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9/25/2014. قلب و عروق. 1. Central obesity By : Dr. H – Aghajani Interventional cardiologist NCDC Director Ministry of Health and Education. Approximately 2/3 billion adult : overweight More than 700 million adult : obese. WHO predict by 2015:.

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9/25/2014

قلب و عروق

1


Central obesity

By :

Dr. H – Aghajani

Interventional cardiologist

NCDC Director

Ministry of Health and Education


Approximately 2 3 billion adult overweight more than 700 million adult obese

Approximately 2/3 billion adult : overweight

More than 700 million adult : obese

WHO predict by 2015:


An estimated 300 million people around the world are obese as defined by a body mass index (BMI) of 30 or more

At least 155 million school-age children worldwide are overweight or obese


Epidemiology

In the world as defined by a body mass index (BMI) of 30 or more:

  • By 2015, an estimated 20 million people will die from cardiovascular disease every year, mainly from heart attacks and strokes (WHO)

  • Despite the decline in the number of deaths in the developed world, CVD is still pre-eminent as a public health issue.

EPIDEMIOLOGY


IHD is responsible for all deaths in 2004 and is as defined by a body mass index (BMI) of 30 or moreestimated to be 14.2% in 2030

In the developing world the prevalence of the risk factors for CVD is increasing


17.5 million people died from as defined by a body mass index (BMI) of 30 or morecardiovascular disease in 2005, representing around 30 % of all global deaths

7.6 million deaths were due to heart attacks and 5.7 million were due to stroke

80% of these deaths occurred in low and middle income countries

In EMRO:

CVD is 31% of all Death causes


Lancet 2007 ; 370:1929 -38 as defined by a body mass index (BMI) of 30 or more


In Iran as defined by a body mass index (BMI) of 30 or more:

Chronic NCDs are 79% of death causes and 85%of diseases burden

CVD is the first cause of death(46%) and IHD is the main causes


Comparison of some risk factors iran and emro region
Comparison of some Risk factors as defined by a body mass index (BMI) of 30 or moreIran and EMRO Region


Food Environment – Influencing Factors as defined by a body mass index (BMI) of 30 or more(Causal Web of influence on the prevalence of obesity – Harris, University of North Carolina)

Macro physical, cultural, economic and social environment

Household/individual/social/

demographic/economic

Dietary

intakes

Energy

expenditures

Obesity

Psychological/behavioural

Clinical

Biological (genetic,

neurochemical, etc)

Emerging

adulthood

Young

adulthood

Older

adulthood

Childhood

Adolescence


Cardiovascular disease risk factors
Cardiovascular disease as defined by a body mass index (BMI) of 30 or moreRiSK FACTORS

  • Sedentary lifestyle

  • Diabetes

  • Hypertension

  • Obesity

  • Stress

  • Hostile personality

  • Cigarette smoking

  • Anabolic steroids

  • Amphetamines

  • Oral contraceptives

  • Diet high in saturated fats

  • Heredity


Cvd relative risk factors emro
Cvd as defined by a body mass index (BMI) of 30 or more relative RISK FACTORS - EMRO


Excessive as defined by a body mass index (BMI) of 30 or morefood intake

Physicalinactivity

Smoking

Stress

Obesity

Atherosclerosis

Atherosclerosis

Hypertension

Diabetes

Dyslipidaemia

Arterial & venous

thrombosis/

cardiac & cerebral events

Arrhythmia

Chronic heart failure

Life style is a Driver of CVD

Life style intervention

Risk factor modification


Unmet clinical needs to address in the next decade
Unmet clinical needs to address in the next decade as defined by a body mass index (BMI) of 30 or more

HDL-C

TNF IL-6

Insulin

AbdominalObesity

Glu

TG

PAI-1

Major Unmet Clinical Need

Novel Risk Factors

Classical Risk Factors

Metabolic syndrome

 LDL-C

 BP

Smoking

T2DM

CARDIOVASCULAR DISEASE


Properties of key adipokines as defined by a body mass index (BMI) of 30 or more

IAA: intra-abdominal adiposity

Marette 2002


Health threat from abdominal obesity is largely due to intra abdominal adiposity
Health threat from abdominal obesity is largely due to intra-abdominal adiposity

Increased Cardiometabolic Risk

Abdominal

Obesity

Dyslipidemia

Hypertension

Glucose Intolerance

Insulin Resistance

Intra-Abdominal

Adiposity

Adapted from Eckel et al 2005


Why is abdominal obesity harmful
Why is abdominal obesity harmful? intra-abdominal adiposity

Abdominal obesity

is often associated with other CV risk factors

is an independent CV risk factor

Adipocytes are metabolically active endocrine organs, not simply inert fat storage

Wajchenberg 2000


Multiple cardiovascular risk factors drive adverse clinical outcomes
Multiple cardiovascular risk factors drive adverse clinical outcomes

Increased Cardiometabolic Risk

Abdominal

obesity

Dyslipidaemia

Hypertension

Glucose intolerance

Insulin resistance

Metabolic Syndrome


Ann med 1992 feb 24 1 15 8

Direct observations show that abdominal (visceral) obesity is more closely associated to NIDDM than CVD, while an increased WHR without obesity may be more closely linked to CVD than NIDDM.

Ann Med. 1992 Feb;24(1):15-8.


E ur heart j 2007 apr 28 7 850 6 epub

For a 1 cm increase in WC, the relative risk (RR) of a CVD event increased by 2% (95% CI: 1-3%) overall after adjusting for age, cohort year, or treatment.

For a 0.01 U increase in WHR, the RR increased by 5% (95% CI: 4-7%). These results were consistent in men and women.

Eur Heart J. 2007 Apr;28(7):850-6. Epub


Abdominal obesity and increased risk of chd
Abdominal obesity and event increased by 2% (95% CI: 1-3%) overall after adjusting for age, cohort year, or treatment.increased risk of CHD

Waist circumference was independently associated with increased age-adjusted risk of CHD, even after adjusting for BMI and other CV risk factors

3.0

2.44

2.31

p for trend = 0.007

2.5

2.06

2.0

Relative risk

1.5

1.27

1.0

0.5

0.0

<69.8 69.8-<74.2 74.2-<79.2 79.2-<86.3 86.3-<139.7

Quintiles of waist circumference (cm)

Rexrode et al 1998


Abdominal obesity and increased risk of cardiovascular events
Abdominal obesity and increased risk of cardiovascular events

Men

Women

Tertile 1

<95

<87

Waistcirc. (cm):

Tertile 2

95–103

87–98

Tertile 3

>103

>98

The HOPE Study

1.4

1.35

1.29

1.27

1.17

1.2

1.16

1.14

Adjusted relative risk

1

1

1

1

0.8

CVD death

MI

All-cause deaths

Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-C, total-C

Dagenais et al 2005


Unmet clinical need associated with abdominal obesity
Unmet clinical need associated with abdominal obesity events

CV risk factors in a typical patient with abdominal obesity

Patients with abdominal obesity (high waist circumference) often present with one or more additional CV risk factors


Abdominal obesity increases the risk of developing type 2 diabetes
Abdominal obesity increases the risk of developing type 2 diabetes

24

20

16

Relative risk

12

8

4

0

<71

71–75.9

76–81

81.1–86

86.1–91

91.1–96.3

>96.3

Waist circumference (cm)

Carey et al 1997


High waist circumference is associated with multiple cardio vascular risk factors
High waist circumference is associated with multiple cardio vascular risk factors

US population age >20 years

30

20

Prevalence of high waistcircumferenceassociated with (%)

10

0

LowHDL-Ca

HighTGb

HighFPGc

HighBPd

>2 riskfactorse

a<40 mg/dL (men) or <50 mg/dL (women); b>150 mg/dL; c>110 mg/dL; d>130/85 mmHg; eNCEP/ATP III metabolic syndrome

NHANES 1999–2000 cohort; data on file


Prevalence pattern of obesity in iran 2007
Prevalence pattern of obesity in iran-2007 vascular risk factors

Female

Male



% vascular risk factors




Relationship between waist circumference bp 140 90 mmhg fbs 126 mg dl iran 2007
Relationship between Waist circumference & Bp≥140/90 vascular risk factorsmmHg&FBS ≥126 mg/dl, Iran-2007

RR


Obesity and cancer
Obesity and Cancer vascular risk factors

Obesity is associated with the following types of cancer:

colon

breast (postmenopausal)

endometrium (the lining of the uterus)

kidney

gallbladder

pancreas

esophagus

National Cancer Institute


In 2002, an estimated 41,000 new cases of cancer in the United States were due to obesity. About 3.2 percent of all new cancers are linked to obesity (1).

14% of deaths from cancer in men & 20% of deaths in women were due to overweight and obesity(2).

Obesity and Cancer

1. Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421.

2. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of Medicine 2003; 348(17):1625–1638.


Obesity and cancer1

Obesity and physical inactivity may account for 25%-30% of cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

Preventing weight gain can reduce the risk of many cancers. Healthy eating and physical activity early in life can prevent overweight and obesity.

Obesity and Cancer

National Cancer Institute


Intervention
Intervention cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

Sessions address:

  • Parents as role models of eating and exercise behavior

  • Nutrition: Moderating Portion Sizes

  • Fruits and Vegetables

  • Family Meals

  • Physical Activity


Session topics continued
Session Topics (continued) cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

  • The Feeding Relationship

  • Mindful Eating

  • Resisting Media Influences

  • Healthy Body Image and Dealing with Teasing


Early intervention
Early Intervention cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

  • Adult interventions have had poor outcomes

  • Treating childhood overweight is an important strategy for the prevention of adult obesity.


Adolescent intervention
Adolescent Intervention cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

  • Physical Activity Intervention

    • monitored, structured physical activity session one day each week

    • two additional days of physical activity at YMCA

  • Behavioral Intervention

    • intake behavioral specialist

    • bi-weekly, ongoing, structured, same gender groups

    • homework is assigned and goal monitoring t

  • Nutrition Intervention

    • 30 minute twice-monthly meetings with the dietitian


A new approach
A New Approach cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus

Our intervention will incorporate an intensive parental intervention within an established adolescent program (TEENS Program).


بر cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus اساس یک مطالعه در آمریکا که در مردان و زنان چاق 64-35 سال انجام شد، تنها 10% کاهش پایدار BMI در افراد چاق، بسته به سن، جنس، و میزان BMI اولیه، با نتایج زیر همراه بود:

کاهش سال های زندگی توام با فشار خون بالا (2/9-1/2 سال)، دیابت نوع2 (1/7-0/5 سال) ، کلسترول خون بالا (0/8-0/3 سال)

کاهش میزان بروز سکته مغزی 13-1 مورد درهزار و بیماری عروق کرونر 38-12 مورد در هزار در طول زندگی.

افزایش امید به زندگی به میزان 7-2 ماه.

کاهش هزینه مراقبت های بهداشتی 5 بیماری مذکور در طول زندگی به میزان 5300-2200 دلار.



مرگ ومیر منتسب به اضافه وزن و چاقی بر حسب سطح توسعه و جنسیت در سال 2000


Daly 2000
DALY چاقی بر حسب سطح توسعه و جنسیت در سال 2000 منتسب به اضافه وزن و چاقی بر حسب سطح توسعه و جنسیت در سال 2000


Can we change our life style
Can we change our life-style? چاقی بر حسب سطح توسعه و جنسیت در سال 2000

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