Obesity, morbidity and mortality

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1 Obesity, morbidity and mortality Alessandro Casini, MD Regional Agency for Nutrition, University of Florence

2 Globesity

3 Determinants of health

4 Risk factors for deaths

5 Preventing Chronic Diseases A vital investment. WHO global report 2006

6 Risk factors for chronic diseases Preventing Chronic Diseases A vital investment. WHO global report 2006

7 Prevalence of overweight (BMI>25 kg/m 2 ) (year: 2005) Preventing Chronic Diseases A vital investment. WHO global report 2006

8 Prevalence of overweight (BMI>25 kg/m 2 ) (year: 2015) Preventing Chronic Diseases A vital investment. WHO global report 2006

9 Prevalence of obesity in US adults Percent of of Population Men Women Source: Health, United States, NCHS.

10 Obesity Trends* Among U.S. Adults (1990) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14%

11 Obesity Trends* Among U.S. Adults (1994) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

12 Obesity Trends* Among U.S. Adults (1998) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

13 Obesity Trends* Among U.S. Adults (2002) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

14 Obesity Trends* Among U.S. Adults (2005) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

15 Prevalence of overweight (rate/100 persons) 29.42% 31.05% 36.38% 35.52% Source: Istat

16 Prevalence of obesity (rate/100 persons) 7.61% 7.68% 10.28% 10.03% Source: Istat

17 All-cause mortality versus BMI in 900,000 adults Collaborative analysis of 57 prospective studies 64 Yearly deaths per 1,000 persons Men Women Body Mass Index (kg/m2) Whitlock et al., Lancet 2009

18 Mortality rates versus BMI in 900,000 adults 16 Men Vascular 16 Women Yearly deaths per 1,000 persons Cancer Yearly deaths per 1,000 persons Vascular Cancer Body Mass Index (kg/m2) Body Mass Index (kg/m2) Whitlock et al., Lancet 2009

19 Life span versus BMI in 900,000 adults 100 Men BMI Women BMI BMI BMI BMI >30 % alive BMI >30 % alive Whitlock et al., Lancet 2009

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21 angiogenesi, pressione arteriosa, fibrinolisi ADIPOCITA angiotensinogeno, PAI-1 ADIPOCHINE deposito di grassi TNFα, IL-6, resistina, leptina, adiponectina bilancio energetico, metabolismo glicolipidico

22 Main causes of death worldwide at all ages (year: 2005) 17.5 milion Preventing Chronic Diseases A vital investiment. WHO global report 2006

23 Modifiable risk factors for MI in 52 countries (the INTERHEART study) Cases: 15,152; Controls: 14,820 Current smoking Diabetes Hypertension Abdominal obesity Fruits and vegetables Exercise Alcohol 3.01 ( ) 3.60 ( ) 2.60 ( ) 2.20 ( ) 0.60 ( ) 0.55 ( ) 0.65 ( ) ApoB/ApoA1 ratio 3.85 ( ) Odds ratio (99% CI) Yusuf et al. Lancet,

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25 Obesity and risk of myocardial infarction Relative risk of myocardial infarction 3,0 2,5 2,0 1,5 1,0 0,5 0,0 < BMI Rexrode et al. JAMA 1997

26 L obesità è un fattore di rischio maggiore per la patologia cardiovascolare (CVD) Incidenza a 26 anni di CVD/ % di peso desiderabile all entrata nello studio Framingham ] <110% % 130% Uomini <50 Uomini 50 Donne <50 Donne 50 Hubert HB et al. Circulation 1983; 67:

27 L obesità addominale aumenta il rischio di coronaropatia (CHD) indipendentemente dal BMI Incidenza 140 di CHD 120 aggiustata all età / persone-anni Circonferenza vita in terzili (cm) Alto ( 81,8) Medio (73,7-81,7) Basso ( 73,6) Alto Medio Basso ( 25,2) (22,2-25,1) ( 22,1) BMI in terzili Rexrode KM et al. JAMA 1998; 280:

28 Elevata prevalenza di sovrappeso e obesità nei pazienti con coronaropatia Prevalenza (%) ,5% 75,4% Uomini Donne ,7% 23,4% 20 0 >25 >30 BMI Montaye M et al. Eur Heart J 2000; 21:

29 Prevalenza di cormorbilità multiple in pazienti sovrappeso/obesi % pazienti Soggetti normopeso (n=8.225): BMI 20-24,9 Soggetti sovrappeso (n=6.003): BMI 25-29,9 Soggetti obesi di classe I (n=1.994): BMI 30-34,9 Soggetti obesi di classe II (n=896): BMI Numero di comorbilità Quesenberry CP et al. Arch Int Med 1998; 158:

30 Comorbilità multiple aumentano il rischio coronarico Rischio coronarico relativo 6 5,0 Dati da NHANES III, n = ,1 2 1,6 2, Numero di fattori di rischio (fumo, obesità, ipertensione, colesterolo alto, diabete) Yusuf HR et al. Prev Med 1998; 27: 1-9

31 Endothelial progenitor cells EPCs Bone marrow Mobilisation Migration Heart Incorporation Endothelium Coronary artery

32 The effect of dietary counseling for weight loss: a meta-analysis analysis Meta-analysis of 46 trials of dietary counseling Dansinger et al., Ann Intern Med 2007

33 La Dieta Mediterranea MENSILE / OCCASIONALE SETTIMANALE GIORNALIERA

34 Mediterranean diet and BMI 1,514 men and 1,528 women, years old Panagiotakos et al., Nutrition 2006

35 Mediterranean diet and obesity 17,238 women and 10,589 men, years old Greater adherence to MD = -31% risk of obesity Mendez et al., J Nutr 2006

36 Mediterranean diet and obesity 497,308 subjects, years old from 10 European countries The EPIC-PANACEA study Greater adherence to MD associated with lower BMI and waist circumference Romaguera et al., J Nutr 2009

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38 Overall mortality Studies included Cardiovascular incidence and/or mortality Cancer incidence and/or mortality Incidence of Parkinson and Alzheimer s diseases 9 studies 4 studies 6 studies 3 studies 514,816 subjects 33,576 deaths 404,491 subjects 3,876 cases 521,366 subjects 10,929 cases 133,626 subjects 783 cases 1,574,299 subjects 49,164 cases Sofi et al., BMJ 2008

39 Adherence to MD and overall mortality Study Weight (%) RR (95% CI) Trichopoulou et al Kouris-Blazos et al Lasheras et al Trichopoulou et al Knoops et al Trichopoulou et al ( ) ( ) ( ) ( ) ( ) ( ) Lagiou et al ( ) Mitrou et al (males) Mitrou et al (females) % ( ) 0.93 ( ) Total (95% CI) ( ) Decreased risk Increased risk Sofi et al., BMJ 2008

40 Adherence to MD and cardiovascular incidence and/or mortality Study Weight (%) RR (95% CI) Trichopoulou et al Knoops et al Lagiou et al ( ) ( ) ( ) Fung et al ( ) Mitrou et al (males) Mitrou et al (females) -9% ( ) 0.88 ( ) Total (95% CI) ( ) Decreased risk Increased risk Sofi et al., BMJ 2008

41 Adherence to MD and cancer incidence and/or mortality Study Weight (%) RR (95% CI) Trichopoulou et al Knoops et al Lagiou et al ( ) ( ) ( ) Fung et al ( ) Mitrou et al (males) Mitrou et al (females) -6% ( ) 0.88 ( ) Total (95% CI) ( ) Decreased risk Increased risk Sofi et al., BMJ 2008

42 Adherence to MD and incidence of Parkinson and Alzheimer s s diseases Study Weight (%) RR (95% CI) Scarmeas et al ( ) Gao et al (males) ( ) Gao et al (females) -13% ( ) Total (95% CI) ( ) Decreased risk Increased risk Sofi et al., BMJ 2008

43 Vascular effects of Mediterranean diet Smith, N Engl J Med 3 December 2009

44 Worldwide adherence to MD MAI = Mediterranean foods/non Mediterranean foods Adherence to MD, MAI ( ) Adherence to MD, MAI ( ) Da Silvas et al., Public Health Nutr 2009

45 Variations of adherence to MD ( ) Non- Mediterranean countries Mediterranean countries Da Silvas et al., Public Health Nutr 2009

46 Can we go back?!...