A Study on Association between Ultrasonographic Visceral Fat Thickness and Cardiovascular Risk in Type 2 Diabetes Mellitus

Premkumar, G (2015) A Study on Association between Ultrasonographic Visceral Fat Thickness and Cardiovascular Risk in Type 2 Diabetes Mellitus. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia and insufficiency of secretion or action of endogenous insulin. Currently the number of cases of diabetes worldwide is estimated to be around 150 million. India leads then world with the largest number of diabetic subjects earning the dubious distinction of being the “diabetic capital of the world”. Obesity has induced many public health problems related to metabolic diseases, including glucose intolerance, hypertension, hyperinsulinemia, dyslipidemia and atherosclerosis. Moreover these complexes are known to increase the risk of cardiovascular diseases. In particular, the accumulation of adipose tissue predominantly in visceral cavity plays a major role in development of metabolic syndrome and cardiovascular disease. Therefore estimating the visceral fat accumulation is important in terms of evaluating the patients with high risk of cardiovascular disease. Generally computerized tomography (CT) is recognized as the standard method of estimating the visceral fat. But, exposure to radiation, high cost of CT, low availability prevents the wide use of CT, in clinical and epidemiological studies. Therefore alternative methods which are simple and non invasive have been used in assessing the visceral fat thickness. Some of the alternative methods are, Body mass Index, waist hip ratio, dual energy X-ray absorptiometry and ultrasonography. Ultrasonography is a reliable and convenient method of quantifying the amount of visceral fat and the diverse USG values have been reported to be useful. AIMS AND OBJECTIVES: 1. To assess the independent relationship between visceral fat thickness and cardiovascular risk in type 2 diabetes patients. 2. To assess whether the above parameters helps to identify the high risk group for cardiovascular diseases. MATERIALS AND METHODS: Place of the Study: The study was conducted at Government Rajaji Hospital, Madurai Medical College, Madurai. Study Design: Observational type of study. Study Population: 50 patients who are known case of type 2 diabetes mellitus were selected from Department of Diabetology, Government Rajaji Hospital, Madurai METHODOLOGY: 50 patients who are known case of type 2 diabetes mellitus were analysed for this study. A thorough clinical evaluation was made and detailed history, blood pressure, height, weight, waist and hip circumference were taken. a) Fasting lipid profile was done by enzymatic methods like zaks method, and spot urine sample for microalbuminuria were taken. b) Visceral fat thickness was measured in fasting and in full expiration. The distance between the internal surface of rectus abdominis muscle and the posterior wall of aorta is measured. RESULTS: 1. Out of the 50 subjects, the visceral fat thickness was measured and patient were categorized into VFT < 5.5, 5.6 – 6.5 , 6.6 – 7.5 and > 7.5. The mean visceral fat was 6.08 among the 50 subjects. 2. Among the 50 diabetic subjects (25 males and 25 females) attending the department of Diabetology in Government Rajaji Hospital, Madurai, with BMI of > 25, increased visceral fat thickness was found in 12 males and 15 females. 3. Among the 50 patients, all the patients who had increased visceral fat thickness had an increased triglyceride level and increased LDL level. Therefore there is a strong positive correlation between increased visceral fat thickness and LDL, TGL levels. 4. Similarly, 13 patients had microalbuminuria, out of which more than 90% of patients had a Visceral fat thickness of more than 7.5. They also had a increased triglyceride level and LDL levels. 5. There was no significant correlation between visceral fat thickness and total cholesterol levels. Similarly even HDL didn’t show show any strong correlation with visceral fat thickness levels. CONCLUSION: Eventhough there are many parameters to assess the cardiovascular risk like BMI, WHR, etc, measuring the visceral fat thickness is a reliable indicator to assess the cardiovascular risk. This study which was conducted in Government Rajaji Hospital among 50 type 2 diabetic subjects, showed a strong positive correlation between visceral fat thickness with LDL and triglycerides levels. Similarly 13 patients had microalbuminuria whose visceral fat thickness was > 7.5. Because of presence of microalbuminuia, there is evidence of subclinical endothelial injury in this patients who are more prone for cardiovascular risk in later part of their life. These patients also had a elevated LDL and TGL which supports the point on cardiovascular risk. Eventhough CT was considered to be gold standard in measuring the visceral fat thickness, there are many studies which showed ultrasonographic measurement of visceral fat was equally efficient in assessing the cardiovascular risk. Moreover due to radiation exposure and cost of CT, this study was conducted with ultrsonographic measurement alone. Therefore, it is concluded that, visceral adiposity has a strong positive correlation with lipid profile and microalbuminuria, by which it is easy to predict the diabetics who are more prone for cardiovascular risk.

Item Type: Thesis (Masters)
Uncontrolled Keywords: diabetes mellitus ; visceral fat thickness ; microalbuminuria ; BMI ; triglycerides and LDL.
Subjects: MEDICAL > General Medicine
Depositing User: Punitha K
Date Deposited: 18 May 2018 18:52
Last Modified: 18 May 2018 18:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/7886

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