营养与相关疾病,第一节 营养与肥胖(Nutrition and obesity),肥胖(obesity)是指人体脂肪的过量贮存，表现为脂肪细胞增多和（或）细胞体积增大，即全身脂肪组织块增大，与其他组织失去正常比例的一种状态。 The condition of being obese; increased body weight caused by excessive accumulation of fat.,一、肥胖的定义、诊断及分类 (Definition 、diagnosis and categorization),(一) Definition,(二) Diagnostic method:,1. 人体测量法 2物理测量法 3化学测量法,(二) Diagnostic method:,1.人体测量法(Anthropometry): 身高(body height) 体重（body weight） 胸围(chest circumference) 腰围(waist circumference) 臀围(hip circumference) 肢体的围度(limbs circumference) 皮褶厚度(skinfold)等参数的测量。,Categories:,1. 身高标准体重法(standard body weight determined by height) 肥胖度(%)实际体重(kg)身高标准体重(kg)/身高标准体重(kg)100%。 判断标准：凡肥胖度10%为超重；20%29%为轻度肥胖；30%49%为中度肥胖；50%为重度肥胖。,2. 皮褶厚度(skinfold ): 3. 体质指数（body mass index, BMI） BMI体重(kg)/身高(m)2,Categories of obesity by BMI,(3)腰围(waist circumference)和腰臀比(waist-to-hip ratio),WHO规定: 男性腰围102cm、女性腰围88cm作为上身性肥胖的标准；腰臀比男性0.9、女性0.8作为上身性肥胖的标准。 我国的标准: 男性85cm，女性80cm作为上身性肥胖的标准。,(二) Diagnostic method:,1.人体测量法(Anthropometry): 2物理测量法 全身电传导(total body electrical conductivity) 生物电阻抗分析(bioelectrical impendence analysis) 双能X线吸收(dual-energy X-ray) 计算机控制的断层扫描(computerized tomographic scans)磁共振扫描(nuclear magnetic resonance scans)。 3化学测量法 稀释法、40K计数法、尿肌酐测定法,（三）肥胖的分类,1.遗传性肥胖(genetic obesity ) 主要指遗传物质(染色体、DNA)发生改变而导致的肥胖，这种肥胖极为罕见，常有家族性肥胖倾向。 2.继发性肥胖(secondary obesity) 主要指由于脑垂体肾上腺轴发生病变、内分泌紊乱或其他疾病、外伤引起的内分泌障碍而导致的肥胖。 3单纯性肥胖(simple obesity) 主要是指排除由遗传性、代谢性疾病、外伤或其他疾病所引起的继发性、病理性肥胖，而单纯由于营养过剩所造成的全身性脂肪过量积累。,二、肥胖的发生机制及影响因素 Causal mechanism and influential factor,1994 Leptin was discovered at Rockefeller University,Sources: Rockefeller Researchers Clone Gene for Obesity. December 1, 1994. Available at: http:/www.healthpolitics.com/home.asp?show=all. Underwood A, Adler J, Hand K, Ulick J. What You Dont Know About Fat. Newsweek. 2004;144:40-47.,(一) 遗传因素(inherited factors),二、肥胖的发生机制及影响因素 Causal mechanism and influential factor,Sources: Rockefeller Researchers Clone Gene for Obesity. December 1, 1994. Available at: http:/www.healthpolitics.com/home.asp?show=all. Underwood A, Adler J, Hand K, Ulick J. What You Dont Know About Fat. Newsweek. 2004;144:40-47.,(二) 环境因素(environmental factors ),Societal factors Food intake and energy expenditure Individual behavior,三、肥胖对健康的危害 Obesity Virtually Guarantees Bad Health,Diseases Tied to Obesity,“For most of evolution, getting enough to eat was a driving force for survival. How many individuals were lost to morbid obesity?”,Hypertension Type 2 diabetes High lipids Cardiovascular disease,Osteoarthritis Stroke Respiratory disease Some cancers,Sources: U.S. Department of Health and Human Services. The Surgeon Generals call to action to prevent and decrease overweight and obesity: what you can do; 2001. Underwood A, Adler J, Hand K, Ulick J. What You Dont Know About Fat. Newsweek. 2004;144:40-47.,四、Epidemiology,BMI 40: Morbidly Obese,Male 60% 29% 4% Female 78% 50% 15%,BMI 30: Obese,BMI 25: Overweight,Black,Mex. Amer.,Male 74% 29% 2% Female 72% 40% 6%,White,Male 68% 28% 3% Female 58% 31% 5%,Sources: American Obesity Association. Obesity in Minority Populations. Available at: http:/www.obesity.org/subs/fastfacts/Obesity_Minority_Pop.shtml. Accessed October 26, 2004. 2001 Obesity and Diabetes Prevalence Among U.S. Adults by Selected Characteristics. CDC. Nutrition and Physical Activity. Obesity Trends. Available at: http:/www.cdc.gov/nccdphp/dnpa/obesity/trend/obesity_diabetes_characteristics.htm. Accessed October 13, 2004.,China 22.8% 7.1%,五、肥胖的预防和治疗 Prevention and treatment,“In the human body, as in the world, if you control fuel resources, you influence a lot of other things as well.”,prosperity : calories technology: exertion indoor entertainment: sedentary behavior marketing of poor food: poorer nutrition,Sources: U.S. Department of Health and Human Services. The Surgeon Generals call to action to prevent and decrease overweight and obesity: what you can do; 2001. Newman C. Why Are We So Fat? National Geographic. August 2004. Underwood A, Adler J, Hand K, Ulick J. What You Dont Know About Fat. Newsweek. 2004;144:40-47., Dr. Gkhan Hotamisligil, Harvard School of Public Health,26,第二节 营养与动脉粥样硬化性冠心病 (Nutrition and coronary atherosclerosis),受累动脉的内膜受损,脂质条纹,平滑肌细胞的迁移增生,胶原纤维分泌,动脉内膜形成以脂质为核心，外有纤维帽包裹的典型斑块,血管管腔狭窄 堵塞导致心肌缺血缺氧,易损性斑块的破裂,预防斑块的形成,促进斑块的消退,提高斑块的稳定性,Formation of coronary atherosclerosis,一、营养与动脉粥样硬化的关系 (Nutrient and atherosclerosis),Triglyceride,Free fatty acid,Cholesterol,Cholesterol ester,Phospholipid,albumin,apoprotein,CM,VLDL,LDL,HDL,1. Plasma lipoproteins,(一)脂类与动脉硬化,lipoproteins,IDL,Dietary fat,small intestine,capillaries,Lipoprotein Lipase,FFA,Adipose, muscle,chylomicrons,chylomicrons reminants,VLDL,Lipoprotein Lipase,FFA,extrahepatic tissue,IDL,HDL,LDL,Endogenous cholesterol,Exogenous cholester