肥胖的并发症优选课件.ppt

1、ClassificationBMI(kg/m2)RiskUnderweight40Extremely highClinical Guidelines on the Identification,Evaluation,and Treatment of Overweight and Obesity in AdultsThe Evidence Report.Obes Res 1998;6(suppl 2).Additional risks:Large waist circumference(men40 in;women 35 in)5 kg or more weight gain since age

2、 18-20 y Poor aerobic fitness Specific races and ethnic groupsWeight(lb)232221191817161515252422212019181716272624232120191817292726242322201918312928262423222120333129272624232221353331292726242322373533312927262423393734323029272624413836343230292726434038363432302827454240373533313028474441393735

3、333129494643403836343230514845424037353332534946444139373533555148454340383634575350474442393735595552494643413937635955524846434140666258555249464441706662585552494644747065615855524946787369656157545149120130140150160170180190200210220320340360240250260230270280290380300400Height(in)01020304050607

4、0Adapted from:Gallagher et al.Am J Clin Nutr 2000;72:694.Body Fat(%)Body Mass Index(kg/m2)0103040602050WomenMenlAbdominal obesitylHyperinsulinemialHigh fasting plasma glucoselImpaired glucose tolerancelHypertriglyceridemialLow HDL-cholesterollHypertensionIsomaa B et al.Diabetes Care.2001;24:683-689.

5、AKA:Insulin Resistance Syndrome;Syndrome X;Dysmetabolic Syndrome;Multiple Metabolic Syndrome1923:Kylin describes clustering of hypertension,gout,and hyperglycemia1988:Reaven describes“Syndrome X”hypertension,hyperglycemia,glucose intolerance,elevated triglycerides,and low HDL cholesterol1998:World H

6、ealth Organization defines“metabolic syndrome”as clustering of hypertension,low HDL,hypertriglyceridemia,insulin resistance,glucose intolerance or type 2 diabetes,high waist-to-hip ratio,and microalbuminuriaAbdominal obesity Glucose intolerance/Insulin resistance Hypertension Atherogenic dyslipidemi

7、aProinflammatory/Prothrombotic stateNational Cholesterol Educational Program(NCEP),Adult Treatment Panel(ATP)III;2001.*Diagnosis is established when 3 of these risk factors are presentRisk FactorDefining LevelAbdominal obesity(Waist circumference)Men102 cm(40 in)Women88 cm(35 in)TG150 mg/dLHDL-C Men

8、40 mg/dL Women130/85 mm HgFasting glucose110(100*)mg/dLExpert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.JAMA.2001;285:2486-2497.*2003 New ADA IFG criteria(Diabetes Care)0510152025303540455020-70+20-2930-3940-4950-5960-6970Prevalence(%)AgeMen WomenFord E et al.JA

9、MA.2002;287:356-359.0%5%10%15%20%25%CHD PrevalenceNo MS/No DM8.7%of Population=54.2%28.7%2.3%14.8%Alexander C,et al.Diabetes 52:1210-1214,200313.9%7.5%19.2%MS/No DMDM/No MSDM/MS010203040MenWomenPrevalence(%)AgeFord E et al.JAMA.2002;287:356-359.WhiteAfrican-AmericanMexican-AmericanOther25%16%28%21%2

10、3%26%36%20%0510152025All-cause MortalityCardiovascular MortalityMortality Rate(%)Without metabolic syndromeWith metabolic syndrome*Isomaa B et al.Diabetes Care.2001;24:683-689.*P 0.001.*0510152025CHDMIStrokePrevalence(%)Without metabolic syndromeWith metabolic syndrome*P 0.001.Isomaa B et al.Diabete

11、s Care.2001;24:683-689.*0123456Relative Risk1.00Nondiabeticthroughoutthe studyHu FB et al.Diabetes Care.2002;25:1129-1134.Prior todiagnosisof diabetesAfter diagnosisof diabetesDiabetic atbaseline2.823.715.02Postmenopausal women.*P=0.03;*P=0.0001.LBM=lean body mass.AT=adipose tissue.Brochu M et al.J

12、Clin Endocrinol Metab.2001;86:1020-1025.InsulinSensitive(n=17)InsulinResistant(n=26)BMI(kg/m2)31.534.7Fat mass(kg)37.339.0Lean body mass(kg)43.848.1*Body fat(%)45.244.8Total Energy Expenditure(cal/d)29553051Glucose disposal(mg/min x kg LBM)11.25.7*Subcutaneous AT(cm2,L4-L5)447+144434+130Visceral AT(

13、cm2,L4-L5)141+53211+85*Subcutaneous AT(cm2,leg)208+64187+82Muscle attenuation(Hounsfield U,leg)42.2+2.643.6+4.8InsulinSensitive(n=17)InsulinResistant(n=26)Total cholesterol(mmol/L)5.14+0.804.84+0.91Triglycerides(mmol/L)1.50+0.852.02+0.87*LDL cholesterol(mmol/L)3.28+0.723.00+0.85HDL cholesterol(mmol/

14、L)1.16+0.470.91+0.31*TC/HDL cholesterol5.0+1.85.7+1.8Systolic BP(mm Hg)137.2+14.5139.7+14.8Diastolic BP(mm Hg)72.5+11.175.6+8.2Postmenopausal women.Data are mean SD.*P=0.01.Brochu M et al.J Clin Endocrinol Metab.2001;86:1020-1025.InsulinSensitive(n=17)InsulinResistant(n=26)Fasting glucose(mmol/L)4.7

15、8+0.305.21+0.61*Fasting insulin(pmol/L)55.2+14.3136.3+88.2*2 hr glucose(mmol/L)6.02+2.317.28+1.672 hr insulin(pmol/L)250.4+98.3955.7+754.8*Glucose area(mmol/L x 10-3)0.79+0.140.91+0.17Insulin area(pmol/L x 10-3)31.6+16.5108.3+4.6*Postmenopausal women.n=12,sensitive;n=23,resistant.Data are mean SD.*P

16、=0.01;*P=0.005;*P=0.001.Brochu M et al.J Clin Endocrinol Metab.2001;86:1020-1025.01020304050BMI 308-y Incidence of Metabolic Syndrome(%)Waist circumference level 2*Han TS et al.Obes Res.2002;10:923-931.*Level 2=waist 40 inches in men or 35 inches in women.9.9820.4519.7733.4305101520253035PercentNeit

17、herLowHighHaffner SM et al.Circulation.2000;101:975-980.Insulin secretionLowLowInsulin resistanceHighHighBothHighLowMetabolic statusHOMA-IR I30-0min/G30-0minHaffner SM et al.Circulation.2000;101:975-980.Low insulin secretion;insulin sensitive(15.9%)Neither(1.5%)Insulin resistant;good insulinsecretio

18、n(28.7%)012345Qt 2Qt 3Qt 4Qt 5012345Qt 2Qt 3Qt 4Qt 5Increasing Insulin ResistanceA:adjusted for age,sex,and ethnicityB:adjusted for age,sex,and ethnicity,LDL,triglyceride,HDL,systolic blood pressure,fasting glucose,smoking,alcohol consumption,and leisure time exerciseHanley A et al.Diabetes Care.200

19、2;25:1177-1184.AHOMA IRBOdds Ratio(95%CI)Increasing Risk of CVDP(trend)0.0001P(trend)0.0075QuintileWaist Circumference(in)Relative Risk for CHD115.0 to 27.51.0227.5 to 29.21.27329.2 to 31.22.08431.2 to 34.02.31534.0 to 54.72.44Adjusted for BMI,age(continuous),age2,smoking,parental history of myocard

20、ial infarction,alcohol consumption,physical activity,menopausal status,hormone replacement therapy,aspirin intake,saturated fat,and antioxidant score.Rexrode W et al.JAMA.1998;280:1843-1848.P 0.001 for trend.lMetabolic syndrome reflects failure of intracellular lipohomeostasis,which prevents lipotox

21、icity in organs of overnourished individualslNormal individuals:lipohomeostasis(ie,lipid overload confined to white adipocytes,designed to store surplus calories)lObese individuals:adipocytes increase leptin secretion in an attempt to enhance oxidation of surplus lipid in nonadipocyteslDeficiency or

22、 nonresponsiveness to leptin prevents these protective events and results in ectopic accumulation of lipidslPancreatic-cells and myocardiocytes are“cellular victims”leading to type 2 diabetes and lipotoxic cardiomyopathyUnger RH.Endocrinology.2003.0.61.01.41.82.22.63.0Relative Risk of DeathBody Mass

23、 index40.0LeanOverweightObese0255075100Chan J et al.Diabetes Care 1994;17:961.Colditz G et al.Ann Intern Med 1995;122:481.Age-Adjusted Relative RiskBody Mass index(kg/m2)2235 kg/m2Quesenberry CP Jr et al.Arch Intern Med.1998;158:466-472.*HMO Setting:Northern California Kaiser Permanente.Healthcare v

24、isitsPharmacyLaboratory testsAll outpatient servicesAll inpatient servicesTotal healthcare$0$2,000$4,000$6,000$8,000$0$400$800$1,200$1,600Burton et al.J Occup Environ Med 1998;40:786.*BMI 27.8 kg/m2 in men;27.3 kg/m2 in women.AbsenteeismHealthcare$4,496$6,822$683$1,546lNew study quantifying state-le

25、vel expendituresModel developed to predict expenditures by combining MEPS and BRFFS datalObesity prevalence for US estimated at 20%of total adult populationlPrevalence varies considerably by stateOverall range:15%(CO)25%(WV)Finkelstein,et al Obes Res.2004;12:18-24.MEPS=1998 Medical Expansion SurveyB

26、RFSS=Behavioral Risk Factor Surveillance Systeml6%total adult medical expenditures are attributable to obesityRange:4%(AZ,CT)7%(AK)l7%Medicare expendituresRange:4%(AZ)10%(DE)l11%adult Medicaid expendituresRange:8%(RI)16%(IN)Finkelstein,et al Obes Res.2004;12:18-24.TotalMedicareMedicaidState%(million

27、s$)%(millions$)%(millions$)AK6.7(195)7.7(17)8.2(29)AZ4.0(752)3.9(154)13.5(242)CA5.5(7,675)6.1(1,738)10.0(1,713)GA6.0(2,133)7.1(405)10.1(385)NY5.5(6,080)6.7(1,391)9.5(3,539)TX6.1(5,340)6.8(1,209)11.8(1,177)Finkelstein,et al Obes Res.2004:12 18-24In the US as a whole,obesity attributable medical expenditures are estimated at$75 billion with$17 billion financed by Medicare and$21 billion financed by Medicaid.谢谢您的聆听与观看THANK YOU FOR YOUR GUIDANCE.感谢阅读！为了方便学习和使用，本文档的内容可以在下载后随意修改，调整和打印。欢迎下载！汇报人：XXX日期：20XX年XX月XX日