童少年单纯性肥胖.ppt

ObesityinChildhoodandAdolescence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FalknerF.andTannerJ.M.HumanGrowth.PlenumPress.NewYorkandLondonLowreyGH.Growthanddevelopmentofchildren.7thed,Chicago,London:YearBookMedicalPublishers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出版社,I.General,2019,WHOformallyannouncedthatobesityisadisease,obesitywillbecomethebiggestenemytothreatenhumanhealthandlifesatisfactionin21century-IOTF国际肥胖特别工作组,InternationalObesityTaskForce,II.DefiningObesity,Obesityisdefinedasanexcessiveaccumulationofbodyfat.,increasingofbodyfatcellenlargementofbodyfatcell,Twotypes:PrimaryobesitySecondaryobesity,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.Screeningobesity,eyeballtestweight-for-heightbodymassindexbodyfatcontentwaist/hipratio,weight-for-height身高标准体重,Obesity:scalebyBMI,BMI=,Weight(kg)Height(m)2,OverweightObesityChina2428WHO2530,ClassificationofbodyweightWHOandNHLBIclassificationofBMI,NHLBI:NationalHeart,Lung,andBloodInstituteAdaptedfromMckdadAH,etal.JAMA.2019;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,717.419.217.218.9818.120.318.119.9918.921.419.021.01019.622.520.022.11120.323.621.123.31221.024.721.924.51321.925.722.625.61422.626.423.026.31523.126.923.426.91623.527.423.727.41723.827.823.827.71824.028.024.028.0,Waist-to-hipratio(WHR):fatdistribution,WAIST-HIPRATIO(WHR)腰臀比,Mostpeoplestoretheirbodyfatintwodistinctways:aroundtheirmiddle(appleshape)aroundtheirhips(pearshape).,Women0.8Man0.95,BMI-WHR,Waistcircumference:腰围bestindicatorofvisceralfat,Female,80cm=increaserisk,Male,90cm=increaserisk,WHO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（skinfoldthickness）：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（bodyfatratio）:轻度肥胖中度肥胖高度肥胖男性202530女性202530以上两种方法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,“theglobalobesityepidemic”“globesity”,Majorproblemindevelopedcountries,OverweightandObesity,WHO（2019）World-wild:oneof10healthriskfactorsDevelopedcountries:oneof5healthriskfactors,US:increase4timesrecentlyfortyyears（Ogdenetal，2019）,USA:Theprevalenceofobesityishighandrisinghigher,Fig.TheprevalenceofchildhoodobesityinChina,1985-2000.,Fig.TheprevalenceofchildhoodoverweightandobesityinChina,2000,General,Higherinnorthernthaninsouthern.北方南方Higherinurbanthan城市农村Rural,notveryhigh,buttheincreasingrateisrapidNogenderdifferenceinpre-school.Higherinboysthangirlsinschool-ageAge-special:1yrhavelightpeak,afterthatreducewithageincrease,5yrrebound,10-13yrsreachthepeak,Manyadulthoodobesitydevelopfromfromchildhoodobesity.Risk:ObesitychildrendevelopintoadulthoodobesityInfant14%7yrschild41%101380%,China,HigherstuntprevalenceWiththeimprovementofnutrition,thestuntingtendtocatch-upgrowth,andtendtoobeselatepregnancy,fetusabsorbmuchenergyhighBMI-obesityExcessfeedingtoinfantsweightincreasefastadiposeearlyrebound脂肪早期重聚earlymaturationpatternpubertycentralandhighBMIobesity,developingcountryandshiftsociety,Trendinunderweightprevalencefrom1990to2019,byregion,Thetrendanalysisisbasedonasubsetof76countrieswithtrenddata,covering83percentoftheunder-fivepopulationinthedevelopingworld.ForCEE/CIS,thebaselineyearis2019;dataavailabilitywaslimitedfortheperiodaround1990.PrevalencewasestimatedusingNCHS/WHO/CDCreferencepopulation,VFactors（Etiology）Obesity:AComplexDisease,Causesofchildhoodobesity,Gene-Gene:linkageandinteractionGeneEnvironment:cooperationandinteractionEnvironmentDiet:energy,dietstructure,softdrinkSocioeconomicstatusPhysicalexerciseLifestyle(sedentary)Commercialinducement,1.Geneticdeterminants遗传因素,Inthetwinsstudies,theheritabilityoftheBMIwasestimatedtobeveryhigh,about80%.Theresultsofadoptionandfamilystudies,however,agreeonaheritabilityofabout33%.,Geneticpredisposition,obgeneleptin,2.Environmentaldeterminants环境因素,FoodintakeSocioeconomicstatusFamilyfactorsPhysicalactivityBraindamageDrugsEndocrinefactorsPsychologicfactors,(1)NewbornandinfancyHeavybirthweight高出生体重Smokinginpregnancy母孕期吸烟Non-breastfeeding非母乳喂养,Differentage，differentfactors,(2)Pre-schoolageWeightlevelandincrementrateCatch-upgrowthoflow-birth-weight-UshapedistributionParentsobesityLongtimeforwatchingTVandshortsleepingtime,BMIANDBIRTHWEIGHTBritishJournalofCancer(2019)91,519524Istheassociationofbirthweightwithpremenopausalbreastcancerriskmediatedthroughchildhoodgrowth?SilvaIS,StavolaBLD,HardyRJ,etal.,(3)SchoolageandadolescenceParentsobesity父母肥胖Increasingvelocityviolent,especiallyStuntchildren生长迟滞儿童Sedentarylifestyle“以静代动”的生活方式watchingTVplaycomputertransportation(mannerofgoingtoschool)deficiencyphysicalexerciselackofoutdooractivity,Dullinafter-school,lackofphysicalexercisemotivation,interestandinducement“threehyper-”dietandsoftdrinkParentslackofnutritionknowledgeStrongcommercialinducementHaveearlypubertygrowthandbodyfatincreaserapidly,VI.Tendtooccurobesity肥胖的易发时期,Thelatepregnancy孕后期Infancy(especiallybefore9months)婴儿期（尤其生后9个月内）Theearlypuberty青春早期Thelatepuberty青春发育后期,Theinfluenceonchildandadolescenthealth,Effectonpsychologypoorself-imagedisinterestedinexercisemoresedentarypossiblysociallyisolated,EffectonhealthCommonsecondarymedicalproblemsincludehypertension,andkneeandbackproblemsObesityIsAssociatedWithIncreasedMorbidityandMortalityObesityIsLinkedwithCardiovascularDisease,VIII.PreventionofObesity肥胖的防治,Comprehensivestrategiesofintervention,Comprehensivestrategiesofintervention:,Theideaofcontrolweightshouldbehavenfromfetus.从小抓起Thehealtheducationonpreventionobesity预防肥胖的健康教育,Properlydealwiththerelationshipbetweendietaryadjustmentandsuitablyphysicalactivity正确处理饮食调整和适当体育活动的关系Behaviortherapy行为疗法Diettherapy饮食疗法Physicalexercisetherapy运动疗法,10oftheWorstFoodsforChildren,SodapopWholemilkHamburgersAmericancheeseHotdogsFrenchfriesandtatertotsIcecreamPizzaloadedwithcheeseandmeatBologna(一种大腊肠)Chocolatebars,10oftheBestFoodsforChildren,Freshfruitsandvegetables(especiallycarrotsticks,cantaloupe,oranges,watermelon,strawberries)ChickenbreastanddrumstickwithoutskinorbreadingCheerios,Wheaties,orotherwhole-grain,low-sugarcerealsSkimor1%milk,Extra-leangroundbeeforvegetarianburgers(GardenburgersorGreenGiantHarvestBurgers)Low-fathotdogs(YvesVeggieCuisineFat-FreeweinersorLightlifeFat-FreeSmartDogs)Non-faticecreamorfrozenyogurtFat-freecornchipsorpotatochipsSeasonedair-poppedpopcornWhole-wheatcrackersorSmallWorldAnimalCrackers,Summary,Concept:obesityT