1、张慧颖Bibliography 儿童少年卫生学儿童少年卫生学（第（第6版），季成叶主编。版），季成叶主编。人民卫生出版社人民卫生出版社 Falkner F.and Tanner J.M.Human GrowthHuman Growth.Plenum Press.New York and London Lowrey GH.Growth and development of children.7th ed,Chicago,London:Year Book Medical Publishers 现代儿童少年卫生学现代儿童少年卫生学，叶广俊主编。人民，叶广俊主编。人民卫生出版社卫生出版社 儿童少年生长
2、发育儿童少年生长发育唐锡麟唐锡麟 人民卫生出版社人民卫生出版社I.General1997,WHO formally announced that obesity is a disease obesity will become the biggest enemy to threaten human health and life satisfaction in 21 century -IOTF 国际肥胖特别工作组国际肥胖特别工作组International Obesity Task Force II.Defining Obesityu Obesity is defined as an exce
3、ssive accumulation of body fat.increasing of body fat cell enlargement of body fat cellTwo types:n Primary obesityn Secondary obesity肥胖，是一种常肥胖，是一种常见的营养代谢疾见的营养代谢疾病，病，是指由于营是指由于营养过剩、缺乏运养过剩、缺乏运动以及遗传因素动以及遗传因素共同作用引起的共同作用引起的身体内脂肪过度身体内脂肪过度堆积的现象，表堆积的现象，表现为全身脂肪组现为全身脂肪组织异常性的增加织异常性的增加III.Screening obesityu eyeb
4、all testu weight-for-heightu body mass indexu body fat content u waist/hip ratiou weight-for-height 身高标准体重身高标准体重 Under 60%serious malnutrition 60-80%moderate malnutrition 80-90%mild malnutrition 90-110%Normal 110-120%Overweight 120-130%mild obesity 130-150%moderate obesity above 150%serious obesityO
5、besity:scale by BMIBMI=Weight(kg)Height(m)2 Overweight Obesity China 24 28 WHO 25 30Classification of body weight WHO and NHLBI classification of BMIBMICLASSIFICATIONWHO and NILBI CHINA 18.5 Underweight 18.524.9 24Normal range 25.029.2 24.027.9Overweight 30.034.9 28.0Obese class 1 35.039.9 Obese cla
6、ss 2 40.0Obese class 3NHLBI:National Heart,Lung,and Blood InstituteAdapted from Mckdad AH,et al.JAMA.1999;282:1519-1522中国学龄儿童青少年超重、肥胖筛查中国学龄儿童青少年超重、肥胖筛查BMIBMI分类标准分类标准年龄（岁）年龄（岁）男男-超重超重 男男-肥胖肥胖 女女-超重超重 女女-肥胖肥胖 7 17.419.217.218.9 8 18.120.318.119.9 9 18.921.419.021.0 10 19.622.520.022.1 11 20.323.621.12
7、3.3 12 21.024.721.924.5 13 21.925.722.625.6 14 22.626.423.026.3 15 23.126.923.426.9 16 23.527.423.727.4 17 23.827.823.827.7 18 24.028.024.028.0 Waist-to-hip ratio(WHR):fat distributionWAIST-HIP RATIO(WHR)腰臀比腰臀比 Most people store their body fat in two distinct ways:around their middle(apple shape)aro
8、und their hips(pear shape).Women Women 0.8 0.8Man Man 0.95 0.95BMI -WHRWaist circumference:腰围腰围 best indicator of visceral fat80 cm=increase risk90 cm=increase riskcmWHO 推荐：推荐：肥胖度肥胖度=实际体重实际体重(kg)身高标准体身高标准体重重(kg)/身高标准体重身高标准体重(kg)100%凡肥胖度凡肥胖度20%，两处的皮下脂肪厚度，两处的皮下脂肪厚度80百分位数或其中一处皮下脂肪厚度百分位数或其中一处皮下脂肪厚度95 百百
9、分位数者为肥胖儿童分位数者为肥胖儿童凡肥胖度凡肥胖度10%，无论两处的皮下脂肪厚，无论两处的皮下脂肪厚度如何，均为体重正常儿童度如何，均为体重正常儿童皮褶厚度（皮褶厚度（skinfold thickness）：测量右侧）：测量右侧肱三头肌肌腹部和右肩胛下角部肱三头肌肌腹部和右肩胛下角部上臂肱三头肌部上臂肱三头肌部 代表四肢代表四肢肩胛下角肩胛下角 代表躯干代表躯干上述二部位之和上述二部位之和 代表全身皮下指标代表全身皮下指标体脂比（体脂比（body fat ratio）:轻度肥胖轻度肥胖 中度肥胖中度肥胖 高度肥胖高度肥胖男性男性 20 25 30女性女性 20 25 30 以上两种方法推算的
10、体脂比和判定的肥胖程度以上两种方法推算的体脂比和判定的肥胖程度易受身高和肌肉发达程度影响易受身高和肌肉发达程度影响 CT断层法：断层法：皮下脂肪面积皮下脂肪面积/内脏脂肪面积内脏脂肪面积 0.4：内脏型肥胖：内脏型肥胖 0.4：皮下脂肪型肥胖：皮下脂肪型肥胖 超声波法：超声波法：腹膜前脂肪的最大厚度腹膜前脂肪的最大厚度/腹壁皮下脂肪的最小厚度腹壁皮下脂肪的最小厚度 MALE:1.0 内脏型肥胖内脏型肥胖 FEMALE:0.7内脏型肥胖内脏型肥胖IV.Epidemiology u“the global obesity epidemic”u“globesity”Major problem in d
11、eveloped countries Overweight and ObesityWHO（2002）uWorld-wild:one of 10 health risk World-wild:one of 10 health risk factorsfactorsuDeveloped countries:one of 5 health Developed countries:one of 5 health risk factorsrisk factorsUS:increase 4 times recently forty years US:increase 4 times recently fo
12、rty years （Ogden et alOgden et al，20022002）USA:The prevalence of obesity is high and rising higherFig.The prevalence of childhood obesity in China,1985-2000.Fig.The prevalence of childhood overweight and obesity in China,2000General,Higher in northern than in southern.北方南方北方南方Higher in urban than 城市
13、农村城市农村Rural,not very high,but the increasing rate is rapid No gender difference in pre-school.Higher in boys than girls in school-ageAge-special:1yr have light peak,after that reduce with age increase,5yr rebound,10-13yrs reach the peak nMany adulthood obesity develop from from childhood obesity.nRi
14、sk:Obesity children develop into adulthood obesity u Infant 14%u 7 yrs child 41%u 1013 80%China Higher stunt prevalence With the improvement of nutrition,the stunting tend to catch-up growth,and tend to obese late pregnancy,fetus absorb much energy high BMI-obesity Excess feeding to infants weight i
15、ncrease fast adipose early rebound 脂肪早期重聚脂肪早期重聚 early maturation pattern puberty central and high BMI obesitydeveloping country and shift societyTrend in underweight prevalence from 1990 to 2006,by region The trend analysis is based on a subset of 76 countries with trend data,covering 83 per The tre
16、nd analysis is based on a subset of 76 countries with trend data,covering 83 per cent of the under-five population in the developing world.For CEE/CIS,the baseline year cent of the under-five population in the developing world.For CEE/CIS,the baseline year is 1996;data availability was limited for t
17、he period around 1990.Prevalence was is 1996;data availability was limited for the period around 1990.Prevalence was estimated using NCHS/WHO/CDC reference population estimated using NCHS/WHO/CDC reference population VFactors （Etiology）Obesity:A Complex DiseaseCauses of childhood obesityuGene-Gene:l
18、inkage and interactionuGeneEnvironment:cooperation and interactionuEnvironment Diet:energy,diet structure,soft drink Socioeconomic status Physical exercise Lifestyle(sedentary)Commercial inducement 1.Genetic determinants 遗传因素遗传因素 In the twins studies,the heritability of the BMI was estimated to be v
19、ery high,about 80%.The results of adoption and family studies,however,agree on a heritability of about 33%.Genetic predisposition ob gene leptin2.Environmental determinants 环境因素环境因素 Food intake Socioeconomic status Family factors Physical activity Brain damage Drugs Endocrine factors Psychologic fac
20、tors(1)Newborn and infancyHeavy birth weight 高出生体重高出生体重Smoking in pregnancy 母孕期吸烟母孕期吸烟Non-breast feeding 非母乳喂养非母乳喂养(2)Pre-school age Weight level and increment rate Catch-up growth of low-birth-weight-U shape distribution Parents obesity Long time for watching TV and short sleeping timeBMI AND BIRTH
21、 WEIGHT British Journal of Cancer(2004)91,519524 Is the association of birth weight with premenopausal breast cancer risk mediated through childhood growth?Silva IS,Stavola BLD,Hardy RJ,et al.(3)School age and adolescenceParents obesity 父母肥胖父母肥胖Increasing velocity violent,especially Stunt children 生
22、长迟滞儿童生长迟滞儿童 Sedentary lifestyle “以静代动以静代动”的生活方式的生活方式 watching TV play computer transportation(manner of going to school)deficiency physical exercise lack of outdoor activity Dull in after-school,lack of physical exercise motivation,interest and inducement“three hyper-”diet and soft drink Parents lac
23、k of nutrition knowledge Strong commercial inducement Have early puberty growth and body fat increase rapidlyVI.Tend to occur obesity肥胖的易发时期肥胖的易发时期 uThe late pregnancy 孕后期孕后期uInfancy(especially before 9 months)婴儿期（尤其生后婴儿期（尤其生后9个月内）个月内）uThe early puberty 青春早期青春早期uThe late puberty 青春发育后期青春发育后期VII.The
24、influence on child and adolescent health u Effect on psychology poor self-image disinterested in exercise more sedentary possibly socially isolatedu Effect on healthCommon secondary medical problems include hypertension,and knee and back problemsObesity Is Associated With Increased Morbidity and Mor
25、talityO b e s i t y I s L i n k e d w i t h Cardiovascular DiseaseVIII.Prevention of Obesity肥胖的防治肥胖的防治 Comprehensive strategies of interventionComprehensive strategies of intervention:The idea of control weight should be haven from fetus.从小抓起从小抓起The health education on prevention obesity 预防肥胖的健康教育预防
26、肥胖的健康教育Properly deal with the relationship between dietary adjustment and suitably physical activity正确处理饮食调整和适当体育活动的关系正确处理饮食调整和适当体育活动的关系Behavior therapy 行为疗法行为疗法Diet therapy 饮食疗法饮食疗法Physical exercise therapy 运动疗法运动疗法10 of the Worst Foods for Children Soda pop Whole milk Hamburgers American cheese Ho
27、t dogs French fries and tater tots Ice cream Pizza loaded with cheese and meat Bologna (一种大腊肠一种大腊肠)Chocolate bars 10 of the Best Foods for Children Fresh fruits and vegetables(especially carrot sticks,cantaloupe,oranges,watermelon,strawberries)Chicken breast and drumstick without skin or breading Ch
28、eerios,Wheaties,or other whole-grain,low-sugar cereals Skim or 1%milk Extra-lean ground beef or vegetarian burgers(Gardenburgers or Green Giant Harvest Burgers)Low-fat hot dogs(Yves Veggie Cuisine Fat-Free weiners or Lightlife Fat-Free Smart Dogs)Non-fat ice cream or frozen yogurt Fat-free corn chip
29、s or potato chips Seasoned air-popped popcorn Whole-wheat crackers or Small World Animal Crackers SummaryConcept:obesityThe trend of obesity prevalence rateThe four age stages in which the children tend to occur obesityGive three environmental factors affecting obesity occurrenceThe influence of obe
30、sity on children healthKeep children fit,we have much can do.思考题：思考题：（1 1）身高标准体重筛查肥胖的标准是：）身高标准体重筛查肥胖的标准是：A.A.实测体重超过身高标准体重的实测体重超过身高标准体重的10%10%B.B.实测体重超过身高标准体重的实测体重超过身高标准体重的20%20%C.C.实测体重超过身高标准体重的实测体重超过身高标准体重的30%30%D.D.实测体重超过身高标准体重的实测体重超过身高标准体重的40%40%（2 2）关于肥胖，不正确的是：关于肥胖，不正确的是：A.A.高糖、高热、高脂肪饮食容易导致肥胖高糖、
31、高热、高脂肪饮食容易导致肥胖 B.B.运动不足容易导致肥胖运动不足容易导致肥胖 C.C.父母肥胖，子女发生肥胖的几率较大父母肥胖，子女发生肥胖的几率较大 D.D.限制饮食是治疗肥胖的有效手段限制饮食是治疗肥胖的有效手段 E.E.预防肥胖应采取综合性措施预防肥胖应采取综合性措施思考题：思考题：（3 3）身高标准体重筛查营养不良的标准是：）身高标准体重筛查营养不良的标准是：A.A.实测体重低于身高标准体重的实测体重低于身高标准体重的60%60%B.B.实测体重低于身高标准体重的实测体重低于身高标准体重的70%70%C.C.实测体重低于身高标准体重的实测体重低于身高标准体重的80%80%D.D.实测
32、体重低于身高标准体重的实测体重低于身高标准体重的90%90%（4 4）儿童少年肥胖发生的易感期有：儿童少年肥胖发生的易感期有：A.A.孕后期孕后期 B.B.生后生后9 9个月内个月内 C.C.青春发育早期青春发育早期 D.3D.37 7岁岁 E.E.青春发育后期青春发育后期 思考题：思考题：（5 5）肥胖对身体的影响主要表现在：）肥胖对身体的影响主要表现在：A.A.体型、体态给学习生活带来的不便体型、体态给学习生活带来的不便 B.B.体型、体象带来的心理苦恼体型、体象带来的心理苦恼 C.C.是心血管疾病、糖尿病等成年期疾是心血管疾病、糖尿病等成年期疾病的重要危险因素病的重要危险因素 D.D.肥胖易导致儿童免疫功能下降肥胖易导致儿童免疫功能下降 E.E.肥胖者对粮食的消耗造成巨大浪费肥胖者对粮食的消耗造成巨大浪费谢谢谢 谢谢谢 ！http:/www.healthpromotion.iehttp:/www.healthpromotion.ie/topics/obesity/topics/obesity/
