Laminite associada à síndrome metabólica equina: revisão sistemática dos fatores de risco e eventos fisiopatológicos
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Data
2021-09-21
Autores
Nardi, Larissa Tonelli
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A laminite é definida como afecção podal caracterizada por perda na integridade da conexão entre lâmina dérmica e epidérmica e é a segunda maior causa de óbito em equinos. A de maior ocorrência é a denominada laminite endocrinopática, a qual é marcada pela resistência à insulina dos tecidos ou hiperinsulinemia e pode ser causada pela síndrome metabólica equina (SME) ou disfunção da pars intermedia da pituitária (PPID). O objetivo desta revisão foi determinar evidências sobre os fatores de risco envolvidos no desenvolvimento da laminite associada à SME. A estratégia de busca foi realizada utilizando os termos laminitis, syndrome metabolic e equidae em sete bases de dados. Os principais critérios de elegibilidade foram estudos incluindo avaliação dos fatores de risco para a ocorrência de laminite associada a SME e descartaram disfunção da pars intermedia da pituitária nos animais avaliados. Foram encontrados 688 estudos, com 383 duplicados e excluídos. Trezentos e cindo estudos passaram por avaliação do título e resumo. A primeira seleção incluiu 85 artigos para leitura na íntegra e destes apenas 37 atenderam aos critérios de elegibilidade e foram incluídos neste estudo. Não foram encontradas evidências suficientes para determinar raça, sexo e idade como fatores de risco para laminite associada a SME. Dois estudos confirmaram o desenvolvimento da laminite a partir da indução por hiperinsulinemia. Oito estudos apresentaram evidências fortes da associação entre a concentração de insulina basal maior em animais laminíticos comparado aos não laminíticos. A obesidade foi associada a episódios de laminite em 6 estudos, encontrando também evidências de hipertrigliceridemia e hipoadponectinemia em animais laminíticos e obesos. A hiperinsulinemia na laminite endocrinopática associada à SME é o principal fator de risco desencadeante das diversas vias fisiopatológicas que ocorrem simultaneamente causando alterações no tecido laminar, confirmando mais uma vez seu papel na patogênese da doença. A obesidade se apresenta como um fator de risco por exacerbar a resistência à insulina, tornando o controle de peso e dos níveis de insulina imprescindíveis para prevenção da laminite endocrinopática. A ausência de um segundo avaliador na seleção dos estudos e a quantidade baixa de estudos epidemiológicos de laminite endocrinopática foram as principais limitações encontradas pelos autores. Esta é a primeira revisão sistemática realizada sobre o tema em questão.
Laminitis is defined as a foot disease characterized by loss in the integrity of the connection between the dermal and epidermal lamina and is the second leading cause of death in horses. The one with the highest occurrence is called endocrinopathic laminitis, which is marked by tissue insulin resistance or hyperinsulinemia and can be caused by equine metabolic syndrome (EMS) or pituitary pars intermedia dysfunction (PPID). The purpose of this review was to determine evidence on the risk factors involved in the development of laminitis associated with EMS. The search strategy was performed using the terms laminitis, metabolic syndrome, and equidae in seven databases. The main eligibility criteria were studies including evaluation of risk factors for the occurrence of EMS-associated laminitis and ruled out dysfunction of the pars intermedia of the pituitary in the evaluated animals. A total of 688 studies were found, with 383 duplicates excluded. Three hundred and five studies were reviewed for title and abstract. The first selection included 85 articles for reading in full and of these only 37 met the eligibility criteria and were included in this study. There was insufficient evidence to determine race, sex and age as risk factors for EMS laminitis. Two studies confirmed the development of laminitis from hyperinsulinemia induction. Eight studies showed strong evidence of the association between higher basal insulin concentration in laminitic animals compared to non-laminitic animals. Obesity was associated with episodes of laminitis in 6 studies, also finding evidence of hypertriglyceridemia and hypoadponectinemia in laminitic and obese animals. Hyperinsulinemia in endocrinopathic laminitis associated with EMS is the main risk factor triggering the various pathophysiological pathways that occur simultaneously causing changes in laminar tissue, confirming once again its role in the pathogenesis of the disease. Obesity is a risk factor for exacerbating insulin resistance, making weight and insulin levels control essential for prevention of endocrinopathic laminitis. The absence of a second reviewer in the selection of studies and the low number of epidemiological studies of endocrinopathic laminitis were the main limitations found by the authors. This is the first systematic review performed on the topic in question.
Laminitis is defined as a foot disease characterized by loss in the integrity of the connection between the dermal and epidermal lamina and is the second leading cause of death in horses. The one with the highest occurrence is called endocrinopathic laminitis, which is marked by tissue insulin resistance or hyperinsulinemia and can be caused by equine metabolic syndrome (EMS) or pituitary pars intermedia dysfunction (PPID). The purpose of this review was to determine evidence on the risk factors involved in the development of laminitis associated with EMS. The search strategy was performed using the terms laminitis, metabolic syndrome, and equidae in seven databases. The main eligibility criteria were studies including evaluation of risk factors for the occurrence of EMS-associated laminitis and ruled out dysfunction of the pars intermedia of the pituitary in the evaluated animals. A total of 688 studies were found, with 383 duplicates excluded. Three hundred and five studies were reviewed for title and abstract. The first selection included 85 articles for reading in full and of these only 37 met the eligibility criteria and were included in this study. There was insufficient evidence to determine race, sex and age as risk factors for EMS laminitis. Two studies confirmed the development of laminitis from hyperinsulinemia induction. Eight studies showed strong evidence of the association between higher basal insulin concentration in laminitic animals compared to non-laminitic animals. Obesity was associated with episodes of laminitis in 6 studies, also finding evidence of hypertriglyceridemia and hypoadponectinemia in laminitic and obese animals. Hyperinsulinemia in endocrinopathic laminitis associated with EMS is the main risk factor triggering the various pathophysiological pathways that occur simultaneously causing changes in laminar tissue, confirming once again its role in the pathogenesis of the disease. Obesity is a risk factor for exacerbating insulin resistance, making weight and insulin levels control essential for prevention of endocrinopathic laminitis. The absence of a second reviewer in the selection of studies and the low number of epidemiological studies of endocrinopathic laminitis were the main limitations found by the authors. This is the first systematic review performed on the topic in question.
Descrição
Palavras-chave
Equino, Hiperinsulinemia, Resistência à insulina, Síndrome metabólica, Equine, Hyperinsulinemia, Insulin resistance, Metabolic syndrome