Metabolički sindrom, pandemija pretilosti i učinkovitost intervencije liječnika obiteljske medicine [Metabolic syndrme, obesity pandemia and effectiveness of intervention of family practitioners]

Ivezić-Lalić, Dragica (2014) Metabolički sindrom, pandemija pretilosti i učinkovitost intervencije liječnika obiteljske medicine [Metabolic syndrme, obesity pandemia and effectiveness of intervention of family practitioners]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The aim of this dissertation was to investigate the effect of a systematic and programmed intervention, primary care, prevention and treatment of MS in persons aged 40 years and over in the care of a family physician. The study was a multicenter, prospective, cohort, and interventional. It was conducted in 59 family practices (FP) in continent and the Croatian coast. Five years, since year 2007. by year 2011. have elapsed from the formation of the study until it was completed. The sample was fourfold stratified, and the results are representative of the population in FPcare. The survey dealt with the relationship between MS and CVD as most important complications that are significantly contributing to clarify the degree of interconnection and interoperability of individual risk factors. Also, higher prevalence of metabolic syndrome was on the continent than in coastal areas. The higher prevalence of metabolic syndrome was in patients in the city versus the countryside. All three criteria of metabolic syndrome present between coronary artery disease, and criteria of MS according to NCEP-ATP III and IDF shows a correlation with cerebrovascular disease, and peripheral vascular disease is a proven connection between the WHO and NCEP-ATP III. Only the NCEP ATP III shows association with all three diagnoses of CVD (coronary, cerebrovascular and peripheral vascular disease), thus we conclude that the population of the Croatian family medicine in the practical application of the best criterion by NCEP-ATP III. We found that the MS as defined by NCEP ATP III criteria, is a better predictor of CVD than obesity.The FP intervention for 24 months reduced the number of patients with metabolic syndrome, as defined by all three criteria. The number of patients with increased waist circumferencereduced. BMI decreased in the same subjects. Determining the incidence rates and the presence of MS in the study population, we have significantly increased our understanding of the prevalence, risk factors and early diagnosis of the metabolic syndrome in patients ≥ 40 years of age in a population of Croatian family medicine. This research found that programmed and systematic interventions FP resulted stopping development process manifest cardiovascular disease

Abstract in Croatian

Cilj ove disertacije bio je istražiti učestalost MS u stanovništva Republike Hrvatske te utjecaj sustavne i programirane intervencije liječnika obiteljske medicine u prevenciji i liječenju MS u osoba životne dobi od 40 i više godina u skrbi liječnika obiteljske medicine. Istraživanje je bilo multicentrično, prospektivno, kohortno te intervencijsko. Provedeno je u 59 ordinacija obiteljske medicine kontinenta i priobalja Republike Hrvatske. Pet godina, od 2007. godine do 2011. godine, proteklo je od oblikovanja studije do njezina završetka. Uzorak LOM je četverostruko stratificiran, a dobiveni rezultati su reprezentativni za populaciju u skrbi LOM. Provedenim istraživanjem obrađen je odnos MS i KVB kao njegove najvažnije komplikacije što značajno pridonosi razjašnjavanju stupnja povezanosti i međudjelovanja pojedinačnih rizičnih čimbenika. Utvrđena je veća učestalost osoba s metaboličkim sindromom na kontinetu u odnosu na priobalje. Utvrđena je veća učestalost metaboličkog sindroma u ispitanika u gradu naspram sela. Sva tri kriterija metaboličkog sindroma prikazujupovezanostskoronarnombolesti, dok kriterij MS prema NCEP ATP III i iDF pokazuje povezanost s cerebrovaskularnom bolesti, a s perifernom vaskularnom bolesti povezanost je dokazana premaWHO i NCEP ATP III. Jedino NCEP ATP III iskazuje povezanost sa sve tri dijagnoze KVB (koronarna, cerebrovaskularna i periferna vaskularna bolest) čime zaključujemo da je za populaciju obiteljske medicine Republike Hrvatske u praktičnoj primjeni najbolji kriterij prema NCEP ATP III. Utvrdili smo da je MS definiran prema NCEP ATP III kriteriju bolji prediktor KVB nego pretilost. Programiranom intervencijom LOM tijekom 24 mjeseca smanjio se broj ispitanika sa metaboličkim sindromom definiranog prema sva tri kriterija. Smanjio broj ispitanika sa povećanim opsegom struka i smanjio se ITM u istih ispitanika. Utvrđivanjem stope incidencije i zastupljenosti MS u istraživanoj populaciji značajno smo proširili spoznaje o proširenosti, rizičnim činiteljima i ranoj dijagnostici metaboličkog sindroma u osoba ≥40 godina starosti u populaciji obiteljske medicine Hrvatske. Ovo je istraživanje utvrdilo da programirana i sustavna intervencija LOM rezultirala zaustavljanjem procesa razvoja manifestne kardiovaskularne bolesti.

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