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9/25/2014

9/25/2014. قلب و عروق. 1. Central obesity By : Dr. H – Aghajani Interventional cardiologist NCDC Director Ministry of Health and Education. Approximately 2/3 billion adult : overweight More than 700 million adult : obese. WHO predict by 2015:.

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9/25/2014

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  1. 9/25/2014 قلب و عروق 1

  2. Central obesity By : Dr. H – Aghajani Interventional cardiologist NCDC Director Ministry of Health and Education

  3. Approximately 2/3 billion adult : overweight More than 700 million adult : obese WHO predict by 2015:

  4. An estimated 300 million people around the world are obese as defined by a body mass index (BMI) of 30 or more At least 155 million school-age children worldwide are overweight or obese

  5. In the world: • By 2015, an estimated 20 million people will die from cardiovascular disease every year, mainly from heart attacks and strokes (WHO) • Despite the decline in the number of deaths in the developed world, CVD is still pre-eminent as a public health issue. EPIDEMIOLOGY

  6. IHD is responsible for all deaths in 2004 and is estimated to be 14.2% in 2030 In the developing world the prevalence of the risk factors for CVD is increasing

  7. 17.5 million people died from cardiovascular disease in 2005, representing around 30 % of all global deaths 7.6 million deaths were due to heart attacks and 5.7 million were due to stroke 80% of these deaths occurred in low and middle income countries In EMRO: CVD is 31% of all Death causes

  8. Lancet 2007 ; 370:1929 -38

  9. In Iran: Chronic NCDs are 79% of death causes and 85%of diseases burden CVD is the first cause of death(46%) and IHD is the main causes

  10. Comparison of some Risk factors Iran and EMRO Region

  11. Food Environment – Influencing Factors(Causal Web of influence on the prevalence of obesity – Harris, University of North Carolina) Macro physical, cultural, economic and social environment Household/individual/social/ demographic/economic Dietary intakes Energy expenditures Obesity Psychological/behavioural Clinical Biological (genetic, neurochemical, etc) Emerging adulthood Young adulthood Older adulthood Childhood Adolescence

  12. Cardiovascular diseaseRiSK FACTORS • Sedentary lifestyle • Diabetes • Hypertension • Obesity • Stress • Hostile personality • Cigarette smoking • Anabolic steroids • Amphetamines • Oral contraceptives • Diet high in saturated fats • Heredity

  13. Cvd relative RISK FACTORS - EMRO

  14. Excessivefood intake Physicalinactivity Smoking Stress Obesity Atherosclerosis Atherosclerosis Hypertension Diabetes Dyslipidaemia Arterial & venous thrombosis/ cardiac & cerebral events Arrhythmia Chronic heart failure Life style is a Driver of CVD Life style intervention Risk factor modification

  15. Unmet clinical needs to address in the next decade HDL-C TNF IL-6 Insulin AbdominalObesity Glu TG PAI-1 Major Unmet Clinical Need Novel Risk Factors Classical Risk Factors Metabolic syndrome  LDL-C  BP Smoking T2DM CARDIOVASCULAR DISEASE

  16. Properties of key adipokines IAA: intra-abdominal adiposity Marette 2002

  17. Health threat from abdominal obesity is largely due to intra-abdominal adiposity Increased Cardiometabolic Risk Abdominal Obesity Dyslipidemia Hypertension Glucose Intolerance Insulin Resistance Intra-Abdominal Adiposity Adapted from Eckel et al 2005

  18. Why is abdominal obesity harmful? Abdominal obesity is often associated with other CV risk factors is an independent CV risk factor Adipocytes are metabolically active endocrine organs, not simply inert fat storage Wajchenberg 2000

  19. Multiple cardiovascular risk factors drive adverse clinical outcomes Increased Cardiometabolic Risk Abdominal obesity Dyslipidaemia Hypertension Glucose intolerance Insulin resistance Metabolic Syndrome

  20. Direct observations show that abdominal (visceral) obesity is more closely associated to NIDDM than CVD, while an increased WHR without obesity may be more closely linked to CVD than NIDDM. Ann Med. 1992 Feb;24(1):15-8.

  21. For a 1 cm increase in WC, the relative risk (RR) of a CVD event increased by 2% (95% CI: 1-3%) overall after adjusting for age, cohort year, or treatment. For a 0.01 U increase in WHR, the RR increased by 5% (95% CI: 4-7%). These results were consistent in men and women. Eur Heart J. 2007 Apr;28(7):850-6. Epub

  22. Abdominal obesity andincreased risk of CHD Waist circumference was independently associated with increased age-adjusted risk of CHD, even after adjusting for BMI and other CV risk factors 3.0 2.44 2.31 p for trend = 0.007 2.5 2.06 2.0 Relative risk 1.5 1.27 1.0 0.5 0.0 <69.8 69.8-<74.2 74.2-<79.2 79.2-<86.3 86.3-<139.7 Quintiles of waist circumference (cm) Rexrode et al 1998

  23. Abdominal obesity and increased risk of cardiovascular events Men Women Tertile 1 <95 <87 Waistcirc. (cm): Tertile 2 95–103 87–98 Tertile 3 >103 >98 The HOPE Study 1.4 1.35 1.29 1.27 1.17 1.2 1.16 1.14 Adjusted relative risk 1 1 1 1 0.8 CVD death MI All-cause deaths Adjusted for BMI, age, smoking, sex, CVD disease, DM, HDL-C, total-C Dagenais et al 2005

  24. Unmet clinical need associated with abdominal obesity CV risk factors in a typical patient with abdominal obesity Patients with abdominal obesity (high waist circumference) often present with one or more additional CV risk factors

  25. Abdominal obesity increases the risk of developing type 2 diabetes 24 20 16 Relative risk 12 8 4 0 <71 71–75.9 76–81 81.1–86 86.1–91 91.1–96.3 >96.3 Waist circumference (cm) Carey et al 1997

  26. High waist circumference is associated with multiple cardio vascular risk factors US population age >20 years 30 20 Prevalence of high waistcircumferenceassociated with (%) 10 0 LowHDL-Ca HighTGb HighFPGc HighBPd >2 riskfactorse a<40 mg/dL (men) or <50 mg/dL (women); b>150 mg/dL; c>110 mg/dL; d>130/85 mmHg; eNCEP/ATP III metabolic syndrome NHANES 1999–2000 cohort; data on file

  27. Prevalence pattern of obesity in iran-2007 Female Male

  28. Prevalence pattern of Overweight & obesity in iran-2007 Male Female

  29. %

  30. Waist circumference (f>88,m>102), NATIONAL SURVEY 2007- IRAN

  31. MEAN Waist circumference IN 4 NATIONAL SURVEY IN IRAN

  32. Relationship between Waist circumference & Bp≥140/90 mmHg&FBS ≥126 mg/dl, Iran-2007 RR

  33. Obesity and Cancer Obesity is associated with the following types of cancer: colon breast (postmenopausal) endometrium (the lining of the uterus) kidney gallbladder pancreas esophagus National Cancer Institute

  34. In 2002, an estimated 41,000 new cases of cancer in the United States were due to obesity. About 3.2 percent of all new cancers are linked to obesity (1). 14% of deaths from cancer in men & 20% of deaths in women were due to overweight and obesity(2). Obesity and Cancer 1. Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421. 2. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of Medicine 2003; 348(17):1625–1638.

  35. Obesity and physical inactivity may account for 25%-30% of cancer of the colon, breast (postmenopausal), endometrial, kidney, and esophagus Preventing weight gain can reduce the risk of many cancers. Healthy eating and physical activity early in life can prevent overweight and obesity. Obesity and Cancer National Cancer Institute

  36. Intervention Sessions address: • Parents as role models of eating and exercise behavior • Nutrition: Moderating Portion Sizes • Fruits and Vegetables • Family Meals • Physical Activity

  37. Session Topics (continued) • The Feeding Relationship • Mindful Eating • Resisting Media Influences • Healthy Body Image and Dealing with Teasing

  38. Early Intervention • Adult interventions have had poor outcomes • Treating childhood overweight is an important strategy for the prevention of adult obesity.

  39. Adolescent Intervention • Physical Activity Intervention • monitored, structured physical activity session one day each week • two additional days of physical activity at YMCA • Behavioral Intervention • intake behavioral specialist • bi-weekly, ongoing, structured, same gender groups • homework is assigned and goal monitoring t • Nutrition Intervention • 30 minute twice-monthly meetings with the dietitian

  40. A New Approach Our intervention will incorporate an intensive parental intervention within an established adolescent program (TEENS Program).

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