肥胖的营养治疗.doc

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1、第十三章　代谢性疾病营养治疗第一节　肥胖症 　　Obesityisdefinedasanexcessbodyfatcontentforstature.Ideally,thebestassessmentofobesitywouldbeameasureofactualbodyfat.Amongadults,thebodymassindex(BMI,expressedaskg/m2)hasbeenrecommendedinternationallyasameasureofobesity.ABMIbetween25.0and29.9definesoverwe

2、ight(24.0to27.9forChinese);aBMI≥30definesobesity(≥28forChinese).Unlikeadult,nouniversaldefinitionoftheweight-for-heightmeasuresnecessarytodefineobesityinyouthexists,butdefinitionshavebeenproposed.WHOexpertcommitteerecommendedthatforinfantsandchildrenachild’sweightforheightbecom

3、paredwithmeanage-andsex-specificvaluesintheNationalCenterforHealthStatistics(NCHS)andWHOreferencedata.Childrenwithaweight-for-heightvalue>2standarddeviationscores(Zscore)abovethemedianareclassifiedasoverweight.ForadolescentsthecommitteerecommendedBMIasthebestindicator;however,a

4、geandsexmuststillbeconsidered.Adolescentswhoseage-andsex-specificBMIis≥85thpercentileBMIofareferencepopulationareclassifiedasatriskforoverweight.　　Obesitycanbeviewedasbothadiseaseandariskfactorforchronicdiseaseandothermorbidities.Increasedfatintheabdominalregionpredictsphysiolo

5、gicalriskfactorsforcardiovasculardisease(CVD),independentofbodymass.Amongadults,bothratioofwaistcircumferencetohipcircumferenceandthewaistcircumferencealonehavebeenusedtoassessbodyfatdistribution.Waist-tohipratios>1.0formenand>0.85forwomenhavebeenusedtoidentifypeopleatincreased

6、riskformorbidity.Forbothadultsandchildren,obesityisassociatedwithahigherprevalenceofriskfactorsforcardiovasculardiseaseandtype2diabetes.Peoplewithoverweightorobesityaremorelikelythannormal-weightpeopletoexperienceelevatedbloodpressure;dyslipidemias,suchashighlevelsoftotalcholes

7、terol,triglycerides,andLDLandlowlevelsofHDL;andinsulinresistance.Theyarealsomorelikelytoexperience2ormoretheseriskfactors.　　Ultimately,overweightandobesityarecausedbyachronicimbalancebetweenenergyintakeandenergyexpenditure.Twobehaviorsarethoughttocontributetoenergyimbalance;exc

8、essiveenergyintakeandinadequatephysicalactivity.Geneti