Pathophysiologie des Metabolisch-Vaskulären Syndroms - Abdominales Fettgewebe als äußeres Zeichen und wesentliche Triebkraft

Häufiges äußeres Zeichen und wesentliche Triebkraft eines Metabolisch-Vaskulären Syndroms (MVS) ist die Akkumulation von abdominalem Fettgewebe, das über eine Messung des Taillenumfangs grob erfasst und palpatorisch, zumindest orientierend, in das subkutane und das viszerale Kompartiment aufgeteilt werden kann. Durch Sonographie heute leicht erfassbar ist die charakteristische Leberverfettung, die u. a. für die erheblich eingeschränkte Wirkung des Insulins an der Leber eine entscheidende Rolle spielt. Dagegen ist die pathologische Fettansammlung im Muskelgewebe, speziell in den Myozyten, mit einfachen klinischen Verfahren nicht zu erkennen, sie kann aber bei massiver viszeraler Fettakkumulation und unzureichender körperlicher Aktivität per se angenommen werden.

Gegenüber der genetisch determinierten Insulinresistenz, die sicherlich eine gewisse Rolle bei der Manifestation des MVS und seiner Folgeschäden spielt, sind deshalb Formen der Insulinresistenz von größerer Bedeutung, die durch Fehlsteuerungen verschiedener Stoffwechselwege im Rahmen der viszeralen Fettakkumulation bei gleich bleibender Fehlernährung und reduzierter körperlicher Aktivität auftreten (lipotoxische Form der Insulinresistenz).

Accumulation of abdominal fatty tissue is a frequent external sign and essential piloting force promoting a metabolic vascular syndrome (MVS). Such an accumulation of fatty tisssue may be roughly detected by means of waist measurement. Palpation may separate this - at least for orientation - into subcutaneous and visceral fatty accumulation. The characteristic fatty degeneration of the liver is now easy to detect via sonography. This fatty degeneration is decisively responsible inter alia for the considerably reduced insulin activity at the liver. On the other hand, it is not so easy to identify the pathological fatty accumulation in the muscular tissue and especially in the myocytes if straightforward clinical methods are employed, but it can be assumed to be present in case of a massive visceral fatty accumulation and insufficient physical activity.

Without doubt a genetically determined insulin resistance is partly responsible for the manifestation of MVS and its resulting harmful effects, but for the reasons set out above it is most important to pay close attention to such kinds of insulin resistance which are due to a misdirection of various metabolic processes in respect of visceral fatty accumulation while nutritional errors persist and physical activity remains unsatisfactory (lipotoxic type of insulin resistance).

Metabolic Vascular Syndrome - abdominal fatty tissue - Waist measurement - insulin resistance

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