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Obesity: Prevalence and the magnithde of the probelm In Iran Fereidoun Azizi

Obesity: Prevalence and the magnithde of the probelm In Iran Fereidoun Azizi Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Scienece s. Obesity. Definition Prevalence : - Global, national - Trends; epidemic Obesity in TLGS

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Obesity: Prevalence and the magnithde of the probelm In Iran Fereidoun Azizi

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  1. Obesity: Prevalence and the magnithde of the probelm In Iran FereidounAzizi Research Institute for Endocrine Sciences ShahidBeheshti University of Medical Scieneces

  2. Obesity • Definition • Prevalence: - Global, national - Trends; epidemic • Obesity in TLGS - Childhood and adolescent • Epigenetic influence • Prevention

  3. Definition • Obesity is an excess of fat (adipose tissue) • Ideally the diagnosis of obesity should be based on the direct demonstration of an excess amount of fat • Very few descriptions before Avicenna

  4. ADVANTAGES OF ANTHROPOMETRY • Objective with high specificity & sensitivity • Readings are numerical & gradable on standard growth charts • Readings are reproducible. • Non-expensive & need minimal training

  5. Limitations of Anthropometry • Inter-observers errors in measurement • Problems with reference standards, i.e. local versus international standards. • Arbitrary statistical cut-off levels for what considered as abnormal values.

  6. Weight classification by Body Mass Index (BMI)

  7. International cut-off points for body mass index for overweight and obesity by sex between 10 and 18 years Overweight Obesity Age( years) Source: Cole et al. BMJ 2000; 320: 1240

  8. THE GLOBAL EPIDEMIC OF OBESITY

  9. Global Deaths According to Cause and Sex, 2008 Hunter DJ. N Engl J Med 2013; 369: 1336

  10. The Weight of the World (1975-2014) NCD Risk factor collaborations, 2015: 1617 studies with 18.8 million participants, in press

  11. Global issues of obesity In 2010, elevated BMI accounted for about 2·8 million deaths each year, and diet-related risk factors (eg, low fruit consumption and high sodium intake) and physical inactivity accounted for 10% of global disability-adjusted life-years. Roberto CA, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. The Lancet. 2015; 385: 2400.

  12. Prevalence of overweight and obesity in children

  13. Prevalence trends for child overweight and obesity in the USA and eight low-income and middle-income countries Lobstein T, et al. Lancet. 2015; 385 (9986):2510-20.

  14. Proportion of Deaths from Noncommunicable Diseases among Persons Younger than 60 Years of Age, According to Income Group of Countries Hunter DJ. N Engl J Med 2013; 369: 1336

  15. Mean age-standardized levels of metabolic risk factors in relation to per-capita gross domestic product (GDP) Danaei G, et al. (Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group) Circulation 2013; 127: 1493

  16. Mean age-standardized levels of metabolic risk factors in relation to western diet. See Methods for how percentiles were calculated Danaei G, et al. (Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group) Circulation 2013; 127: 1493

  17. The deviation from national average-overweight or obese (BMI≥25), Men; IR.Iran 2007

  18. The deviation from national average-overweight or obese (BMI≥25), Women; IR.Iran 2007

  19. Male TC, BMI and SBP trends in Iran between 1980 and 2008 BMI TC SBP Female Farzadfar et al. Lancet 2011, Finucane et al. Lancet 2011, Danaei et al. Lancet 2011

  20. Number (in million) overweight and obese individuals ≥ 20 years old in Iran (2014) * Calculation for 75 million population

  21. Prevalence of diabetes among Iranian adult population across categories of general obesity (2005–2011) Esteghamati A, et al. Diabet Res ClinPract 2014; 103: 319

  22. Prevalence of diabetes among Iranian adult population across categories of central obesity (2005–2011) Esteghamati A, et al. Diabet Res ClinPract 2014; 103: 319

  23. Risk factors and influences

  24. Etiology of Obesity Energy Expenditure Sedentary lifestyle Energy Intake High fat, high-calorie diet GeneticPredisposition

  25. Tehran Lipid and Glucose Study

  26. TLGSCohort 63.2 % Phase 5 Phase 4 Phase 3 Phase 1 Phase 2 1998-2001 2011- … 2005-2008 2001-2005 2008-2011 71.9 % 57.9 % 15005 71.0 % ? Continuous NCD outcomes follow-up

  27. Deign: Prospective cohort study Participants: 6,215 subjects aged >30 years ,free of cardiovascular disease (CVD) stratified by body mass index and dysmetabolic status Length of F/U : A mean of 8.1 years Outcome: CVD Am J Cardiol 2011;107:412–416

  28. Results • The prevalence of dysmetabolic status in normal-weight, overweight , and obese participants was 12.5%, 47.1%, and 76%,respectively • Overall, of 6,215 subjects, 3.5% and 6.5% Had MNOW and MHO phenotypes respectively

  29. Kaplan-Meier curves of 8.1-year freedom from CVD by BMI and dysmetabolic status . Proportion of subjects free from cardiovascular disease Obese without dysmetabolic status (n=13) Overweight without dysmetabolic status (n=51) Normal weight without dysmetabolic status (n=64) Obese with dysmetabolic status (n=126) Overweight with dysmetabolic status (n=162) Normal weight with dysmetabolic status (n=30) Log Rank test: X2, 152; P<0.001 Years

  30. Key messages • Normal-weight subjects with dysmetabolic status had higher risk for future CVD compared to healthy obese subjects • From a clinical point of view, it seems reasonable to recommend more attention being paid to assessment of cardiovascular risk factors along with BMI status.

  31. CHD In Adolescent 3 A child who has born obese 4 Diabetes Fatty liver In Adolescent Obese Adolescent 1 2

  32. Hormonal changes in children with obesity before and after weight loss Reinehr, T. Nat. Rev. ENDOCRINOLOGY 2013; 9: 607

  33. Poor adult health type 2 diabetes mellitus, hypertension, early puberty, menstrual irregularities and polycystic ovary syndrome, steatohepatitis, sleep apnea, asthma, benign intracranial hypertension, musculoskeletal disorders, and psychological problems Lakshman R, et al. Downloaded from http://circ.ahajo1u7r7n0als.org/ by guest on June 15, 2014

  34. Prevalence of obesity among children between the ages 5.3 and 15.5 years(1998-2010)(TLGS)

  35. Trend of overweight and obesity prevalence among children in USA and Tehran USA TLGS

  36. Trend of overweight and obesity prevalence among children in USA and Tehran USA TLGS

  37. Cumulative incidence of obesity from baseline through fifth phase of TLGS, according to weight in baseline, and risk ratio for overweight versus normal weight children

  38. Annual incidence of overweight and obesity among children between phase 1 and phase 4 according to baseline weight USA TLGS

  39. Annual incidence of overweight and obesity among children between phase 1 and phase 4 according to baseline weight USA TLGS

  40. Lifestyle diseases • Lifestyle diseases (diseases of longevity or diseases of civilization) - increase in frequency as countries become more industrialized and people live longer. • These include type 2 diabetes, heart disease, metabolic syndrome, obesity, atherosclerosis, chronic renal failure, osteoporosis, stroke, depression. • Also includes Alzheimer's disease, asthma, COPD, and cirrhosis

  41. Lifestyle diseases • They are caused by an inappropriate relationship of people with their environment • Onset is insidious, they take years to develop, and once encountered are difficult cure • Potentially can be prevented by changes in diet, environment, and lifestyle

  42. Developmental Origins of Health and Disease (DOHaD) • Chronic disease outcomes have their roots in fetal and early childhood development • The world faces a crisis of increasing chronic diseases  reduction of health and welfare and increased financial burden of NCDs • This includes obesity, type 2 DM, insulin resistance, dyslipidemia, CVD and atherosclerotic disease • They are seen at a younger age as chronic disorders in childhood and adolescents • Serves as a framework to assess the effect of early nutrition and growth on long-term health

  43. Developmental plasticity and chronic diseases

  44. Epigenetics – gene environment interactions In 1957, Conrad Waddington proposed the concept of an epigenetic landscape to represent the process of cellular decision-making during development. At various points in this dynamic visual metaphor, the cell (represented by a ball) can take specific permitted trajectories, leading to different outcomes or cell fates. Goldberg AD et al. Cell 2007; 128: 635-638.

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