RELATIONSHIP BETWEEN OBESITY AND THE INCREASED RISK OF MAJOR COMPLICATIONS IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Obesity and non-insulin-dependent diabetes mellitus (NIDDM) are closel y linked. They frequently occur together in patients, and body mass in dex (BMI) is the strongest risk factor for the development of NIDDM. B oth obesity and NIDDM are also major causes of morbidity and mortality from atherogenic macrovascular disease, and they are independent risk factors for coronary heart disease. The risk of developing NIDDM and cardiovascular disease is affected by the regional distribution of bod y fat. Visceral obesity is associated with a higher degree of risk tha n peripheral obesity. The metabolic and circulatory changes associated with visceral obesity lead to the development of insulin resistance a nd increased lipoprotein synthesis. For example, the change in the pop ulation profile of lipoproteins in the blood, and alterations in the l evels of oxidative stress lead to an increased cardiovascular and macr ovascular risk. The changes in lipid metabolism also affect haemorrheo logical function. They have been linked to decreased fibrinolysis (a s erious cardiovascular risk factor) through elevated levels of plasmino gen activator inhibitor factor, high blood viscosity, and increased er ythrocyte aggregability. Increased BMI also appears to be associated w ith endothelial dysfunction, which is a major factor in atheroma plaqu e formation and development of thrombosis. Visceral obesity therefore adds a significant burden to the already increased cardiovascular risk inherent in NIDDM. However, even moderate weight loss may successfull y reverse the majority of changes seen with visceral obesity.