obesità nel bambino: epidemiologia e prevenzione

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1 Obesità, Nutrizione e Stili di vit. Trento 31 Mrzo 27 obesità nel bmbino: epidemiologi e prevenzione Cludio Mffeis Diprtimento Mterno Infntile e Biologi-Genetic Sezione di Peditri - Università di Veron PREVALENCE OF OVERWEIGHT AND OBESITY IN 2-6-YEAR-OLD ITALIAN CHILDREN Overweight 2,% 2,% 1,% 1,% mles femles totle,%,% Ntionl reference I.O.T.F. C.D.C. Obesity 18,% 16,% 14,% 12,% 1,% 8,% 6,% 4,% 2,%,% Ntionl reference I.O.T.F. C.D.C mles femles totle Mffeis C et l. Obes Res, 26 persistence of obesity from childhood into dulthood totl smple mesured in 2 dulthood norml weight over weight obese.6 reciprocl of dult BMI.4 r = -.2, P< reltive BMI t bseline Mffeis C et l. J Clin Endocrinol Metb 22;87:

2 reltion between obesity from childhood to dulthood nd the metbolic syndrome: popultion bsed study obese dults non-obese dults non-obese In childhood obese In childhood women 3 9 totl men Odds rtio BMI <27.7 m, <26.6 w. ; BMI <1.8 b, <1.6 g. Erikson JG, et l. BMJ 1999;318: dipose tissue: regultor of inflmmtion. Regultion of food intke Energy homeostsis Adipocyte differentition Body weight control IL;ILR,TNF,MCP1 Leptin, IL-6, IL-1/IL-1R Sensitivity to insulin TNF, IL6, IL1/ILR, Adiponectin, Leptin, Resistin WAT Metbolism Inflmmtion Energy storge Control of inflmmtion Vsculr inflmmtion? Crdiovsculr protection IL1/IL1R,TNF,IL6,IL8,MC P1, RANTES,IP1 IL8,MCP1,RANTES,IP1, Resistin Adiponectin, L1R,IL1 Juge-Aubry C et l., 2 Obesity nd Inflmmtion: Evidence for n Elementry Lesion Electron microscopic fetures of subcutneous dipose tissue in obese children. v g m l d d d d d v v m dipocytes m mcrophge v vessel g grnulocyte degenerting dipocytes l lymphocyte d lipid droplets Sbrbti A, Mffeis C et l. Peditrics 26 2

3 metbolic consequences of ft gin in children FAT MASS SAT INSULIN RESISTANCE VAT LIPOTOXICITY HIGH BLOOD PRESSURE IGT HIGH TRIGLYCERIDES DIABETES Mffeis C 27 the virtuous qurtet WAT pncres muscle liver bnormlities in FA metbolism my result in inpproprite ectopic ccumultion of lipids, which is involved in the development of insulin resistnce pregnncy first yer diposity rebound puberty 3 ft mss mle femle Age (yers) Dietz WH Am J Clin Nutr

4 birth weight nd type 2 dibetes in Pim Indin children nd young dults ge group (yers) birth weight (kg) < > 4. Prevlence (Mntel-Henszel X 2 test, controlled for ge nd sex) Dbele D et l. Dib Cre 1999;22:944 lrge mternl weight loss from obesity surgery prevents trnsmission of obesity to children who were followed for 2 to 18 yers 7 before mternl surgery fter mternl surgery prevlence childen: norml weight overweight, obese 3 Krl JG et l. Peditrics 27 rpid weight gin during infncy nd obesity in young dulthood in cohort of Africn Americns Adjusted nlysis obese in young dulthood: rpid weight gin ctegory ( to 4 months): sex (F) birth weight (kg) gesttionl ge (wk) firstborn sttus birth yer mternl BMI (kg/m 2 ) mternl ge (y) mternl eduction (y) OR 9% CI P , , ,14.3,1.68.4, , , ,1.3.69, Stettler N, et l. Am J Clin Nutr 23 4

5 diposity rebound dequte sleep mong dolescents in positively ssocited with helth sttus nd helth-relted behviors Independent vrible: dequte sleep (higher vs lower) OR (9% c.i.) Dependent vrible: Helth responsbility (higher vs lower) Stress mngment (higher vs lower) Nutrition (higher vs lower) Exercise (higher vs lower) Body size (Non-overweight vs Overweight) 1.6 ( ) 7.6 (.3-1.8) 3. ( ) 2.1 (1.6-3.) 1.7 ( ) Chen MY, et l. BMC Public Helth 26 GENE ENVIRONMENT NEUROENDOCRINE SYSTEM BEHAVIOUR NUTRIENT BALANCE Mffeis C, 26 OBESITY

6 long-term weight loss mintennce Definition: individuls who hve intentionlly lost t lest 1% of their body weight nd kept it off t lest one yer. 2% of overweight individuls re successful weight losers. THE NATIONAL WEIGHT CONTROL REGISTRY diet + physicl ctivity: 89% diet: 1% physicl ctivity: 1% strtegies very consistently reported: consuming low-clorie (18 kcl/dy), low-ft (2%) diet doing high levels of physicl ctivity (3 kcl/week) weighing themself frequently consuming brekfst dily ft mss 2 r =.28 P< lipid intke (% of energy intke) Klesges RC et l. AJCN 94 Gzznig JM, et l.ajcn 93 Mffeis C et l. Int J Obes 96 covert mnipultion of dietry ft nd energy density: effect on substrte flux nd food intke in men eting d libitum MJ ft blnce MJ energy blnce 2 2 high ft 1 1 medium ft low ft time (dys) time (dys) Stubb RJ, et l. AJCN 199; 62:

7 reduction in portion size nd energy density of foods re dditive nd led to sustined decreses in energy intke Dy 1 Dy 2 energy intke (kcl) 4 3 1% ED, 1% portion 1% ED, 7% portion 7% ED, 1% portion 7% ED, 7% portion 2 1 brekfst lunch dinner snck brekfst lunch dinner snck Rolls BJ et l., 26 high-fibre, low-ft diet predicts long-term weight loss nd decresed type 2 dibetes risk: the Finnish Dibetes Prevention Study low-ft/ high fibre low-ft/ low fibre high-ft/ high fibre high-ft/ low fibre weight chnge (kg) from bseline to yer three men djusted men - 4 Lindstrom J, et l. Dibetologi 26 group ssignment, ge, sex, bseline BW, ft, fibre, VLDL-use, & bseline nd follow-up period physicl ctivity high-fibre, low-ft diet predicts long-term weight loss nd decresed type 2 dibetes risk: the Finnish Dibetes Prevention Study Hzrd rtio for dibetes low-ft/ high fibre low-ft/ low fibre high-ft/ high fibre high-ft/ low fibre men djusted men djusted men # 2 1 group ssignment, ge, sex, bseline BW, ft & fibre intke, bseline 2-h glucose, bseline nd follow-up period physicl ctivity # + weight chnge Lindstrom J, et l. Dibetologi 26 7

8 Comprison of the Atkins, Ornish, Weight Wtchers, nd Zone diets for weight loss nd hert disese risk reduction Energy CHO Ft Prot Fiber (g) Atkins (n.4) Zone (n.4) Weight Wtchers (n.4) Ornish (n.4) weigh chnge - 2 (kg) months 6 months 12 months Dnsinger ML, et l. JAMA 2 4 energy intke 3 dily ptterns of energy intke in children 2 1 Morning Afternoon Brekfst Lunch Dinner snck snck Night snck Mffeis C, et l. Int J Obes

9 energy (kcl) energy intke energy expenditure thresold of energy expenditure yers Hill & Wytt J Appl Physiol, 2 PHYSICAL ACTIVITY AND BODY FAT FAT MASS PHYSICAL ACTIVITY LEVEL (PAL) AGE (yers) ssocition of fmily environment with children s TV viewing nd with low levels of physicl ctivity BMI z-score.8 Fmily cluster: FM, Ft intke, TV (h/dy) obesogenic.4. non obesogenic 8 11 dughter s ge (yers) Dvidson KK, et l. Obes Res 2 9

10 prents obesity-relted behviors predict girls chnge in BMI 7 percent overweight 3 fther cceptnce incresing fther cceptnce decresing 6 12 time (months) pternl but not mternl prenting style ws relted to child weight outcome fthers increse in cceptnce period my be especilly powerful becuse it is contrry to the usul developmentl trend t this ge, which is for children to perceive their prents s less ccepting over time Stein RI, et l. Obes Res 2 Nutrient oxidtion mesured during wlking t speeds of 4,, nd 6 km/h, respectively, in group of obese prepubertl children Mffeis, C. et l. J Clin Endocrinol Metb 2;9: viscerl bdominl ft is correlted with whole-body ft nd physicl ctivity mong 8-y-old children t risk of obesity viscerl dipose tissue (cm 3 ) r = -.43 P< totl physicl ctivity (ccelerometer hours/week) Selens BE et l. Am J Clin Nutr 27 1

11 improvement of erly vsculr chnges nd crdiovsculr risk fctors in obese children fter six-month exercise progrm len obese 14 P <.1 intervention control flow-medited vsodiltion P <.1 P = ns bseline fter 6 months Meyer AA et l. J Am Coll Crd 27 Recommnded Dietry Allownces: re they pproprite? 4 PAL = Energy requirement (kcl/dy) 2 PHYSICAL ACTIVITY PAL = 1.4 THERMOGENESIS 1 BASAL GROWTH ge, gender, ft-free mss, ft mss, thyroid function, food intke Mffeis C 27 Recommnded Dietry Allownces: re they pproprite? PAL = INDEX OF PHYSICAL ACTIVITY = TOTAL ENERGY EXPENDITURE / BASAL ENERGY EXPENDITURE = 1.7 SAFE LEVEL FOR WEIGHT MAINTENANCE IN ADULTS Cse 1: 1-yer-old boy, BW= 3 kg, BMR: 12 kcl/dy RDA: 22 kcl/dy. Estimted PAL: 22/12 = 1.8 Cse 2: 1-yer-old boy, BW= 4 kg, BMR: 14 kcl/dy RDA: 22 kcl/dy. Estimted PAL: 22/14 = 1.6 Cse 3: 1-yer-old boy, BW= 2 kg, BMR: 1 kcl/dy RDA: 22 kcl/dy. Estimted PAL: 22/1 = 2.2 However, the men PAL in 1-yer-old boys is 1.. Therefore, in ll the three cses the RDA overestimte requirements nd expose to ft gin. Mffeis C 27 11

12 TAKE HOME MESSAGE Approching prevention nd tretment of obesity in the single individul do not use the RDA to estimte energy requirements but use the fctoril method. Mffeis C 27 12