OBESITA
Definizione- Diagnosi Accumulo patologico di tessuto adiposo La diagnosi si basa sulla misurazione dell IMC ( e non dell adiposità) IMC > 30 < 35 >35 < 40 > 40 OBESITA I GRADO OBESITA II GRADO OBESITA III GRADO
Correlazione IMC/massa adiposa IMC
RAND Research L Obesità è associata alle malattie croniche in misura maggiore della povertà, del fumo e dell alcool. Sturm R. The Effects of Obesity, Smoking, and Problem Drinking on Chronic Medical Problems and Health Care Costs. Health Affairs. 2002;21(2):245-253. Sturm R, Wells KB. Does Obesity Contribute As Much to Morbidity As Poverty or Smoking? Public Health. 2001;115:229-295
Mortality Ratio Obesità e Mortalità - 1989 2.5 2.0 Digestive Disease Pulmonary Disease Cardiovascular Disease Gallbladder Disease Diabetes Mellitus Men Women 1.5 1.0 0 Moderate Risk Very Low Risk Low Risk Moderate Risk High Risk 20 25 30 35 40 BMI (kg/m 2 ) Very High Risk Gray DS. Med Clin North Am. 1989)
Epidemiologia
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad AH.
Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad AH.
Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Obesity Trends*Among U.S. Adults BRFSS, 2001 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20-24% 25% Source: Mokdad A A H, H, et et al. al. JAMA 2003;289:1 1999;282:16;2003;289:1
Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10%-14% 15-19% 20-24% 25% Source: Mokdad A A H, H, et et al. al. JAMA 2003;289:1 1999;282:16;2003;289:1
% di Adulti che non fanno attività fisica durante il tempo libero - 1998 8 33.8-51.1 28.0-33.5 22.8-27.2 17.5-22.6 From CDC report Chronic Diseases and Their Risk Factors: The Nation s Leading Causes of Death
Mortalità per cardiopatia ischemica per 100,000 1996-6 144-179 126-142 114-125 82-114 From CDC report Chronic Diseases and Their Risk Factors: The Nation s Leading Causes of Death
Mortalità per Stroke per 100,000 1996 2 National Vital Statistics Report, Vol 47, No 9, 11/10/98 46.6-63.3 43.1-46.1 38.9-42.9 30.6-38.6
Prevalenza Obesità nel Mondo Percentage of total population (ages 15+) with BMI >30; compiled between 1996-2003. OECD Factbook: Economic, Environmental and Social Statistics, 2005.
Causa dell Obesità Interazione tra: predisposizione genetica e fattori, comportamentali-ambientali. STILE DI VITA FATT. PSICOLOGICI MALATTIE GENI OBESITA
STILE DI VITA FATT. PSICOLOGICI MALATTIE GENI Bilancio Energetico Cibo bevande introito Metab Basale Termogenesi Attività fisica dispendio
Evidenze dell influenza Genetica Se familiari obesi, 70-80% di possibilità di diventare obesi Anche bambini normopeso da madri obese hanno >% grasso Studi sui gemelli e adottati confermano
Influenze ambientali Forti segnali all introito Deboli segnali allo stop Aumento disponibilità Trasporti automatizzati Riscaldamenti
Fattori sociali una ricerca in cui si chiedeva ai soggetti di tenere un diario completo del cibo assunto si è trovata una relazione molto netta tra quantità di cibo ingerito e numero di persone presenti durante il pasto (più persone ci sono più abbondante è il pasto). Inoltre si è trovato che la corrispondenza, normalmente riscontrata, tra tempo passato dall ultimo pasto e quantità di cibo ingerito valeva solo quando i soggetti mangiavano da soli
Regolazione Bilancio energetico Estremamente complessa Molte pathways omeostatiche e comportamentali che interagiscono Introito finalizzato a soddisfare bisogni ma anche a conservare energia
Intake energetico Controllato da: Sist. orosensorio Sist. gastrointestinale Sistema circolatorio Metabolismo Sist. Nerv. centrale
Controllo appetito INFLUENZE COGNITIVA SOCIOCULTURALE GUSTATORIA NEUROENDOCRINA GASTROINTESTIN. METABOLICA Controllo, Emozioni, Esperienze precedenti, Associazioni condizionanti Religione, Livello Educazione, Tradizioni, Livello economico, Palatabilità, Preferenze innate e acquisite, Sazietà cibospecifica, Stimoli sensitivi associati a nutrienti, fase cefalica Peptidi oressigeni e anoressigeni, asse entero-insulare, Segnali adipostatici, Bilancia attività sist simpatico/parasimp Composizione nutrienti, Contenuto acqua, densità energetica, digeribilità, ph, osmolarità, dimensione stomaco, velocità svuotamento, assorbimento Metabolismo epatico, interazioni nutrienti-genotipo COMPORTAMENT. Età, sesso, occupazione, livello att fisica, fase sviluppo
Malattie e sindromi associate a Obesità Ipertensione Ictus cerebrale Diabete mellito, Tipo 2 Sindrome Metabolica Mortalità cardiovascolare Cancro endometrio, mammella, prostata, colon. Calcoli colescisti Osteoartriti Malattie respiratorie e apnea nel sonno
Proporzione di malattie da attribuire all Obesità DM tipo 2 61% K endometrio calcolosi bil 30% 34% osteoartr 24% m cv ipertensione 17% 17% k colon k seno 11% 11% 0% 10% 20% 30% 40% 50% 60% 70% BMI 30 kg/m 2 Adapted from: Wolf AM, Obes Res, 1998
Rischio relativo 7 6 5 4 3 2 1 BMI e Rischio Relativo di Comorbilità Diabete tipo 2 Ipertensione Colelitiasi CHD 0 21 22 23 24 25 26 27 28 29 30 BMI Willett WC, et al. N Engl J Med. 1999.
Rischio di diabete di tipo 2 in donne secondo il BMI Rischio relativo di Diabete tip 2 100 93.2 75 54.0 50 25 0 1.0 <22 22-22.9 2.9 4.3 5.0 23-23.9 BMI 24-24.9 8.1 25-26.9 15.8 27-28.9 27.6 29-30.9 40.3 31-32.9 33-34.9 35 Adapted from Colditz et al. Ann Intern Med 1995; 122: 481-6
How does obesity cause cardiovascular disease? Chart Title Abdominal Obesity (deep visceral fat) Lipolysis (insensitive to insulin) FFA Muscle & Pancreas Insulin resistance Hyperinsulinemia Met. Syn., DM T2 Liver Gluconeogenesis Inc. Trigs and LDL Dec. HDL Blood Vessels Hypertension Hypercoagulable state Endothelial dysfunction Cardiovascular disease
Obesity and Cardiovascular Risk Visceral Obesity Sodium Retention Volume Expansion Heart Rate Endothelial Dysfunction Diabetes Mellitus Dyslipidemia Cardiac Output Atherosclerosis Arterial Resistance Hypertension Eccentric Hypertrophy Concentric Hypertrophy Congestive Heart Failure (CHF), Coronary Artery Disease (CAD), Sudden Death (Adapted with permission from Zhang R, Reisin E. Am J Hypertens. 2000)
Obesity Assessment: Risk Factors Existing Disease Conditions* Other Obesityassociated Diseases Cardiovascular Risk Factors Other Risk Factors Established CHD Other atherosclerotic diseases Type 2 diabetes Sleep apnea OB/GYN abnormalities Osteoarthritis Gallstones/ gall bladder disease Stress incontinence Hypertension (SBP 140 mmhg or DBP 90 mmhg, or currently taking antihypertensive medication) LDL cholesterol 160 mg/dl HDL cholesterol < 35 mg/dl Impaired fasting glucose 110 125 mg/dl Family history of premature CHD Age (men 45 years; women 55 years or menopausal) *Patients with these conditions are at very high risk for disease complications and mortality. Patients with three of these factors are at high absolute risk. Definite MI or sudden death at/before 55 years in father or other male first degree relative or at/before 65 years of age in mother or other first degree female relative. (NIH. Obes Res. 1998) Serum triglycerides > 200 mg/dl Physical inactivity
Controlling Obesity Can Drastically Reduce Medical Costs Total direct and indirect costs of obesity: United States, estimated to be at least $99.2 billion (1995) direct costs: 5.7%, National Health Expenditure costs due obesity-associated diseases (eg, CHD, diabetes, osteoarthritis) 6% 10% weight loss reduces treatment costs* $123 for the insulin-treated diabetic patient $61 for the hyperlipidemic patient $43 for the sulfonylurea-treated diabetic patient *Reduction in costs/month/patient. (Wolf AM, Colditz GA. Obes Res. 1998) (Greenway FL, et al. Obes Res. 1999)
Health Benefits of Modest Weight Loss* Possible risk of death CHD risk MI rate stroke rate improves serum lipids Improves prognosis in type 2 diabetic patients glucose, insulin Can significantly reduce sleep apnea osteoarthritis symptoms Reduces relapse rate of asthma *Modest weight loss = minimum of 5 lbs. (Camargo CA, et al. Arch Intern Med. 1999) (Goldstein DJ. Int J Obes. 1992) (Suratt PM, Findley LJ. N Engl J Med. 1999) (Gelber AC. Am J Med. 1999)