1 / 22

Adipositas en galsteenlijden

Adipositas en galsteenlijden. Jaap Seidell, VU en VU medisch centrum, Amsterdam, Netherlands. Delft, 26 januari 2010. " Benefits Supervisor Sleeping “, Lucian Freud.

adolfo
Download Presentation

Adipositas en galsteenlijden

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adipositas en galsteenlijden Jaap Seidell, VU en VU medisch centrum, Amsterdam, Netherlands Delft, 26 januari 2010

  2. "Benefits Supervisor Sleeping“, Lucian Freud Thursday, May 15, 2008 Obesity Allows Artist to Hit the Jackpot With the sale Freud gained the honour of his painting selling for the highest dollar value of any painting ever painted by a living artist ($33.6 million dollars).

  3. Obesity in the Netherlandsadults- self reported height and weight CBS

  4. Incidence of cholecystectomy plus symptomatic gallstones per 100,000 person years in women (Stampfer et al, AJCN, 1992) Rell. Risk Body mass index

  5. Inpatient hospital days per 1000, person-years in women by weight status. (Liu et al, J Publ Health 2008) Adjusted for age, SES, smoking, alcohol, parity, HRT, disease history

  6. Incidence of gallstone disease in US men (Tsai et al, AJCN 2004) Rell. Risk Waist circ. (cm) Adjusted for age, PA, fiber, diuretics, NSAID, smoking, alcohol, caffeine, energy intake

  7. Weight change and risk for gallbladder disease Stampfer et al, AJCN 1992

  8. Mechanisms linking obesity and gallbladder disease • Defective gallbladder motility ? • Hyperinsulinemia (increased heapic cholesterol secretion / supersauration (through HMG CoA, or hepatic LDL receptors). • Dieting (e.g. fat restrtiction/ bariatric surgery). • Confounders: thiazide diuretics, fiber intake, PA, alcohol

  9. Determinants of obesity- foresight UK, 2007

  10. Relative risks associated with obesity

  11. The larger the reduction in body weight • the lower the risk of diabetes during the study - DPS Weight change (%) from baseline to year 1 OR Quintile Mean Range for DM 95% CI 1 -11 -22; -7 0.17 (0.05-0.50) 2 -5 -7; -3 0.39 (0.17-0.92) 3 -2 -3; -1 0.87 (0.43-1.76) 4 +0 -1; +1 1 5 +3 +1; +16 2.18 (1.15-4.15)

  12. Reduction of the risk of diabetes with • the lifestyle intervention was largest • in the lowest baseline BMI tertile - DPS BMI Relative 95% CI (kg/m2) Risk < 28.6 0.22 0.06 - 0.77 28.6 - 32.1 0.34 0.15 - 0.79 32.2 - 0.59 0.31 - 1.09

  13. Obese patients have unrealistic weight loss goals

  14. Ketenzorgproject Intensieve zorg voor patiënten met co-morbiditeit en ernstige Beperkingen(2e/3e lijn) hoger obesitas Preventie ernstige obesitas Professionele behandeling in de eerste lijn Afhanke-lijkheid / Kosten Vroegsignalering Advisering en ondersteuning/ zelfmanagement overgewicht gezondheidsbevordering/ advies op maat lager

  15. Ketenzorgproject: partners Isala klinieken, MCC-klik hoger obesitas Preventie ernstige obesitas MCC-klik, Progez, Icare (thuiszorg), Achmea Groene Land Afhanke-lijkheid / Kosten Icare (thuiszorg) GGD IJssel-Vecht, Sportservice Zwolle overgewicht gezondheids- bevorderende instellingen lager

  16. Conclusies • Obesitas is een belangrijke determinant van galsteenlijden • Gewichtsverlies is onafhankelijk daarvan ook een voorspeller. • Preventie en goede ketenzorg bij obesitas kunnen belangrijke bijdragen leveren aan preventie van gaklsteenlijden • Organisatie van de zorg (preventie in zorg) zal de komende jaren worden verbeterd (partnerschap overgewicht)

More Related