Úvodník

Štěpán Svačina

Vnitr Lek 2010, 56(10):1018  

The incidence of obesity and its complications in the Czech Republic

M. Matoulek, Š. Svačina, J. Lajka

Vnitr Lek 2010, 56(10):1019-1027  

Over the recent years, the incidence of obesity is continuously rising. A research conducted in 2008-2009 on a representative sample of Czech population (n = 2,058) suggests that 23% of adult population of the Czech Republic are obese and 34% are overweight. This represents an increase of 5% in the number of obese people (17% vs. 22%), while the number of overweight remains practically the same (35% vs. 34%). A more significant shift in female waist circumference compared to male has also been shown. The incidence of hypertension in the evaluated sample was more than a two-fold higher in obese participants (48 % vs. 21 %) and as much as 3-fold higher...

Adipose tissue hormones

M. Haluzík, P. Trachta, D. Haluzíková

Vnitr Lek 2010, 56(10):1028-1034  

Adipose tissue had been traditionally considered a passive energy storage site without direct influence on energy homeostasis regulation. This view has been principally changed during early nineties by the discovery of hormonal production of adipose tissue. At present, the list of hormonally active substances of adipose tissue includes more than one hundred factors with paracrine or endocrine activity that play an important role in metabolic, food intake a inflammatory regulations and many other processes. Only minority of adipose tissue-derived hormones is produced exclusively in fat. Most of these factors is primarily put out by other tissues and...

Genetics of obesity

I. Aldhoon Hainerová

Vnitr Lek 2010, 56(10):1035-1042  

Animal models and family studies led to the identification of cases of rare monogenic forms of human obesity. Rare Mendelian syndromes as Prader-Willi syndrome and Bardet-Biedl syndrome represent cases of genetically determined obesity. Genome wide linkage and classical candidate gene studies were in general unsuccessful concerning the identification of genes of common obesity. On the other hand, genome-wide association studies (GWAS) were found to be effective, as also variants with only a minor effect have been detected. Seventeen polygenic variants influencing body weight regulation were clearly confirmed. It is assumed that more of these variants...

Clinical and genetic aspects of monogenic obesity

D. Lesayová, J. Staník, D. Gašperíková, I. Klimeš

Vnitr Lek 2010, 56(10):1043-1049  

High prevalence of obesity in all of age categories is currently one of the biggest problem in medicine. Identification of etiology of obesity can individualise an approach to the patient and it is essential for choosing a target management and therapy. Beside the largest group with polygenic inheritance are clinically important also patients with "syndromic obesity", where obesity is only one of the signs and monogenic obesity, where obesity is the major clinical phenotype (patients with mutations in gene for leptin, leptine receptor, prohormone convertase 1, melanocortine receptor 4, brain-derived neurotropic factor and tyrosin kinase receptor B)....

Complications of obesity - pathogenesis

B. Krahulec

Vnitr Lek 2010, 56(10):1050-1052  

Author discuss possible patogenetic mechanisms of obesity complications. He separates metabolic complications, especially risk factors of atherosclerosis collected in syndrome of insulin resistance. Here can be added also hyperuricaemia and nonalcoholic fatty liver disease. Mechanical complications of obesity are first of all breath disorders, gastrooesophageal reflux disease and ostaoarthritis.

Smoking and obesity

P. Sucharda

Vnitr Lek 2010, 56(10):1053-1057  

Smoking and obesity represent the current leading preventable health risks. Smoking and obesity increase the risk of many types of cancer, both smoking and abdominal obesity are insulinoresistant states, leading to endothelial dysfunction and high cardiovascular morbidity and mortality. Combining obesity with current smoking increases the risk of premature death more than 10-fold; the risk for obesity increases with number of cigarettes per day. Maternal smoking and smoking in families represent higher risk for children overweight/obesity. Weight gain after smoking cessation may be moderate, mostly is temporary and may be reduced by appropriate education...

Past, present and future of obesity pharmacotherapy

Ľ. Fábryová

Vnitr Lek 2010, 56(10):1058-1064  

Obese (BMI ≥ 30 kg/m²) and overweight (BMI ≥ 25 and < 30 kg/m²) individuals are at high risk of developing serious chronic health problems, including type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease. Caloric restriction, increased physical activity and behavioral therapy remain the primary treatment options for the management of body weight in these individuals. When a weight loss of 5-10% cannot be achieved in 3-6 months by lifestyle changes drug therapy might be indicated. This review will provide a brief history of obesity pharmacotherapy, discuss the status of currently available obesity drugs...

Metabolic surgery

M. Fried

Vnitr Lek 2010, 56(10):1065-1068  

In the beginning of the 21st century obesity still represents health, social and economical threat for most of economically wealthy countries worldwide. Estimated direct costs for obesity and related comorbidities treatment exceed 5% of the total health care spendings both in the US and in European Union. However, in addition there are obesity related indirect costs linked to more frequent work sickness leave, higher unemployment rates and owerall lower productivity of obese patients. Surgical treatment of obesity (bariatric surgery) is the most effective long-term treatment modality to those suffering from higher degrees of obesity. Bariatric surgery...

Physical activity in the treatment of obesity

H. Svačinová, M. Matoulek

Vnitr Lek 2010, 56(10):1069-1073  

Physical activity is a pivotal component in the treatment of obesity. An increase in energy expenditure through physical activity in combination with a weight reduction diet intensifies negative energy balance, brings a reduction in fat reserves and, simultaneously, prevents loss of an active body mass. The main aim and significance of physical activity in obese individuals is not the weight reduction itself but its positive effects on factors that represent an increased cardiovascular risk. When prescribing a physical activity to an obese individual, selection of a suitable form, intensity, duration and frequency of load should all be considered....

Obesity and arterial hypertension

Ľ. Gašpar, P. Poliak, M. Makovník, S. Hlinšťáková, B. Krahulec, T. Pišková, M. Bendžala

Vnitr Lek 2010, 56(10):1074-1077  

Obesity is an independent risk factor for the development and progression of hypertension, cardiovascular disease and chronic kidney disease. There is growing evidence that obesity and associated metabolic abnormalities may induce and accelerate renal complications in essential hypertension. The clustering of obesity and other features of the metabolic syndrome might have important implications for prevention, particularly with regard to whether interventions targeted at visceral obesity would have beneficial effects on cardiovascular and renal morbidity.

Treatment of an obese diabetic

Š. Svačina

Vnitr Lek 2010, 56(10):1078-1081  

Weight reduction is an important component of comprehensive management of diabetes. Weight reduction can be achieved using 6 methods: 1. diet 2. physical activity, 3. psychotherapy, 4. bariatric surgery, 5. pharmacotherapy of obesity, 6. selection of an appropriate antidiabetic medication. Orlistat is the only antiobesity agent presently available in the Czech Republic. Weight neutral (metformin and gliptins) and weight reducing antidiabetics (incretine analogues exenatide and liraglutide) and insulin analogue detemir are suitable antidiabetic drugs. We thus have a sufficient range of options available for weight reduction in diabetic patients.

Obesity and a risk of carcinoma

J. Payer, P. Jackuliak, M. Nagyová

Vnitr Lek 2010, 56(10):1082-1087  

At present, obesity and tumour diseases represent an important healthcare issue that has its socioeconomic and social dimensions. It has been known from literature for some time that certain types of tumours are more common in obese people than in people with normal body weight. About 3.2% of newly diagnosed cancers in men and 8.8% in women are associated with high body mass index (BMI). However, many studies suggest a more significant correlation between a waist-to-hip ratio (WHR) and a risk of cancer than a BMI. This is in line with the current orientation of knowledge not only to the quantity but mainly to the distribution of adipose tissue within...

Obesity - the risk factor of cardiovascular disease in patients with chronic kidney disease?

D. Ližičárová, E. Hirnerová, B. Krahulec

Vnitr Lek 2010, 56(10):1088-1092  

In general population obesity is regarded as a predisposing factor for chronic disease such as type 2 diabetes and cardiovascular disease. Obesity increases the risk of kidney disease and adversely affects the progress of kidney disease among patients with diagnosed kidney disease. The main reason of mortality in chronic kidney disease patients is cardiovascular disease, however, the real meaning of obesity as a risk factor of cardiovascular diseases is still uncertain. While in a general population obesity causes higher cardiovascular mortality, many studies reflect inverse association in chronic kidney disease patients. Obesity is associated with...

Eating disorders in obese individuals - a psychiatric or internal medicine issue?

E. Kravarová, Š. Slabá, Š. Svačina

Vnitr Lek 2010, 56(10):1093-1095  

Many relations are connecting obesity and eating disorders - one disease is often modifying the other. Anorexia Nervosa and Bulimia Nervosa are mostly treated by psychiatrists. Internal medicine specialists are mostly involved only in complications (e. g. malnutrition, ion disorders). Obesity is mostly treated only by internists. Psychiatrists are only involved in some depressive patients. Obese patients with eating disorders are mostly not sent to psychiatric diagnostics. In this article an overview of eating disorder symptoms and classification is given - binge eating disorder, night eating syndrome and grazing. These symptoms are defined and possibilities...

Poruchy příjmu potravy a obezita - nutnost interdisciplinárního přístupu - editorial

E. Češková

Vnitr Lek 2010, 56(10):1096-1097  

Obesity prevention

D. Müllerová

Vnitr Lek 2010, 56(10):1098-1102  

Obesity is chronic disease, with increased prevalence since sixties of last century, now widespread as well in developing countries, not only in developed countries, like on the beginning. Obesity with its co-morbidities reduces longitude and quality of life. Treatment and indirect costs of obesity are rising and economically demanding. At present time there are not sufficient data supporting effectiveness of specific community preventive intervention. Interventional activity being in progress are based on active mobilization of citizens to active life style, with healthy diet and increased physical activity, with effort to build up anti-obese physical...

A new concept of clinical classification of obesity

P. Sucharda

Vnitr Lek 2010, 56(10):1103-1104  

Current classification of obesity is based on the relative body weight and fat tissue distribution, it does not provide relevant information on functional status, quality of live and patient prognosis. A combination of obesity classes with 5 stages is being proposed, where the stages are defined by the presence of risk factors, obesity-related diseases and the level of functional impairment. Individual stages are associated with recommended preventive and treatment approaches.