“中华诵·全国学生规范汉字(1)ppt课件

1、Overweight ChildrenPrevalence, Problems, and Solutions (?) David L. Gee, PhDFCSN 547 Nutrition UpdateSummer 2004Assessment of Overweight in Childrenn1997 Expert Panel nThe Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services nPED

2、IATRICS Vol. 102 No. 3 September 1998, p. e29 nRecommends that BMI be routinely used to screen children for overweightnDefined nOverweight as a BMI for age over the 95th percentilenRisk for overweight as a BMI for age between the 85th and 95th percentileIs a childs BMI useful in predicting adult obe

3、sity?Note: in 1999-2000, 26% of 20-39 yo were obese.Prevalence of Overweight Children in the USPrevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-20021999-2004A. Hedley et al.JAMA 2004; 291: 2847-2850C. Ogden et al.JAMA 2006; 295: 1549-1555Prevalence of Overweight

4、and Obesity Among US Children, Adolescents, and Adults, 1999-2002(2003-2004)nNHANESn1999-2000nN=4115 adultsnN=4018 childrenn2001-2002nN=4390 adultsnN=4258 childrennAdult prevalencen65.1% overweight or obese (66.3%)n30.4% obese (32.2%)n5.1% extreme obese (BMI40) (4.8%)Prevalence of Overweight and Obe

5、sity Among US Children, Adolescents, and Adults, 1999-20022003-2004nChildren 6-19 yrsn31% at risk for overweight or overweightn6-11: 37.2%12-19: 34.3%n16% overweightnAt risk for overweight or overweight nby agen2-5 = 22.6% (26.2%)n6-11 = 31.2% (37.2%)n12-19 = 30.9% (34.3%)Prevalence of Overweight an

6、d Obesity Among US Children, Adolescents, and Adults, 1999-20022003-2004nAt risk for overweight or overweight nby gendernBoys = 31.8% (34.8%)nGirls = 30.3% (32.4%)nAt risk for overweight or overweightnBy ethnicitynWhite = 28.2% (29.2%b, 27%g)n33.5%, 35.4%b, 31.5%g nBlack = 35.4% (31%b, 40%g)n35.1%,

7、30.4%b, 40.0%gnMexican-American = 39.9% (42.8%b, 36.6%g)n37.0%, 41.4%b, 32.2%gType 2 Diabetes in the YoungThe evolving epidemic(review article)Z. BloomgardenDiabetes Care 2004 (Apr); 27:998-1010Type 2 Diabetes in the YoungThe evolving epidemicPrevalencenNHANES III (1988-1994)n3000 subjects, 12-19 yo

8、nIFG: 17.6 per 1000nHbA1c6%: 3.9 per 1000nDiabetes (all types): 4.1 per 1000nExtrapolate: 600,000 US adolescents with some degree of glycemic abnormalitynHow many with Type 2 diabetes?Type 2 Diabetes in the YoungThe evolving epidemicPrevalencenSinha et al., NEJM 346:802-810, 2002n167 obese adolescen

9、ts and childrenn4% prevalence of Type 2 DMnAll in Hispanic and black adolescentsnIGTn16% obese whiten27% obese blackn26% obese Hispanicn(UK study found risk of Type 2 DM 13.5 times greater in Asian than white children)Prevalence of T2 diabetes has increased significantly (2-3X)among Indian children

10、in the past 30 years.Type 2 Diabetes in the YoungThe evolving epidemicPrevalence Trendsn10 fold increase from 1982-1994 in CincinnatinJ. Ped. 128:608-615, 1996n% of diabetic children w/ T2 increased from 9.4% (1994) to 20% (1998) (Florida)nPub. Health Rep. 117:373-379, 2002n1/3rd of children w/ diab

11、etes have T2 in OH, AR, CA(Hispanics)nDiabetes Care 22:345-354, 1999Type 2 Diabetes in the YoungThe evolving epidemicPrevalencenOther factors:nGendernGirls 1.7 times more likely than boysnDiabetes Care 22:345-354, 1999nFamily Historyn2/3rd of children w/ T2DM with at least one parent with T2DMnDiabe

12、tes Care 23:381-389, 2000Type 2 Diabetes in the YoungThe evolving epidemicPrevalencenOther factors (1998 study from India)n Low birthweightnHigh prepubertal weightType 2 Diabetes in the YoungThe evolving epidemicScreeningnPrevalence of T2DM in young low but growingnPrevalence of overweight growing r

13、apidlynScreening of all children not cost effectiven$10,000 per case found (Japan/Taiwan study)nADA/AAP Consensus PositionnDiabetes Care 2000nTesting 10yr if BMI 85th pct with 1o or 2o relative with DM, at risk ethnic group, or signs of insulin resistance (metabolic syndrome)Obesity and the Metaboli

14、c Syndrome in Children and AdolescentsR. Weiss et al.NEJM 350:2362-74,2004Obesity and the Metabolic Syndrome in Children and AdolescentsnMetabolic SyndromenCluster of metabolic abnormalities associated with insulin resistancenDiagnosis of Metabolic Syndrome in AdultsnThree or more of the following:n

15、Abdominal Obesitynmen 40 waist circumferencenwomen 35 waist circumferencenHypertriglyceridemia (150 mg/dl)nLow HDLnmen 40 mg/dlnwomen 130/85 mmHg)nPre-diabetes ( 110 mg/dl)Obesity and the Metabolic Syndrome in Children and AdolescentsMethodsn439 obese children/adolescentsn31 overweight siblingsn20 n

16、on-obese siblingsn41% white, 31% black, 27% HispanicnAdministered oral GTTnMeasured BP, plasma lipids, C-reactive proteinObesity and the Metabolic Syndrome in Children and AdolescentsCriteria for Metabolic Syndrome in ChildrennObesity (instead of waist circumference)nObese = z-score 2.0 for BMI nMod

17、erate Obese = z-score 2.0-2.5nSevere Obese = z-score 2.5nMetabolic valuesnTG: 95th pctnHDL-C: 5th pctnGlucose intolerance following OGTTnInsulin resistance = fasting gluxfasting plasma insulin/22.5Obesity and the Metabolic Syndrome in Children and AdolescentsAnthropometric & Metabolic Characteristic

18、sNon-obeseOverweightModerate ObeseSevere ObeseBMI18.424.533.440.6Glucose(mg/dl,0.05)87.486.890.590.2InsulinuU/ml,.00110.314.631.338.6Insulin resistance.0012.23.127.058.69TriglyceridesMg/dl, .00148.483.1104.696.5Obesity and the Metabolic Syndrome in Children and AdolescentsAnthropometric & Metabolic

19、CharacteristicsNon-obeseOverweightModerate ObeseSevere ObeseHDL-CMg/dl,.00158.546.741.139.9LDL-CMg/dl, p=.4192.295.598.197.3Systolic BPmmHg,4hrs TV/daynBMI of children who watch 4hrs per day significantly greater than those watching 2hrs per daynTV in childs bedroom significant predictor of overweig

20、htReducing childrens television viewing to prevent obesity: A randomized controlled trial.n192 3rd & 4th grade children in two matched public elementary schoolnIntervention groupn18-lesson, 6-month classroom curriculum to reduce TV, videotape, and videogame usenMeasures at 0 and 8 monthsReducing chi

21、ldrens television viewing to prevent obesity: A randomized controlled trial.nCompared to controls, children in intervention group had statistically significant relative decreases in BMI, TSF, waist circumference, and W/H ratio.Reducing childrens television viewing to prevent obesity: A randomized controlled trial.nThe intervention significantly decrease childrens television viewing and video game use.Reducing childrens television viewing to prevent o