代谢综合症肥胖、高血压、高血脂的药物治疗与饮食 控制及运动 治疗的关系，培养积极健康的 生活方式

1. 代谢综合症肥胖、高血压、高血脂的药物治疗与饮食控制及运动治疗的关系，培养积极健康的生活方式代谢综合症肥胖、高血压、高血脂的药物治疗与饮食控制及运动治疗的关系，培养积极健康的生活方式 孙鲁超 5091719014

2. Definitions • IDF(International Diabetes Federation) • Central obesity • AND any two of the following: • Raised triglycerides: > 150 mg/dL (1.7 mmol/L) • Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females • Raised blood pressure: systolic BP > 130 or diastolic BP >85 mm Hg • Raised fasting plasma glucose :(FPG)>100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes • Also WHO and NCEP(The US National Cholesterol Education Program Adult Treatment Panel)

3. Obesity • The overweight/obese children, compared to normal-wt. ones, presented significantly higher blood pressure, total-cholesterol, total-cholesterol/high d. lipoprotein cholesterol (HDL) ratio, triglycerides, Apolipoprotein（载脂蛋白）B and C-reactive protein levels, while HDL and Apolipoprotein A-I were significantly lower. At baseline, the prevalence of MS was 16.4% in overweight/obese and 0% in normal-wt. children. European Journal of Nutrition (2011), 50(6), 391-400

4. Map of dietary energy availability per person per day in 1961 (up) and 2001–2003 (down) in kcal/person/day World Resources Institute. Retrieved Oct. 18, 2009

5. Diet • Dietary guidelines for populations and individuals: • 1 The greater the variety of food in the diet, the greater the guarantee that the diet is balanced and contains all the necessary nutrients. • 2 Cereals (e.g. bread, pasta, rice), potatoes and pulses should be the base of any diet, with the result that carbohydrates represent between 50 and 60% of the energy in the diet. • 3 Fats should not exceed 30% of the daily intake, the consumption of saturated fats and trans-fatty acids should be reduced. British Journal of Nutrition (2006), 96(Suppl. 1), S8-S11

6. Diet • 4 Proteins should provide between 10 and 15% of the total energy, combining proteins of animal origin with those of vegetable origin. • 5 The daily intake of fruit and vegetables should be increased to reach at least 400 g/day, that is, at least five portions a day of these foods. • 6 The consumption of products rich in free sugars, such as sweets, cakes and soft drinks, should be moderated. • 7 The consumption of salt, from all sources, should be reduced to below 5 g/day, and the use of iodized salt promoted.

7. Diet • 8 Drink between one and two litres of water a day. • 9 Never go without a full breakfast, consisting of dairy products. cereals (e.g. bread, biscuits, breakfast cereals) and fruit, giving between 15 and 20 min to the meal • 10 Involve all members of the family in activities related to eating: shopping, planning the weekly menu, and preparing and cooking the food.

8. Physical Activity • BMI(Body mass index) was significantly associated with increased CVD(Cardiovascular disease) risk factors. • Body fatness, leisure time physical activity were associated with cardiovascular risk factors in young overweight and obese adults. • Physical activity are associated with improved cardiovascular risk factors independently of body fatness in younger overweight and obese individuals. British Journal of Nutrition (2006), 96(Suppl. 1), S8-S11

9. Physical Activity • Walking is the most common form of physical activity— it improves health in many ways and is generally safe. Therefore, brisk walking for at least 30min daily can be recommended as the principal form of physical activity at the population level. • In large, prospective, epidemiological studies, sedentary occupations and sedentary activities such as watching television and playing video games are associated with an increased risk of developing obesity and type 2 diabetes independently of physical activity in men and women. Applied Physiology, Nutrition, and Metabolism, 2007, 32:(1) 76-88

10. Treatment • The first line treatment is change of lifestyle (e.g., Dietary and physical activity). However, if in three to six months of efforts at remedying risk factors prove insufficient, then drug treatment is frequently required. • The majority of drugs that have been approved over the years for the treatment of obesity have been the so-called anorexiants.（减食欲剂）

11. Fenfluramine(芬氟拉明) • The serotonergic [5-hydroxytryptamine (5-HT)] system of the brain is known to play an important role in appetite control and the regulation of food intake. Fenfluramine stimulates central release of serotonin and inhibits serotonin reuptake, and thereby decreases food intake mainly via the serotonin 2C, 1A and 1B receptor. Neuropharmacology 59 (2010) 619-626

12. Fenfluramine • In the mid-1990s, heart valve disease was shown to be associated with the use of Fenfluramine as a diet drug. • Fenfluramine-related heart valve disease was reported both with administration of Fenfluramine alone, or in combination with phentermine (Phen), a monamine oxidase inhibitor that was co-administered to sustain Fenfluramine’s effects. • Fenfluramine was withdrawn from human use by the U.S. Food and Drug Administration in 1997. The American Journal of Pathology Volume 175, Issue 3 , Pages 988-997, September 2009

13. Sibutramine(西布曲明) • Sibutramine, an agent that blocks the reuptake of serotonin and norepinephrine by presynaptic nerve terminals and thereby induces satiety, was approved by the FDA in 1997. • The increase in the risk of cardiovascular events in the Sibutramine Cardiovascular Outcomes (SCOUT) trial could be directly related to the higher blood pressure and heart rate observed in the sibutramine-treated subjects, as compared with those receiving placebo. Alternatively, blood pressure and heart rate could simply be markers of other adverse mechanisms resulting in cardiovascular events. New England Journal of Medicine 2010;363(10):972-4

14. Conclusion • Dietary changes • Increasing physical activity Healthy Lifestyle

15. Thank You