Preventive examinations for obesity

Laboratory, imaging and anthropometric tests play a key role in the diagnosis of obesity and its complications, as well as in monitoring progress in weight loss. Are you overweight or obese? Find out which preventive examinations you should perform, how often and why?

Weight gain that accompanies obesity as its main symptom increases the risk of obesity in people suffering from about 50 other serious diseases that may cause premature death. They include, among others heart attack, stroke, hypertension, type 2 diabetes, colorectal cancer, breast cancer, non-alcoholic fatty liver, gout, sleep apnea or depression.

Due to this fact, it is very important that people with obesity regularly undergo preventive examinations in order to avoid these serious complications. In addition, such tests may be useful in identifying diseases coexisting with or causing obesity, such as, for example, Cushing's syndrome, polycystic ovary syndrome, or hypothyroidism. We suggest what preventive examinations should be systematically performed by overweight people, i.e. those in a pre-obesity state, and those suffering from obesity.

Contents:

1. Laboratory tests - complete blood count
2. Laboratory research - carbohydrate management
3. Laboratory tests - lipid profile and risk assessment of cardiovascular diseases
4. Laboratory tests - hormone balance
5. Laboratory tests - liver enzymes
6. Laboratory tests - diagnosis of kidney diseases
7. Laboratory tests - general urine test
8. Other preventive examinations
9. Anthropometric research

Laboratory tests - complete blood count

Blood morphology is a basic laboratory test that allows you to detect various pathologies at an early stage. The test is ordered to each person at least once a year as part of preventive examinations. Blood morphology allows, among others to detect anemia, the cause of which may be a deficiency of iron, vitamin B12 and folic acid. People with obesity, despite the excessive supply of food, may paradoxically suffer from nutritional deficiencies. The blood count also includes the study of the white blood cell system (the number of white blood cells and theirparticular types) allowing, among others. to detect ongoing inflammation.

Laboratory research - carbohydrate management

One of the most common obesity disorders are those related to abnormal blood glucose levels and insulin secretion and cell sensitivity (insulin resistance). The basic tests assessing carbohydrate metabolism are blood glucose (fasting norm: 70-99 mg / dl) and insulin (fasting should be between 2.60-24.90 mIU / l, but preferably when it does not exceed 10 mIU / l). ). In the case of abnormal fasting glycaemia, when the glucose value is between 100 and 125 mg / dl, in an obese person, the so-called glucose curve. This test involves measuring fasting blood glucose and administering 75 g of glucose in the first and second hours after its administration.

A useful marker for assessing blood glucose levels is the determination of glycosylated hemoglobin. This parameter reflects the average blood glucose concentration in the last 3 months. It is a stable marker of blood glucose and is independent of short-term dietary changes.

Based on fasting glucose and insulin values, you can also estimate whether an obese person also has insulin resistance. Based on these two parameters, the HOMA index (HOMA-IR,Homeostatic model assessment ) or QUICKI ( Quantitative insulin sensitivity check index ) ). Insulin resistance is a phenomenon that can make weight reduction significantly more difficult, and also be the first sign of type 2 diabetes.

Regardless of age, a person suffering from obesity should perform carbohydrate metabolism tests every year.

Laboratory tests - lipid profile and cardiovascular disease risk assessment

Another blood parameter that is disturbed in people with obesity is the lipid profile. The examination of the lipid profile consists of: total cholesterol, LDL and HDL cholesterol and triglycerides.

Obesity in itself is a factor that increases the risk of cardiovascular disease, therefore, in obese people, profile testing should be performed once a year. In turn, in order to monitor the effectiveness of dietary or pharmacological treatment, the test should be performed once every 3 months.

The determination of parameters such as homocysteine ​​and highly sensitive C-reactive protein (hsCRP) is also important when assessing the risk of cardiovascular (circulatory system) diseases. Increasing these two rates may increase the risk of cardiovascular disease. Additionally, hsCRP is an inflammation marker that is almost always the caseaccompanies obesity and is one of the causes of obesity-related diseases.

Laboratory tests - hormone balance

Obesity causes many hormonal disorders, but also vice versa: hormonal disorders - e.g. hypothyroidism - can lead to obesity. In order to diagnose functional disorders of the thyroid gland, the level of TSH is tested, which is currently the most sensitive indicator of functional disorders of this organ. The level of fasting TSH is dependent on age and should be in the range of 0.3-4 mU / L in adults. However, it is believed that the values ​​above 2 mU / l with the co-occurring symptoms of hypothyroidism may already indicate disturbances in its functioning. The level of TSH is often determined together with the so-called free fractions of thyroid hormones - fT3 and fT4.

It is also very important to check your sex hormones regularly. In people with obesity (e.g. as a result of too high insulin levels) there is an excessive synthesis of estrogens and androgens, which may cause fertility disorders. Therefore, these tests should be especially ordered in women who are trying to conceive. On the other hand, in obese men there may be a decrease in testosterone, and thus a decrease in sperm quality and a decrease in libido.

Another important hormone that requires monitoring is cortisol. This hormone in obese people undergoes excessive biological degradation, which may result in its excessive production by the adrenal glands. Looking at the problem from a different angle, excess cortisol is also characteristic of chronically stressed people. As a result, Cushing's syndrome and related cushingoid obesity may develop.

Excess cortisol causes insulin resistance and the accumulation of adipose tissue around the abdomen, which may cause problems with weight loss in obese patients. Cortisol levels can be measured in a laboratory from blood, urine, or saliva. The measurement is best done at a few points throughout the day as cortisol secretion changes throughout the day.

Laboratory tests - liver enzymes

People with obesity are more likely to develop nonalcoholic fatty liver disease. In order to assess the state of the liver function, alanine aminotransferase (ALT) and asparagine aminotransferase (AST) tests should be performed, the increased activity of which is observed in steatosis or steatohepatitis. At the onset of the disease, the increase in ALT, which is more liver specific, is more significant, followed by AST. Increased levels of another enzyme, glutaryltranspeptidase (GGTP), are less frequently observed. Laboratory standard for ALT and ASPis below 40IU / l, and for GGTP below 35UI / l in women and below 40UI / l in men.

Laboratory tests - diagnosis of kidney diseases

People with obesity have a higher risk of developing chronic kidney disease or obesity-related glomerulopathy with enlarged glomeruli. Therefore, the assessment of kidney function is another test that can be used in the prophylaxis of this group of patients. Laboratory markers of kidney function include: on the determination in the blood of the concentration of substances (products of nitrogen metabolism) that are excreted by the kidneys. Their increase in the blood indirectly indicates impaired renal function. The most important are:

• urea- (laboratory norm: 15-40 mg / dl), sometimes replaced by the marking BUN, which is calculated from the formula BUN=urea x 0.46; its concentration in the blood depends on many factors, including supply of protein in the diet, so it is best to determine it together with the level of creatinine,
• creatinine - (laboratory norm: 0.6-1.3 mg / dl), usually together with creatinine, creatinine clearance is also calculated to assess the glomerular filtration rate (GFR),
• uric acid - (laboratory norm for women is 30-50 mg / l, and for men it is 40-60 mg / l), its increase in blood, apart from being a marker of kidney failure, may be the cause of gout uranowa.

Laboratory tests - general urine test

People with obesity should also periodically perform a general urine test, which can be a source of information about the onset of pathologies. In addition to testing the color, pH, and weight of your urine, you can test the amount of protein in the urine (which may indicate renal failure) and the presence of glucose and ketone bodies (which may indicate diabetes).

Other preventive examinations

In addition to laboratory tests, endoscopic tests are important in the prevention of diseases in obese people, such as:

• colonoscopy, which allows the identification of polyps in the intestine and precancerous lesions,
• ultrasound examination (USG) of individual organs such as the thyroid gland, kidneys, liver or breasts in women, which supplements laboratory diagnostics,
• spirometry test (spirometry) helpful in the prevention of respiratory diseases such as asthma.

Anthropometric research

Anthropometric tests are also useful in diagnosing the type of obesity and then monitoring the effectiveness of the implemented weight reduction treatment. The simplest and most frequently used method of diagnosing obesity is the calculation of the BMI ( body mass index ). However, this indicator does notwill allow you to assess the content of body fat, muscle and water in the body. This is important because people with a high BMI index do not have to be obese at all, but only have a large muscle mass.

The BMI index will also not allow to estimate the content of the abdominal (viscellular) adipose tissue, which has the greatest pathogenic potential. Its content can be estimated by simply measuring the waist-hip ratio ( WHR, ), but similarly to the BMI index, it is not very accurate.

For a more accurate measurement of the thickness of adipose tissue, the following methods are used:

• computed tomography (CT),
• nuclear magnetic resonance (MRI),
• Dual Energy X-ray Absorptiometry,
• electrical bioimpedance - this method uses differences in the conductivity of tissues (adipose tissue resists more than muscle tissue) and consists in the flow of low-concentration current through the body; the procedure is easy and accessible, therefore it is often used in doctor's and dietary offices.

References:1. Tałałaj M.Obesity and kidney diseases.Postępy Nauk Medycznych, vol. XXVI, No. 5B, 2013, 26-302. Demissie M. and Milewicz A.Hormonal disorders in obesity . Diabetologia Praktyczna 2003, 4, 3, 207-209.3.Internal diseasesedited by Szczeklik A., Medycyna Praktyczna Kraków 20054.Laboratory diagnostics with elements of clinical biochemistry . A textbook for medical students edited by Dembińska-Kieć A. and Naskalski J.W., Elsevier Urban & Partner Wydawnictwo Wrocław 2009, 3rd edition 5. Shuster A. et al.The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis.Br J Radiol. 2012, 85 (1009), 1-10.6. http: //www.labtestsonline.pl

Important

Poradnikzdrowie.pl supports safe treatment and a dignified life of people suffering from obesity. This article does not contain discriminatory and stigmatizing content of people suffering from obesity.