疾病营养运动

病 体检：浮喂养历 病常见食物维生素B1,B2含量名称名称(瘦病叶酸面粉强USFoodandDrugAdministrationregulationin1996requiringthatallflouranduncookedcereal-grainproductsintheUnitedStatesbefortifiedwithfolicacid(140g/100g)byJanuary1998(8).MandatoryfolicacidfortificationwasalsoimplementedinCanadain1998(9)andinChileasignificantreduction(15–50%)inNTDsintheUnitedasignificant(60%)reductionintheincidenceofneuroblastoma(from1.57casesper10000birthsin1996to0.62casesper10000birthsafter1997,whenfolicacidfortificationoffoodbecamemandatoryinCanadaHowever,itisimpossibletodefini yattributethedecreaseintheincidenceofNTDsintheUnitedStatessolelytofortification(24)becauseNTDratesintheUnitedStates(andworldwide)weredecreasingevenbeforefortificationbegan,possiblyasaresultoffactorssuchasimprovednutritionorprenataldiagnosisandtermination.folicacidfortificationmaymasksymptomsofvitaminB-12primarilyintheelderlypopulation,havebeenchildrenwithacu experiencedanacceleratedprogressionofleukemiasomeEuropeancountrieswasevenlabeledaspublichealthAmJClinNutr结肠癌患病NationwidefortificationofenricheduncookedcerealgrainswithfolicacidbeganintheUnitedStatesandCanadain1996and1997,respectively,andbecamemandatoryin1998.TherationalewastoreducethenumberofbirthscomplicatedbyneuraltubeConcurrently,theUnitedStatesandCanadaexperiencedabruptreversalsofthedownwardtrendincolorectalcancer(CRC)incidencethatthetwocountrieshadenjoyedintheprecedingdecade:absoluteratesofCRCbegantoincreasein1996(UnitedStates)and1998(Canada),peakedin1998(UnitedStates)and2000(Canada),andhavecontinuedtoexceedthepre-1996/1997trendsby4to6additionalcasesper100,000CancerEpidemiolBiomarkersPrev过Clinicalcourseofepithelialtumorsovertime,fromtheneoplasiastagetometastases.Modi.edfromGoetal.碘缺乏与碘盐强化政严重的缺碘可引起成人的地方性粘液性水肿和婴儿的地方性呆严重的母亲缺碘 的生长和脑发育。地方性呆小病根据缺和遗传的相互作用可见两种形式中之一（神经性或粘液水肿性鉴别甲状腺激素合成中几种代谢 能引起成人和婴儿的甲状腺功能退地方性缺碘仍然是甲状腺功能减退的主要原因当碘化物摄入量大于每日需要量的20倍即每日2mg时即可发生慢。在某些地区，尤其在 居民每摄入量多达5080，引高有人生甲肿多状腺功能仍正常。有些人发生粘液性水肿而另一些人则反常地发生甲状腺功能亢进（odBado现象甲状腺对碘 增可导致制效最起状肿或粘液性水肿。极高剂量的碘化物色的 ，疮损害碘强化营养需要量

M 碘盐与甲 600 率：from1993to2011,theincidenceofthyroidcancerincreasedabout15-fold,fromlessthan5per100,000populationtoalmost70per100,000;thyroidcancermortalitywasnearlyaflatline—justabove0per100,000—androsevery

NEnglJMed2014;371:1765-单纯性营养素缺 认知性营养素缺维生素缺乏病的原：大米反复淘洗与脚气环境因素：日照与佝偻 营养缺乏病 和治缺B1缺B2缺pp缺C缺A缺D缺碘缺铁缺钙－

食物摄入骨质疏松造成骨小樑结构损Bonesinwhichtrabecularbonepredominatesareparticularlyvulnerabletoosteoporoticfracture.Becauseofthebones'largesurfaceareasrelativetotheirvolume,thinnedtrabeculaeareparticularlysubjecttoresorption.Shownisascanningelectronmicrographoftrabecularbonefromahealthywoman(topleft)andawomanwithosteoporosis(topright).The ethinnerinosteoporosis,andeventuallyarelost,reducingbonestrength.Inadvancedosteoporosis,trabeculaemaybe yresorbedsothatthecontinuityofthetrabecularlatticeislost(bottom).Lossofstrutsofthelatticedramaticallyreducesbone若700／770／797膳食／身体缺膳食1天／周／月／年缺，可造成身体每日500mg钙补充剂以上，急性心血管事件增加30%（RCT荟萃）——BMJ11年队列）——Heart2012;98:920- 加20%（39万人12年队列）——JAMAInternMed 补钙5年）——JBoneMinRes;25,2010,2777–2785 onlinefirst饮食中的钙不增加肾的风险，还具有保护作用；钙补充剂在一定条件下可能具有促进肾形成的作用，肾病VitaminDandCalcium》2011营养与慢Whenrequirementsareestimatedtodecreaseriskofdisease,particularlychronicdisease,associationsmaynotbeeasilyidentifiedinshort-termstudies.Further,theAIsdevelopedinthisreportmaybeattheupperrangeofintakestypicallyfoundinnationwidesurveysifthecriterionor echoseninvolveschronicdisease.Theimplicationwouldbethatitmightbedesirabletoachieveanincreaseinthemeanintakeofthepopulationinordertolowerrisk.However,theFNB：DietaryReferenceIntakes:ApplicationsinDietaryAssessment，ISBN:0-309-50254-3,tativeFNB：DietaryReferenceIntakes:ApplicationsinDietaryAssessment，ISBN:0-309-50254-3,1988-2000年的队列人群 体重正常成人在11年内成为缺少运动和食物过量可以使肥胖悄然而至

的人年增加体重公斤千卡男）和61千卡（女）11年来维持正常体重的人年增加体重.（男和30千卡（女）40年=50千克体少吃一两口，多动15多吃？少动与实际观察到的重变化，区分膳AmJClinNutr调定点稳态理论的质加或减少导致致加或减少导致致世 B：口腔、咽、喉、食道、 B：口腔、咽、喉、食道、

WhyDietaryCholesterolIsNoEnemyNumberThecholesterolmoleculeisuniquetotheanimalkingdom.Inhumans,cholesterolisprimarilyendogenousinorigin—thatis,manufacturedbyourbodies.Thereisalsoexogenouscholesterol,whichcomesfromfattyfoodsofanimalorigin.Thesecondconceptisthatofintestinalcholesterol,thecholesterolthatpassesintotheintestine.Someofitisreabsorbedandsomeiseliminatedinthefeces.Inintestinalcholesterol,adistinctionshouldthereforebemadebetweenthecholesterolmanufacturedinthebodyandexcretedinbile,anddietarycholesterol,whichcomesfromthefoodweeat.Thethirdconceptisthatofthelipoproteinsthattransportcholesterol.Wesimplisticallytalkaboutbadcholesterol,orlow-densitylipoprotein(LDL)cholesterol,becausetheselipoproteinsareatherogenic,andconverselyaboutgoodcholesterol,orhigh-densitylipoprotein(HDL)cholesterol,becausetheselipoproteinsprotectagainstatherosclerosis.Mostofthedebatesovercholesterolarisefromtheconfusionbetweenthesedifferentconcepts. Medscape.Mar19,2015胆固醇代谢的平

胆固醇

胆固醇调节

Whatistheimpactofdietarycholesteroloncardiovascular(CV)risk?First,byexaminingtheeffectofahigh-cholesteroldietonthelevelofoneofthemainCVriskfactors:LDLcholesterol.TheimpactofdietarycholesterolonLDLlevelsisvariable.Itdependsonboththeindividualandhisorherunderlyingdiet.Whileitmayhaveanimpact,weknowthatthemostimportantthingforreducingplasmaLDLlevelsistoreducesaturatedfatintakeinfavorofunsaturatedfats.Inthiscontext,reducingdietarycholesterolisnotuseless,butneitherisitthemostimportantthing.Andsecond,byexaminingtherelationshipbetweentheconsumptionofthefoodwiththehighestcholesterolcontent,eggs,andtheriskforcoronaryeventsorstroke.Forthis,weonlyhaveobservationalstudies,butoverall,eggsdonotpromotetheoccurrenceofCVdisease.Becareful,though,becauseaccordingtosomeofthemeta- ysesoftheseobservationalstudies,dietarycholesterolcouldhaveaharmfuleffect,specificallyinpeoplewithtype2diabetes,althoughthereasonforthisisnotreallyknown.Moreover,twostudiespublishedinlate2014concerningintestinalOnewasageneticstudythatfoundthattheCVriskwashigherinpeoplewhoabsorbedintestinalcholesterolespeciallywellbecauseofaspecificformoftheintestinalcholesteroltransporter.[2]TheotherwastheIMPROVE-ITstudy,whichshowedthattheriskforCVeventswasreducedbyinhibitingcholesterolabsorptionintheintestinewithezetimibe(Zetia®).[3]Itisimportanttounderstandthatthesetwostudiesmainlyconcernedtheabsorptionofendogenouscholesterol.Consequently,onecannotdrawanyconclusionsaboutdietarycholesterol,whichaccountsforonlyasmallportionofintestinalcholesterol.Medscape.Mar19,不同膳食脂肪对血胆固醇的影Dietary 100mgSatFats

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+血 –织糖类的营单糖和双糖：fructose,glucose,蔗糖麦芽糖乳糖 寡（聚）糖：链长=3-10，（糊精多（聚）糖：糖原、淀粉、膳食纤糖消化吸收的生物学指GlycemicIndex：葡萄糖吸收的速复合膳食的血糖生成指 平均GIc=GI1W1+GI2W2+GI3W3+GlycemicLoad=GI糖含食物中的糖类糖00营养治疗MedicalNutrition

总热精制糖/血糖指脂供热比蔬菜水低血糖预Medicalnutritiontherapyformsalargepartofthiseducation,andthereareanumberofgoals.Weightlossdoesnothavetobeoverwhelmingtoreducehyperglycemiaorothermacrovascularriskfactors.Areductionofabout5%to10%ofbodyweighthassubstantialmetabolicbenefits.Patientsarenotalwayshappywitha5%weightloss;theirgoalsaresometimesmorecosmeticorsocial.Butmetabolically,eventhatamountofweightlosswillbeveryEvolutionsinInsulinTherapy: sonTreatmentRamachandiranCooppan,MD;PeterN.Weissman,MDReleaseDate:October8, 运动独立于药物的治疗作肌=251例39-70 分四有氧：3天/周，75%最大心率，45分/阻力：3天/周，7套器械锻炼，大负荷8重复×3

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AnnInternMed.运动分类：按生理功能分才能完成的运动。如步行、慢跑、蹬自行车等。关节功能锻炼：通过躯体或肢体的伸展、屈曲和运胰岛素样作LightLight Exercisetime(

有益健康的身体活动每周150分钟中等强度或75身体活动量=强度每次活动时间频研 证明有益健康的最低活动鼓励加倍最低活动鼓励大强Lackofphysicalactivitycausesnearly10%ofallprematuredeathsintheworld,duetocardiovasculardisease,type2diabetes,andbreastandcolonPhysicalinactivityisresponsibleforanestimated5.3millionofthe57milliondeathsoccurredworldwidein2008andiscomparabletotheimpactofwell-knowndiseaseriskfactorssuchassmokingandIncontrast,morethan1.3milliondeathsworldwidecouldbepreventedifmorepeoplegotthe mendeddoseofthispowerfuldrugthatis150minutesaweekof ensityphysical Furthermore,ifwecouldeliminatephysicalthelifeexpectancyoftheworld’spopulationwouldincreaseby0.68Lancet.2012:380:219-Freshevidencethatjustalittlebitofexercise,suchas20minuteswalkingaday,isbeneficial—regardlessofwhetherpeopleareoverweight/obeseornot—hasemergedfromaEuropeanInfact,themostpronouncedreductioninprematur deathriskwasobservedamongindividualswhowerenormalweight/ab minallyleanand"modera yinactive,"comparedwiththoseofthesamebuildwhowerecomple yinactive,whichwasdefinedashavingasedentaryjobwithnoreportedrecreationalphysicalactivity.Lookingatthisanotherway,thestudy—inmorethan330,000menandwomen—showedthatasmanyprematuredeathsmaybeattributabletolackofphysicalactivitycomparedwiththenumber ttributabletoobesity,theresearchers peopletoloseweightcanbearealchallenge,andwhileweshouldcontinuetoaimatreducingpopulationlevelsofobesity,public-healthinterventionsthatencouragepeopletomakesmallbutachievablechangesinphysicalactivitycanhavesignificanthealthbenefitsandmaybeeasiertoachievefCmentedDrNickWareham(MedicalResearchCouncilEpidemiologyUnit,IsEffectofPhysicalActivityIndependentofBMI,WaistIntheirpaper,DrEkelundandcolleaguesnotethatphysicalinactivityhasconsistentlybeenassociatedwithanincreasedriskforall-causemortalityindependentofgeneraladiposityasdefinedbybodymassindex(BMI).Andpriorrerchthathasexaminedassociationsbetweenphysicativity,BMI,andsuggeststhtivityprotectsagainstprematuredeathbutdoesnoiminatetheincreasedassociatedwithhighSotheysetouttoexaminetherelationshipbetweenphysicala