In some people, obesity interacts with inherited factors
and leads to the onset of insulin resistance. This metabolic abnormality
in turn is responsible for altered glucose metabolism and a predisposition to
type 2 diabetes. In addition, it causes a number of subclinical abnormalities
that predispose to cardiovascular disease and accelerate its onset. The most
important among these are type 2 diabetes, dyslipidemia, and hypertension. When
clustered together with other insulin resistance–related subclinical
abnormalities, these are referred to as the metabolic syndrome (Abate,
2000). Virtually all obese women with hypertension demonstrate elevated plasma
insulin levels. Levels are even higher in women with excessive fat in the
abdomen—an apple shape, compared with those whose fat is in the hips and
thighs—a pear shape (American College of Obstetricians and Gynecologists, 2003).
In fact, Gus and associates (2004) reported that for women, a waist
circumference greater than 88 cm was more predictive of hypertension than a BMI
greater than 30 kg/m2.
Criteria used by the National Institutes of Health (2001)
to define the metabolic syndrome are shown in Table below. Of interest, the
American Diabetes Association eschews the "syndrome" designation and urges
consideration for these and other cardiovascular-disease risk factors that occur
singly or in combination (Kahn and colleagues, 2005).
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aThose with normal values while taking medications
are considered to meet these criteria.
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Referensi:
Williams Obstetrics 23rd Edition (McGraw-Hill) 2009