儿童少年卫生学-儿童少年单纯性肥胖课件

1、Obesity in Childhood and Adolescence儿童少年单纯性肥胖张慧颖Bibliography 儿童少年卫生学（第6版），季成叶主编。人民卫生出版社Falkner F. and Tanner J.M. Human Growth. Plenum Press. New York and LondonLowrey GH. Growth and development of children. 7th ed, Chicago, London: Year Book Medical Publishers现代儿童少年卫生学，叶广俊主编。人民卫生出版社儿童少年生长发育唐锡麟 人民卫生

2、出版社I. General1997, WHO formally announced that obesity is a disease obesity will become the biggest enemy to threaten human health and life satisfaction in 21 century - IOTF 国际肥胖特别工作组International Obesity Task Force II. Defining Obesity Obesity is defined as an excessive accumulation of body fat. in

3、creasing of body fat cell enlargement of body fat cellTwo types: Primary obesity Secondary obesity肥胖，是一种常见的营养代谢疾病， 是指由于营养过剩、缺乏运动以及遗传因素共同作用引起的身体内脂肪过度堆积的现象，表现为全身脂肪组织异常性的增加III. Screening obesity eyeball test weight-for-height body mass index body fat content waist / hip ratio weight-for-height 身高标准体重 U

4、nder 60%serious malnutrition 60-80%moderate malnutrition 80-90%mild malnutrition 90-110%Normal 110-120%Overweight 120-130%mild obesity 130-150%moderate obesity above 150%serious obesityObesity: scale by BMIBMI = Weight (kg) Height (m)2 Overweight Obesity China 24 28 WHO 25 30Classification of body w

5、eight WHO and NHLBI classification of BMIBMICLASSIFICATIONWHO and NILBI CHINA 18.5 Underweight 18.524.9 24Normal range 25.029.2 24.027.9Overweight 30.034.9 28.0Obese class 1 35.039.9 Obese class 2 40.0Obese class 3NHLBI: National Heart, Lung, and Blood InstituteAdapted from Mckdad AH, et al. JAMA. 1

6、999; 282: 1519-1522中国学龄儿童青少年超重、肥胖筛查BMI分类标准年龄（岁） 男-超重 男-肥胖 女-超重 女-肥胖 7 17.419.217.218.9 8 18.120.318.119.9 9 18.921.419.021.0 10 19.622.520.022.1 11 20.323.621.123.3 12 21.024.721.924.5 13 21.925.722.625.6 14 22.626.423.026.3 15 23.126.923.426.9 16 23.527.423.727.4 17 23.827.823.827.7 18 24.028.024.0

7、28.0Waist-to-hip ratio (WHR): fat distributionWAIST - HIP RATIO (WHR) 腰臀比 Most people store their body fat in two distinct ways: around their middle (apple shape) around their hips (pear shape). Women 0.8Man 0.95BMI - WHRWaist circumference: 腰围 best indicator of visceral fatFemale80 cm = increase ri

8、skMale90 cm = increase riskcmWHO 推荐：肥胖度 = 实际体重(kg)身高标准体重(kg) / 身高标准体重(kg) 100% 凡肥胖度20%，两处的皮下脂肪厚度80百分位数或其中一处皮下脂肪厚度95 百分位数者为肥胖儿童凡肥胖度10%，无论两处的皮下脂肪厚度如何，均为体重正常儿童皮褶厚度（skinfold thickness）：测量右侧肱三头肌肌腹部和右肩胛下角部上臂肱三头肌部 代表四肢肩胛下角 代表躯干上述二部位之和 代表全身皮下指标体脂比（body fat ratio）: 轻度肥胖 中度肥胖 高度肥胖男性 20 25 30女性 20 25 30 以上两种方法

9、推算的体脂比和判定的肥胖程度易受身高和肌肉发达程度影响CT断层法： 皮下脂肪面积/内脏脂肪面积 0.4：内脏型肥胖 0.4：皮下脂肪型肥胖超声波法： 腹膜前脂肪的最大厚度/腹壁皮下脂肪的最小厚度 MALE: 1.0 内脏型肥胖 FEMALE: 0.7内脏型肥胖IV. Epidemiology “the global obesity epidemic” “globesity”Major problem in developed countries Overweight and ObesityWHO（2002）World-wild: one of 10 health risk factorsDev

10、eloped countries: one of 5 health risk factorsUS: increase 4 times recently forty years （Ogden et al，2002）USA : The prevalence of obesity is high and rising higherFig. The prevalence of childhood obesity in China, 1985-2000.Fig. The prevalence of childhood overweight and obesity in China, 2000Genera

11、l, Higher in northern than in southern.北方南方Higher in urban than 城市农村Rural, not very high, but the increasing rate is rapid No gender difference in pre-school. Higher in boys than girls in school-ageAge-special: 1yr have light peak, after that reduce with age increase, 5yr rebound, 10-13yrs reach the

12、 peak Many adulthood obesity develop from from childhood obesity.Risk : Obesity children develop into adulthood obesity Infant 14 % 7 yrs child 41 % 1013 80 %ChinaHigher stunt prevalenceWith the improvement of nutrition, the stunting tend to catch-up growth, and tend to obese late pregnancy, fetus a

13、bsorb much energy high BMI - obesityExcess feeding to infants weight increase fast adipose early rebound 脂肪早期重聚 early maturation pattern puberty central and high BMI obesitydeveloping country and shift societyTrend in underweight prevalence from 1990 to 2006, by region The trend analysis is based on

14、 a subset of 76 countries with trend data, covering 83 per cent of the under-five population in the developing world. For CEE/CIS, the baseline year is 1996; data availability was limited for the period around 1990. Prevalence was estimated using NCHS/WHO/CDC reference population VFactors （Etiology）

15、 Obesity: A Complex DiseaseCauses of childhood obesityGene-Gene: linkage and interactionGeneEnvironment: cooperation and interactionEnvironment Diet: energy, diet structure, soft drink Socioeconomic status Physical exercise Lifestyle (sedentary) Commercial inducement 1. Genetic determinants 遗传因素 In

16、the twins studies, the heritability of the BMI was estimated to be very high, about 80%.The results of adoption and family studies, however, agree on a heritability of about 33%.Genetic predispositionob gene leptin2. Environmental determinants 环境因素 Food intake Socioeconomic status Family factors Phy

17、sical activity Brain damage Drugs Endocrine factors Psychologic factors(1) Newborn and infancyHeavy birth weight 高出生体重Smoking in pregnancy 母孕期吸烟Non-breast feeding 非母乳喂养Different age，different factors(2) Pre-school ageWeight level and increment rateCatch-up growth of low-birth-weight - U shape distri

18、butionParents obesityLong time for watching TV and short sleeping timeBMI AND BIRTH WEIGHT British Journal of Cancer (2004) 91, 519524 Is the association of birth weight with premenopausal breast cancer risk mediated through childhood growth? Silva IS, Stavola BLD, Hardy RJ, et al.(3) School age and

19、 adolescenceParents obesity 父母肥胖Increasing velocity violent, especially Stunt children 生长迟滞儿童 Sedentary lifestyle “以静代动”的生活方式 watching TV play computer transportation (manner of going to school) deficiency physical exercise lack of outdoor activityDull in after-school, lack of physical exercise moti

20、vation, interest and inducement“three hyper-”diet and soft drinkParents lack of nutrition knowledgeStrong commercial inducementHave early puberty growth and body fat increase rapidlyVI. Tend to occur obesity肥胖的易发时期 The late pregnancy 孕后期Infancy (especially before 9 months) 婴儿期（尤其生后9个月内）The early pub

21、erty 青春早期The late puberty 青春发育后期 The influence on child and adolescent health Effect on psychology poor self-image disinterested in exercise more sedentary possibly socially isolatedEffect on healthCommon secondary medical problems include hypertension, and knee and back problemsObesity Is Associate

22、d With Increased Morbidity and MortalityObesity Is Linked with Cardiovascular DiseaseVIII. Prevention of Obesity肥胖的防治 Comprehensive strategies of interventionComprehensive strategies of intervention:The idea of control weight should be haven from fetus. 从小抓起The health education on prevention obesity

23、 预防肥胖的健康教育Properly deal with the relationship between dietary adjustment and suitably physical activity正确处理饮食调整和适当体育活动的关系Behavior therapy 行为疗法Diet therapy 饮食疗法Physical exercise therapy 运动疗法10 of the Worst Foods for ChildrenSoda pop Whole milk Hamburgers American cheese Hot dogs French fries and tate

24、r tots Ice cream Pizza loaded with cheese and meat Bologna (一种大腊肠)Chocolate bars 10 of the Best Foods for ChildrenFresh fruits and vegetables (especially carrot sticks, cantaloupe, oranges, watermelon, strawberries) Chicken breast and drumstick without skin or breading Cheerios, Wheaties, or other w

25、hole-grain, low-sugar cereals Skim or 1% milk Extra-lean ground beef or vegetarian burgers (Gardenburgers or Green Giant Harvest Burgers) Low-fat hot dogs (Yves Veggie Cuisine Fat-Free weiners or Lightlife Fat-Free Smart Dogs) Non-fat ice cream or frozen yogurt Fat-free corn chips or potato chips Seasoned air-popped popcorn Whole-wheat crackers or Smal