肥胖和代谢综合征PPT课件

Inflammation is the underlying cause of the metabolic syndrome
– Treatment:
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a) reduce obesity and increase activity b) insulin sensitizers c) statins, ACE Inhibitors, ARBs
– Treatment: reduce obesity and increase activity
Insulin resistance is the underlying cause of the metabolic syndrome (WHO)
– Treatment: a) reduce obesity and increase activity b) insulin sensitizers
>150 mg/dL
<40 mg/dL <50 mg/dL >130/>85 mm Hg >110 (>100)**mg/dL
** 2003 New ADA IFG criteria (Expert Panel…,Diabetes Care 26:3160-3167, 2003)
* The Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497.
**The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160-3167, 2003
WHO Metabolic Syndrome Definition 1999: Based on Clinical Criteria
Insulin resistance (type 2 diabetes, IFG, IGT)*
Plus any 2 of the following: – Elevated BP (>140/90 or drug Rx) – Plasma TG >150 mg/dl – HDL <35 mg/dl (men); <40 mg/dl (women) – BMI >30 and/or W/H >0.9 (men), >0.85 (women) – Urinary albumin >20 mg/min; Alb/Cr >30 mg/g
Novel Risk Factors
CRP PAI-1 Fibrinogen
CORONARY HEART DISEASE
Adapted from Reaven G. Drugs. 1999;58 (suppl):19-20
ATP III: The Metabolic Syndrome*
*Diagnosis is established when >3 of these risk factors are present
± Glucose intolerance
Uric Acid Metabolism
Dyslipidemia
Hemodynamic
Uric acid Urinary uric acid clearance
TG PP lipemia HDL-C PHLA Small, dense LDL
SNS activity Na retention Hypertension
The Metabolic Syndrome: Historical Perspective
1988: Syndrome X
Insulin Resistance
Glucose Intolerance
Hyperinsulinemia
TG
HDL-C Hypertension
CORONARY HEART DISEASE
Reaven G. Diabetes. 1988;37:1565-1607.
The Metabolic Syndrome: Current Perspective
Body Size BMI
Central Adiposity
Insulin Resistance
+
Hyperinsulinemia
Glucose Metabolism
Risk Factor
Abdominal obesity† (Waist circumference‡)
Men Women TG HDL-C Men Women Blood Pressure Fasting glucose
Defining Level
>102 cm (>40 in) >88 cm (>35 in)
Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes
High LDL-C
Metabolic Syndrome
Type 2 Diabetes
Coronary Heart Disease
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.
* Note that 1999 WHO uses hyperinsulinemic euglycemic clamp
Obesity and Metabolic Syndrome
Steven M. Haffner, MD
Conceptual Framework for the Metabolic Syndrome
Environmental causes are responsible for the epidemic of the metabolic syndrome (NCEP)