View
230
Download
2
Category
Tags:
Preview:
Citation preview
יתר השמנת
ע" חמד
26.1.06
פרופ' ארדון רובינשטין
BMI-Associated Disease RiskClassification
BMI (kg/m2)
Risk
Underweight<18.5Increased
Normal18.5-24.9Normal
Overweight25.0-29.9Increased
ObeseI30.0-34.9High
II35.0-39.9Very High
III>40Extremely highAdditional risks:• Large waist circumference (men>40 in; women >35 in)• 5 kg or more weight gain since age 18-20 y• Poor aerobic fitness• Specific races and ethnic groups
0
10
20
30
40
50
60
70
Bod
y F
at
(%)
Body Mass Index (kg/m2)
Women
Men
Relationship Between BMI and Percent Body Fat in Men and
Women
Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome
Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosis
Coronary heart diseaseCoronary heart disease
DiabetesDiabetes
DyslipidemiaDyslipidemia
HypertensionHypertension
Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome
OsteoarthritisOsteoarthritis
SkinSkin
Gall bladder diseaseGall bladder disease
CancerCancerbreast, uterus, cervixbreast, uterus, cervixcolon, esophagus, pancreascolon, esophagus, pancreaskidney, prostatekidney, prostate
PhlebitisPhlebitisvenous stasisvenous stasis
GoutGout
Medical Complications of Obesity
Idiopathic intracranial Idiopathic intracranial hypertensionhypertension
StrokeStroke
Severe pancreatitisSevere pancreatitis
CataractsCataracts
37.8
10.4
41.1
11.8
39.1
12.2
39.4
19.9
0
10
20
30
40
50
BMI 25-29.9 BMI >30
NHES (1960–62) NHANES I (1971–74)
NHANES II (1976–80) NHANES III (1988–94)
Age-Adjusted Prevalence ofOverweight and Obesity in
Men
Perc
en
t
_
Age-Adjusted Prevalence of Overweight and Obesity in
Women
23.6
15.1
23.6
16.1
24.3
16.3
24.7 24.9
0
10
20
30
40
50
BMI 25-29.9 BMI > 30
NHES (1960–62) NHANES I (1971–74)
NHANES II (1976–80) NHANES III (1988–94)
Per
cen
t
_
Obesity Trends* Among U.S. Adults: BRFSS, 1988
(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults: BRFSS, 1994
(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends Among* U.S. Adults: BRFSS, 2000
10.812.5
19.1 20.3 19.7
33.2
23.9
41.2
0
10
20
30
40
50
Men
Women
% Distribution of BMI >30 kg/m% Distribution of BMI >30 kg/m22 by Ageby Agein 695 Men & 1020 Women in Israel, 2000in 695 Men & 1020 Women in Israel, 2000
25-34 35-4425-34 35-44 45-54 55-65 years 45-54 55-65 years
0
5
10
15
20
25
30
Austral China Czech Fin Germ Isr Spain Swed UK USA Yugos
MenWomen
Obesity BMI>30 in Israel, 2000 : comparison Obesity BMI>30 in Israel, 2000 : comparison withwithcountries: WHO Monica 1987-92, Obes Res countries: WHO Monica 1987-92, Obes Res 19991999
%
%
Pre
vale
nce
Pre
vale
nce
Obesity (BMI>30) among females by ethnicity & Obesity (BMI>30) among females by ethnicity &
years of education (%)First National Health & years of education (%)First National Health &
Nutrition Survey (MABAT) 1999-2000Nutrition Survey (MABAT) 1999-2000
26.924.4
16.1 14.8
65.9
21.9
1013.7
0
10
20
30
40
50
60
70
80
0-8 8-11 12 >12
Jews Arab
Diabetes (%) among Jews & Arabs aged 25-64 by sex & years of education
12.0
7.45.4 5.8
18.4
6.1 4.8 0.90
5
10
15
20
<=8 9-11 12 >12(academic)
Years of education
Perc
ent
First National Health & Nutrition Survey First National Health & Nutrition Survey (MABAT),1999-2000(MABAT),1999-2000
males
females
11.515.2
5.1 3.7
18.6
0.0 4.7 4.7
0
5
10
15
20
<=8 9-11 12 >12(academic)
Years of education
Perc
ent
JewsJews
ArabsArabs
NHANES III Prevalence of Hypertension* According to BMI
14.9 15.2
22.127.727
32.7
41.937.8
0
10
20
30
40
50
Men Women
BMI <25 BMI 25-<27 BMI 27-<30 BMI > 30
Perc
en
t
Prevalence of Hypertension* According to BMI by Sex
Perc
en
t
14.9
22.127
41.9
15.2
27.732.7
37.8
0
10
20
30
40
50
<25 25-<27 27-<30 >30
Men Women
BMI Levels
_
Obesity and Diabetes Risk
0
20
40
60
80
100
<20 20-25 25-30 30-35 35-40 >40
BMI Levels
Incid
en
ce o
f N
ew
Cases
per
1,0
00 P
ers
on
-Years
0
25
50
75
100
Relationship Between BMI and Risk of Type 2 Diabetes
Age-A
dju
sted R
ela
tive R
isk
Body Mass index (kg/m2)
MenMen
>22 >23 23-
23.9
24-
24.9
25-
26.9
27-
28.9
29-
30.9
31-
32.9
33-
34.9
35+
1.0
2.91.0
4.31.0
5.01.5
8.12.2
15.8
4.4
27.6
40.3
54.0
93.2
6.711.6
21.3
42.1
WomenWomen
Metabolic Syndrome
•Abdominal obesity
•Hyperinsulinemia
•High fasting plasma glucose
•Impaired glucose tolerance
•Hypertriglyceridemia
•Low HDL-cholesterol
•Hypertension
Clinical Identification of the Metabolic Syndrome*: NCEP-ATP III
*Diagnosis is established when >3 of these risk factors are present
Risk FactorDefining Level
Abdominal obesity
(Waist circumference)
Men>102 cm (>40 in)
Women>88 cm (>35 in)
TG>150 mg/dL
HDL-C
Men<40 mg/dL
Women<50 mg/dL
Blood pressure>130 / >85 mm Hg
Fasting glucose>110 )<100(** mg/dL
** 2003 New ADA IFG criteria (Diabetes Care)
Metabolic Syndrome :Impact on Mortality
0
5
10
15
20
25
All- cause Mortality Cardiovascular Mortality
Mort
alit
y R
ate
(%
) Without metabolic syndromeWith metabolic syndrome
*P < 0.001.
Metabolic Syndrome: Impact on Cardiovascular Health
0
5
10
15
20
25
CHD MI Stroke
Pre
vale
nce
(%
)
Without metabolic syndromeWith metabolic syndrome
*P < 0.001.
26- Year Incidence of Coronary Heart Disease in Men
177
255
350333366
440
0
100
200
300
400
500
600
<25 25-<30 30+
<50 years 50+ years
Incid
en
ce/
1,0
00
BMI Levels
0.6
1.0
1.4
1.8
2.2
2.6
3.0
Relationship Between BMI and Cardiovascular Disease Mortality
Rela
tive R
isk
of
Death
Body Mass index
<18.5
MenMen
18.5–
20.4
20.5–
21.9
22.0–
23.4
23.5–
24.9
25.0–
26.4
26.5–
27.9
28.0–
29.9
30.0–
31.9
32.0–
34.9
35.0–
39.9
>40.0
Lean Overweight
Obese
WomenWomen
Relationship of BMI to Excess Mortality
Mort
ality
Rati
o
Body Mass Index (kg/[m2])
300Age at Issue
20-29250
200
150
100
50
150
30-39
20 25 30
Low
Risk
4035
High
Risk
Moderate
Risk
0
10
20
30
40
50
60
Direct Cost * of Chronic Diseases in the United States
Dir
ect
Cost
($ B
illio
ns)
Type 2Diabete
s
*Adjusted to 1995 dollars.
Obesity CoronaryHeart
Disease
Hyper-tension
Stroke
$18.1$18.4
$38.7
$51.6$53.2
0
10000
20000
30000
40000
Effect of Obesity on Expected Lifetime Medical Care Costs* in
Men
Costs
($)*
Body Mass Index (kg/m2)
32.5 27.537.5
55-6445-54
*Total cost of CHD, type 2 DM, hypertension, hypercholesterolemia, stroke
Age (y)
35-4422.5
$0
$2,000
$4,000
$6,000
$8,000
$0
$400
$800
$1,200
$1,600
Economic Effect of Obesity to Business: 3-Year Costs to First Chicago NBD
*BMI >27.8 kg/m2 in men; >27.3 kg/m2 in women.
AbsenteeismHealthcare
LeanLean
$4,496
$6,822
$683
$1,546
ObeseObese**
Recommended