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P
eripheral
polyneuropathy
in
severely
obese
patients
with
metabolic
syndrome
but
without
diabetes
: A
ssociation
with
low
HDL-
cholesterol
R
ev
A
ssoc
M
ed
B
ras
2017; 63(4):324-331
327
Table 2 shows anthropometric and clinical data expressed
as median, evaluated for the presence of PPN according
to MNSI. The group with neuropathy showed higher
serum levels of LDL-cholesterol compared to those wi-
thout neuropathy (p=0.046). There was a tendency towards
higher serum levels of triglycerides in the neuropathy
group compared to the non-neuropathy group (p=0.118).
On the other hand, there was no significant differ-
ence between the results of neuropathy and non-neurop-
athy groups, respectively, on: age (34.5 years vs. 34 years,
p=0.350), height (1.66mvs. 1.63m, p=0.866), weight (118 kg
vs. 116 kg, p=0.443), BMI (44.9 kg/m² vs. 42.5 kg/m²,
p=0.207), waist circumference (123 cm vs. 122 cm, p=0.374),
systolic blood pressure (SBP) (130 mmHg vs. 130 mmHg,
p=0.852), diastolic blood pressure (DBP) (80 mmHg
vs. 80 mmHg, p=0.341), mean blood pressure (MBP)
(96.7 mmHg vs. 96.7 mmHg, p=0.442), fasting blood glu-
cose (89.4 mg/dL vs. 93.8 mg/dL, p=0.273), blood glucose
2 hours after oral intake of 75 g of glucose (126 mg/dL
vs. 126 mg/dL, p=0.889), HDL-cholesterol (43.5 mg/dL vs.
45 mg/dL, p=0.457), creatinine (0.82 mg/dL vs. 0.8 mg/dL,
p=0.965), TSH (2.5 mU/L vs. 2.2 mU/L, p=0.437) and vita-
min B12 (416 pg/mL vs. 449 pg/mL, p=0.432).
Based on the evaluated data, we performed a multi-
variate Poisson regression (Table 3) in order to assess
which of the factors were independently associated with
the occurrence of PPN in non-diabetic Ob-II,III,MetS
individuals.
In the model, the variables used were low HDL-choles-
terol, serum levels of LDL-cholesterol and triglycerides. PPN
was associated independently with low HDL-cholesterol
(p=0.047), but there was no association with serum levels
of LDL-cholesterol (p=0.118) and triglycerides (p=0.239).
D
iscussion
Few studies assess the prevalence of PPN and factors as-
sociated to it in severe obesity and metabolic syndrome
patients. This study aimed to evaluate the prevalence and
some factors that could be associated with PPN in both
men and women with severe obesity and MetS without
DM. We observed an 11% prevalence of PPN in our sam-
ple with no difference in gender prevalence. Ylitalo et al.,
looking into data frommen and women in the NHANES
study, found a 10.9% prevalence of PPN in the obese
group.
12
Although we found a similar number of indivi-
duals with PPN, it seems important to identify differen-
ces between Ylitalo’s study and ours. In the comparative
study, participants were older than 40 years, obesity was
determined by a lower BMI (≥ 30 kg/m²) and participants
were not selected for the presence of MetS. Moreover,
diabetic patients were not excluded and the presence of
PPN was evaluated using Semmes-Weinstein monofila-
ment applying pressure on three different points at the
plantar surface of each foot (method which identifies
neuropathy only later than the majority of other methods).
In the literature, data is not consistent when consid-
ering the prevalence of PPN in subjects without diabetes.
Singleton et al. evaluated 107 patients with idiopathic
neuropathy and obtained a 34% prevalence of IGT indi-
viduals, of which 92% had neuropathic pain and 81% had
sensory complaints.
13
Smith and Singleton found a 45%
prevalence of pre-diabetes in patients with idiopathic
TABLE 1
Characteristics of 218 patients with MetS, degree II and III obesity and without DM, assessed for the PPN presence
(≥ 2.5). The numbers shown are the total number of patients with the condition described in each group. The percentage of
patients with the condition described in each group is shown in the parentheses.
PPN Group (n=24)
No PPN Group (n=194) p-value
Female sex (%)
19 (79.2)
158 (81.4)
0.784
b
Degree II obesity (%)
c
6 (25.0)
52 (26.8)
1.000
a
Degree III obesity (%)
c
18 (75.0)
142 (73.2)
SAH (%)
15 (62.5)
92 (47.4)
0.239
a
Low HDL-c (%)
22 (91.7)
138 (71.1)
0.057
a
High LDL-c (%)
5 (20.8)
25 (12.9)
0.341
b
Hypertriglyceridemia (%)
14 (58.3)
83 (42.8)
0.219
a
High fasting blood glucose (%)
6 (25.0)
63 (32.5)
0.610
a
High blood glucose 2h post-intake of 75 g of glucose (%)
6/21 (28.6)
57/179 (31.8)
0.954
a
Metformin use (%)
0 (0.0)
10 (5.2)
0.606
b
a
Chi-Squared test.
b
Fisher’s exact test.
c
BMI: body mass index.
SAH: systemic arterial hypertension; HDL-c: high-density lipoprotein cholesterol; LDL-c: low-density lipoprotein cholesterol; MetS: metabolic syndrome; DM: diabetes mellitus;
PPN: peripheral polyneuropathy.