The main risk factors and risk groups for the development of metabolic syndrome and other complex diseases

Kompleksne bolesti (metabolički sindrom, šećerna bolest, pretilost, kardiovaskularne bolesti), a posebice šećerna bolest tipa 2 i debljina dvije su pandemije modernog doba koje se popularnim imenom nazivaju diabesity, te predstavljaju jedan od najznačajnijih problema javnog zdravstva u razvijenom svijetu. Glavni čimbenici rizika za razvoj metaboličkog sindroma, kardiovaskularnih bolesti, šećerne bolesti i pretilosti na koje se može utjecati su nezdrava prehrana, tjelesna neaktivnost, izloženost duhanskom dimu i pretjerana konzumacija alkoholnih pića. Raširenost ovih čimbenika rizika predstavlja odraz današnjeg trenda globalizacije, urbanizacije i starenja populacije. Podaci brojnih istraživanja jasno upućuju na zaključak kako je u pozadini ovog globalnog problema moderan način života u ‘toksičnom okolišu’ (tzv. obesogenic environment), a koji podrazumijeva sve veću dostupnost jeftine hrane bogate mastima i šećerom, uklopljenu u sve manju potrebu za kretanjem. U kontekstu kompleksnih bolesti često se ističe i njihova povezanost s nepovoljnim socioekonomskim statusom (nizak stupanj formalnog obrazovanja, niska razina prihoda domaćinstva, ruralna sredina i nezaposlenost) te stresom. Osim navedenih čimbenika, utvrđen je i određen utjecaj genetičke komponente (veći je rizik u osoba čiji su roditelji ili rođaci također pretili ili boluju od šećerne bolesti), kao i dob, spol, intrauterino okruženje (epigenetički „imprinting“, fetalno programiranje), porođajna tjelesna masa te životni stil (konzumacija alkohola i izloženost duhanskom dimu). Ipak, najvažnijim rizičnim čimbenicima smatraju se oni koji su ujedno i reverzibilni, a to su fizička neaktivnost, nepravilna prehrana (hrana visoke energetske, a niske biološke vrijednosti) te inzulinska rezistencija.

Complex diseases (metabolic syndrome, diabetes, obesity, cardiovascular diseases), and in particular type 2 diabetes and obesity are two pandemics of modern time that are popularly called diabesity, and represent one of the most important public health problems in the developed world. The main risk factors for the development of metabolic syndrome, cardiovascular diseases, diabetes and obesity that may be affected on are unhealthy diet, physical inactivity, exposure to tobacco smoke and excessive consumption of alcoholic beverages. The prevalence of these risk factors reflects today’s trend of globalization, urbanization and aging of population. Data of numerous studies clearly indicate that in the background of this global problem is the modern way of life in the ‘toxic environment’ (aka. obesogenic environment), which implies the increasing availability of cheap food rich in fats and sugar, blended in less need for movement. In the context of complex diseases, often is emphasized their association with adverse socioeconomic status (low level of formal education, low level of household income, rural areas and unemployment) and stress. In addition to these factors, there has been a definite influence of genetic components (risk is higher in people whose parents or relatives are also overweight or suffering from diabetes), as well as age, sex, intrauterine environment (epigenetic “imprinting”, fetal programming), birth body weight and lifestyle (alcohol consumption and exposure to tobacco smoke). However, the most important risk factors are considered to be those that are also reversible, such as physical inactivity, unhealthy diet (food with high energetic but low biological value) and insulin resistance.

Given the above, recognition of individuals at high risk and determination of risk behavior for the development of obesity and diabetes, are the focus of activities aimed at the prevention of these complex diseases. This complex, but also a necessary task, first of all should be focused on intervention in childhood and adolescence, when habits related to nutrition and physical activity are created. Women of child-bearing age are also important but often neglected risk group. The latest research suggests that negative lifestyle during pregnancy (exposure to tobacco smoke, drugs and alcohol during pregnancy, poor nutrition, lack of physical activity), and psychosocial characteristics of pregnant women increases the risk of developing cardiovascular diseases and type 2 diabetes in adulthood of the offspring. Complications at birth, premature delivery, c-section, postpartum haemorrhage and low birth body weight of the child are also more common in obese women and women with gestational diabetes, while pregnancy itself is associated with an increased risk of maternal, fetal and neonatal death.

S obzirom na navedeno, prepoznavanje pojedinaca pod visokim rizikom te utvrđivanje rizičnog ponašanja za razvoj debljine i šećerne bolesti, u središtu su aktivnosti koje za cilj imaju prevenciju ovih kompleksnih bolesti. Ovaj složen, ali ujedno i nužan zadatak, prije svega bi morao biti usmjeren na intervencije u dječjoj i adolescentskoj dobi, kada se stvaraju navike vezane uz prehranu i tjelesnu aktivnost. Žene fertilne dobi također su iznimno važna, no često zanemarena rizična skupina. Najnovija istraživanja ukazuju kako negativan životni stil u trudnoći (izloženost duhanskom dimu, drogi i alkoholu u trudnoći, loša prehrana, nedovoljna tjelesna aktivnost), te psihosocijalne osobine trudnice povećavaju rizik za razvoj kardiovaskularnih bolesti i šećerne bolesti tipa 2 u odrasloj dobi potomka. Komplikacije pri porođaju, prijevremeni porođaj, carski rez, poslijeporođajno krvarenje te mala porođajna tjelesna masa djeteta također su češći u pretilih žena i žena s gestacijskim dijabetesom, a sama trudnoća povezana je s povišenim rizikom od majčinske, fetalne i novorođenačke smrti.