PATOFISIOLOGI DAN DIAGNOSA OBESITAS Bambang Suprapto

OBESITASDEFINISIKLASIFIKASISIAPA OBESE?KOMPLIKASIPENURUNAN BERAT BADANPATOFISIOLOGIDIAGNOSA

DEFISINSI OBESITASBMI >25 (ASIA)BMI>30 (EROPA + AMERIKA)KELEBIHAN LEMAK:- WANITA: N = 20 -27% BB- PRIA : N = 12 15% BB

BODY MASS INDEX BMI = BB (kg) : TB (m)2BB = Berat badanTB = Tinggi badan

LEMAK TUBUH(Deurenberg et al, 1991)% lemak = 1,2 (BMI) + 0,23(umur) 10,8 (gender) 5,4

% lemak= persen lemak tubuhBMI = kg/m2Umur = tahunGender: laki-laki = 1 wanita = 0

KLASIFIKASI OBESITAS (1)BMI (kg/m2) WHO (1995) Deskripsi populer

KLASIFIKASI OBESITAS (2)WHO (2000) WPRO (2000) < 18,5 UNDERWEIGHT < 18,5 18,5 24,9 NORMAL 18,5 22,9 25,0 29,9 Pre-obese/overweight 23,0 24,9 30,0 34,9 OBESE I 25,0 29,9 35,0 39,9 OBESE II > 30,0>40,0 OBESE IIISumber: Anuurad, et al (2003)

KLASIFIKASI OBESITAS (3)SEX-SPECIFIC CUT-OFF-POINTS FOR WAIST CIRCUMFERENCE: Level 1 Level 2(alerting zone) (action level)Men > 94 cm > 102 cmWanita > 80 cm > 88 cm(Sumber; Kopelman et al, 2005)

KLASIFIKASI OBESITAS (4)

Underweight 23,0 At risk 23,0 24,9 Increased ModerateObese class I 25,0 29,9 Moderate SevereObese Class II > 30,0 Severe Very severeBMI (Kg/m2) Risk of comorbidities Waist circumference < 90 cm (men) > 90 cm < 80 cm (women) > 80 cm

(Sumber: WHO, IASO, IOTF, 2000)

SIAPA KEGEMUKAN?FAKTOR DEMOGRAFIK (umur, gender, etnisitas)FAKTOR SOSIAL BUDAYA (tingkat pendidikan, penghasilan, status perkawinan)FAKTOR BIOLOGIS (paritas)FAKTOR PERILAKU (asupan makanan, merokok, konsumsi alkohol, kegiatan jasmani)

KOMPLIKASI OBESITASDIABETES MELLITUS TIPE 2PENYAKIT JANTUNG KORONERKANKEROSTEOARTRITISBATU EMPEDUSLEEP APNOEAGANGGUAN REPRODUKSIGANGUAN KEHAMILANGANGGUAN PSIKOLOGISSOCIAL PENALTIES

MANFAAT PENURUNAN BERAT BADAN (5-10%BB)MORTALITAS UMUM: TURUN 20%KEMATIAN AKIBAT DM: TURUN 30%KEMATIAN AKIBAT KANKER: TURUN 40%TEKANAN DARAH: TURUN 10 mm HgLIPID: CHOLESTEROL TURUN 15%DIABETES: PENGENDALIAN KADAR GULA DARAH LEBIH BAIK

PATOFISIOLOGI OBESITAS (1) ENERGY - ENERGY = ENERGY IN OUT STOREDENERGY STORED = FAT STORAGE

ENERGY STORESENERGY INTAKE ENERGY OUTPUTFecal energy(2)

PATOFISIOLOGI OBESITAS (2)MOLECULARBEHAVIORALPRADER WILLI SYNDROMEPEGULATSUMO

ADIPOSE TISSUELeptinLep-RAnabolic pathway Catabolic pathwayNeuronsNeurons POMCHypothalamusAGRP MC4R

Food intakeMSH------------- +-+-PC1

FOODENERGY INTAKEEnergy lostIn facesENERGY IN CIRCULATIONEnergy lostIn urineEnergyabsorbedBodyEnergystoresFat (77%)Protein (22%)Glycogen(

Components of energy expenditureBMRTEF-------------------------Spontaneous activityEXERCISERestingMetabolic RateNon restingMetabolicrate_________________Beyond

Voluntary

control

BASAL METABOLIC RATE% body weight % BMR Skin,bone,gut: 33%Adipose tissue: 21%Skeletal muscle: 40%Organs (brain, liver, heart, kidney):

THERMOGENESISISOMETRIC THERMOGENESISDYNAMIC THERMOGENESISPSYCHOLOGICAL THERMOGENESISCOLD-INDUCED THERMOGENESISDIET-INDUCED THERMOGENESISDRUG-INDUCED THERMOGENESIS

CONTROL OF FOOD INTAKEHUNGER-SATIETY CONTROL CENTRES IN THE BRAIN:-NPY/AgRP NEURONS = OREXIGENIC- POMC/CART NEURONS= ANOREXIGENIC- LATERAL HYPOTHALAMUS = OREXIGENIC

HUNGER-SATIETY SIGNALS FROM THE PERIPHERYSIGNALS FROM THE GASTROINTESTINAL TRACTAMINOSTATIC SIGNALSGLUCOSTATIC AND GLYCOGENOSTATIC SIGNALSLIPOSTATIC AND ADIPOSITY SIGNALSLEPTIN AND INSULINHEPATIC NUTRIENT METABOLISM SIGNALS

INTEGRATED MODELS OF FOOD INTAKE CONTROLSHORT-TERM (HOUR TO HOUR) BLOOD GLUCOSE HOMEOTSTASISMEDIUM-TERM (DAY-TO-DAY) MAINTENANCE OF ADEQUATE HEPATIC STORES OF GLYCOGENLONG-TERM (WEEKS, MONTHS OR YEARS) MAINTENANCE OF THE BODYS FAT AND PROTEIN COMPARTMENTS

Blood metabolites Higher centres Gut Glucose Cognition CCK Fatty acids Sensorial Ghrelin Amino acids Learning GIP.GLP-1,PYYEPISODIC SIGNALSHYPOTHALAMUSSNSEnergyexpenditureADIPOSE TISSUEEnergy intakeTONIC SIGNAL Leptin Insulin

Major effectsMinor effectsAdditive over timeOutcomeLow SESGenderEnvironmentEconomicsNutritionActivityInactivitySmokingPrevalence ofoverweight orobesity+Schematic representation of the determinants ofOverweight and obesity

ENERGY BALANCEINTAKE EXPENDITUREIntake>>Expenditure ObesityIntake

DIAGNOSA OBESITASBMI > 25; BMI>30TRICEPS SKINFOLD:LAKI-LAKI > 16 MM WANITA > 28 MMWAIST CIRCUMFERENCELAKI-LAKI: > 102 CMWANITA : > 88 CM