Metabolic syndrome: the dysmetabolic state of dysfunctional adipose tissue and insulin resistance
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Notice bibliographique
Résumé
The current world epidemic of obesity represents a tremendous medical and public health challenge. A major consequence of obesity has been a rapid acceleration in the prevalence of type 2 diabetes;1 however, it is now recognized that even before the development of diabetes, many individuals have the constellation of athero-thrombotic inflammatory abnormalities characteristic of type 2 diabetes.2 Thus, the cluster of metabolic abnormalities is not the consequence of the hyperglycaemic state of type 2 diabetes but is rather pathophysiologically related to insulin resistance, the most prevalent form of insulin resistance being present in individuals with excess visceral as well as ectopic fat.3 Thus, even in the absence of hyperglycaemia, abdominally obese patients with an excess of visceral and ectopic fat deposition are likely to have the clustering of risk factors associated with insulin resistance. In this regard, the pivotal role of insulin resistance in the pathophysiology of the cluster of risk factors was first reported by Reaven4 and designated syndrome X. Since his seminal paper, numerous groups have utilized the term insulin resistance syndrome in the description of this cluster of athero-thrombotic inflammatory abnormalities.5,6 In 2001, the guidelines developed by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) committee considered abdominal obesity as central in the pathophysiological development of the insulin resistance syndrome.7 Since the measurement of insulin resistance was not practical in the context of primary care clinical practice, the guidelines provided clinicians with simple diagnostic criteria, including waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, blood glucose, and blood pressure to identify patients with the cluster of risk factors, resulting in an increased risk of diabetes and cardiovascular disease (CVD). The cluster of athero-thrombotic inflammatory risk factors was designated as the metabolic syndrome. Many groups have confused the NCEP-ATP III five criteria to diagnose the metabolic syndrome in the context of clinical practice with the conceptual definition of the syndrome. The definition of the metabolic syndrome has a pathophysiological basis3,8 and places insulin resistance and abdominal obesity at the core of the cluster of abnormalities. The NCEP-ATP III five criteria should not be considered as the definition of the metabolic syndrome but rather as simple screening tools. Refining the discriminating capabilities of these tools is work in progress. For instance, the International Diabetes Federation (IDF)9 has placed more emphasis than NCEP-ATP III on the importance of abdominal obesity and recognized the important ethnic differences in susceptibility to visceral adiposity and related metabolic abnormalities.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle