哈爾濱醫(yī)科大學(xué)兒童少年衛(wèi)生學(xué)兒童少年單純性肥胖

1、張慧穎bibliography 兒童少年衛(wèi)生學(xué)兒童少年衛(wèi)生學(xué)（第（第6版），季成葉主編。版），季成葉主編。人民衛(wèi)生出版社人民衛(wèi)生出版社 falkner f. and tanner j.m. human growthhuman growth. . plenum press. new york and london lowrey gh. growth and development of children. 7th ed, chicago, london: year book medical publishers 現(xiàn)代兒童少年衛(wèi)生學(xué)現(xiàn)代兒童少年衛(wèi)生學(xué)，葉廣俊主編。人民，葉廣俊主編。人民衛(wèi)生出版社衛(wèi)

2、生出版社 兒童少年生長發(fā)育兒童少年生長發(fā)育唐錫麟唐錫麟 人民衛(wèi)生出版社人民衛(wèi)生出版社i. general1997, who formally announced that obesity is a disease obesity will become the biggest enemy to threaten human health and life satisfaction in 21 century - iotf 國際肥胖特別工作組國際肥胖特別工作組international obesity task force ii. defining obesityu obesity is def

3、ined as an excessive accumulation of body fat. increasing of body fat cell enlargement of body fat celltwo types:n primary obesityn secondary obesity肥胖，是一種常肥胖，是一種常見的營養(yǎng)代謝疾見的營養(yǎng)代謝疾病，病， 是指由于營是指由于營養(yǎng)過剩、缺乏運(yùn)養(yǎng)過剩、缺乏運(yùn)動以及遺傳因素動以及遺傳因素共同作用引起的共同作用引起的身體內(nèi)脂肪過度身體內(nèi)脂肪過度堆積的現(xiàn)象，表堆積的現(xiàn)象，表現(xiàn)為全身脂肪組現(xiàn)為全身脂肪組織異常性的增加織異常性的增加iii. scree

4、ning obesityu eyeball testu weight-for-heightu body mass indexu body fat content u waist / hip ratiou weight-for-height 身高標(biāo)準(zhǔn)體重身高標(biāo)準(zhǔn)體重 under 60%serious malnutrition 60-80%moderate malnutrition 80-90%mild malnutrition 90-110%normal 110-120%overweight 120-130%mild obesity 130-150%moderate obesity above

5、150% serious obesityobesity: scale by bmibmi = weight (kg) height (m)2 overweight obesity china 24 28 who 25 30classification of body weight who and nhlbi classification of bmibmiclassificationwho and nilbi china 18.5 underweight 18.524.9 24normal range 25.029.2 24.027.9overweight 30.034.9 28.0obese

6、 class 1 35.039.9 obese class 2 40.0obese class 3nhlbi: national heart, lung, and blood instituteadapted from mckdad ah, et al. jama. 1999; 282: 1519-1522中國學(xué)齡兒童青少年超重、肥胖篩查中國學(xué)齡兒童青少年超重、肥胖篩查bmibmi分類標(biāo)準(zhǔn)分類標(biāo)準(zhǔn)年齡（歲）年齡（歲） 男男- -超重超重 男男- -肥胖肥胖 女女- -超重超重 女女- -肥胖肥胖 7 17.419.217.218.9 8 18.120.318.119.9 9 18.921.41

7、9.021.0 10 19.622.520.022.1 11 20.323.621.123.3 12 21.024.721.924.5 13 21.925.722.625.6 14 22.626.423.026.3 15 23.126.923.426.9 16 23.527.423.727.4 17 23.827.823.827.7 18 24.028.024.028.0 waist-to-hip ratio (whr): fat distributionwaist - hip ratio (whr) 腰臀比腰臀比 most people store their body fat in two

8、 distinct ways: around their middle (apple shape) around their hips (pear shape). women women 0.8 0.8man man 0.95 0.95bmi - whrwaist circumference: 腰圍腰圍 best indicator of visceral fat80 cm = increase risk90 cm = increase riskcmwho 推薦：推薦：肥胖度肥胖度 = 實(shí)際體重實(shí)際體重(kg)身高標(biāo)準(zhǔn)體身高標(biāo)準(zhǔn)體重重(kg) / 身高標(biāo)準(zhǔn)體重身高標(biāo)準(zhǔn)體重(kg) 100% 凡

9、肥胖度凡肥胖度20%，兩處的皮下脂肪厚度，兩處的皮下脂肪厚度80百分位數(shù)或其中一處皮下脂肪厚度百分位數(shù)或其中一處皮下脂肪厚度95 百百分位數(shù)者為肥胖兒童分位數(shù)者為肥胖兒童凡肥胖度凡肥胖度10%，無論兩處的皮下脂肪厚，無論兩處的皮下脂肪厚度如何，均為體重正常兒童度如何，均為體重正常兒童皮褶厚度（皮褶厚度（skinfold thickness）：測量右側(cè)）：測量右側(cè)肱三頭肌肌腹部和右肩胛下角部肱三頭肌肌腹部和右肩胛下角部上臂肱三頭肌部上臂肱三頭肌部 代表四肢代表四肢肩胛下角肩胛下角 代表軀干代表軀干上述二部位之和上述二部位之和 代表全身皮下指標(biāo)代表全身皮下指標(biāo)體脂比（體脂比（body fat ra

10、tio）: 輕度肥胖輕度肥胖 中度肥胖中度肥胖 高度肥胖高度肥胖男性男性 20 25 30女性女性 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(dá)程度影響易受身高和肌肉發(fā)達(dá)程度影響 ct斷層法：斷層法： 皮下脂肪面積皮下脂肪面積/內(nèi)臟脂肪面積內(nèi)臟脂肪面積 0.4：內(nèi)臟型肥胖：內(nèi)臟型肥胖 0.4：皮下脂肪型肥胖：皮下脂肪型肥胖 超聲波法：超聲波法： 腹膜前脂肪的最大厚度腹膜前脂肪的最大厚度/腹壁皮下脂肪的最小厚度腹壁皮下脂肪的最小厚度 male: 1.0 內(nèi)臟型肥胖內(nèi)臟型肥胖 female: 0.7內(nèi)臟型肥胖內(nèi)臟型肥胖iv.

11、epidemiology u “the global obesity epidemic”u “globesity”major problem in developed countries overweight and obesitywho（2002）uworld-wild: one of 10 health risk world-wild: one of 10 health risk factorsfactorsudeveloped countries: one of 5 health developed countries: one of 5 health risk factorsrisk

12、factorsus: increase 4 times recently forty years us: increase 4 times recently forty years （ogden et alogden et al，20022002）usa : the prevalence of obesity is high and rising higherfig. the prevalence of childhood obesity in china, 1985-2000.fig. the prevalence of childhood overweight and obesity in

13、 china, 2000general, higher in northern than in southern.北方南方北方南方higher in urban than 城市農(nóng)村城市農(nóng)村rural, not very high, but the increasing rate is rapid no gender difference in pre-school. higher in boys than girls in school-ageage-special: 1yr have light peak, after that reduce with age increase, 5yr r

14、ebound, 10-13yrs reach the peak nmany adulthood obesity develop from from childhood obesity.nrisk : obesity children develop into adulthood obesity u infant 14 %u 7 yrs child 41 %u 1013 80 %china higher stunt prevalence with the improvement of nutrition, the stunting tend to catch-up growth, and ten

15、d to obese late pregnancy, fetus absorb much energy high bmi - obesity excess feeding to infants weight increase fast adipose early rebound 脂肪早期重聚脂肪早期重聚 early maturation pattern puberty central and high bmi obesitydeveloping country and shift societytrend in underweight prevalence from 1990 to 2006,

16、 by region the trend analysis is based on a subset of 76 countries with trend data, covering 83 per the trend analysis is based on a subset of 76 countries with trend data, covering 83 per cent of the under-five population in the developing world. for cee/cis, the baseline year cent of the under-fiv

17、e population in the developing world. for cee/cis, the baseline year is 1996; data availability was limited for the period around 1990. prevalence was is 1996; data availability was limited for the period around 1990. prevalence was estimated using nchs/who/cdc reference population estimated using n

18、chs/who/cdc reference population vfactors （etiology） obesity: a complex diseasecauses of childhood obesityugene-gene: linkage and interactionugeneenvironment: cooperation and interactionuenvironment diet: energy, diet structure, soft drink socioeconomic status physical exercise lifestyle (sedentary)

19、 commercial inducement 1. genetic determinants 遺傳因素遺傳因素 in the twins studies, the heritability of the bmi was estimated to be very high, about 80%. the results of adoption and family studies, however, agree on a heritability of about 33%.genetic predisposition ob gene leptin2. environmental determin

20、ants 環(huán)境因素環(huán)境因素 food intake socioeconomic status family factors physical activity brain damage drugs endocrine factors psychologic factors(1) newborn and infancyheavy birth weight 高出生體重高出生體重smoking in pregnancy 母孕期吸煙母孕期吸煙non-breast feeding 非母乳喂養(yǎng)非母乳喂養(yǎng)(2) pre-school age weight level and increment rate c

21、atch-up growth of low-birth-weight - u shape distribution parents obesity long time for watching tv and short sleeping timebmi and birth weight british journal of cancer (2004) 91, 519524 is the association of birth weight with premenopausal breast cancer risk mediated through childhood growth? silv

22、a is, stavola bld, hardy rj, et al.(3) school age and adolescenceparents obesity 父母肥胖父母肥胖increasing velocity violent, especially stunt children 生長遲滯兒童生長遲滯兒童 sedentary lifestyle “以靜代動以靜代動”的生活方式的生活方式 watching tv play computer transportation (manner of going to school) deficiency physical exercise lack

23、 of outdoor activity dull in after-school, lack of physical exercise motivation, interest and inducement “three hyper-”diet and soft drink parents lack of nutrition knowledge strong commercial inducement have early puberty growth and body fat increase rapidlyvi. tend to occur obesity肥胖的易發(fā)時(shí)期肥胖的易發(fā)時(shí)期 u

24、the late pregnancy 孕后期孕后期uinfancy (especially before 9 months) 嬰兒期（尤其生后嬰兒期（尤其生后9個(gè)月內(nèi)）個(gè)月內(nèi)）uthe early puberty 青春早期青春早期uthe late puberty 青春發(fā)育后期青春發(fā)育后期vii. the influence on child and adolescent health u effect on psychology poor self-image disinterested in exercise more sedentary possibly socially isolate

25、du effect on healthcommon secondary medical problems include hypertension, and knee and back problemsobesity is associated with increased morbidity and mortalityo b e s i t y i s l i n k e d w i t h cardiovascular diseaseviii. prevention of obesity肥胖的防治肥胖的防治 comprehensive strategies of interventionc

26、omprehensive strategies of intervention:the idea of control weight should be haven from fetus. 從小抓起從小抓起the health education on prevention obesity 預(yù)防肥胖的健康教育預(yù)防肥胖的健康教育properly deal with the relationship between dietary adjustment and suitably physical activity正確處理飲食調(diào)整和適當(dāng)體育活動的關(guān)系正確處理飲食調(diào)整和適當(dāng)體育活動的關(guān)系behavio

27、r therapy 行為療法行為療法diet therapy 飲食療法飲食療法physical exercise therapy 運(yùn)動療法運(yùn)動療法10 of the worst foods for children soda pop whole milk hamburgers american cheese hot dogs french fries and tater tots ice cream pizza loaded with cheese and meat bologna (一種大臘腸一種大臘腸) chocolate bars 10 of the best foods for chi

28、ldren fresh fruits and vegetables (especially carrot sticks, cantaloupe, oranges, watermelon, strawberries) chicken breast and drumstick without skin or breading cheerios, wheaties, or other whole-grain, low-sugar cereals skim or 1% milk extra-lean ground beef or vegetarian burgers (gardenburgers or

29、 green giant harvest burgers) low-fat hot dogs (yves veggie cuisine fat-free weiners or lightlife fat-free smart dogs) non-fat ice cream or frozen yogurt fat-free corn chips or potato chips seasoned air-popped popcorn whole-wheat crackers or small world animal crackers summaryconcept: obesitythe trend of obesity prevalence ratethe four age stages in which the children tend to occur obesitygive three environmental factors affecting obesity occurrencethe influence of obesity on children healthkeep children fit,we have much can do.思考題：思考題：（1 1）身高標(biāo)準(zhǔn)體重篩查肥胖的標(biāo)準(zhǔn)是：）身高標(biāo)準(zhǔn)體重篩查肥胖的標(biāo)準(zhǔn)是： a. a. 實(shí)測體