Analysis Of Risk Factors In Obese Patients With Metabolic Abnormalities And Study On Lifestyle Intervention For Weight Loss

Chapter 1 Analysis of risk factors in obese patients with metabolic abnormalitiesObjective:To explore risk factors related to metabolic abnormalities in obese patients.Methods:A total of 217 obese patients who visited the multidisciplinary clinic for obesity of Nanjing Drum Tower Hospital were divided into metabolic syndrome(MS)group and non-MS group according to whether combined MS.General conditions,metabolic indicators and body composition of the patients in the two groups were compared to clarify the risk factors of metabolic abnormalities.Results:The prevelence of MS was 51.6%in this cross-sectional study.In MS group,112 participants(54 men and 58 women)aged 33.8 years old,Body mass index(BMI)was 33.8 kg/m~2and obesity duration was 19.1 years.In non-MS group,105participants(54 men and 51 women)aged 31.7 years old,BMI was 33.2 kg/m~2and obesity duration was 19.0 years.Patients in the MS group had higher serum fasting blood glucose(FPG),two-hour blood glucose(2h PG),glycated hemoglobin(Hb A1c),insulin resistance index(HOMA-IR),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),systolic blood pressure(SBP),diastolic blood pressure(DBP),waist circumference(WC),waist-to-hip ratio(WHR),body fat rate and trunk fat rate(P<0.05),but lower high density lipoprotein cholesterol(HDL-C),limb muscle rate and leg muscle rate(P<0.05).Dividing all patients into four groups(Q1?Q4)based on the quartile of the leg muscle rate and correcting mixed factors such as age,sex,BMI,HOMA-IR,fatty liver,etc.,we found the low level of leg muscle rate remained an independent risk factor for MS[Q4 7.546(95%CI:2.427 to 14.856),P<0.05].Spearman correlation analysis showed that leg muscle rate was negatively correlated with WC,2h PG,HOMA-IR,visceral fat area(VFA),body fat rate and sedentary time(r=-0.174?-0.873,P<0.05),and was positively correlated with basal metabolic rate(BMR)and physical activity(r=0.198?0.453,P<0.05).Conclusions:The level of leg muscle rate in obese patients with MS is lower than those without MS.Leg muscle rate is an independent risk factor for MS,which is associated with decreased physical activity and prolonged sitting time.Chapter 2 Study on lifestyle intervention for weight loss in obese patientsObjective: To explore the weight loss efficiency and influencing factors of 3-month lifestyle intervention in obese patients.Methods: This prospective study included 90 obese patients who have completed 3months of lifestyle intervention in the multidisciplinary clinic for obesity at Drum Tower Hospital Affiliated to Nanjing University Medical School.The weight loss efficiency of obese patients was evaluated under this weight loss management model.Participants were divided into effective weight loss group and ineffective weight loss group based on whether weight loss ?5%.The basic data,condition of follow-up,and changes of dietary structure,physical activity,behavior custom,emotional state,body composition and metabolic indices of the two groups were compared.The independent predictors for effective weight loss were determined based on binary logistic models.Results: The study included 90 obese patients,aged(33.5±9.7)years old,male accounted for 55.6%,baseline BMI was(32.8±4.2)kg/m2,baseline daily intake of total calories was(1941.6 ± 353.3)kcal,carbohydrates was(241.7 ± 52.7)g,protein was(75.2 ± 22.5)g,fat was(74.9 ± 17.0)g,physical activity assessment showed that45.6% of patients were lack of physical activity,30% were insufficient,14.4% were appropriate,and 10% were adequate.After 3 months of lifestyle intervention,60% of obese patients achieved effective weight loss.The average weight loss of the effective group was 10.4%,and that of the ineffective group was 2.5%.The daily intake of total calories and level of physical activity increased in the two groups,but the metabolic indices and body composition improved in effective weight loss group more significantly.History of childhood obesity and follow-up compliance were different between the two groups.A multivariate logistic regression model including age,gender,baseline BMI,history of childhood obesity,and follow-up compliance found that the follow-up compliance was independently related to the effectiveness of weight loss(OR 3.437,95%CI 1.259~9.384,P<0.05).Kendall's tau-b correlation analysis showed that follow-up compliance was positively correlated with education level(r = 0.223,P <0.05)and follow-up rate at the first month(r = 0.254,P <0.05),and negatively correlated with the history of drinking(r =-0.249,P <0.05).Conclusions: After 3 months of lifestyle intervention,60% of obese patients achieved effective weight loss.Follow-up compliance is an independent predictor of the effective weight loss on short-term lifestyle interventions in obese patients.Patients with higher follow-up compliance more likely to achieve effective weight loss.