Mexitalia Persagi Obesitas 14.02.2015 wt -...
Transcript of Mexitalia Persagi Obesitas 14.02.2015 wt -...
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DAMPAK OBESITAS TERHADAP KESEHATAN
Maria Mexitalia Departemen IKA Fakultas Kedokteran Undip / RSUP Dr. Kariadi SEMARANG
Obesitas merupakan penimbunan jaringan lemak tubuh secara
berlebihan
§ Sebagian besar obesitas yang terjadi
pada orang tua dimulai sejak masa
anak
TANDA KLINIS OBESITAS § Wajah membulat § Pipi tembem § Dagu rangkap § Leher relatip pendek § Dada membusung dengan payudara membesar § Perut membuncit dan berlipat § Tungkai X, saling gesek § Penis kecil tersembunyi
Z-score
Indikator Pertumbuhan
TB/U BB/U BB/TB BMI/U
Di atas +3 Obese (kegemukan)
Obese (kegemukan)
Di atas +2 Overweight (BB lebih)
Overweight (BB lebih)
Di atas +1 Possible risk of overweight (Berisiko BB lebih)
Possible risk of overweight
(Berisiko BB lebih)
Median (nol)
Gizi Baik
Di bawah -1
Di bawah -2 Perawakan pendek
BB kurang Gizi kurang Gizi kurang
Di bawah -3 Perawakan sangat pendek
BB sangat kurang
Gizi buruk Gizi buruk
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The importancy of early life nutri2on for human being
CR DRS2013
Growth and muscle mass body composi5on
Perawakan pendek (stunted)
2007 % 2010 %
WHO 2006 (0-5 years)
39274 38.6 8653 41.7
(Sjarif DR, 2011)
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Stun2ng syndrome
( Branca & Ferrari, 2002)
Metabolic Programming
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Non Alcoholic Fatty Liver Disease (NAFLD)
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Metabolic Syndrome
Triglyceride ↑ ≥ 150 mg/dl
HDL cholesterol ↓ < 40 mg/dl
Waist circumference ≥ Percentile 90th
Fasting Glucose ↑ ≥ 100 mg/dl
METABOLIC RISK FACTORS
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Systolic Blood Pressure ≥ 130 mmHg Diastolic Blood Pressure ≥ 85 mmHg
International Diabetes Federation 2007
Six studies of metabolic syndrome 1. Metabolic syndrome in obese adolescents 2. The association of adiponectin level and non-alcoholic
fatty liver disease (NAFLD) in obese adolescent
3. Aspartat amino transferase-platelet ratio index (APRI) and body mass index in fatty liver children.
4. Early risk of atherosclerosis and metabolic syndrome in nonalcoholic fatty liver Indonesian children
5. The effects of diet and exercise on body mass index, physical fitness, hsCRP and lipid profile in obese children
6. Effect of diet modification to fibrosis chirossis index (FCI) in adolescent with NAFLD
Metabolic syndrome in obese adolescents
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Methods § Cross sectional study, 116 students
§ Junior High School (Domenico Savio)
§ Anthropometric, blood pressure, lipid profile
§ Metabolic syndrome : § Presence of ≥ 3 risk factors (NCEP – ATP III for
adolescents). § Waist circumference (based on p > 90th in the same
school measurement for 1155 students at 2005) § Male 93 cm, Female 87 cm
Triglyceride ↑ ≥ 110 mg/dl
HDL cholesterol ↓ ≤ 40 mg/dl
Waist circumference ≥ Percentile 90th
Fasting Glucose ↑ ≥ 110 mg/dl
METABOLIC RISK FACTORS
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Blood pressure ↑ ≥ Percentiie 90th
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Criteria for the Metabolic Syndrome NCEP – ATP III for adolescents
Characteristic of the subjects
BOYS
GIRLS
Obese n=57
Normal n=25
p Obese n=22
Normal n=12
p
Weight (kg) 70.2 (10.0) 43.2 (0.3) <0.001 69.2 (0.6) 45.0 (3.5) <0.001
Height (cm) 156.0 (7.2) 160.0 (7.3) 0.893 154 (6.2) 154 (4.3) 0.898
BMI (kg/m2) 28.8 (2.9) 18.4 (1.1) <0.001ª 29.1 (2.5) 19.0 (0,6) <0.001ª
Body fat (%) 33.5 (7.5) 18.9 (5.4) <0.001 37.7 (4.0) 25.7 (1.1) <0.001
Waist (cm) 93.3 (8.1) 66.6 (3.6) <0.001ª 83.9 (6.2) 65.7 (5.0) <0.001a
Systolic BP (mmHg)
121 (10.7) 115 (8.5) 0.042 120 (11.2) 112 (6.1) 0.013
Diastolic BP (mmHg)
77 (9.7) 71 (8.0) 0.190 79 (8.1) 120 (11.2) 0.002ª
* Mann-Whitney
Laboratory findings
Boys
Girls
Obese n=57
Normal n=25
p Obese n=22
Normal n=12
p
Blood glucose (mg/dl)
97.0 ± 10.1 91.2 ± 8.0 0.006 93.6 ± 8.4 90.5 ± 6.6 0.272
Total cholesterol (mg/dl)
183.0 ± 38.1 157.3 ± 25.0 <0.001 184.6 ± 36.0 173.3 ± 22.3 0.331
HDL (mg/dl) 47.8 ± 9.4 49.5 ± 9.7 0.350 50.1 ± 9.6 50.2 ± 9.0 0.971
LDL (mg/dl) 110 ± 35.8 93.0 ± 21.1 0.004ª 112.8 ± 32.0 105.4 ± 23.3 0.736 ª
* Mann-Whitney
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Prevalence risk factors of metabolic syndrome
Percentage (CI 95%)
Risk Factors ≥ 1
Risk Factors ≥ 2
Risk Factors ≥ 3*
Risk Factors ≥ 4*
Sex Boys
(n=82) 73.2 (63.6-82.8) 42.7 (31.9-53.4) 25.6 (15.5-35.7) 9.8 (3.4-16.2)
Girls (n=34)
70.6 (55.3-85.9) 38.2 (21.9-54.5) 11.8 (4.4-19.2) 0
Nutritional Status
Normal (n=79)
51.4 (35.3-67.5) 10.8 (0.7-20.8) 0 0
Obese (n=37)
82.3 (73.9-90.7) 55.7 (44.7-66.6) 31.6 (21.3-41.8) 10.1 (3.5-16.7)
§ 31.6% obese adolescents meet the criteria of metabolic syndrome (> 3 criteria) and 10.1% (> 4 criteria)
§ USA (NHANES III) § 28.7% (>3 criteria) § 5,8% (> 4 criteria)
Cook, Arch Pediatr Adolesc Med 2003
§ Australia : § Boys 73.5% and girls 44.4% (> 2 criteria)
Denney-Wilson E, Arch Pediatr Adolesc Med 2008
Early risk of atherosclerosis and metabolic syndrome in nonalcoholic fatty liver Indonesian children
Natural History of Atherosclerosis
Endothelial dysfunction Fatty streak
0 years
10 20
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Natural History of Atherosclerosis
Fibrous plaque Calcification, hemorrhage, ulceration, thrombosis
20
years
30 40
Method § Cross sectional study, 72 subjects.
§ Obesity and NAFLD (n = 19), Obesity non NAFLD (n = 17), control healthy children (n= 36)
§ Anthropometry, blood pressure (BP), lipid profile, alanine transaminase (ALT), homeostatic model (HOMA) for insulin resistance (IR), adiponectin, and hsCRP as early marker for atherosclerosis were measured.
§ Metabolic syndrome (MetS) : International Diabetes Federation (IDF) consensus 2007.
§ The data were analyzed by ANOVA, spearman correlation and linear multivariate regression.
Conclusion § Risk of Mets adolescents to get NAFLD was 5.6 times
(OR 5.60; 95%CI 1.51-20.77)
§ There was positive correlation between waist circumference, body fat percentage, lipid profile, liver function test (ALT) and insulin resistance with hcCRP as early marker for atherosclerosis.
Adulthood
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Overview of Diabetes in the United States
Insulin Resistance
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Natural History of Type 2 Diabetes Development of Type 2 Diabetes
Relationship Between Obesity and Insulin Resistance and Dyslipidemia
Insulin Resistance: Associated Conditions
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Cardiovascular Disease and Diabetes
Probability of Death From CHD in Patients With Type 2 Diabetes With or Without Previous MI
International Diabetes Federation Definition:
Abdominal obesity plus two other components: elevated BP, low HDL, elevated TG, or impaired fasting glucose
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Summary § NAFLD in obese adolescents was associated
with metabolic syndrome. § Children with NAFLD may be at a higher risk for
cardiovascular disease than children without NAFLD.
§ Abdominal obesity will increase the risk of metabolic syndrome and cardiovascular disease
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