1、Medical Complications of Obesity,BMI-Associated Disease Risk,Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in AdultsThe Evidence Report. Obes Res 1998;6(suppl 2).,Additional risks:Large waist circumference (men40 in; women 35 in)5 kg or more weight ga
2、in since age 18-20 yPoor aerobic fitnessSpecific races and ethnic groups,Weight (lb),Body Mass Index Chart,Relationship Between BMI and Percent Body Fat in Men and Women,Adapted from: Gallagher et al. Am J Clin Nutr 2000;72:694.,Body Fat (%),Body Mass Index (kg/m2),0,10,30,40,60,20,50,WomenMen,Pulmo
3、nary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome,Nonalcoholic fatty liver diseasesteatosissteatohepatitiscirrhosis,Coronary heart disease Diabetes Dyslipidemia Hypertension,Gynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome,Osteoarthritis,Skin,
4、Gall bladder disease,Cancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate,Phlebitisvenous stasis,Gout,Medical Complications of Obesity,Idiopathic intracranial hypertension,Stroke,Cataracts,Severe pancreatitis,Metabolic Syndrome,Abdominal obesityHyperinsulinemiaHigh fasting plasma g
5、lucoseImpaired glucose toleranceHypertriglyceridemiaLow HDL-cholesterolHypertension,Evolution of Metabolic Syndrome,Isomaa B et al. Diabetes Care. 2001;24:683-689.,AKA: Insulin Resistance Syndrome; Syndrome X; Dysmetabolic Syndrome; Multiple Metabolic Syndrome,1923: Kylin describes clustering of hyp
6、ertension, gout, and hyperglycemia,1988: Reaven describes “Syndrome X” hypertension, hyperglycemia, glucose intolerance, elevated triglycerides, and low HDL cholesterol,1998: World Health Organization defines “metabolic syndrome” as clustering of hypertension, low HDL, hypertriglyceridemia, insulin
7、resistance, glucose intolerance or type 2 diabetes, high waist-to-hip ratio, and microalbuminuria,Abdominal obesity Glucose intolerance/ Insulin resistance Hypertension Atherogenic dyslipidemiaProinflammatory/Prothrombotic state,Characteristics of the Metabolic Syndrome: NCEP-ATP III,National Choles
8、terol Educational Program (NCEP), Adult Treatment Panel (ATP) III; 2001.,Diabetes,CVD,Clinical Identification of the Metabolic Syndrome*: NCEP-ATP III,*Diagnosis is established when 3 of these risk factors are present,Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in
9、Adults. JAMA. 2001;285:2486-2497.,* 2003 New ADA IFG criteria (Diabetes Care),Increasing Prevalence of NCEP Metabolic Syndrome with Age (NHANES III),Prevalence (%),Age,Men Women,Ford E et al. JAMA. 2002;287:356-359.,Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Ag
10、e 50+,CHD Prevalence,No MS/No DM,8.7%,% of Population = 54.2% 28.7% 2.3% 14.8%,Alexander C, et al. Diabetes 52: 1210-1214, 2003,13.9%,7.5%,19.2%,MS/No DM,DM/No MS,DM/MS,Prevalence of the Metabolic Syndrome Varies by Sex and Race/Ethnicity (NHANES III),Prevalence (%),Age,Ford E et al. JAMA. 2002;287:
11、356-359.,25%,16%,28%,21%,23%,26%,36%,20%,Metabolic Syndrome: Impact on Mortality,Mortality Rate (%),Without metabolic syndromeWith metabolic syndrome,*,Isomaa B et al. Diabetes Care. 2001;24:683-689.,*P 0.001.,*,Metabolic Syndrome: Impact on Cardiovascular Health,Prevalence (%),Without metabolic syn
12、dromeWith metabolic syndrome,*,*P 0.001.,Isomaa B et al. Diabetes Care. 2001;24:683-689.,*,*,Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes,Relative Risk,1.00,Nondiabeticthroughoutthe study,Hu FB et al. Diabetes Care. 2002;25:1129-1134.,Prior todiagnosisof diabetes,After diagnos
13、isof diabetes,Diabetic atbaseline,2.82,3.71,5.02,Characteristics of Metabolically Normal Obese and Metabolically Abnormal Obese Subjects,Postmenopausal women.*P = 0.03; *P = 0.0001.LBM = lean body mass.AT = adipose tissue.,Brochu M et al. J Clin Endocrinol Metab. 2001;86:1020-1025.,Lipids and Lipopr
14、oteins & Resting BP in Insulin-Sensitive and Insulin-Resistant Obese Subjects,Postmenopausal women. Data are mean SD. *P = 0.01.,Brochu M et al. J Clin Endocrinol Metab. 2001;86:1020-1025.,Oral Glucose Tolerance in Insulin-Sensitive and Insulin-Resistant Obese Subjects,Postmenopausal women.n = 12, s
15、ensitive; n = 23, resistant.Data are mean SD.*P = 0.01; *P = 0.005; *P = 0.001.,Brochu M et al. J Clin Endocrinol Metab. 2001;86:1020-1025.,Waist Size vs BMI and the Metabolic Syndrome,8-y Incidence of Metabolic Syndrome (%),Waist circumference level 2*,Han TS et al. Obes Res. 2002;10:923-931.,*Leve
16、l 2 = waist 40 inches in men or 35 inches in women.,9.98,20.45,19.77,33.43,Both Insulin Resistance and Decreased Insulin Secretion Predict the Risk of Developing Type 2 Diabetes: 7-Year Incidence,Percent,NeitherLowHigh,Haffner SM et al. Circulation. 2000;101:975-980.,Insulin secretionLowLow,Insulin
17、resistanceHighHigh,BothHighLow,Metabolic statusHOMA-IR I30-0min/G30-0min,Distribution by Metabolic Status Among Converters to Type 2 Diabetes(83% of Prediabetic Subjects are Insulin Resistant),Haffner SM et al. Circulation. 2000;101:975-980.,Both (54%),(n = 195),Low insulin secretion; insulin sensit
18、ive (15.9%),Neither (1.5%),Insulin resistant;good insulinsecretion (28.7%),Insulin Resistance (HOMA-IR Quintiles) are Related to CV Disease: San Antonio Heart Study,Increasing Insulin Resistance,A: adjusted for age, sex, and ethnicity,B: adjusted for age, sex, and ethnicity, LDL, triglyceride, HDL,
19、systolic blood pressure, fasting glucose, smoking, alcohol consumption, and leisure time exercise,Hanley A et al. Diabetes Care. 2002;25:1177-1184.,A,HOMA IR,B,Odds Ratio (95% CI),Increasing Risk of CVD,P (trend) 0.0001,P (trend) 0.0075,Intra-Abdominal Fat Mass and CHD Risk in Type 2 Diabetes,Adjust
20、ed for BMI, age (continuous), age2, smoking, parental history of myocardial infarction, alcohol consumption, physical activity, menopausal status, hormone replacement therapy, aspirin intake, saturated fat, and antioxidant score.,Rexrode W et al. JAMA. 1998;280:1843-1848.,P 0.001 for trend.,Ectopic
21、Lipids and the Metabolic Syndrome,Metabolic syndrome reflects failure of intracellular lipohomeostasis, which prevents lipotoxicity in organs of overnourished individualsNormal individuals: lipohomeostasis (ie, lipid overload confined to white adipocytes, designed to store surplus calories)Obese ind
22、ividuals: adipocytes increase leptin secretion in an attempt to enhance oxidation of surplus lipid in nonadipocytesDeficiency or nonresponsiveness to leptin prevents these protective events and results in ectopic accumulation of lipidsPancreatic -cells and myocardiocytes are “cellular victims” leadi
23、ng to type 2 diabetes and lipotoxic cardiomyopathy,Unger RH. Endocrinology. 2003.,Relationship Between BMI and Cardiovascular Disease Mortality,Relative Risk of Death,Body Mass index,40.0,Lean,Overweight,Obese,Relationship Between BMI and Risk of Type 2 Diabetes,Chan J et al. Diabetes Care 1994;17:9
24、61.Colditz G et al. Ann Intern Med 1995;122:481.,Age-Adjusted Relative Risk,Body Mass index (kg/m2),MenWomen,1.0,2.9,1.0,4.3,1.0,5.0,1.5,8.1,2.2,15.8,4.4,27.6,40.3,54.0,93.2,6.7,11.6,21.3,42.1,Waist-HipRatioTertile,Abdominal Fat Distribution Increases the Risk of Coronary Heart DiseaseThe Iowa Women
25、s Health Study,Folsom et al. Arch Intern Med 2000;160:2117.,Relative risk,Body Mass Index Tertile,2,1,3,3,2,1,Relationship Between Weight Gain in Adulthood and Risk of Type 2 Diabetes Mellitus,Relative Risk,Weight Change (kg),Willett et al. N Engl J Med 1999;341:427.,MenWomen,Direct Cost * of Chroni
26、c Diseases in the United States,Direct Cost ($ Billions),Type 2Diabetes,Wolf AM, Colditz GA. Obes Res. 1998;6:97-106.Hodgson TA, Cohen AJ. Med Care. 1999;37:994-1012.,*Adjusted to 1995 dollars.,Obesity,CoronaryHeart Disease,Hyper-tension,Stroke,$18.1,$18.4,$38.7,$51.6,$53.2,Effect of Obesity on Expe
27、cted Lifetime Medical Care Costs* in Men,Costs ($)*,Body Mass Index (kg/m2),32.5,27.5,37.5,55-64,45-54,*Total cost of CHD, type 2 DM, hypertension, hypercholesterolemia, stroke,Age (y),Thompson et al. Arch Intern Med 1999;159:2177.,35-44,22.5,Increase in Healthcare Costs Among Obese Compared with Le
28、an (BMI 35 kg/m2,Quesenberry CP Jr et al. Arch Intern Med. 1998;158:466-472.,*HMO Setting: Northern California Kaiser Permanente.,Economic Effect of Obesity to Business: 3-Year Costs to First Chicago NBD,Burton et al. J Occup Environ Med 1998;40:786.,*BMI 27.8 kg/m2 in men; 27.3 kg/m2 in women.,Abse
29、nteeism,Healthcare,LeanObese*,$4,496,$6,822,$683,$1,546,Annual Medical Expenditures Attributable to Obesity in US,New study quantifying state-level expendituresModel developed to predict expenditures by combining MEPS and BRFFS dataObesity prevalence for US estimated at 20% of total adult population
30、Prevalence varies considerably by stateOverall range: 15% (CO) 25% (WV),Finkelstein, et al Obes Res. 2004; 12:18-24.,MEPS = 1998 Medical Expansion SurveyBRFSS = Behavioral Risk Factor Surveillance System,Annual Medical Expenditures Attributable to Obesity in US,6% total adult medical expenditures ar
31、e attributable to obesityRange: 4% (AZ, CT) 7% (AK)7% Medicare expendituresRange: 4% (AZ) 10% (DE)11% adult Medicaid expendituresRange: 8% (RI) 16% (IN),Finkelstein, et al Obes Res. 2004; 12:18-24.,Annual Medical Expenses Attributable to Obesity in Selected States,Finkelstein, et al Obes Res. 2004: 12 18-24,In the US as a whole, obesity attributable medical expenditures are estimated at $75 billion with $17 billion financed by Medicare and $21 billion financed by Medicaid.,
