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Herz-Kreislauf-Erkrankungen: Basis der gesunden Ernährung. Univ.-Prof. Dr. Günter Steurer AKH der Stadt Wien - Universitätskliniken. Univ.-Prof. Dr. G. Steurer. INHALT. Herz-Kreislauf-Erkrankungen Prävention: Industrie & EU, wie Herz-Kreislauferkrankungen unser Leben beeinflussen

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herz kreislauf erkrankungen basis der gesunden ern hrung

Herz-Kreislauf-Erkrankungen:Basis der gesunden Ernährung

Univ.-Prof. Dr. Günter Steurer

AKH der Stadt Wien - Universitätskliniken

slide2

Univ.-Prof. Dr. G. Steurer

INHALT

  • Herz-Kreislauf-Erkrankungen
  • Prävention: Industrie & EU,
  • wie Herz-Kreislauferkrankungen unser Leben beeinflussen
  • kardiovaskuläre Risikofaktoren,
  • wie wir mit einem blutdruckfreundlichen Lebensstil gegensteuern können,
  • welche Rolle Sie als Schularzt dabei spielen können.
kardiovaskul re erkrankungen projektierte mortalit t 1990 2020
Kardiovaskuläre ErkrankungenProjektierte Mortalität 1990-2020

Globale Veränderung in %

CHD Schlaganfall

Mann Frau Mann Frau

Entwickelte Staaten + 48 +19 +56 +28

Entwicklungsstaaten +137 +127 +124 +107

Gesamte Welt +100 +80 +106 +78

pr vention prim r vs sekund r industrie eu
Prävention: primär vs. sekundär Industrie & EU
  • Primäre Prävention: Behandlung bei kardiovaskulärer Risikosituation (Sex, Alter, Nikotinabusus, Hypertonie, Hyperlipidämie, metabolisches Syndrom)
  • Sekundäre Prävention: nach Erkrankung
  • Behandlungsstrategien: Lebens-gewohnheiten (EU & Industrie) und Pharmakotherapie (ACE-I, ARB, ß-Blocker, ASS, Statine, Diuretika)
herz kreislauf krankheiten

Univ.-Prof. Dr. G. Steurer

Herz-Kreislauf-Krankheiten

Aorten-

Aneurysma

Herzinfarkt

Schlaganfall

Atherosklerotische

Nephropathie

PAVK: Arterielle

Verschlusskrankheit

Atherosklerotische

Retinopathie

slide9

Univ.-Prof. Dr. G. Steurer

Risikofaktoren

Was macht unser Herz krank?

Übergewicht

Alter

Männlich

Blutdruck

Rauchen

Blutzucker

Blutfette

gef verkalkung atherosklerose
„Gefäßverkalkung“ Atherosklerose

Druck Schäden Ablagerungen

Durchblutung gestört Beine, Augen, Herz- u. Nierenschwäche

Verengt + Blutgerinnsel Herzinfarkt, Schlaganfall

Univ.-Prof. Dr. G. Steurer

10

bluthochdruck nderung von lebensgewohnheit
BluthochdruckÄnderung von Lebensgewohnheit
  • Bluthochdruck:
    • Systolisch ≥140 mmHg, diastolisch ≥ 90 mmHg
  • Bei 68 Prozent der Bevölkerung ist ein erhöhter Blutdruck bekannt, 54% werden behandelt und 27% sind gut eingestellt („kontrolliert“)
  • Die Kosten (€) für die medikamentöse Behandlung des Bluthochdrucks und der Komplikationen sind enorm.
  • Die Vorbeugung der Bluthochdruckerkrankung mit nicht medikamentösen Maßnahmen von größter Bedeutung
bluthochdruck lebensgewohnheiten
BluthochdruckLebensgewohnheiten
  • Hoher Verzehr von Salz
  • Übergewicht und körperliche Inaktivität
  • Alkoholmissbrauch
  • Geringer Verzehr von Kalium, Magnesium, Kalzium & Ballaststoffen
  • Chronischer Stress
salz und blutdruck res mee der studien

Univ.-Prof. Dr. G. Steurer

Salz und Blutdruck Resümee der Studien

Direkter Zusammenhang zwischen Salzaufnahme, Blutdruck & Herz-Kreislauf-Erkrankungen

Plus

3-6 mmHg

Mehr als

5,8 g/Tag

In Österreich

10.200/Jahr

In Österreich

650 Mio €/Jahr

Am J Clin Nutr 1997; NEJM 2010

salz berschuss und herzkrankheiten

Univ.-Prof. Dr. G. Steurer

Salzüberschuss und Herzkrankheiten

Schlaganfall

Plötzlicher Herztod

Herzinfarkt

Aortenaneurysma

Verdickter

Herzmuskel

Herzinsuffizienz

Arteriosklerose

Salz

Risiko-

faktoren

Chronisches

Herzversagen

das wei e gold im berfluss2

Univ.-Prof. Dr. G. Steurer

Das weiße Gold im Überfluss

9 g

> 15 g

5,8 g

Konsum

im Schnitt

Oberer

Bereich

Empfehlung

weniger salz weniger tote

Univ.-Prof. Dr. G. Steurer

Weniger Salz – Weniger Tote

Was 3 g weniger Salz / Tag in 1 Jahr ausmachen

N Engl J Med 2010

schicksal chance

Univ.-Prof. Dr. G. Steurer

Schicksal & Chance
  • SCHICKSAL:Genetische Veranlagung, männliches Geschlecht, Alter
  • CHANCE:Wahl des richtigen Lebensstils = blutdruckfreundlich

Wir können gegensteuern

der blutdruckfreundliche lebensstil

Univ.-Prof. Dr. G. Steurer

Der blutdruckfreundliche Lebensstil
  • Weniger Salz
  • Richtige Ernährung(Kalium!)
  • Das richtige Gewicht
  • Ausreichend Bewegung / Fitness
  • Alkohol in Maßen
  • Rauchen möglichst nicht

... und der blutdruckfreundliche Bäcker

wo das salz herkommt

Univ.-Prof. Dr. G. Steurer

Wo das Salz herkommt

80 % aus verarbeiteten Lebensmitteln

Brot & Gebäck

Fleisch

Käse

Fertigprodukte

Suppen

salz in brot in zahlen

Univ.-Prof. Dr. G. Steurer

Salz in Brot in Zahlen

Heute:

Ziel: 240 g

Risiko Imageverlust

Risiko rote Ampel

zielgruppe kinder jugendliche
Zielgruppe Kinder/Jugendliche

Univ.-Prof. Dr. G. Steurer, Dr. K. Gruber, Mag. A. Mörixbauer

wie man das erreichen k nnte
Wie man das erreichen könnte

Univ.-Prof. Dr. G. Steurer, Dr. K. Gruber, Mag. A. Mörixbauer

slide28

Univ.-Prof. Dr. G. Steurer,

Mag. A. Mörixbauer

„Herzstück Brot“

täglich:

+

+

+

3 Portionen

¼ kg

+ 1 P. Erd., Nud., Reis, Flo.

+

5 Portionen

¼kg

+

+ 1Port. Erd., Nud., Reis, Flo.

+

+

+

+

1 Portion

1,5 Liter

2-3 Esslöffel

impact on cardiovascular disease obesity and hypertension
Impact on CardiovascularDiseaseObesityandhypertension
  • The prevalence of elevated blood pressure increases progressively with increasing BMI
  • Increased visceral adiposity is more significantly associated with hypertension than overall obesity
weight loss interventions a systematic review and meta analysis
Weight Loss InterventionsA systematicreviewand meta-analysis

Weight-Loss Outcomes:

A Systemic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up

  • Design:
    • A search was conducted and 80 studies were identified
    • Weight loss at 6, 12, 24, 36 and 48 months
    • 8 types of weight loss interventions

Journal of the American Dietetic Association, 2007;107:1755-67

weight loss outcomes average weight loss of subjects
Weight-Loss OutcomesAverageweightlossofsubjects

8 types of weight loss interventions:

  • Advice alone
  • Exercise alone: 2,4
  • Diet alone: 4,9 kg
  • Diet & exercise:7,9
  • Meal replace: 8,6
  • Orlistat: 8,3
  • Sibutramine: 8,2
  • Very-low-energy diet: 17,9
weight loss interventions walking interventions and weight loss
Weight Loss InterventionsWalking interventionsandweightloss

A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss

  • Purpose:
    • To show that individuals who walk more tend to be thinner than those who walk less
  • Methods
    • Meta-analysis of studies with a pedometer-based walking intervention lasting at least 4 weeks
  • Results of 9 studies:
    • Cohort sample of 307 participants, 73% women and 27% men
    • Duration of the intervention of 4 weeks to 1 year
    • Weight change of -1.27 kg (-1.85—0.70 kg)
    • Longer intervention duration was associated with a greater weight change
    • On average 0.05 kg per week during the interventions

Annals of Family Medicine, 2008;6:69-77

weight loss interventions exercise training and fat mass loss
Weight Loss InterventionsExercisetrainingandfat-massloss

The Effects of Exercise Training on Fat-Mass Loss in Obese Patients During Energy Intake Restriction

  • Dietary restriction combined with endurance exercise training are effective
  • Exercise interventions without dietary restrictions are less effective
  • Addition of exercise interventions within a dietary restriction programme does not induce a greater fat-mass loss than dietary restrictions alone due to a compensatory reduction in daily physical activity following the implementation of exercise training

Sports Med, 2007; 37:31-46.

effects of exercise training on fat mass
EffectsofExercise Training on FatMass
  • Combination of dietary restriction with endurance training
    • Average weight loss after 16 weeks: 11 kg
    • Average weight loss without dietary restriction: 3 kg
  • Exercise intervention seems to prevent the decline in fat-free mass that is generally observed during energy intake restriction
  • Reduction in the visceral fat depots
  • Subjects with the highest baseline fat mass experienced the greatest absolute fat mass reduction
  • Men showed a larger bodyweight loss compared to women
endurance training and energy balance
Endurance Training andEnergy Balance
  • The only way to prevent obesity is to restore the balance between caloric intake and energy expenditure
  • Addition of exercise interventions within a dietary restriction programme does not induce a greater fat-mass loss than dietary restrictions alone due to a compensatory reduction in daily physical activity
  • Energy balance:
    • Food intake
    • Energy expenditure through physical activity
      • physical activity levels declined over the last few decades
    • Energy expenditure through basal metabolic rate
      • with dietary restriction, basal metabolic rate decrease by 10-20%
influence of training modalities on fat mass loss
Influenceof Training Modalities on Fat-Mass Loss
  • No direct influence of training intensity on fat-mass loss
  • A greater amount of exercise training induces a grater greater fat-mass loss
  • Walking and cycling reduce body weight, whereas swimming does not
  • Inclusion of resistance training in addition to a dietary restriction intervention does not influence fat-mass loss, but could augment fat-free mass and, as such, prevent a decrease in basal metabolic rate during energy intake restriction
weight loss interventions strategies to sustained weight loss
Weight Loss InterventionsStrategiestosustainedweightloss

Comparison of Strategies for Sustained Weight Loss

The Weight Loss Maintenance Controlled Trial

  • Background:
    • Behavior weight loss interventions achieve short-term success, but regain is common
  • Objective:
    • To compare two weight loss maintenance interventions with a self-directed control group

JAMA 2008;299:1139-48

strategies to sustained weight loss initial weight loss interventions
StrategiestoSustainedWeight LossInitial weightlossinterventions

Phase 1 intervention (group-based behavioral interv.)

  • A trained interventionist led 20 weekly group sessions over 6 months
  • Intervention goals were to reach 180 minutes per week of moderate physical activity (walking); reduced caloric intake (adopted DASH diet)
  • Participants were taught to record food and physical activity and to calculate caloric intake

Maintenance interventions were randomly assigned to 1 of 3 groups

    • Self-directed weight loss
    • Interactive technology intervention
    • Personal-contact intervention
strategies for sustained weight loss adjusted weight change by treatment group
StrategiesforSustainedWeight LossAdjustedweightchangebytreatmentgroup

The majority with an initial 6-month weight loss maintained weight loss after 30 months

Monthly brief personal-contact sessions provided modest benefit in sustained weight loss, whereas an Internet-based intervention provided early but transient benefit

strategies for sustained weight loss pediatric obesity
StrategiesforSustainedWeight LossPediatricobesity

Treatment of Pediatric Obesity: A systemic Review and Meta-Analysis of Randomized Trials

  • Conclusion:
    • Limited evidence supports the short-term efficacy of medication and lifestyle interventions. The long-term efficacy and safety of pediatric obesity treatments remain unclear.
  • Discussion:
    • 1. Short-term efficacy of pharmacological interventions
    • 2. Moderate treatment effect of physical activity on adiposity but not on BMI
    • 3. Small to moderate treatment effect of combined lifestyle interventions on BMI.

J Clin Endocrinol Metab, 2008;93:4600-5

kampagne gesteigerter konsum von brot und geb ck
Kampagne: gesteigerter Konsum von Brot und Gebäck
  • MUW (Univ.-Klinik für Innere Medizin II, Abteilung für Kardiologie): Günter Steurer
  • WKÖ (Müller und Bäcker): Rainhard Kainz
  • Ernährungsmedizin: Kurt Widhalm (Seminare)
  • Ernährungswissenschaft: Angela Mörixbauer
  • RedaktionMedien: Karin Gruber
  • Schulärztereferat der ÖÄK: Gudrun Weber
  • Koordination Schulärztlicher Dienst: Elisabeth Wilkens
    • Schulärzte
das ergebnis
Das Ergebnis

Univ.-Prof. Dr. G. Steurer