哈爾濱醫(yī)科大學-兒童少年衛(wèi)生學-兒童少年單純性肥胖課件

ObesityinChildhoodandAdolescence

兒童少年單純性肥胖Bibliography

《兒童少年衛(wèi)生學》（第6版），季成葉主編。人民衛(wèi)生出版社FalknerF.andTannerJ.M.HumanGrowth.PlenumPress.NewYorkandLondonLowreyGH.Growthanddevelopmentofchildren.7thed,Chicago,London:YearBookMedicalPublishers《現(xiàn)代兒童少年衛(wèi)生學》，葉廣俊主編。人民衛(wèi)生出版社《兒童少年生長發(fā)育》唐錫麟人民衛(wèi)生出版社I.General1997,WHOformallyannouncedthatobesityisadisease

obesitywillbecomethebiggestenemytothreatenhumanhealthandlifesatisfactionin21century----IOTF國際肥胖特別工作組InternationalObesityTaskForce

II.DefiningObesity

Obesityisdefinedasanexcessiveaccumulationofbodyfat.increasingofbodyfatcellenlargementofbodyfatcellTwotypes:PrimaryobesitySecondaryobesity肥胖，是一種常見的營養(yǎng)代謝疾病，是指由于營養(yǎng)過剩、缺乏運動以及遺傳因素共同作用引起的身體內(nèi)脂肪過度堆積的現(xiàn)象，表現(xiàn)為全身脂肪組織異常性的增加III.Screeningobesity

eyeballtestweight-for-heightbodymassindexbodyfatcontentwaist/hipratio

……weight-for-height身高標準體重Under60%seriousmalnutrition60-80%moderatemalnutrition80-90%mildmalnutrition90-110%Normal110-120%Overweight120-130%mildobesity130-150%moderateobesityabove150%seriousobesityClassificationofbodyweight

WHOandNHLBIclassificationofBMIBMICLASSIFICATIONWHOandNILBICHINA＜18.5Underweight18.5~24.9~24Normalrange25.0~29.224.0~27.9Overweight30.0~34.928.0~Obeseclass135.0~39.9Obeseclass2≥40.0Obeseclass3NHLBI:NationalHeart,Lung,andBloodInstituteAdaptedfromMckdadAH,etal.JAMA.1999;282:1519-1522Waist-to-hipratio(WHR):fatdistributionWAIST-HIPRATIO(WHR)腰臀比

Mostpeoplestoretheirbodyfatintwodistinctways:aroundtheirmiddle(appleshape)aroundtheirhips(pearshape).Women—≤0.8Man—≤0.95BMI----WHRWaistcircumference:腰圍

bestindicatorofvisceralfatFemale>80cm=increaseriskMale>90cm=increaseriskcm皮褶厚度（skinfoldthickness）：測量右側肱三頭肌肌腹部和右肩胛下角部上臂肱三頭肌部－－代表四肢肩胛下角－－代表軀干上述二部位之和－－代表全身皮下指標體脂比（bodyfatratio）:

輕度肥胖中度肥胖高度肥胖男性≥20％ ≥25％ ≥30％女性≥20％ ≥25％ ≥30％－－以上兩種方法推算的體脂比和判定的肥胖程度易受身高和肌肉發(fā)達程度影響CT斷層法：皮下脂肪面積/內(nèi)臟脂肪面積

＞0.4：內(nèi)臟型肥胖＜0.4：皮下脂肪型肥胖超聲波法：

腹膜前脂肪的最大厚度/腹壁皮下脂肪的最小厚度 MALE:＞1.0——內(nèi)臟型肥胖FEMALE:＞0.7——內(nèi)臟型肥胖IV.Epidemiology“theglobalobesityepidemic”“globesity”USA:TheprevalenceofobesityishighandrisinghigherFig.TheprevalenceofchildhoodobesityinChina,1985-2000.Fig.TheprevalenceofchildhoodoverweightandobesityinChina,2000Manyadulthoodobesitydevelopfromfromchildhoodobesity.Risk:ObesitychildrendevelopintoadulthoodobesityInfant14%7yrschild41%10～1380%ChinaHigherstuntprevalenceWiththeimprovementofnutrition,thestuntingtendtocatch-upgrowth,andtendtoobeselatepregnancy,fetusabsorbmuchenergy—highBMI----obesityExcessfeedingtoinfants—weightincreasefast—adiposeearlyrebound脂肪早期重聚

—earlymaturationpatternpuberty—centralandhighBMIobesitydevelopingcountryandshiftsocietyCausesofchildhoodobesityGene---Gene:linkageandinteractionGene—Environment:cooperationandinteractionEnvironment

Diet:energy,dietstructure,softdrinkSocioeconomicstatus

PhysicalexerciseLifestyle(sedentary)Commercialinducement

1.Geneticdeterminants遺傳因素Inthetwinsstudies,theheritabilityoftheBMIwasestimatedtobeveryhigh,about80%.Theresultsofadoptionandfamilystudies,however,agreeonaheritabilityofabout33%.Geneticpredispositionobgeneleptin2.Environmentaldeterminants環(huán)境因素①Foodintake②Socioeconomicstatus③Familyfactors④Physicalactivity⑤Braindamage⑥Drugs⑦Endocrinefactors⑧Psychologicfactors(1)NewbornandinfancyHeavybirthweight高出生體重Smokinginpregnancy母孕期吸煙Non-breastfeeding非母乳喂養(yǎng)Differentage，differentfactors(2)Pre-schoolageWeightlevelandincrementrateCatch-upgrowthoflow-birth-weight---UshapedistributionParentsobesityLongtimeforwatchingTVandshortsleepingtimeBMIANDBIRTHWEIGHT

BritishJournalofCancer(2004)91,519–524

Istheassociationofbirthweightwithpremenopausalbreastcancerriskmediatedthroughchildhoodgrowth?

SilvaIS,StavolaBLD,HardyRJ,

etal.(3)SchoolageandadolescenceParentsobesity父母肥胖Increasingvelocityviolent,especiallyStuntchildren生長遲滯兒童Sedentarylifestyle“以靜代動”的生活方式——watchingTVplaycomputertransportation(mannerofgoingtoschool)deficiencyphysicalexerciselackofoutdooractivityDullinafter-school,lackofphysicalexercisemotivation,interestandinducement“threehyper-”dietandsoftdrinkParentslackofnutritionknowledgeStrongcommercialinducementHaveearlypubertygrowthandbodyfatincreaserapidlyVI.Tendtooccurobesity

肥胖的易發(fā)時期

Thelatepregnancy孕后期Infancy(especiallybefore9months)嬰兒期（尤其生后9個月內(nèi)）Theearlypuberty青春早期Thelatepuberty青春發(fā)育后期Theinfluenceon

childandadolescenthealth

Effectonpsychologypoorself-imagedisinterestedinexercisemoresedentarypossiblysociallyisolatedEffectonhealthCommonsecondarymedicalproblemsincludehypertension,andkneeandbackproblemsObesityIsAssociatedWithIncreasedMorbidityandMortalityObesityIsLinkedwithCardiovascularDiseaseVIII.PreventionofObesity

肥胖的防治ComprehensivestrategiesofinterventionComprehensivestrategiesofintervention:Theideaofcontrolweightshouldbehavenfromfetus.從小抓起Thehealtheducationonpreventionobesity預防肥胖的健康教育Properlydealwiththerelationshipbetweendietaryadjustmentandsuitablyphysicalactivity正確處理飲食調整和適當體育活動的關系Behaviortherapy行為療法Diettherapy飲食療法Physicalexercisetherapy運動療法10oftheWorstFoodsforChildrenSodapopWholemilkHamburgersAmericancheeseHotdogsFrenchfriesandtatertotsIcecreamPizzaloadedwithcheeseandmeatBologna(一種大臘腸)Chocolatebars10oftheBestFoodsforChildrenFreshfruitsandvegetables(especiallycarrotsticks,cantaloupe,oranges,watermelon,strawberries)ChickenbreastanddrumstickwithoutskinorbreadingCheerios,Wheaties,orotherwhole-grain,low-sugarcerealsSkimor1%milkExtra-leangroundbeeforvegetarianburgers(GardenburgersorGreenGiantHarvestBurgers)Low-fathotdogs(YvesVeggieCuisineFat-FreeweinersorLightlifeFat-FreeSmartDogs)Non-faticecreamorfrozenyogurtFat-freecornchipsorpotatochipsSeasonedair-poppedpopcornWhole-wheatcrackersorSmallWorldAnimalCrackersSummaryConcept:obesityThetrendofobesityprevalencerateThefouragestagesinwhichthechildrentendtooccurobesityGivethr