Abril - 2017

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Nienov OH et al.
324 Rev Assoc M ed Bras 2017; 63(4):324-331
ORIGINAL ARTICLE
Peripheral polyneuropathy in severely obese patients with
metabolic syndrome but without diabetes: Association with low
HDL-cholesterol
Otto Henrique Nienov 1, Luciana Matte2, Lisiane Stefani Dias1,2, Helena Schmid1,2,3 *
1Health Sciences Graduate Program, Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
2Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
3Department of Internal Medicine, Hospital de Clínica de Porto Alegre. Obesity Treatment Center, Hospital Santa Rita, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
Summary
Study conducted at Obesity Treatment
Center, Hospital Santa Rita, Complexo
Hospitalar Santa Casa de Misericórdia de
Porto Alegre, Porto Alegre, RS, Brazil
Article received: 10/7/2016
Accepted for publication: 12/1/2016
*Correspondence:
Departamento de Medicina Interna,
Hospital de Clínicas de Porto Alegre
Address: Rua Ramiro Barcelos,
2.350/700
Porto Alegre, RS – Brazil
Postal code: 90035-903
Introduction: The purpose of this study was to evaluate the prevalence of peripheral
polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and
metabolic syndrome (MetS) but without diabetes and to investigate possible
associated factors.
Method: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS
patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess
the presence of PPN.
Results: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based
on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly
associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol
(p=0.057) showed a tendency toward this association. On a Poisson regression
analysis, when the three possible associations were included, low HDL-cholesterol
(p=0.047) remained independently associated.
Conclusion: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI
showed a high prevalence and was associated with low levels of HDL-cholesterol.
In order to diagnose that complication, neurological evaluation should be
performed in these patients.
Keywords: polyneuropathies, obesity, metabolic syndrome, HDL cholesterol.
Introduction
Clinical trial results have shown that intensive metabolic
control reduces the incidence and progression of neuro-
pathy in patients with type 1 diabetes mellitus (DM1).
Yet, for patients with type 2 diabetes mellitus (DM2), it
is unclear that glycemic control has such a striking effect,
although other microvascular complications can be clearly
prevented. Since polyneuropathy occurring in patients
with DM2 has been related to risk factors such as obesity,
dyslipidemia, peripheral arterial disease, vitamin deficien-
cies and pre-diabetes, these and other factors often asso-
ciated with DM2 presence could have a relevant impact
as a determinant of disease onset and progression.1-3
Currently, few studies have investigated the associa-
tion and risk factors for progression of peripheral poly-
neuropathy (PPN) in non-diabetic severely obese patients
with metabolic syndrome (MetS). If in DM2 these asso-
ciations have a great impact on PPN, patients who have
them, even before presenting metabolic changes consistent
with the diagnosis of DM, could already present PPN.
Therefore, knowing the prevalence of PPN and its risk
factors in patients with predisposition to DM could be
useful to define the determining factors of PPN in obese
patients with and without DM2. Considering the aspects
above, we sought to establish the prevalence of PPN in
obese patients grade II and III with MetS and without
DM (non-diabetic Ob-II,III,MetS patients) in which pos-
sible risk factors such as hyperglycemia, dyslipidemia,
increased body weight or waist circumference, use of met-
formin and decreased serum vitamin B12 levels could be
associated with presence of PPN as defined by the Mich-
igan Neuropathy Screening Instrument (MNSI).