Mexitalia Persagi Obesitas 14.02.2015 wt - asdijateng.comasdijateng.com/wp-content/download/materi2.pdf · 2/13/15 2 Theimportancyofearlylifenutrionforhuman$ being$ CR DRS2013...

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DAMPAK  OBESITAS  TERHADAP  KESEHATAN  

Maria Mexitalia Departemen IKA Fakultas Kedokteran Undip / RSUP Dr. Kariadi SEMARANG

Obesitas merupakan penimbunan jaringan lemak tubuh secara

berlebihan

§ Sebagian besar obesitas yang terjadi

pada orang tua dimulai sejak masa

anak

TANDA KLINIS OBESITAS § Wajah membulat §  Pipi tembem § Dagu rangkap §  Leher relatip pendek § Dada membusung dengan payudara membesar §  Perut membuncit dan berlipat § Tungkai X, saling gesek §  Penis kecil tersembunyi

Z-score

Indikator Pertumbuhan

TB/U BB/U BB/TB BMI/U

Di atas +3 Obese (kegemukan)

Obese (kegemukan)

Di atas +2 Overweight (BB lebih)

Overweight (BB lebih)

Di atas +1 Possible risk of overweight (Berisiko BB lebih)

Possible risk of overweight

(Berisiko BB lebih)

Median (nol)

Gizi Baik

Di bawah -1

Di bawah -2 Perawakan pendek

BB kurang Gizi kurang Gizi kurang

Di bawah -3 Perawakan sangat pendek

BB sangat kurang

Gizi buruk Gizi buruk

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The  importancy  of  early  life  nutri2on  for  human  being  

CR DRS2013

Growth  and  muscle  mass  body  composi5on  

Perawakan  pendek  (stunted)  

2007 % 2010 %

WHO 2006 (0-5 years)

39274 38.6 8653 41.7

(Sjarif DR, 2011)

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Stun2ng  syndrome  

(  Branca  &  Ferrari,  2002)  

Metabolic  Programming  

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Non Alcoholic Fatty Liver Disease (NAFLD)

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Metabolic  Syndrome  

Triglyceride ↑ ≥ 150 mg/dl

HDL cholesterol ↓ < 40 mg/dl

Waist circumference ≥  Percentile 90th

Fasting Glucose ↑ ≥ 100 mg/dl

METABOLIC RISK FACTORS

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Systolic Blood Pressure ≥ 130 mmHg Diastolic Blood Pressure ≥ 85 mmHg

International Diabetes Federation 2007

Six studies of metabolic syndrome 1.  Metabolic syndrome in obese adolescents 2.  The association of adiponectin level and non-alcoholic

fatty liver disease (NAFLD) in obese adolescent

3.  Aspartat amino transferase-platelet ratio index (APRI) and body mass index in fatty liver children.

4.  Early risk of atherosclerosis and metabolic syndrome in nonalcoholic fatty liver Indonesian children

5.  The effects of diet and exercise on body mass index, physical fitness, hsCRP and lipid profile in obese children

6.  Effect of diet modification to fibrosis chirossis index (FCI) in adolescent with NAFLD

Metabolic syndrome in obese adolescents

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Methods §  Cross sectional study, 116 students

§  Junior High School (Domenico Savio)

§  Anthropometric, blood pressure, lipid profile

§  Metabolic syndrome : §  Presence of ≥ 3 risk factors (NCEP – ATP III for

adolescents). §  Waist circumference (based on p > 90th in the same

school measurement for 1155 students at 2005) §  Male 93 cm, Female 87 cm

Triglyceride ↑ ≥ 110 mg/dl

HDL cholesterol ↓ ≤ 40 mg/dl

Waist circumference ≥  Percentile 90th

Fasting Glucose ↑ ≥ 110 mg/dl

METABOLIC RISK FACTORS

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Blood pressure ↑ ≥  Percentiie 90th

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Criteria for the Metabolic Syndrome NCEP – ATP III for adolescents

Characteristic of the subjects

BOYS

GIRLS

　 Obese n=57

Normal n=25

p Obese n=22

Normal n=12

p

Weight (kg) 70.2 (10.0) 43.2 (0.3) <0.001 69.2 (0.6) 45.0 (3.5) <0.001

Height (cm) 156.0 (7.2) 160.0 (7.3) 0.893 154 (6.2) 154 (4.3) 0.898

BMI (kg/m2) 28.8 (2.9) 18.4 (1.1) <0.001ª 29.1 (2.5) 19.0 (0,6) <0.001ª

Body fat (%) 33.5 (7.5) 18.9 (5.4) <0.001 37.7 (4.0) 25.7 (1.1) <0.001

Waist (cm) 93.3 (8.1) 66.6 (3.6) <0.001ª 83.9 (6.2) 65.7 (5.0) <0.001a

Systolic BP (mmHg)

121 (10.7) 115 (8.5) 0.042 120 (11.2) 112 (6.1) 0.013

Diastolic BP (mmHg)

77 (9.7) 71 (8.0) 0.190 79 (8.1) 120 (11.2) 0.002ª

* Mann-Whitney

Laboratory findings

Boys

Girls

　 Obese n=57

Normal n=25

p Obese n=22

Normal n=12

p

Blood glucose (mg/dl)

97.0 ± 10.1 91.2 ± 8.0 0.006 93.6 ± 8.4 90.5 ± 6.6 0.272

Total cholesterol (mg/dl)

183.0 ± 38.1 157.3 ± 25.0 <0.001 184.6 ± 36.0 173.3 ± 22.3 0.331

HDL (mg/dl) 47.8 ± 9.4 49.5 ± 9.7 0.350 50.1 ± 9.6 50.2 ± 9.0 0.971

LDL (mg/dl) 110 ± 35.8 93.0 ± 21.1 0.004ª 112.8 ± 32.0 105.4 ± 23.3 0.736 ª

* Mann-Whitney

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Prevalence risk factors of metabolic syndrome

Percentage (CI 95%)

Risk Factors ≥ 1

Risk Factors ≥ 2

Risk Factors ≥ 3*

Risk Factors ≥ 4*

Sex Boys

(n=82) 73.2 (63.6-82.8) 42.7 (31.9-53.4) 25.6 (15.5-35.7) 9.8 (3.4-16.2)

Girls (n=34)

70.6 (55.3-85.9) 38.2 (21.9-54.5) 11.8 (4.4-19.2) 0

Nutritional Status

Normal (n=79)

51.4 (35.3-67.5) 10.8 (0.7-20.8) 0 0

Obese (n=37)

82.3 (73.9-90.7) 55.7 (44.7-66.6) 31.6 (21.3-41.8) 10.1 (3.5-16.7)

§  31.6% obese adolescents meet the criteria of metabolic syndrome (> 3 criteria) and 10.1% (> 4 criteria)

§  USA (NHANES III) §  28.7% (>3 criteria) §  5,8% (> 4 criteria)

Cook, Arch Pediatr Adolesc Med 2003

§  Australia : §  Boys 73.5% and girls 44.4% (> 2 criteria)

Denney-Wilson E, Arch Pediatr Adolesc Med 2008

Early risk of atherosclerosis and metabolic syndrome in nonalcoholic fatty liver Indonesian children

Natural History of Atherosclerosis

Endothelial dysfunction Fatty streak

0 years

10 20

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Natural History of Atherosclerosis

Fibrous plaque Calcification, hemorrhage, ulceration, thrombosis

20

years

30 40

Method §  Cross sectional study, 72 subjects.

§  Obesity and NAFLD (n = 19), Obesity non NAFLD (n = 17), control healthy children (n= 36)

§  Anthropometry, blood pressure (BP), lipid profile, alanine transaminase (ALT), homeostatic model (HOMA) for insulin resistance (IR), adiponectin, and hsCRP as early marker for atherosclerosis were measured.

§  Metabolic syndrome (MetS) : International Diabetes Federation (IDF) consensus 2007.

§  The data were analyzed by ANOVA, spearman correlation and linear multivariate regression.

Conclusion §  Risk of Mets adolescents to get NAFLD was 5.6 times

(OR 5.60; 95%CI 1.51-20.77)

§  There was positive correlation between waist circumference, body fat percentage, lipid profile, liver function test (ALT) and insulin resistance with hcCRP as early marker for atherosclerosis.

Adulthood

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Overview of Diabetes in the United States

Insulin Resistance

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Natural History of Type 2 Diabetes Development of Type 2 Diabetes

Relationship Between Obesity and Insulin Resistance and Dyslipidemia

Insulin Resistance: Associated Conditions

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Cardiovascular Disease and Diabetes

Probability of Death From CHD in Patients With Type 2 Diabetes With or Without Previous MI

International Diabetes Federation Definition:

Abdominal obesity plus two other components: elevated BP, low HDL, elevated TG, or impaired fasting glucose

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Summary §  NAFLD in obese adolescents was associated

with metabolic syndrome. §  Children with NAFLD may be at a higher risk for

cardiovascular disease than children without NAFLD.

§  Abdominal obesity will increase the risk of metabolic syndrome and cardiovascular disease

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