慢性病的環(huán)境因素分析

慢性病的環(huán)境因素分析第一頁(yè)，共五十五頁(yè)，2022年，8月28日WhatWeWillCoverEnvironmentalfactorsarekeydriversofmanycommonchronicdiseasesEnvironmentalfactorsalterkeybiologicalpathwaysleadingtochronicdiseaseImportantenvironmentaldeterminantsofhealthinclude:Foodsystem/nutritionanddietToxicchemicalsBuiltenvironment/physicalactivityPsychological&socioeconomicstressExamplesofcrosscuttingsolutionsforhealthypeople&ahealthyenvironment第二頁(yè)，共五十五頁(yè)，2022年，8月28日Scope&ContextoftheProblemAcenturyofchangeinnatural,builtandsocialenvironmentshascaused

majorchangesinthepatternsanddistributionofdiseases.Weareseeingdramaticincreasesinchronicdiseases,andatyoungerages,manyofwhich,suchasdiabetes,arethemselvesriskfactorsfordementia.Theover-65populationwillnearlydoubleby2030tomorethan71million,sharplyincreasingthenumberofpeopleatriskofchronicdiseasesofaginglikeAlzheimer’sandParkinson’sdiseases,amongothers.Environmentalfactorsplayakeyroleinhealthacrossthelifespan.Thustheyofferamajorpreventionopportunity.第三頁(yè)，共五十五頁(yè)，2022年，8月28日TheChangingEnvironmentand

DiseasePatternsDuringthepastcentury,humanactivityhasalteredvirtuallyallaspectsoftheworld’secosystems:Pervasivespreadofsyntheticchemicals;airandwaterpollution.Industrializedfoodsupply.Destructionofcriticalnaturalhabitats,stressingecosystems.Climatechange.Howwelive,eat,work,playandsocializehavesubstantiallychanged:Builtenvironmentshaveincreasedsocialisolationformanypeople;reducedphysicalactivity.Growingincomegapincreasesdiseaserisk.Diseasesofcivilization-obesity,diabetes,cardiovasculardisease,hypertension.第四頁(yè)，共五十五頁(yè)，2022年，8月28日EnvironmentDrivesChronicDiseaseWesternDiseaseClusterDiabetesObesityAbnormalLipidsMetabolicSyndromeCardiovascularDiseaseFoodsystem/DietFossilFuelsSocioeconomicStressChemicalsBuiltEnvironment/TransportationInflammationDisruptedInsulinSignalingOxidativeStress

Alzheimer’sParkinson’sAlteredPathwaysEnvironmentalFactorsChronicDisease第五頁(yè)，共五十五頁(yè)，2022年，8月28日ProfoundPublicHealthImpact

OfEnvironmentally-DrivenWesternDiseaseClusterObesity/overweight–2/3USadults,prevalencex2in~25yrsPre/Diabetes–40%USadults,prevalenceDM~x2over20yrs

Cardiovasculardisease–stillleadingcauseofdeath.Hypertensionincreasing./nchs/FASTATS/lcod.htm,Hajjar03Metabolicsyndrome=earlysignsofotherclusterdiseases;35%adults,~55%>60yrsFordES05Alzheimer’sdisease–?>84yrsold,5.3MAlzheimer’sAssoc.第六頁(yè)，共五十五頁(yè)，2022年，8月28日Alzheimer’sDisease/dementiaNotaninevitablefeatureofnormalaging.Progressiveimpairmentofmemoryandmultipleothercognitivefunctions,severeenoughtointerferewithdailyfunctioning.Expectedtotriplebymid-centurytoover13million.Likelycausedbyvarying combinationsofgeneticand environmentalfactors.

AnnualcostsinUSover$150billion.第七頁(yè)，共五十五頁(yè)，2022年，8月28日Parkinson’sDiseaseProgressivemovementdisorderthatincludestremors,stiffness,andslowmovement.Mayleadtoseveredisability.Likelycausedbyvariablecombinationsofgeneticandenvironmentalfactors.About50,000newcasesannuallyinUS.*PrevalenceinUSexpectedtodoubleby2030.**

DuetothelackofregistriesandbaselinedataonParkinson’sDisease,thefiguresusedhereareestimates.

第八頁(yè)，共五十五頁(yè)，2022年，8月28日Alzheimer’sandParkinson’sDiseasesCharacterizedby:

abnormalproteindepositschronicinflammationabnormaloxidativestressManyneuroscientistsarebeginningtothinkofsomeneurodegenerativediseasesalongacontinuum,withoutclearlydistinctboundariesinclinicalorpathologicalmanifestations

第九頁(yè)，共五十五頁(yè)，2022年，8月28日ContinuumofAge-AssociatedCognitiveImpairment第十頁(yè)，共五十五頁(yè)，2022年，8月28日EnvironmentDrivesChronicDiseaseEarlylifeexperiencescaninfluencelater-lifehealthanddisease.Multiplefactorsinteracttoinfluencehealth&disease.

Environmentalfactorscanalternaturalpathwayswhich

inturncanleadtochronicdisease.

Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily,community,societyandecosystem.

BasicPrinciples第十一頁(yè)，共五十五頁(yè)，2022年，8月28日ToxicexposuresoxidativestressObesity,hypertension,Cardiovasculardisease,diabetesAlzheimer’s,dementia,Parkinson’sLowbirthweightEarlylifeexperiencescaninfluencelater-lifehealth,diseaseAgingbeginsatconception第十二頁(yè)，共五十五頁(yè)，2022年，8月28日MultipleFactorsInteracttoInfluenceHealth&Diseasebuilt

environmentdiseasestressenergychemicalsnutrients第十三頁(yè)，共五十五頁(yè)，2022年，8月28日Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily,community,society,andecosystem.第十四頁(yè)，共五十五頁(yè)，2022年，8月28日AlteredPathwaysEnvironmentDrivesChronicDiseaseEnvironmentalFactorsInflammationDisruptedInsulinSignalingOxidativeStressChronicDiseaseMechanismsofAction第十五頁(yè)，共五十五頁(yè)，2022年，8月28日Definedbymicroscopic

characteristics&laboratorytest:inflammatorycells&mediatorsCLASSICALCONCEPT

OFINFLAMMATIONDefinedbyappearance.“Calor,dolor,rubor,tumor.”Heat,pain,redness,swelling.TheNewConceptofInflammation“Atherosclerosisisaninflammatorydisease.”(2)Ross,Russell.Atherosclerosis–AnInflammatoryDisease.NEJM1999,340(2);115-126.第十六頁(yè)，共五十五頁(yè)，2022年，8月28日第十七頁(yè)，共五十五頁(yè)，2022年，8月28日InsulinSignaling=

NormalMetabolismInsulinsignaling↓

bloodsugar↓

arterydisease↓

triglycerides第十八頁(yè)，共五十五頁(yè)，2022年，8月28日Insulinsignaling↑bloodsugar

↑

arterydisease

↑

triglyceridesInflammationOxidativestressDisruptedInsulinSignaling=

InflammatoryMetabolism第十九頁(yè)，共五十五頁(yè)，2022年，8月28日AlteredPathwaysEnvironmentDrivesChronicDiseaseEnvironmentalFactorsChronicDiseaseFoodSystem/Diet第二十頁(yè)，共五十五頁(yè)，2022年，8月28日

NovelNutrientsArePervasive,PromoteInflammatoryMetabolism第二十一頁(yè)，共五十五頁(yè)，2022年，8月28日What’s“Novel”intheWesternDiet?“Hypotheticalschemeoffat,fattyacid(ω6,ω3,transandtotal)intake(aspercentageofcaloriesfromfat)andintakeofvitaminsEandC(mg/d).Datawereextrapolatedfromcross-sectionalanalysesofcontemporaryhunter-gathererpopulationsandfromlongitudinalobservationsandtheirputativechangesduringthepreceding100years[75].”FromAPSimopoulos,Theimportanceoftheratioofomega-6/omega-3essentialfattyacids.Biomedicine&Pharmacotherapy56(2002)365-379.Years%ofcaloriesfromfatmg/day第二十二頁(yè)，共五十五頁(yè)，2022年，8月28日HighGlycemicCarbohydratesIncreasetheRiskofChronicDiseaseHighglycemiccarbohydratesbreakdownquicklyduringdigestion,rapidlyreleasingglucose(sugar)intothebloodstream.ΔPlasmaInsulin,mg/dlTime,minsINSULINEMICRESPONSELowglycemicfoodHighglycemicfood第二十三頁(yè)，共五十五頁(yè)，2022年，8月28日第二十四頁(yè)，共五十五頁(yè)，2022年，8月28日PropertiesofFattyAcids

Omega-3

Omega-6

SaturatedFood

Perishable Durable IncreasedinSystem

Shortshelflife Processedfoodsfactoryfarmed

Increasedin Longshelflifeanimals pasture-fed animals

Immune

Anti-inflammatory

Inflammatory&

InflammatoryProperties

Anti-inflammatory

Evolutionary

Recentmarked

Recentmarked

RecentmarkedContext

decline

increase

increase第二十五頁(yè)，共五十五頁(yè)，2022年，8月28日↓Omega-3,(↑Omega-6)

Insulinsignaling↑bloodsugar

↑

arterydisease

↑

triglyceridesInflammationOxidativestressNovelNutrientsDisruptInsulinSignaling,

DriveInflammatoryMetabolismSaturatedfat↓Antioxidants

HighGlycemicCarbohydratesFructose

第二十六頁(yè)，共五十五頁(yè)，2022年，8月28日Increaserisks

saturatedandtransfatshighglycemiccarbohydrateslackoffruits/vegetables/omega3sexcessomega6s?Reducerisks

fruits,vegetablesomega3slowglycemiccarbohydratesMediterraneandietInfluenceofNutrition

onChronicDisease

第二十七頁(yè)，共五十五頁(yè)，2022年，8月28日BenefitsofMediterranean-TypeDiet

onChronicDiseaseRiskClinicalinterventionstudies70%↓heartattacks,cardiacdeath&totalmortalityDeLogeril9460%

↓cardiaceventsinCVDpatients*Ornish98~50%↓metabolicsyndromeEsposito0439%↓inCRPEsposito04↓insulinresistanceEsposito04↓weightEsposito04Prospectiveobservationstudies80%↓diabetesMartinez-Gonzalez08~31%↓all-cause&cardiovascularmortality,22%↓cancermortality**calculatedfromSofi08

73%Alzheimer’smortality

Scarmeas0725-30%↓Parkinson’sdiseaseGao0778%↓childhoodasthmamaternaldietChatzi08*10%lowfat,vegetariandiet+exercise,stressreduction**Forevery2pointincreaseinadherence(ona9pointscale),riskreductionswereobservedof0.91forallcausemortality,0.91forCVmortality,0.94foroccurrenceandmortalityfromneoplasm.Toconveytheimplicationsofthesefindings,wehaveappliedtheriskreductionsacrossa9pointadherencescaletoyieldacalculated~31%↓all-cause&CVmortalityanda22%↓incancermortality.第二十八頁(yè)，共五十五頁(yè)，2022年，8月28日Benefitsof

Sustainably-ProducedFoodNutritionalbenefits:Generallyhigherlevelsofvitamins,mineralsandphytochemicals(oftendependentonsoilquality)

HigherOmega-3contentOrganicsamplescontainedhigherconcentrationsofpolyphenolsandantioxidantsin75%ofthematchedpairsrepresentingthosenutrients

Benefitsforfarmworkersandcommunities:Reducedexposuretopesticides

第二十九頁(yè)，共五十五頁(yè)，2022年，8月28日AlteredPathwaysEnvironmentDrivesChronicDiseaseEnvironmentalFactorsChronicDiseaseToxicChemicalsAirpollution,Leadandotherheavymetals,somePesticides,BisphenolAandotherEndocrineDisruptors第三十頁(yè)，共五十五頁(yè)，2022年，8月28日第三十一頁(yè)，共五十五頁(yè)，2022年，8月28日LeadCumulativeoccupationalexposure↑c(diǎn)ognitiveimpairmentShih20072xriskParkinson’sCoon2006Cumulativecommunityexposure

↑c(diǎn)ognitiveimpairmentShih2006Upto15yearscognitiveagingWeisskopf2004AnimalstudiesofearlylifeexposureLate-lifeAlzheimer’smarkersBasha2005,Lahiri2007

第三十二頁(yè)，共五十五頁(yè)，2022年，8月28日PesticidesParkinson’sDiseaseHumanstudies-24/31studiesshow↑risksforPD.(OR1.6-7)Brown2006Animals-Rotenone¶quatdamagedopaminergicneuronsinstriatalregionofbrainUverskyVN2004-Combinationsofmanebandparaquat;prenatalexposure“primes”thebrain,increasingadultsusceptibilityCory-Slechta2005Cognitivedecline/dementiaLowlevelfungicidesinvineyards3.5xpoorattention,memoryBaldi2001

Occupationalexposureinmenassociatedwith2xriskofdevelopingADBaldi2003InsulinResistance,metabolicsyndrome

Lee2006,2007,2007Somepersistentpesticidesshowstrongdose-responserelationtoinsulinresistance andmetabolicsyndrome.

第三十三頁(yè)，共五十五頁(yè)，2022年，8月28日Foundinpolycarbonateplastic,resins,sealants.Exposuresarenearlyubiquitous.Endocrinedisruptor,oxidativestress.Causesfataccumulation&insulin

resistanceatlowlevels(animals).Alanso-Magdelena2006,Wada20073-fold↑Cardiovasculardisease.Lang20082-fold↑InsulinResistance.Lang2008

BisphenolA

polycarbonate第三十四頁(yè)，共五十五頁(yè)，2022年，8月28日Insulinsignaling↑bloodsugar

↑

arterydisease

↑

triglyceridesInflammationOxidativestressEnvironmentalFactorsDisruptInsulinSignaling,

DriveInflammatoryMetabolismEndocrine

Disruptors-BPA,dioxins,PCBs,somepesticidesSaturatedfatHighGlycemicCarbohydratesAirPollution↓Antioxidants

↓Omega-3

Fructose

SomePesticidesLead,otherheavymetals第三十五頁(yè)，共五十五頁(yè)，2022年，8月28日AlteredPathwaysEnvironmentDrivesChronicDiseaseEnvironmentalFactorsChronicDiseaseBuiltEnvironmentPhysicalActivity第三十六頁(yè)，共五十五頁(yè)，2022年，8月28日HealthBenefitsofPhysicalActivityReducedongoinglevelsofoxidativestressandinflammatoryburden.

Brooks2008,Attipoe2008InverselyassociatedwiththerisksofAlzheimer’s/dementiaandcognitivedecline.Rovio2005SubjectsatriskforADwhowalked150min.perweekshowedimprovementsincognitionwhilethecontrolgroupshowednonetchangefrombaselineat1.5yrs.Lautenschlager2008Increasingphysicalactivityatanyageimprovesphysicalandemotionalwellbeing.第三十七頁(yè)，共五十五頁(yè)，2022年，8月28日WalkableCitiesProjectsCommunityGardensFarmer’sMarketsRailstoTrailsLivableCommunitiesEnhanceHealthyAging第三十八頁(yè)，共五十五頁(yè)，2022年，8月28日Cuba-lostfossilfuels↑biking,walking,localplant-basedfood↑physicalactivity

50%↓obesity50%↓mortality:DM51%,CVD35%,stroke20%,allcause18%FrancoMetal.ImpactofEnergyIntake,PhysicalActivity,andPopulation-wideWeightLossonCardiovascularDiseaseandDiabetesMortalityinCuba,1980-2005.AJE166,12;Sept.19,2007SustainableFood&TransportationSolutions:

TheCubaExample第三十九頁(yè)，共五十五頁(yè)，2022年，8月28日GreenSpace

ReducesStress,Mortality,ImprovesCognitiveFunctionShortenspostsurgicalrecoverytime,reducesneedforpainmedications.

Ulrich‘84Attentiondeficitsimproveafterawalkinthepark.Effect=methylphenidate.

Taylor’08Accesstogreenspacereducestheeffectofpovertyonmortalityby~50%.Mitchell‘08第四十頁(yè)，共五十五頁(yè)，2022年，8月28日Insulinsignaling↑bloodsugar

↑

arterydisease

↑

triglyceridesInflammationOxidativestressEnvironmentalFactorsDisruptInsulinSignaling,

DriveInflammatoryMetabolismObesityEndocrine

Disruptors-BPA,dioxins,PCBs,somepesticides

InactivitySaturatedfatHighGlycemicCarbohydratesAirPollution↓Antioxidants

↓Omega-3

Fructose

Lead,otherheavymetalsSomePesticides第四十一頁(yè)，共五十五頁(yè)，2022年，8月28日AlteredPathwaysEnvironmentDrivesChronicDiseaseEnvironmentalFactorsChronicDiseaseSocio-Economic

StressDepression,poverty,violence,inadequatehealthcare第四十二頁(yè)，共五十五頁(yè)，2022年，8月28日Socioeconomic,PsychosocialStressorsStress,depressionriskfor CVD,AD

Sesso,Kario,OwnbyPeoplewithlowerSEstatusareatriskforexposuretomultipleenvironmentalhazards↑damage.Lead+stress

↑c(diǎn)ognitiveimpairment

Glass2009Lead+airpollution↑CVautonomicdysfunctionPark2008第四十三頁(yè)，共五十五頁(yè)，2022年，8月28日

Peoplewholiveinneighborhoodsthatlacksocialcohesion,sidewalks,orsafetylimittheirexerciseandhaveanincreasedriskofdepressionandpossiblyobesity.

BerkeEM07,MolnarBE04EffectsoftheBuiltEnvironmentonHealth第四十四頁(yè)，共五十五頁(yè)，2022年，8月28日Insulinsignaling↑bloodsugar

↑

arterydisease

↑

triglyceridesInflammationOxidativestressEnvironmentalFactorsDisruptInsulinSignaling,

DriveInflammatoryMetabolismObesityEndocrine

Disruptors-BPA,dioxins,PCBs,somepesticides

InactivitySaturatedfatHighGlycemicCarbohydratesAirPollution↓Antioxidants

↓Omega-3

Fructose

Lead,otherheavymetalsSomePesticidesStress第四十五頁(yè)，共五十五頁(yè)，2022年，8月28日MultipleFactorsInteracttoInfluence

Health

&

Disease第四十六頁(yè)，共五十五頁(yè)，2022年，8月28日EnvironmentalFactorsChronicDisease

AlteredBiologicalPathways↑GreenhouseGasesClimateCrisis

Heat,drought,storms,fires,icesheetinstability,sealevelrise,lossofglacialirrigation,refugees,foodinsecurity/starvation,tropicaldiseases

EnvironmentalFactorsDriveChronicDiseaseandtheClimateCrisis

第四十七頁(yè)，共五十五頁(yè)，2022年，8月28日Solutions

for

HealthyPeople&AHealthyPlanet第四十八頁(yè)，共五十五頁(yè)，2022年，8月28日MajorIllnessesArePreventable

PersonalActionstoProfoundlyReduceRisks

PersonalLevel–“ApproachestoHealthyLiving”Eathealthy–whole,fresh,unprocessed,plantbasedfoodsAvoidtoxicantswheneverpossibleExerciseBesociallyengaged

第四十九頁(yè)，共五十五頁(yè)，2022年，8月28日Localized,diversifiedandsustainablefoodproduction

Clean,renewableenergy

↓

airpollution,chemicalexposuresMasstransitthatconnectswithbikepathsandsidewalks

canreduce

airpollution&obesityChemicalregulatoryreform“Safersubstitute”programsandgreenproductdesign↓toxicexposures,ecosystem,wildlifecontamination;jobcreationUniversalhealthcarediseasepreventi