医学精品课件：2014中德班肥胖.ppt

1、 Obesity and Metabolic syndromeTongji HospitalHushuhong 2014.9Obesity lObesity is a condition in which excess body fat has accumulated to an extent that health may be negatively affected.Epidemiology l1997 WHO formally recognized obesity as a global epidemic.l 2005 the WHO estimates that at least 40

2、0 million adults(9.8%)are obese,with higher rates among women than men.Overweight is Rising in USAThis overweight classification combines those who are classified as overweight(BMI 25-29.9)and those who are obese(BMI 30).56.064.565.766.3Adapted from:the Centers for Disease Control and Prevention(CDC

3、)Prevalences of Overweight and Obesity in Chinese Adults a in 2007-2008.05101520253035超重肥胖男男女女WEIPING JIA,2012 ADA Presentation Abstract.Abstract Number:2902-PO 30.8%24.9%6.0%4.9%WHO Definition of Obesity in 1997BMI ClassificationlLess than 18.5 underweightl18.524.9 normal weightl25.029.9 overweight

4、l30.034.9 class I obesityl35.039.9 class II obesitylOver 40.0 class III obesity Diagnosis and Classification of Obesity The surgical literature breaks down class III obesity into further categories.BMI 40 severe obesity l BMI of 40.049.9 morbid obesity lBMI of 50 super obese WHO Definition of Obesit

5、y for Asia in 1999BMI ClassificationlLess than 18.5 underweightl18.522.9 normal weightl23.024.9 overweightl25.029.9 mild obesitylOver 30.0 severe obesityDefinition of Obesity in Chinalover-weight was defined as BMI of 2427.9 kg/m2 and lobesity was defined as BMI 27.9 kg/m2.Central obesity Waist circ

6、umference102 cm in men(90cm for chinese)88 cm in women(80cm for chinese)lThe regional distribution of body fat affects risk factors for the heart disease and type 2 diabetesAn obese male with a body mass index of 46 kg/m2.Weight 146 kg,height 177 cm abdominal CTnormal weightobese personComplication

7、of ObesityObesity on average reduces life expectancy by 67 years.Excessive body weight is associated with various diseasesparticularly:lcardiovascular diseases(CVD)l diabetes mellitus type 2lobstructive sleep apnealcertain types of cancerlosteoarthritis Cause of Obesity1.excessive caloric intake and

8、 lack of physical activity2.Genetic susceptibility is thought to explain most cases of obesity Polymorphisms in various genes controlling appetite and basal metabolismManagementPrinciple 1.Decrease of energy intake 2.Increase of energy expenditureThe primary treatment for obesity lDietingl Physical

9、exerciselAnti-obesity drugsl Bariatric surgery(weight loss operation)Dieting Diets to promote weight loss are generally divided into three categories:1.low-fat 2.low-calorie 3.very low calorie Low-fat diet:therapeutic Lifestyle Changes(TLC)diet in NCEP ATP III Nutrient Recommended Intake as%of Total

10、 CalorieslTotal Fat 2535%Saturated Less than 7%Polyunsaturated Up to 10%Monounsaturated Up to 20%lCarbohydrate 5060%of total calorieslProtein Approximately 15%lCholesterol Less than 200 mg per dayTotal Calories Balance energy intake and expenditure to maintain desirable body weight and prevent weigh

11、t gainLow-calorie dietlLow-calorie diets usually produce an energy deficit of 5001000 calories per daylLow-calorie diet can result in a 0.5 kilogram weight loss per week.Very low-calorie dietlProviding 200800 kcal/day,maintaining protein intake but limiting calories from both fat and carbohydrates.l

12、 Producing an average weekly weight loss of 1.52.5 kilograms.lThese diets are not recommended for general use.Less Physical exerciselWith physical exercise,muscles consume energy derived from both fat and glycogenlDue to the large size of leg muscles,walking,running,and cycling are the most effectiv

13、e means of exercise to reduce body fat.lPhysical activityin in NCEP ATP III:enough moderate exercise to expend at least 200 kcal per day Anti-obesity medications Only one anti-obesity medication are currently approved for long term use:orlistat,which reduces intestinal fat absorption by inhibiting p

14、ancreatic lipase Medications are not FDA approved for use in children.Bariatric surgery(weight loss surgery)l Surgical interventions lOnly recommended for severely obese people(BMI 40)who have failed to lose weight with dietary modification and pharmacological treatment.The most common approaches ar

15、e:l Reducing the volume of the stomach(adjustable gastric banding)lReducing the length of bowel,directly reducing absorption(gastric bypass surgery).adjustable gastric bandinggastric bypass surgery:The Roux-en-Y Gastric Bypass Procedure Metabolic syndrome lIt is characterized by a constellation of m

16、etabolic risk factors in one individual.lThe metabolic syndrome is closely associated with insulin resistanceATP IIICharateristics of metabolic syndromelAbdominal obesitylAtherogenic dyslipidemialRaised blood pressurelInsulin resistance glucose intolerancelProthrombotic statelProinflammatory stateAT

17、P IIIIntra-abdominal adiposity promotes insulin resistance内脏肥胖启动胰岛素抵抗内脏肥胖启动胰岛素抵抗 Hepatic FFA flux(portal hypothesis)FFAliver Insulin resistance PAI-1 Adiponectin IL-6 TNFa a Intra-abdominaladiposityNet result:periphere Insulin resistance InflammationHeilbronn et al 2004;Coppack 2001;Skurk&Hauner 200

18、4 suppression of lipolysis by insulinAdipokines：Diagnosis：Metabolic SyndromeThe NCEP Adult Treatment Panel III(ATP III)defined metabolic syndrome as the presence of 3 of the following:l(1)abdominal obesity:waist circumference 102 cm(40 inches)for men and 88 cm(35 inches)for women;l(2)triglycerides 1

19、50 mg/dL;l(3)HDL cholesterol 40 mg/dL for men and 50 mg/dL for women;l(4)BP 130/85 mm Hg;and l(5)fasting glucose 110 mg/dL.Chinese:Male 90 cm,Female 80 cmEurope :Male 94cm,Female 80 cmAtherogenic dyslipidemialHigh TGlLow HDL-ClHigh small and dense LDL Relationship between TG levels and LDL particle

20、size累计比例累计比例TG(mg/dl)Large LDLAustin M,et al.Circulation.1990;82:495-506.Small and dense LDLTG浓度 mg/dl 10 50102030 Type 2 Diabetes:A Natural HistoryAdapted from International Diabetes Center(IDC).Minneapolis,Minnesota.duration of diabetes Cell functionPlasma glucoseIRInsulin secretion126 mg/dLFBGPBG

21、Multiple Risk Factor ManagementGoals:Minimize Risk of Type 2 Diabetes and Cardiovascular DiseaselObesitylGlucose Intolerance/Insulin ResistancelLipid DisorderslHypertension Lifestyle intervention Brisk walking -30 min./day 10%reduction in body wt.DPP-4=dipeptidyl peptidase-4;TZDs=thiazolidinediones.

22、DeFronzo RA.Ann Intern Med.1999;131:281303.Buse JB et al.In:Williams Textbook of Endocrinology.10th ed.Philadelphia:WB Saunders;2003:14271483.PancreasGlucose levelMuscle and fatLiverBiguanidesTZDsBiguanidesSulfonylureasGlinidesTZDsAlpha-glucosidase inhibitorsGutGLP-1RAGLP-1RABiguanidesDPP-4 inhibito

23、rsDPP-4 inhibitorsMedication-Insulin Resistance/Diabetes:Other medications:lHypertension(Goal:130/80):ACE inhibitors,ARBsOthers-thiazides,calcium channel blockers,beta blockers,alpha blockerslHyperlipidemia(Goals:LDL 2.6 mmol/l,TG 1.1 mmol/l):Statins,Fibrates,NiacinlPlatelet inhibitors:ASA,clopidogr

24、elConclusionlObesity is a chronic epidemic diseaselObesity induce or related to multiple metabolic risk state for CVD and T2DM(metabolic syndrome)lLifestyle intervention has a central role in treatment of obesitylMedication and surgical interventions are also helpful in some indicated patients with obesity/metabolic syndromeThanks!