Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Postępy Nauk Medycznych 12/2016, s. 910-914
*Jarosław Kozakowski
Obesity and musculoskeletal system
Otyłość a układ mięśniowo-szkieletowy
Department of Endocrinology, Centre of Postgraduate Medical Education, Bielański Hospital, Warsaw
Head of Department: Professor Wojciech Zgliczyński, MD, PhD
Streszczenie
Otyłość nazywana „tsunami XXI wieku” prowadzi do rozwoju wielu zaburzeń metabolicznych i chorób, będąc przyczyną zwiększonej zachorowalności i umieralności. Z drugiej strony, choroby narządu ruchu są obecnie główną przyczyną niepełnosprawności i drugą co do częstości przyczyną wizyt u lekarza. Z wielu badań epidemiologicznych jasno wynika, że nadmierna masa ciała wpływa niekorzystnie na przebieg niemal wszystkich chorób układu mięśniowo-kostnego, od choroby zwyrodnieniowej stawów, poprzez choroby metaboliczne (m.in. osteoporoza, dna moczanowa), tzw. choroby układowe tkanki łącznej (reumatoidalne zapalenie stawów, toczeń rumieniowaty układowy), aż po choroby rzadkie (np. idiopatyczna hiperostoza) czy rzadko rozpoznawane (np. fibromialgia). Choć najczęściej zależność między wzrostem masy ciała a przebiegiem chorób układu ruchu potwierdzona jest badaniami obserwacyjnymi i populacyjnymi, a mechanizmy destrukcyjnego działania otyłości na układ mięśniowo-kostny pozostają wciąż niewyjaśnione, to uznaje się, że mają one charakter złożony i obejmują wpływ czynników biomechanicznych, dietetycznych, genetycznych, zapalnych i metabolicznych. W wielu przypadkach wydaje się mieć znaczenie nie tylko sam wzrost masy ciała, ale także jego charakter: czy dotyczy on masy tłuszczu, czy beztłuszczowej masy ciała, w tym mięśni szkieletowych. Dużą rolę w etiopatogenezie zmian w układzie mięśniowo-kostnym pod wpływem otyłości zdają się odgrywać produkty zmienionej tkanki tłuszczowej – adipokiny i cytokiny prozapalne.
Ogromne rozpowszechnienie zarówno otyłości, jak i chorób układu ruchu wymaga poznania przez lekarzy ich wzajemnych relacji.
Summary
Obesity called “tsunami of the 21st century” leads to the development of many metabolic disorders and diseases and is a cause of increased morbidity and mortality. On the other hand, diseases of the musculoskeletal system are now the main cause of disability and the second cause of doctor visits.
With many epidemiological studies, it is clear that excessive body weight adversely affects the course of almost all diseases of the musculoskeletal system, such as osteoarthritis, metabolic diseases, e.g. osteoporosis or gout, connective tissue diseases – rheumatoid arthritis, systemic lupus erythematosus, rare diseases like idiopathic hyperostosis, or rarely diagnosed as fibromyalgia. Although in many cases the relationship between the increasing weight and the course of the musculoskeletal system diseases is confirmed only on the basis of observational and epidemiological studies, and the mechanisms of the destructive impact of obesity on musculoscelestal system remain unexplained it is considered that they are complex, and include the biomechanical, diet, genetic, inflammatory and metabolic factors. In many cases not only the increase in body weight seems to have a meaning but also its nature: whether it relates to fat mass, or lean body mass, including skeletal muscles. A large role in etiopathogenesis of the musculoskeletal system changes under the influence of obesity seem to play adipokines and proinflammatory cytokines – products of changed fat tissue.
A huge spread of both obesity and diseases of the musculoskeletal system requires knowledge by doctors of their mutual relations.
Definition and diagnosing of obesity
World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that present a risk to health (1). “Algorithms of diagnosis and treatment of endocrine diseases” prepared by Polish Society of Endocrinology define obesity as a chronic illness, characterized by excessive fat accumulation, which increases the risk of many social diseases, including cardio-vascular or metabolic ones and cancers (2). Obesity is currently the most common metabolic disease all over the world, according to WHO reaching an epidemic size and posing a key health problem in developed and developing countries (3). Obesity is measured with BMI index, calculated as a body weight multiplied by body height squared (kg/m2). BMI equal to or higher than 30 kg/m2 indicates obesity, and over 40 kg/m2 is considered as morbid obesity. Depending on the location of excessive fat tissue obesity can be classified as abdominal (central), gynoid or mixed one.
Obesity is a key element of the so-called metabolic syndrome (MS). For example: MS criteria as defined by International Diabetes Federation (IDF) include: abdominal obesity (female waist > 80 cm, male waist > 94 cm), and at least two symptoms of the following:
– fasting blond glucose ≥ 100 mg/dL (5.6 mmol/L),
– triglyceride level ≥ 150 mg/dL (1.7 mmol/L),
– HDL-C cholesterol in male < 40 mg/dL and female < 50 mg/dL,
– blood pressure ≥ 130/85 mmHg.
In 2014 an estimated 1.9 billion of people over eighteen were overweight, and 600 million were obese. In other words: 13% of the world population were obese (11% males and 15% females). In 1980-2014 the number of obesity cases increased more than twice (1). An increasing number of obese children and young people is of particular concern.
The number of overweight or obese people in Poland is presented in table 1 (4).
Tab. 1. The number of overweight and obesity cases in Poland (4)
StudyMalesFemales
Overweight and obesity (%)Obesity (%)Overweight and obesity (%)Obesity (%)
“Household Food Consumption and Anthropometric Survey”, IŻŻ, 200056.715.748.619.9
NATPOL, 200258194819
WOBASZ, 2003-200561.121.148.622.4
NATPOL, 2011 ? 25  
GUS, 200452.112.639.112.5
GUS, 201161.416.644.615.2
Obesity is a direct cause of many metabolic disturbances and disorders. It constitutes a basic element of metabolic syndrome, adds to development of insulin resistance, type 2 diabetes, hypertension, dyslipidemia, and consequently arteriosclerosis, non-alcoholic fatty liver disease, cardiovascular disease and stroke. Obesity is also connected with sleep apnea, cholelithiasis, infertility (women) and erection problems (men) and constitutes a risk factor in many types of cancer, e.g. oesophagus, endometrial, breast or colon cancer.
Obesity and the musculoskeletal system
It is believed, that the relationship between obesity and musculoskeletal diseases is complex, involving biomechanical, dietary, genetic, inflammatory, and metabolic factors. Excess body weight has long been claimed to be related to many symptoms and diseases of muscles and bone. These are presented in table 2.
Tab. 2. Relationship between obesity and symptoms and diseases of musculoskeletal system (5)
Symptoms and diseases of musculoskeletal system related to obesity
– degenerative disease (knees, hips, palms)
– spinal pain
– diffuse idiopathic skeletal hyperostosis
– gait disturbances
– soft tissues illnesses (e.g. carpal tunnel syndrome, plantar fasciitis)
– osteoporosis
– gout
– fibromyalgia
– connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus)
Osteoarthritis (OA) is the most common skeleton disease. Numerous epidemiological studies indicate a clear relation between BMI and the development of degenerative changes, evaluated both clinically and with an x-ray (6, 7). The odds ratio (OD) for the development of degenerative changes in knees for BMI increased by 5 units is 1.6 (8). In a study of twins it was proven that an increase of body weight by 1 kg leads to increased risk of radiological changes in knee and interphalangeal joints (9). The impact of obesity on the development of osteoarthritis, which is visible in many joints, e.g. hips, palms, patellofemoral and others indicates a share of both mechanical and metabolic factors in their etiopathogenesis. These factors have not been well recognized so far, however, an increased amount of cartilage oligomeric matrix protein (COMP) and the products of collagen type 2 degradation in joint cartilages of obese people were found (10). Those with osteoarthritis were also found to have leptin (cytokine coming from fat tissue) in the synovia. Its quantity indicated a correlation with BMI. Leptin was also found in cartilages and osteophytes (5). Current research which MRI scan helps to image the relation between body composition and the condition of cartilage. A study with MRI and densitometry proved for instance a positive correlation between muscle weight and the thickness of cartilage of the tibia. Such correlation was not found for fat weight (11). Also a correlation between body weight and the degree of damage of cartilage was found. Studies of activity of destructive factors indicate that the damage to cartilage in obese people precedes the occurrence of radiological symptoms of osteoarthritis. Excess body weight is also a strong prognostic of the development of changes in joints. The impact of obesity on joint structures may depend on the placement of bone structures. E.g. varus malalignment of femurs increases the effect of excess body weight on knees, while valgus malalignment of bones are not so affected by obesity (12). Also exercise is an important factor. It must be borne in mind that in physiological conditions the pressure on knee joint cartilages while walking is about three times as high as normally. Running or walking upstairs mean the pressure increases 6-10 times. It is obvious that in obesity such loads must be particularly destructive.
Another common musculoskeletal problem is back pain. The studies on the impact on such symptoms are unclear, although excess body weight seems to add to a higher exposure to radical pain and the occurrence of neurological symptoms. Also the chronic character of pain seems to be related to BMI increase (13). In a group of physically working middle-aged men it was proven with MRI that overweight is related to lowering the signal from nucleus pulposus, however, it has not been established if the symptom is related to clinical symptomatology (14). It was found that in obese patients fat tissue could expand within dura matter, which can lead to stenosis of the spinal canal (15). On the other hand cervical and lumbar spine pains as well as foot pains were proven to diminish after a significant reduction of body weight following a bariatric surgery (16).
A diffuse idiopathic skeletal hyperostosis occurs much more rarely than back pain. The illness is characterized by bone hypertrophy in the connections of ligaments, aponeuroses, synovial capsules. Changes are particularly visible in dorsal vertebrae, where large pseudo-spurs similar to parrot’s beaks, usually including several vertebrae. Also some changes within inner table of the frontal bone were noticed. Although etiopathogenesis of the diseases has not been well recognized, it was found to occur more often in patients with a high BMI (17). Also the leptin levels in people with idiopathic skeletal hyperostosis is higher than in general population (18). However, the role of this adipokine in the development of changes in periarticular tissues is not known.

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otrzymano: 2016-11-03
zaakceptowano do druku: 2016-11-30

Adres do korespondencji:
*Jarosław Kozakowski
Department of Endocrinology Centre of Postgraduate Medical Education Bielański Hospital
Cegłowska 80, 01-809 Warszawa
tel. +48 (22) 834-31-31 fax +48 (22) 834-31-31
jkozakowski@cmkp.edu.pl

Postępy Nauk Medycznych 12/2016
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