Pathological changes in the vessels of the lower extremities in obese patients
Lahoda D., Velychko V., Danylchuk H., Venher Y., Malcheniuk D.
Today, the problem of overweight and obesity is considered a worldwide pandemic. Thus, in the new 2022 report of the World Health Organization (WHO) on obesity in the European region, it is emphasized that the prevalence of overweight and obesity in the region has reached epidemic proportions and continues to grow. It is well known that obesity leads to the occurrence of cardiovascular diseases, oncological diseases, type 2 diabetes mellitus (T2D) and problems with the musculoskeletal system, which significantly affects the quality and length of a person’s life. According to research data, the relationship between body mass index and lower extremity joint pain has not been clearly established and remains controversial. While some studies have shown that obesity is associated with a higher prevalence and incidence of DPV, other researchers have failed to find a similar association. Some data even indicate an inverse relationship between BMI and prevalent DPV. Our study was retrospective in nature. According to the design, we analyzed 76 charts of patients with a diagnosis of “obesity” who underwent outpatient treatment at the office of the “School of Diabetes and Overweight” of the City Health Center of Odesa. The patients were offered to undergo ultrasound duplex scanning of the vessels of the NC along with an anthropometric examination. Comprehensive ultrasound was performed on the TOSHIBA APLIO MH diagnostic system (Japan). In addition, a certain cohort of patients was asked to take the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), which we adapted for Ukrainian patients. The CIVIQ questionnaire was developed by Launois with co-authors in 1996. This disease-specific questionnaire, namely DPV, has demonstrated its validity, excellent internal consistency, and high reproducibility. It is a valuable tool for assessing the quality of life of patients in an outpatient setting. During the survey, it was established that the most common comorbid pathologies were T2DM in 39 patients (51.31 %), AH-21 (27.63 %) and dyslipidemia in 29 patients (38.15 %). Drawing conclusions from such comorbidity, we can say that the majority of patients who took part in our study had metabolic syndrome, namely in 59 cases (77.63 %). Most of the patients namely 42 (55.26 %) patients had grade 3 obesity, 19 (25.00 %) grade 2 obesity and 15 (19.74 %) patients had grade 1 obesity. When asked about possible complaints from lower limbs, almost all patients, namely 73 (96.05 %) had at least one or several complaints, namely: a feeling of fullness in the lower extremities, heaviness, pain, cramps, fatigue, swelling, especially with standing and walking, intermittent lameness. Such patients were prescribed ultrasound of the lower extremities. With the help of ultrasound, the majority of patients were diagnosed with: chronic venous insufficiency and varicose veins of the lower limbs, 48 (65.75 %) and 25 (34.25 %), respectively. After obtaining the data of ultrasound lower limbs, a Spearman correlation regression analysis was conducted and it was determined that there is a direct close relationship between the degree of obesity severity and the development of chronic venous insufficiency and varicose veins of the NK (ρ=0.835; ρ=0.804, respectively). Considering not all of the above, there is a need to survey patients about the presence of complaints from the side of lower limbs with further possible more in-depth research, which may include ultrasound and the use of the CIVIQ questionnaire in outpatient practice. This will speed up the diagnosis and further management of patients with obesity and DPV. In addition, all patients living with obesity should be given recommendations on rational eating behavior and physical activity and, if necessary, recommend behavioral therapy.
Key words: obesity, diseases of peripheral vessels, comorbid pathology, chronic venous insufficiency, varicose veins.
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