Obesity, morbidity and mortality Alessandro Casini, MD Regional Agency for Nutrition, University of Florence
Globesity
Determinants of health
Risk factors for deaths
Preventing Chronic Diseases A vital investment. WHO global report 2006
Risk factors for chronic diseases Preventing Chronic Diseases A vital investment. WHO global report 2006
Prevalence of overweight (BMI>25 kg/m 2 ) (year: 2005) Preventing Chronic Diseases A vital investment. WHO global report 2006
Prevalence of overweight (BMI>25 kg/m 2 ) (year: 2015) Preventing Chronic Diseases A vital investment. WHO global report 2006
Prevalence of obesity in US adults Percent of of Population 40 40 30 30 20 20 10 10 10.7 10.7 12.2 12.8 12.2 12.8 20.6 20.6 30.2 30.2 15.7 15.7 16.8 16.8 17.1 17.1 26 26 34 34 0 Men Women 1960-62 1971-74 1976-80 1988-94 2001-2004 Source: Health, United States, 2007. NCHS.
Obesity Trends* Among U.S. Adults (1990) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14%
Obesity Trends* Among U.S. Adults (1994) (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19%
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%
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%
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%
Prevalence of overweight (rate/100 persons) 29.42% 31.05% 36.38% 35.52% Source: Istat
Prevalence of obesity (rate/100 persons) 7.61% 7.68% 10.28% 10.03% Source: Istat
All-cause mortality versus BMI in 900,000 adults Collaborative analysis of 57 prospective studies 64 Yearly deaths per 1,000 persons 32 16 Men Women 8 0 15 20 25 30 35 40 Body Mass Index (kg/m2) Whitlock et al., Lancet 2009
Mortality rates versus BMI in 900,000 adults 16 Men Vascular 16 Women Yearly deaths per 1,000 persons 14 12 10 8 6 4 2 Cancer Yearly deaths per 1,000 persons 14 12 10 8 6 4 2 Vascular Cancer 0 15 20 25 30 35 0 15 20 25 30 35 Body Mass Index (kg/m2) Body Mass Index (kg/m2) Whitlock et al., Lancet 2009
Life span versus BMI in 900,000 adults 100 Men BMI 22-25 100 Women BMI 22-25 80 BMI 25-30 80 BMI 25-30 BMI >30 % alive 60 40 BMI >30 % alive 60 40 20 20 0 0 Whitlock et al., Lancet 2009
angiogenesi, pressione arteriosa, fibrinolisi ADIPOCITA angiotensinogeno, PAI-1 ADIPOCHINE deposito di grassi TNFα, IL-6, resistina, leptina, adiponectina bilancio energetico, metabolismo glicolipidico
Main causes of death worldwide at all ages (year: 2005) 17.5 milion Preventing Chronic Diseases A vital investiment. WHO global report 2006
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 (2.36-3.43) 3.60 (3.15-5.18) 2.60 (2.15-2.95) 2.20 (1.95-2.40) 0.60 (0.45-0.80) 0.55 (0.39-0.83) 0.65 (0.32-0.85) ApoB/ApoA1 ratio 3.85 (3.23-4.38) 0 1 2 Odds ratio (99% CI) Yusuf et al. Lancet, 2004 3 4
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 <21 21-23 23-25 25-27 27-29 29-32 32 BMI Rexrode et al. JAMA 1997
L obesità è un fattore di rischio maggiore per la patologia cardiovascolare (CVD) Incidenza a 26 anni di CVD/1000 700 600 500 400 300 200 241 338 417 519 485 589 % di peso desiderabile all entrata nello studio Framingham 158 135 278 ] 382 376 452 <110% 110-129% 130% 100 0 Uomini <50 Uomini 50 Donne <50 Donne 50 Hubert HB et al. Circulation 1983; 67: 968-977
L obesità addominale aumenta il rischio di coronaropatia (CHD) indipendentemente dal BMI Incidenza 140 di CHD 120 aggiustata all età /100.000 100 persone-anni 80 60 40 20 0 77 106 128 46 110 89 97 55 83 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: 1843-1848
Elevata prevalenza di sovrappeso e obesità nei pazienti con coronaropatia Prevalenza (%) 100 80 79,5% 75,4% Uomini Donne 60 40 32,7% 23,4% 20 0 >25 >30 BMI Montaye M et al. Eur Heart J 2000; 21: 808-813
Prevalenza di cormorbilità multiple in pazienti sovrappeso/obesi % pazienti 60 50 40 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 35 30 20 10 0 Numero di 0 1 2 3 comorbilità Quesenberry CP et al. Arch Int Med 1998; 158: 466-472
Comorbilità multiple aumentano il rischio coronarico Rischio coronarico relativo 6 5,0 Dati da NHANES III, n = 2.255 4 3,1 2 1,6 2,2 0 1 2 3 4 Numero di fattori di rischio (fumo, obesità, ipertensione, colesterolo alto, diabete) Yusuf HR et al. Prev Med 1998; 27: 1-9
Endothelial progenitor cells EPCs Bone marrow Mobilisation Migration Heart Incorporation Endothelium Coronary artery
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
La Dieta Mediterranea MENSILE / OCCASIONALE SETTIMANALE GIORNALIERA
Mediterranean diet and BMI 1,514 men and 1,528 women, 18-89 years old Panagiotakos et al., Nutrition 2006
Mediterranean diet and obesity 17,238 women and 10,589 men, 29-65 years old Greater adherence to MD = -31% risk of obesity Mendez et al., J Nutr 2006
Mediterranean diet and obesity 497,308 subjects, 25-70 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
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
Adherence to MD and overall mortality Study Weight (%) RR (95% CI) Trichopoulou et al. 1995 Kouris-Blazos et al. 1999 Lasheras et al. 2000 Trichopoulou et al. 2003 Knoops et al. 2004 Trichopoulou et al. 2005 9.68 0.69 (0.48 0.99) 6.22 0.79 (0.50 1.25) 2.81 0.48 (0.22 1.02) 16.81 0.75 (0.64 0.87) 11.19 0.88 (0.82 0.94) 8.22 0.93 (0.89 0.97) Lagiou et al. 2006 12.61 0.93 (0.83 1.04) Mitrou et al. 2007 (males) Mitrou et al. 2007 (females) 0.1 0.2 0.5 1 2-9% 15.71 16.46 0.92 (0.91 0.94) 0.93 (0.91 0.95) Total (95% CI) 100 0.91 (0.89-0.94) Decreased risk Increased risk Sofi et al., BMJ 2008
Adherence to MD and cardiovascular incidence and/or mortality Study Weight (%) RR (95% CI) Trichopoulou et al. 2003 Knoops et al. 2004 Lagiou et al. 2006 4.29 0.95 (0.90 1.00) 27.73 0.89 (0.77 1.03) 12.21 0.91 (0.82 1.01) Fung et al. 2006 3.78 0.94 (0.91 0.97) Mitrou et al. 2007 (males) Mitrou et al. 2007 (females) -9% 34.11 17.88 0.96 (0.92 1.00) 0.88 (0.81 0.96) Total (95% CI) 100 0.91 (0.90-0.96) 0.1 0.2 0.5 1 2 Decreased risk Increased risk Sofi et al., BMJ 2008
Adherence to MD and cancer incidence and/or mortality Study Weight (%) RR (95% CI) Trichopoulou et al. 2003 Knoops et al. 2004 Lagiou et al. 2006 4.29 0.95 (0.90 1.00) 27.73 0.89 (0.77 1.03) 12.21 0.91 (0.82 1.01) Fung et al. 2006 3.78 0.94 (0.91 0.97) Mitrou et al. 2007 (males) Mitrou et al. 2007 (females) -6% 34.11 17.88 0.96 (0.92 1.00) 0.88 (0.81 0.96) Total (95% CI) 100 0.94 (0.92-0.96) 0.1 0.2 0.5 1 2 Decreased risk Increased risk Sofi et al., BMJ 2008
Adherence to MD and incidence of Parkinson and Alzheimer s s diseases Study Weight (%) RR (95% CI) Scarmeas et al. 2006 82.32 0.83 (0.70 0.89) Gao et al. 2007 (males) 9.88 0.93 (0.80 1.08) Gao et al. 2007 (females) -13% 7.80 0.85 (0.72 1.00) Total (95% CI) 100 0.87 (0.80-0.96) 0.1 0.2 0.5 1 2 Decreased risk Increased risk Sofi et al., BMJ 2008
Vascular effects of Mediterranean diet Smith, N Engl J Med 3 December 2009
Worldwide adherence to MD MAI = Mediterranean foods/non Mediterranean foods Adherence to MD, MAI (1961-1965) Adherence to MD, MAI (2000-2003) Da Silvas et al., Public Health Nutr 2009
Variations of adherence to MD (1961-2003) Non- Mediterranean countries Mediterranean countries Da Silvas et al., Public Health Nutr 2009
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