9/25/2014
This presentation is the property of its rightful owner.
Sponsored Links
1 / 55

9/25/2014 PowerPoint PPT Presentation


  • 103 Views
  • Uploaded on
  • Presentation posted in: General

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:.

Download Presentation

9/25/2014

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


9 25 2014

9/25/2014

1


9 25 2014

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:


9 25 2014

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:

  • 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


9 25 2014

IHD is responsible for all deaths in 2004 and is estimated to be 14.2% in 2030

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


9 25 2014

17.5 million people died from cardiovascular 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


9 25 2014

Lancet 2007 ; 370:1929 -38


9 25 2014

In Iran:

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 Iran and EMRO Region


9 25 2014

Food Environment Influencing Factors(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 diseaseRiSK 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 relative RISK FACTORS - EMRO


9 25 2014

Excessivefood 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

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


9 25 2014

Properties of key adipokines

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?

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 andincreased 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

95103

8798

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

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

7175.9

7681

81.186

86.191

91.196.3

>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 19992000 cohort; data on file


Prevalence pattern of obesity in iran 2007

Prevalence pattern of obesity in iran-2007

Female

Male


Prevalence pattern of overweight obesity in iran 2007

Prevalence pattern of Overweight & obesity in iran-2007

Male

Female


9 25 2014

%


Waist circumference f 88 m 102 national survey 2007 iran

Waist circumference (f>88,m>102), NATIONAL SURVEY 2007- IRAN


Mean waist circumference in 4 national survey in iran

MEAN Waist circumference IN 4 NATIONAL SURVEY IN IRAN


Relationship between waist circumference bp 140 90 mmhg fbs 126 mg dl iran 2007

Relationship between Waist circumference & Bp140/90 mmHg&FBS 126 mg/dl, Iran-2007

RR


Obesity and cancer

Obesity and Cancer

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


9 25 2014

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):415421.

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):16251638.


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

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)

  • The Feeding Relationship

  • Mindful Eating

  • Resisting Media Influences

  • Healthy Body Image and Dealing with Teasing


Early intervention

Early Intervention

  • Adult interventions have had poor outcomes

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


Adolescent intervention

Adolescent Intervention

  • 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

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


9 25 2014

64-35 10% BMI BMI :

(2/9-1/2 ) 2 (1/7-0/5 ) (0/8-0/3 )

13-1 38-12 .

7-2 .

5 5300-2200 .


9 25 2014


9 25 2014

2000


Daly 2000

DALY 2000


Can we change our life style

Can we change our life-style?

Buy a dog!


  • Login