肥胖与代谢综合征 (2).pptVIP

肥胖与代谢综合征 * * * * * * 1947年,法国的医生Vague及其同事首先提出肥胖不是一种均一的疾病,脂肪组织的区域分布与糖代谢、脂代谢紊乱密切相关,并将肥胖分为两种类型,一种为男性型肥胖 ，又叫中心性肥胖、、苹果型肥胖;另一种为女性型肥胖，又叫下半身肥胖、梨型肥胖。 苹果型肥胖，即中心性肥胖的人会有更高的患心脏病、脑卒中和糖尿病的危险。这是因为苹果形身材的人沿身体的中部负载了过多的体重，即腹部、胸部和周围的内脏器官，如心脏。 由于肥胖的发生率很高，与肥胖相关的疾病谱涉及范围很广，尤其是心血管病，因此世界心脏联盟把今年的世界心脏日主题定为肥胖与心脏病，其中尤其强调了中心性肥胖的重要性，认为在超重和肥胖人群中，腹型肥胖是发生心血管病的最主要危险因素，同时建议将腰围测量作为常规的检测指标纳入临床诊疗过程中。 * * * * * * * * 胰岛素抵抗的基本概念，通俗地说就是身体里的胰岛素降低血糖的作用降低，造成胰岛β细胞的胰岛素过多分泌（Overproduction）来满足机体的需要，进而，胰岛过度工作，乃至衰竭。 胰岛素降低游离葡萄糖浓度的能力下降：利用和代谢葡萄糖最主要的器官脂肪和肌肉对胰岛素不敏感， 此外，胰岛素抵抗存在后，肝脏糖异生即将非糖物质转化为葡萄糖的速度加快。 * The clinical approach to obesity can be viewed as a pyramid consisting of several levels of therapeutic options. All patients should be involved in an effort to change their lifestyle behaviors to decrease energy intake and increase physical activity. Lifestyle modification also should be a component of all other levels of therapy. Pharmacotherapy can be a useful adjunctive measure for properly selected patients. Bariatric surgery is an option for patients with severe obesity who have not responded to less-intensive interventions. The number of obese patients who require a specific level of treatment decreases as one moves up the pyramid. Lifestyle modification, which involves a program of appropriate diet, physical activity, and behavior therapy, should be considered for all patients with a body mass index (BMI) ?25 kg/m2. Long-term pharmacotherapy should be considered in appropriate patients who were unable to achieve adequate weight loss after 6 months of lifestyle therapy and who have a BMI ?30 kg/m2, or ?27 kg/m2 with concomitant obesity-related disease. Bariatric surgery may be necessary in patients with severe obesity who failed to lose weight with nonsurgical therapy. Eligible surgical candidates should have a BMI ?40 kg/m2 or a BMI ?35 kg/m2 and a concomitant serious obesity-related disease. Reference 1. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in