking 407.7 mm ² as the critical value of their product. Exceeding this value indicates the need for correction of the patient's MT.

 We examined 158 men (aged 30 to 72 years, average age 55.3 ± 1.3), patients with stable angina pectoris of functional classes I-IV, and 22 men with uncomplicated myocardial infarction (aged 30 to 71 years, average 56.1 ± 2.2). In addition to general clinical examination, body weight and length, IR were determined, 10 QOL caliperometry was used, and the level of cholesterol and low density lipoproteins (LDL) in the blood serum was studied by the enzymatic method. To assess the severity of abdominal fat deposition, we determined the ratio of the waist circumference (OT), measured at the navel (between the edge of the costal arch and the ilium crest), to the circumference of the hips (OB) at the level of large trochanters.

 Statistical processing of the obtained data was carried out using a computer in the program "Microsoft Excel 7.0" using Student's t test, correlation and regression analysis.

 It turned out that the thickness of the QOL measured on the abdomen and on the side correlates most closely with the MMT. They also have relatively small coefficients of variation (see table. 1). It can be assumed that these folds most accurately reflect the size of the BMI and, in contrast to skin-fat folds on the limbs, are little dependent on the activity of regional muscle groups.

The regression equations were calculated:
ЖМТ (%) = 10.82 + 0.51; КЖС5-0,0008; КЖС5 ² ,
ЖМТ (%) = 9.49 + 0.78 · КЖС6-0.782 · КЖС6 ² ,
ЖМТ (%) = 14.09 + 0.016 · КЖС5 · КЖС6,
where КЖС5 and КЖС6 are the thickness of the skin-fat folds on the abdomen and on the side.

 Obviously, when using the product of two CLCs, the accuracy of the estimation of fat deposition increases: the correlation coefficient of this product with the MMT is 0.91 (P <0.01), the relationship is almost straightforward.

 It should be emphasized that this product is reliably associated with serum cholesterol and LDL (r = 0.24 and 0.27, respectively), as well as with RT, OB and their ratio (r = 0.67, 0.64 and 0 , 33, respectively, all P <0.01), i.e., reflects the severity of the most pathogenic variant of exogenous obesity - according to the android type.

 It turned out that in patients with coronary artery disease, BMI correlates with the presence of angina pectoris (r = 0.24; P <0.05). The correlation coefficient between the functional class St and MMT was 0.47 (P <0.05).

The regression equation is calculated:
The likelihood of angina pectoris (%) = 128.35 - 8.177 · MMC + 0.21 · MMC ² ,
according to which the dependence of anginal pain syndrome on MMT is J-shaped and its role increases significantly with MMT> 22.0% (see the drawing, which shows the dependence of the likelihood of angina pectoris (%) in patients with coronary heart disease on body fat mass (MMT) )

 The clinical significance of anginal pain in patients with coronary artery disease undoubtedly, the presence and severity of angina pectoris directly affect both the prognosis of the disease and the quality of life of patients. Therefore, the indicated value of the MMC was accepted as the maximum allowable for this group of patients.

 The selected criterion (MMT = 22.0%) falls into the range of normal values of MMT according to the literature (closer to its upper boundary). In addition, significant anthropometric and clinical differences were found between the groups obtained. In particular, a BMI value of over 22.0% in patients with angina pectoris is associated with a greater atherogenicity of the lipid composition of the plasma (see table. 2).

From the regression equations it follows that if the maximum normal value of the BMI for patients St is taken to be 22.0%, then the maximum normal value of QOL on the abdomen will be 22.6 mm, on the side - 21.1 mm, and their maximum allowable product is 407.7 mm ² .

 Clinical examples.

Patient B., 60 years old, retired. Case history N 1173. Diagnosis: CHD: exertional angina (functional class III). Postinfarction cardiosclerosis (suffered in 1991, large-focal myocardial infarction of the posterior wall of the left ventricle). HIIA. Objective data: body length 177 cm, MT 85.0 kg, IR 26.8 kg / m ² , OT / OB = 1.0, MMT 22.9%. The thickness of the KZhS on the abdomen is 20.2 mm, on the side 21.4 mm, the product of the latter is 432.3 mm ² . In a blood test: cholesterol 5.8 mmol / L, LDL 5.2 g / L.

Patient S., 63 years old, retired. Case history N 1856. Diagnosis: CHD: angina pectoris (functional class III). Post-infarction cardiosclerosis (post-1993 large-focal posterior myocardial infarction). HIIA. Objective data: body length 174 cm, MT 80.0 kg, IR 26.4 kg / m ² , OT / OB = 0.9, LMW 21.9%. The thickness of the KZhS on the abdomen is 19.4 mm, on the side 20.6 mm, the product of the latter is 399.6 mm ² . In a blood test: cholesterol 5.2 mmol / L, LDL 4.1 g / L.

 The presence of angina pectoris in both patients was confirmed using a bicycle ergometry test.

 Obviously, in patient B., the product of the GLC thickness on the abdomen and on the side is significantly higher, which is associated with increased MMT, android type fat deposition and a higher atherogenicity of the blood lipid spectrum, while age, severity of angina pectoris and heart failure, IR in patients are significantly do not differ. In both patients, the IR value corresponds to the borderline body weight.

 Thus, the author proposes to consider the product of KZhS, measured on the abdomen and on the side, exceeding 407.7 mm, as an indicator of excess fat deposition for patients with coronary artery disease. This method can be used both in clinical practice (when planning rehabilitation measures) and for scientific purposes. The proposed technique is informative, non-invasive, does not require expensive equipment, takes a minimum of time.

Claims (1)

The method of caliperometric assessment of fat deposition in patients with coronary heart disease, which consists in measuring the thickness of the skin-fat folds with a caliper, characterized in that they determine the thickness of the folds on the side and abdomen, with the calculation of their product and with a value of the latter over 407.7 mm ² talk about the presence of excess fat deposition in the patient.

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