BMI25~30Kg/m 2 (BMI 30Kg/m 2 ) 1982 7.2 1.0 1992 24.6% 2.9% 10.4% 1.0% 1997 2002 21.51% 17.60% 2.92% 5.6%
人体脂肪含量分析 kg cm kg/m^2 69 150 30,7 pfrimmer 35 31 30 50 Realisation ffk II0205 70 160 180 25 20 200 体重 15 10 体质指数 体质指数 BMI BMI 人体测量分析((BIA) 人体测量分析 DEXA CT CT NMR 双标水标记方法
Studies of appetite regulation reveal weak physiological defences against energy-dense (high-fat) diets Energy intake (kj/day) 16000 14000 12000 10000 8000 6000 4000 200 300 400 500 600 700 800 900 Energy density (kj/100 g) Prentice. Am J Clin Nutr 1998; 67: 535S-541S
100g) 612kcal 500Kcal 430Kcal 150Kcal
2007 25g 30g 6g 300g 300g 30g~50g 125g~225g 300g~500g 300g~500g 200g~400g 250g~400g
50 1959 1982 1992 2002 1985 1985~1990 1990
2005
n=486 * J. Nutr. 2008.138:1469-1475
Romaina Iqbal, et al. Circulation, 2008; 118: 1929-1937. INTERHEART 52 262 4
Romaina Iqbal, et al. Circulation, 2008; 118: 1929-1937. BMI N=42 42,504
95%CI 6 0.94 (0.92 to 0.96) 4 0.91 (0.87 to 0.95) 9 0.91 (0.89 to 0.94) 0.1 0.2 0.5 1 2 5 BMJ 2008;337:a1344-50
Weight Loss with a Low-Carbohydrate, Mediterranean,or Low-Fat Diet Methods In this 2-year trial, randomly,322 moderately obese subjects,52ys;bmi 31;Male 86% three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; low-carbohydrate, non restricted-calorie
Weight Loss with a Low-Carbohydrate, Mediterranean,or Low-Fat Diet Low-fat diet: 1500 kcal/d for women and 1800 kcal/d for men, 30% fat, 10% saturated fat,300 mg cholesterol/d.low-fat grains, vegetables, fruits, and limit additional fats, sweets, and high-fat snacks Mediterranean Diet: moderate-fat, restricted-calorie, rich in vegetables and low in red meat,with poultry and fish replacing beef and lamb. energy 1500 kcal/d women and 1800 kcal/d for men, with <35% fat;30 to 45 g of olive oil +a handful of nuts (five to seven nuts, <20 g/d) Low-Carbohydrate Diet: low-carbohydrate, non restricted-calorie diet aimed to provide 20 g of carbohydrates/d for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein,and fat were not limited.
Methods: RCT 40 US clinical centers 1993-2005 48 835 postmenopausal women 50-79 Randomly assigned to a usual-diet comparison group (n=29 294 [60.0%]) or an intervention group with a 20% low-fat dietary pattern with increased vegetables, fruits, and grains (n=19 541 [40.0%]). Trends toward reduced incidence were greater with greater Decreases in total fat intake and weight loss Weight loss predictor of reduced risk of diabetes. Arch Intern Med. 2008;168(14):1500-1511
(SCFA) 4-6 6C (MCFA) 8-12 C (LCFA) > 16 C 2 ω-9 ( ( n-9) ; ω-6,, ( n-6) AA ω-3,, ( n-3) α-,, EPA,DHA;
Impact of ad libitum low fat diets on body weight Lee-Han et al. (1988) Boyd et al. (1990) Buzzard et al. (1990) Ornish et al. (1990) Bloemberg et al. (1991) Sheppard et al. (1991) Baer (1993) Hunninghake et al. (1993) Kasim et al. (1993) Raben et al. (1995) Pritchard et al. (1996) Siggard et al. (1996) Simon et al. (1997) Weststrate et al. (1998) Stefanick et al. (1998) Stefanick et al. (1998) Overall (fixed effects) Overall (random effects) -30-20 -10 0 10 Weight loss difference (Control - Intervention)(kg) Astrup et al. Brit J Nutr 2000; 83: S25-S32
Weight loss on an ad libitum low fat, low sugar diet Body weight (kg) 4 2 0-2 -4 Control Low fat - high sugar * -6 Low fat - low sugar 0 2 3 4 5 6 Time (months) p< 0.01 time effect Poppitt et al. Am J Clin Nutr 2002; 75: 11-20
GI
mg/dl µu/ml 75 2 48 5 JAMA. 2002;287(18):2414-2423 Diabetes Care December 2008 vol. 31 no. 12 2281-2283
GI GI Β 2 JAMA. 2002;287(18):2414-2423
Effect of ad libitum sugars vs sweeteners on body weight Change in body weight (kg) 2.5 1.5 05 0.5 * ** ** ** -0.5-1.5 Sugars Sweeteners -2.5 0 2 4 6 8 10 *p=0.05 **p=0.0001 Raben et al. Am J Clin Nutr 2002; 76: 721-9 Time (wk)
Weight loss on a calorie-controlled low fat, low sugar diet Change in weight (kg) 0 Placebo + lifestyle -3-4.1 kg -6-9 -12 0 52 104 156 208 Week Sjöstrom et al. 9th ICO, São Paulo Sept 2002
Farvid MS, et al. Diabetes Research and Clinical Practice, 2004,65:21-8. mg/dl) HDL L-c ( 40.6 24% HDL-c 50.4 n=69 p<0.01 01 2-3% 1mg/dl
Methods: A randomized, double-blind, placebo-controlled clinical trial( 2006-2007)in, Taiwan. obese women (16-60) BMI > 27 The subjects were randomly divided Group A (n Z 41) received GTE while Group B (n Z 37) took cellulose as a placebo, one capsule (400 mg) three times each day for 12 weeks. Results: There was only a 0.3% reduction in BW (0.15 kg) after 12 weeks of treatment with GTE. Within group comparison revealed that the GTE group had significant reduction in LDL-cholesterol and triglyceride, and marked increase in the level of HDL-cholesterol, adiponectin and ghrelin. On the other hand, the placebo group showed significant reduction in ti triglyceride id only, and a marked dincrease in the level lof ghrelin alone.
LAP-BAND 36% >50% 22% 2% 不 降 5% FDA Approves Implanted Stomach Band to Treat Severe Obesity (June 5, 2001)
LAP-BAND 89% (51%) (34%) (27%) (24%) 9 % 25% FDA Approves Implanted Stomach Band to Treat Severe Obesity (June 5, 2001)
LAP-BAND -600~1000kcal/d >50g/dg (DRIs) <200ml,
LAP-BAND -1w SR 3-6 100-200kcal 10g tid 0-4d PN 4d-2w 3w-4w SR 9 300kcal /400ml 15g/d + + + +VC+VBco 3 +VC+VBco
-3w Op 1w-2w 1m kg 121.5 118 113 108 % 57.4-48.5 BMI 48.7 43.33 R 20.7 21 Hb 148 138 136 - LYM/WBC 1.06/6.95 1.37/6.15 1.02/10.41 - PA 267 - - 149 FBG 7.0 9.2 5.3 5.1
Quit smoking for 1-3 months Avoid rapid weight gain before surgery Fitness course 1 week ago Avoid irritating foods for one week Liquid diet for one day, preoperatively GI preparation(+-)
BMI 16 55 14 12 50 50.07 49.27 48.07 10 46.87 8 6 45 45.26 43.26 4 2 40 40.64 0 9 1 16 9 6 9 11 9 16 9 25 9 27 10 2 10 9 10 15 10 28 35 9 1 9 8 9 15 9 24 10 8 10 29 12 10 120 ALT 4 37 3.7 TG 14 100 3.4 12 10 80 3.1 2.8 8 60 2.5 6 4 40 2.2 1.9 2 20 1.6 0 9 1 9 6 9 11 9 16 9 25 9 27 10 2 10 9 10 15 10 28 0 1.3 1
Obesity is caused by large portions of energy dense foods together with inactive lifestyles superimposed on a genetic susceptibility to weight gain Genetics loads the gun - the environment pulls the trigger. George Bray, 1996
600 kcal/day (<30% energy), (<10%) (>50%) (<10%) +