Investigation of the relationship between body fat composition and metabolic syndrome criteria in morbid obesity cases

Aim: Obesity and metabolic syndrome is a serious public health problem that is rapidly increasing all over the world and affects large masses. The relationship between obesity and metabolic syndrome criteria is a remarkable issue for researchers, and studies on this subject are still ongoing. Not that, we aimed to compare the metabolic syndrome criteria and body fat change during the two-month period from the onset and above the treatment in individuals with a body mass index (BMI) ≥40 kg / m2 (morbidly obese), as well as the comparison of morbid obese cases with normal weight cases. Method: In this retrospective study, 224 cases with BMI ≥40 kg / m2 (morbid obesity study group) who applied to Zonguldak Bülent Ecevit University Obesity and Diabetes Application and Research Center (OBDİM-EASO COM) between 1 May 2017 and 1 October 2019 and 235 cases (control group) with normal BMI (18.0-25 kg / m2) were included. The subjects who had a follow-up for three months or more and followed up for one year were included in the study group. In the information management system of the center, demographic characteristics, height, weight, waist circumference, BMI, systolic blood pressure, diastolic blood pressure, pulse rate, body fat analysis (right arm, left arm, right leg, left leg, trunk and whole body ) and metabolic parameters (fasting blood glucose, fasting insulin, triglyceride and high-density lipoprotein cholesterol values) were determined. First of all, the data of the study group and the control group were compared. Statistical analysis of changes in body fat analysis and metabolic parameters of the study group at the beginning and within twelve months was performed. Results: The mean age of 224 patients in the study group was 41.3 ± 9 years, the mean BMI was 45.8 ± 5.2 kg / m2, and the majority were female (86.2%). When the morbid obese group and control group were compared; Weight, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, pulse minute number, fasting blood glucose, fasting insulin, triglyceride and YDL-k levels were found significantly higher in the morbid obese group compared to the control group (p <0.001). In terms of fat distribution, the measurements of morbid obese patients were found to be significantly higher (p <0.001). It was found that 39.7% of morbidly obese cases were partially or completely exercise compliance, and 46.9% had partial or complete nutritional compliance. Nutritional and exercise compliance of the patients were not at the desired level. 98.2% (n = 221) of the cases were using orlistat, 40.6% (n = 91) metformin, 3.6% (n = 8) sodium glucose transporter inhibitor-2 and 0.9% (n = 2) was using glucagon-like peptide-1 analog. In the history of the cases, 22.6% diagnosed with diabetes mellitus, 29% diagnosed with hypertension, 23.7% hypothyroidism, 5.4% hyperlipidemia, 7.4% psychopathology, 4% asthma, 1.3% obstructive sleep apnea syndrome, 0.9% malignancy (treated disease-free breast cancer, one gynecological cancer, one prostate cancer) 0.9% coronary artery disease was detected. As a result of the measurements and examinations, 59.4% prediabetes (impaired fasting glucose / impaired glucose tolerance) and diabetes were detected, while 63.3% of hypertension was detected. During the follow-up period, weight loss was less than 5% in 84 (38%) of the study group cases, 5 -10% weight loss in 78 (35%), 10-15% weight loss in 43 (20%) and 16 ( It was observed that 7%) provided more than 15% weight loss. It was found that in all body parts of morbid obese patients, the right arm, left arm, right leg, left leg body and total body fat percentages decreased significantly (p <0.001). When the metabolic criteria were evaluated after weight loss, the following conclusions were reached; None of the cases could reach the desired criteria around the waist. The average fasting blood glucose decreased by 4.9% compared to the initial value, the mean systolic blood pressure decreased by 5.7%, and the average diastolic blood pressure decreased by 13.6%. The mean serum triglyceride level did not change. The average YDL-k level decreased by 4.6%. Initially, the percentage of whole body fat; A positive correlation was found between YDL-k (r = 0.256, p <0.001), between weights (r = 0.170, p = 0.011), and between BMI (r = 0.429, p <0.001). With the percentage of whole body fat in the follow-up during the treatment process; weight positive (r = 0.255, p <0.001), BMI positive (r = 0.535, p <0.001), waist circumference positive (r = 0.200, p = 0.003) and pulse minute number positive (r = 0.159, p = 0.017) there was a correlation. Conclusion: Metabolic syndrome criteria have been standardized and accepted in the last century. When obesity becomes morbid obesity as BMI increases, physiopathological changes are the target of treatments. In our study, the relationship between the symptoms of the disease and the criteria of the metabolic syndrome in cases with BMI 40kg / m2 was found. The difference of these parameters from normal weight was determined and compared. Sustaining more than 5% weight loss for more than three months during the treatment process is predicted to be successful. How the anthropometric, regional fat distribution and metabolic syndrome criteria changed in the first year of treatment in our morbidly obese patients was determined. With these data, the parameters that are more important in the follow-up of morbid obesity cases have been transferred to the current literature. With weight loss, regional and whole-body fat distribution changes significantly. While there is a change in the distribution of fat, blood pressure and glycemic variability among the metabolic syndrome criteria are more pronounced. Obesity causes of morbid obesity and complications should be handled with their physiopathological processes. Monitoring of fat distribution and metabolic syndrome criteria is important and necessary in the management of morbid obesity. Keywords: Morbid Obesity, Metabolic Syndrome, Body Fat Composition