行为干预:饮食控制、锻炼、控制体重课件(PPT 46页).ppt
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- 行为干预:饮食控制、锻炼、控制体重课件PPT 46页 行为 干预 饮食 控制 锻炼 体重 课件 PPT 46
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1、Slide SourceLipidsOnlinewww.lipidsonline.orgSlide SourceLipidsOnlinewww.lipidsonline.org0%20%40%60%80%NCEP. Adult Treatment Panel III Report. 2001. Slide SourceLipidsOnlinewww.lipidsonline.org0%20%40%60%80%NCEP. Adult Treatment Panel III Report. 2001. Slide SourceLipidsOnlinewww.lipidsonline.org-60%
2、-40%-20%0%Law MR et al. BMJ 1994;308:367-372.Slide SourceLipidsOnlinewww.lipidsonline.orgnAtherogenic dietnSedentary lifestylenObesityExpert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.lipidsonline.orgnTherapeutic diet to lower LDL-CnPhysically active on a daily basisnWeight controlEx
3、pert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.lipidsonline.orgnSaturated fats (7% total calories) and cholesterol (200 mg/d)nAlso therapeutic options: Plant stanols/sterols (2 g/d) Increased viscous fiber (1025 g/d)Expert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.l
4、ipidsonline.orgnPrimary emphasis is to reduce saturated fats nTotal fat should range 2530% for most casesnThose with metabolic syndromenAvoid very high fat intakesnAvoid very low fat intake (low HDL-C, high TG)nTotal fat intake can range from 3035% if extra fat is unsaturatednMay reduce some lipid a
5、nd nonlipid risk factorsnClinical judgment required. Slide SourceLipidsOnlinewww.lipidsonline.orgSlide SourceLipidsOnlinewww.lipidsonline.orgn178 Women / 231 MenDietary fat 25%; saturated fat 7.5%nLDL reduction High cholesterol only: 7.6 to 8.8%nLDL reduction Combined hyperlipidemia:8.1%Walden CE et
6、 al. Arterioscler Thromb Vasc Biol 1997;17:375-382.Slide SourceLipidsOnlinewww.lipidsonline.org age 22 to 67nDifferent groups of subjects:nWhite, blacknWomen: younger and postmenopausalnMen: younger, older-20%-10%0%10%20%30%40%nCompared to average American diet, when saturated fat fell from 15% to 6
7、.1%, LDL-C fell by 11%nHDL-C fell from 52.2 to 46.2nLp(a) rose from 15.5 to 18.2Ginsberg HN et al. Arterioscler Thromb Vasc Biol 1998;18:441-449.Total FatSat FatsLDLSlide SourceLipidsOnlinewww.lipidsonline.orgnAvoidnTrans fatty acids*nAddnDietary fibernPlant sterol/stanol ester margarinesExpert Pane
8、l. JAMA 2001;285:2486-2497.* Keep trans fatty acids lowSlide SourceLipidsOnlinewww.lipidsonline.orgnTFA more densely packed than cis formsnUsual intake: only 23% of energynIf consumed in high amounts: LDL-C; HDL-CnExamples of TFAStick margarine, cookies, biscuits, white breadLichtenstein AH et al. N
9、 Engl J Med 1999;340:1933-1940Slide SourceLipidsOnlinewww.lipidsonline.orgnSterols are essential components of cell membranesnCholesterol exclusively an animal sterolnWe ingest almost as much plant sterols as we do dietary cholesterolnStanols absorbed even less wellnPlant sterols/stanols lower chole
10、sterolnInterfere with micellar absorption of cholesterolnNo malabsorption of fatLaw MR et al. BMJ 2000;320:861-864.Slide SourceLipidsOnlinewww.lipidsonline.orgnIf 2 g of plant sterol or stanol is added to average daily portion of margarine, it has variable effect on LDL-C by age group:n Age LDL-C re
11、duced by: 5059 21 mg/dl or 0.54 mmol/l 4049 17 mg/dl or 0.43 mmol/l 3039 13 mg/dl or 0.33 mmol/lLaw MR et al. BMJ 2000;320:861-864.Slide SourceLipidsOnlinewww.lipidsonline.orgPlant StanolnCrystalline powdernRestricted fat solubilitynMelting range 140150oCR C - = OOHOSlide SourceLipidsOnlinewww.lipid
12、sonline.org200210220230240250Cholesterol (mg/dl)Miettinen TA et al. N Engl J Med 1995;333:1308-1312.1995 Massachusetts Medical Society. All rights reserved.Slide SourceLipidsOnlinewww.lipidsonline.orgnDose: Maximum is 2 g/dnMeta-analysis results:nLDL-C lowering about 913%nLowering greater in elderly
13、nAdditive to statin therapynUsed in various population groupsnWell-toleratednMay decrease LDL-C adjusted carotenoidsLaw M et al. BMJ 2000;320:861-864.Lichtenstein AH et al. Circulation 201;103:1177-1179Slide SourceLipidsOnlinewww.lipidsonline.orgnTLC for patients with LDL-C = 160Walden CE et al. Art
14、erioscler Thromb Vasc Biol 1997;17:375-382.Jenkins DJ et al. Curr Opin Lipidol 2000;11:49-56.Cato N. Stanol meta-analysis. Personal communication, 2000.Slide SourceLipidsOnlinewww.lipidsonline.orgExpert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.lipidsonline.orgnConstellation of majo
15、r risk factors, life-habit risk factors and emerging risk factorsnOver-represented among populations with CHDnClue is distinctive body-type with increased abdominal circumference (although some leaner men and women with abdominal obesity without increased waist)Slide SourceLipidsOnlinewww.lipidsonli
16、ne.orgExpert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.lipidsonline.orgExpert Panel. JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinewww.lipidsonline.orgnIncludes risk factors not routinely measurednInsulin resistancenSmall dense LDLnEndothelial dysfunctionnAbnormal sympathetic nerv
17、ous activitynProthrombotic markersPAI-1, fibrinogennProinflammatory markers such as CRPSlide SourceLipidsOnlinewww.lipidsonline.orgnDesignn522 middle-aged overweight (BMI 31)n172 men and 350 womennMean duration 3.2 yearsnIntervention Group: Individualized counselingnReducing weight, total intake of
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