肥胖的并发症课件

Medical Complications of ObesityMedical Complications of ObesiBMI-Associated Disease RiskClassificationBMI(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 18-20 yPoor aerobic fitnessSpecific races and ethnic groupsBMI-Associated Disease RiskClaWeight(lb)2322211918171615152524222120191817162726242321201918172927262423222019183129282624232221203331292726242322213533312927262423223735333129272624233937343230292726244138363432302927264340383634323028274542403735333130284744413937353331294946434038363432305148454240373533325349464441393735335551484543403836345753504744423937355955524946434139376359555248464341406662585552494644417066625855524946447470656158555249467873696561575451491201301401501601701801902002102203203403602402502602302702802903803004006464Height(in)62626060707068686666727274747676Body Mass Index ChartWeight(lb)2325272931333537394Relationship Between BMI and Percent Body Fat in Men and WomenAdapted from:Gallagher et al.Am J Clin Nutr 2000;72:694.Body Fat(%)Body Mass Index(kg/m2)0103040602050WomenMenRelationship Between BMI and PPulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndromeNonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosisCoronary heart diseaseCoronary heart disease DiabetesDiabetes Dyslipidemia Dyslipidemia Hypertension HypertensionGynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndromeOsteoarthritisOsteoarthritisSkinSkinGall bladder diseaseGall bladder diseaseCancerCancerbreast,uterus,cervixbreast,uterus,cervixcolon,esophagus,pancreascolon,esophagus,pancreaskidney,prostatekidney,prostatePhlebitisPhlebitisvenous stasisvenous stasisGoutGoutMedical Complications of ObesityIdiopathic intracranial Idiopathic intracranial hypertensionhypertensionStrokeStrokeCataractsCataractsSevere pancreatitisSevere pancreatitisPulmonary diseaseNonalcoholic Metabolic SyndromelAbdominal obesitylHyperinsulinemialHigh fasting plasma glucoselImpaired glucose tolerancelHypertriglyceridemialLow HDL-cholesterollHypertensionMetabolic SyndromeAbdominal obEvolution of Metabolic SyndromeIsomaa B et al.Diabetes Care.2001;24:683-689.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 Health 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 microalbuminuriaEvolution of Metabolic SyndromAbdominal obesity Glucose intolerance/Insulin resistance Hypertension Atherogenic dyslipidemiaProinflammatory/Prothrombotic stateCharacteristics of the Metabolic Syndrome:Characteristics of the Metabolic Syndrome:NCEP-ATP IIINCEP-ATP IIINational Cholesterol Educational Program(NCEP),Adult Treatment Panel(ATP)III;2001.DiabetesDiabetesCVDCVDAbdominal obesity CharacteristClinical Identification of the Metabolic Clinical Identification of the Metabolic Syndrome*:NCEP-ATP IIISyndrome*:NCEP-ATP III*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 Men40 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)Clinical Identification of theIncreasing Prevalence of NCEP Metabolic Increasing Prevalence of NCEP Metabolic Syndrome with Age(NHANES III)Syndrome with Age(NHANES III)Prevalence(%)AgeMen WomenFord E et al.JAMA.2002;287:356-359.Increasing Prevalence of NCEP Prevalence of CHD by the Metabolic Syndrome and Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+Diabetes in the NHANES Population Age 50+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/MSPrevalence of CHD by the MetabPrevalence of the Metabolic Syndrome Varies Prevalence of the Metabolic Syndrome Varies by Sex and Race/Ethnicity(NHANES III)by Sex and Race/Ethnicity(NHANES III)Prevalence(%)AgeFord E et al.JAMA.2002;287:356-359.WhiteAfrican-AmericanMexican-AmericanOther25%16%28%21%23%26%36%20%Prevalence of the Metabolic SyMetabolic Syndrome:Impact on MortalityMortality Rate(%)Without metabolic syndromeWith metabolic syndrome*Isomaa B et al.Diabetes Care.2001;24:683-689.*P 0.001.*Metabolic Syndrome:Impact on Metabolic Syndrome:Impact on Metabolic Syndrome:Impact on Cardiovascular HealthCardiovascular HealthPrevalence(%)Without metabolic syndromeWith metabolic syndrome*P 0.001.Isomaa B et al.Diabetes Care.2001;24:683-689.*Metabolic Syndrome:Impact on Elevated Risk of CVD Prior to Clinical Diagnosis Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetesof Type 2 DiabetesRelative Risk1.00Nondiabeticthroughoutthe studyHu FB et al.Diabetes Care.2002;25:1129-1134.Prior todiagnosisof diabetesAfter diagnosisof diabetesDiabetic atbaseline2.823.715.02Elevated Risk of CVD Prior to Characteristics of Metabolically Normal Obese Characteristics of Metabolically Normal Obese and Metabolically Abnormal Obese Subjectsand Metabolically Abnormal Obese SubjectsPostmenopausal women.*P=0.03;*P=0.0001.LBM=lean body mass.AT=adipose tissue.Brochu M et al.J 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(cm2,L4-L5)141+53211+85*Subcutaneous AT(cm2,leg)208+64187+82Muscle attenuation(Hounsfield U,leg)42.2+2.643.6+4.8Characteristics of MetabolicalLipids and Lipoproteins&Resting BP in Insulin-Lipids and Lipoproteins&Resting BP in Insulin-Sensitive and Insulin-Resistant Obese SubjectsSensitive and Insulin-Resistant Obese Subjects InsulinSensitive(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/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.Lipids and Lipoproteins&RestOral Glucose Tolerance in Insulin-Sensitive Oral Glucose Tolerance in Insulin-Sensitive and Insulin-Resistant Obese Subjectsand Insulin-Resistant Obese Subjects InsulinSensitive(n=17)InsulinResistant(n=26)Fasting glucose(mmol/L)4.78+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=0.01;*P=0.005;*P=0.001.Brochu M et al.J Clin Endocrinol Metab.2001;86:1020-1025.Oral Glucose Tolerance in InsuWaist Size vs BMI and the Metabolic Syndrome8-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.9.9820.4519.7733.43Waist Size vs BMI and the MetaBoth Insulin Resistance and Decreased Insulin Both Insulin Resistance and Decreased Insulin Secretion Predict the Risk of Developing Type 2 Secretion Predict the Risk of Developing Type 2 Diabetes:7-Year IncidenceDiabetes:7-Year IncidencePercentNeitherLowHighHaffner SM et al.Circulation.2000;101:975-980.Insulin secretionLowLowInsulin resistanceHighHighBothHighLowMetabolic statusHOMA-IR I30-0min/G30-0minBoth Insulin Resistance and DeDistribution by Metabolic Status Among Converters to Type 2 Diabetes(83%of Prediabetic Subjects are Insulin Resistant)(83%of Prediabetic Subjects are Insulin Resistant)Haffner SM et al.Circulation.2000;101:975-980.Both Both(54%)(54%)(n=195)(n=195)Low insulin secretion;insulin sensitive(15.9%)Neither(1.5%)Insulin resistant;good insulinsecretion(28.7%)Distribution by Metabolic StatInsulin Resistance(HOMA-IR Quintiles)are Insulin Resistance(HOMA-IR Quintiles)are Related to CV Disease:San Antonio Heart StudyRelated to CV Disease:San Antonio Heart StudyIncreasing 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.2002;25:1177-1184.AHOMA IRBOdds Ratio(95%CI)Increasing Risk of CVDP(trend)0.0001P(trend)0.0075Insulin Resistance(HOMA-IR QuIntra-Abdominal Fat Mass and CHD Risk in Type 2 DiabetesQuintileWaist 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 myocardial 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.Intra-Abdominal Fat Mass and CEctopic Lipids and the Metabolic SyndromelMetabolic syndrome reflects failure of intracellular lipohomeostasis,which prevents lipotoxicity 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 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.Ectopic Lipids and the MetabolRelationship Between BMI and Cardiovascular Disease MortalityRelative Risk of DeathBody Mass index40.0LeanOverweightObeseRelationship Between BMI and CRelationship Between BMI and Risk of Type 2 Relationship Between BMI and Risk of Type 2 DiabetesDiabetesChan 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)MenMenWomenWomen222323-23.924-24.925-26.927-28.929-30.931-32.933-34.935+1.02.91.04.31.05.01.58.12.215.84.427.640.354.093.26.711.621.342.1Relationship Between BMI and RWaist-HipRatioTertileAbdominal Fat Distribution Increases the Risk of Coronary Heart DiseaseThe Iowa Womens Health StudyThe Iowa Womens Health StudyFolsom et al.Arch Intern Med 2000;160:2117.Relative riskBody Mass Index Tertile213321Waist-HipRatioTertileAbdominRelationship Between Weight Gain in Adulthood Relationship Between Weight Gain in Adulthood and Risk of Type 2 Diabetes Mellitusand Risk of Type 2 Diabetes MellitusRelative RiskWeight Change(kg)Willett et al.N Engl J Med 1999;341:427.-10-505101520MenMenWomenWomenRelationship Between Weight GaDirect Cost*of Chronic Diseases in the United StatesDirect Cost($Billions)Type 2DiabetesWolf AM,Colditz GA.Obes Res.1998;6:97-106.Hodgson TA,Cohen AJ.Med Care.1999;37:994-1012.*Adjusted to 1995 dollars.ObesityCoronaryHeart DiseaseHyper-tensionStroke$18.1$18.4$38.7$51.6$53.2Direct Cost*of Chronic DiseaEffect of Obesity on Expected Lifetime Medical Care Costs*in MenCosts($)*Body Mass Index(kg/m2)32.527.537.555-6445-54*Total cost of CHD,type 2 DM,hypertension,hypercholesterolemia,strokeAge(y)Thompson et al.Arch Intern Med 1999;159:2177.35-4422.5Effect of Obesity on Expected Increase in Healthcare Costs Among Obese Increase in Healthcare Costs Among Obese Compared with Lean(BMI 25 kg/m2)PatientsCompared with Lean(BMI 35 kg/m2Quesenberry CP Jr et al.Arch Intern Med.1998;158:466-472.*HMO Setting:Northern California Kaiser Permanente.Healthcare visitsPharmacyLaboratory testsAll outpatient servicesAll inpatient servicesTotal healthcareIncrease in Healthcare Costs AEconomic Effect of Obesity to Business:3-Year Costs to First Chicago NBDBurton et al.J Occup Environ Med 1998;40:786.*BMI 27.8 kg/m2 in men;27.3 kg/m2 in women.AbsenteeismHealthcareLeanLeanObese*Obese*$4,496$6,822$683$1,546Economic Effect of Obesity to Annual Medical Expenditures Attributable to Annual Medical Expenditures Attributable to Obesity in USObesity in USlNew study quantifying state-level expendituresModel developed to predict expenditures by combining MEPS and BRFFS datalObesity prevalence for US estimated at 20%of total adult populationlPrevalence varies considerably by stateOverall range:15%(CO)25%(WV)Finkelstein,et al Obes Res.2004;12:18-24.MEPS=1998 Medical Expansion SurveyBRFSS=Behavioral Risk Factor Surveillance SystemAnnual Medical Expenditures AtAnnual Medical Expenditures Attributable to Obesity in USl6%total adult medical expenditures are attributable to obesityRange:4%(AZ,CT)7%(AK)l7%Medicare expendituresRange:4%(AZ)10%(DE)l11%adult Medicaid expendituresRange:8%(RI)16%(IN)Finkelstein,et al Obes Res.2004;12:18-24.Annual Medical Expenditures AtAnnual Medical Expenses Attributable to Annual Medical Expenses Attributable to Obesity in Selected StatesObesity in Selected StatesTotalMedicareMedicaidState%(millions$)%(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.Annual Medical Expenses Attrib演讲完毕，谢谢观看！Thank you for reading!In order to facilitate learning and use,the content of this document can be modified,adjusted and printed at will after downloading.Welcome to download!汇报人：XXX汇报日期：20XX年10月10日演讲完毕，谢谢观看！Thank you for readin