Date post: | 20-Feb-2018 |
Category: |
Documents |
Upload: | ioana-zaha |
View: | 231 times |
Download: | 7 times |
of 39
7/24/2019 4.curs 2 diabet-2
1/39
20 / zi x 20 m = 400 m20 / zi x 20 m = 400 m
Distana de mers / jos /Distana de mers / jos /anan400 x 365 = 146.000 m400 x 365 = 146.000 m
146 km = 25 h mers146 km = 25 h mers
1 h mers = 113-226 kcal1 h mers = 113-226 kcal
ner!ia "sal#at$% = 2&00-6000 kcalner!ia "sal#at$% = 2&00-6000 kcal
S. Rssner, 2002
0.4-0.& k! es't adi(os / an0.4-0.& k! es't adi(os / an
Stilul de via Sedentarismul
7/24/2019 4.curs 2 diabet-2
2/39
Stilul de viaStilul de via- Fumatul -- Fumatul -
7/24/2019 4.curs 2 diabet-2
3/39
Stilul de viaStilul de via- Stresul -- Stresul -
7/24/2019 4.curs 2 diabet-2
4/39
7/24/2019 4.curs 2 diabet-2
5/39
Aport energeticAport energetic(caloric)(caloric)
ConsumConsumenergeticenergetic
Obezitatea = dezechilibru energeticObezitatea = dezechilibru energetic
7/24/2019 4.curs 2 diabet-2
6/39
Cel mai frecvent, obezitatea este poligenicCel mai frecvent, obezitatea este poligenic
Adipozitatea este reglat prin procesul deAdipozitatea este reglat prin procesul dehomeostazie energetichomeostazie energetic
Adipozitatea este reglat prin controlul activ alAdipozitatea este reglat prin controlul activ alcreierului asupra aportului energetic icreierului asupra aportului energetic iconsumului energeticconsumului energetic
n acest proces de reglare particip multiplen acest proces de reglare particip multiplesisteme i organesisteme i organe
7/24/2019 4.curs 2 diabet-2
7/39
CreierulCreierul influeninflueneazeaz homeostahomeostazia energeticzia energetic viaviasistem nervossistem nervos somaticsomatic iiautonomautonom, prin a!a, prin a!a
hiphipotalamo"otalamo"hipofizarhipofizar
Activitate mActivitate motorotorieie
Activitate siActivitate simpatmpaticicActivitate pActivitate parasarasiimpatmpaticic
Activare neuroendocrinActivare neuroendocrin
7/24/2019 4.curs 2 diabet-2
8/39
Controlul adipozitiiControlul adipozitii
#moral
$$%ormoni de a%ormoni de adipodipozitatezitate&&'nsulina, leptina'nsulina, leptina
alana energeticalana energetic
totocarea de caloriicarea de calorii
*C*C+ecanisme r+ecanisme reglatoeglatoareare
Aport energeticAport energetic,,Consum energeticConsum energetic
7/24/2019 4.curs 2 diabet-2
9/39
7/24/2019 4.curs 2 diabet-2
10/39
Adiposetissue
+uscleiver-' tract
'ncreased food inta.e'ncreased fat storage
'nsulin resistance%/"C
0--lucose upta.eAdiponectin
%1pothalamus2 hunger
*ucleus accumbens2motivation to eat 3
3
33
rain 4eripheral tissues
Bensaid M, 2003; Pagotto U, 2005; Osei-Hyiaman D, 2005; Di Marzo V, 2005; Li !L, 2005
istemul endocanabinoidistemul endocanabinoid
7/24/2019 4.curs 2 diabet-2
11/39
ObezitateaObezitatea"" epidemiologieepidemiologie" definiie" definiie
" clasificare," clasificare," diagnostic" diagnostic" factori de risc" factori de risc" etiopatogenez" etiopatogenez
" risc cardio"metabolic" risc cardio"metabolic"" principii de management clinicprincipii de management clinicindromul metabolicindromul metabolic
" definiie" definiie" diagnostic" diagnostic" factori de risc" factori de risc" etiopatogenez" etiopatogenez" risc cardiometabolic" risc cardiometabolic" principii de management clinic" principii de management clinic
7/24/2019 4.curs 2 diabet-2
12/39
Mecanice Metabolice Mecanice i metabolice
- lumbago
- accidente profesionale sau
rutiere- intertrigo
- incontinen urinar
- edem i celulit
- dehiscena plgilor
- constipaie, disconfort
abdominal (balonri)- reflux esofagian
- insulinorezisten
- diabet zaharat tip 2, scderea
toleranei la glucoz, glicemiebazal modificat,
- dislipidemie,
- boli cardiovasculare
aterosclerotice,
- litiaz biliar,
- hirsutism,- cancer de sn, uter, prostat
- sterilitate,
- dismenoree
- gut
- hipertensiune arterial,
- dispnee,
- varice, hemoroizi,- artroze,
- transpiraii,
- insuficien respiratorie
- apnee !n somn,
- risc anestezic,
-disgravidie, eclampsie, natereprematur
5'C#5'6 O67'089''5'C#5'6 O67'089''
7/24/2019 4.curs 2 diabet-2
13/39
La brbai La femei
- cardiopatie iscemic- diabet !aarat tip 2,
- dislipidemie,- accidente vasculare cerebrale,- ipertensiune arterial,- artro!e,
- ulcer "astro-duodenal,- apnee #n somn
- infarct miocardic $i an"inpectoral,
- diabet !aarat tip 2,- accidente vasculare cerebrale- cancer uterin,- irsutism, dismenoree,
- ovar policistic,- litia! biliar %renal &'- "ut %&'- probleme psiosociale
5iscul asociat cu distribuia abdominal a esutului adipos
7/24/2019 4.curs 2 diabet-2
14/39
Circumferina taliei: se coreleaz cu obezitateaCircumferina taliei: se coreleaz cu obezitatea
visceralvisceral
:;;
;;
;
;?; @; >;; >
7/24/2019 4.curs 2 diabet-2
15/39
Adiopzitatea intra"abdominal DAdiopzitatea intra"abdominal Drisc cardiometabolic maEorrisc cardiometabolic maEor
"ers#a$ %% et a&, 200'; Lee !H et a&, 2005;Boden ( et a&, 2002
+ar.eri inflamatori
(C"reactive protein)
Acizi grailiberi
'nflamaie
'nsulinorezisten
/islipidemie
5isccardiometabolic
crescut
Adipo.ine
%iperinsulinemie/isglicemie
7/24/2019 4.curs 2 diabet-2
16/39
LeptinLeptinaa
PGPG
AngiotensinogenAngiotensinogen
AgoutiAgouti
PAI-1PAI-1
ResistinResistin
AdiponectinAdiponectin
AdipsinAdipsin
Il-6 + sRIl-6 + sR
TNF-alpha + sRTNF-alpha + sR
FFactoractortisulartisular
TGF-betaTGF-beta
SteroidsSteroids
Apo EApo E
IGF-1IGF-1
VisfatinVisfatin
MCP-1MCP-1
AGLAGL Fact. cretereFact. cretere
es.es.AdiposAdiposVisceralVisceral
Obezitatea &Obezitatea &Sindromul metabolicSindromul metabolic--patogenezpatogenez
Tataranni PA: Diabetes, 54(4).April 2005.917927
ADIPOSOPATIE
7/24/2019 4.curs 2 diabet-2
17/39
7/24/2019 4.curs 2 diabet-2
18/39
'ntra"abdominal Adiposit1 Beeds /irectl1into the iver
ecretion ofmetabolicall1 active
substances (adipo.ines)
*et result2'nsulin resistance
'nflammationHei&)ronn L et a&* Int J Obes Relat Metab Disord.200';2+ & './2-2/*oa1 * Proc Nutr Soc* 200/;40.3'-54*r 6 7 Haner H* Int J Obes Relat Metab Disord.200';2+./358-4'*
%epatic BBA flu!(portal h1pothesis)
suppression of lipol1sis b1 insulin
BBA
'nsulin resistance
/1slipidaemia
4A'">Adiponectin
'"?
0*B
'ntra"abdominal
adiposit1
4ro"atherogenic
7/24/2019 4.curs 2 diabet-2
19/39
%igh 'ntra"abdominal Adiposit1 ('AA)Associates Fith 'nsulin 5esistance
Po&iot M et a&* Diabetes./2;'/.+24-3'*
'AA2 intra"abdominal adiposit1ignificantl1 different from >non"obese, ,
; ?; >@;
>,,,,< >,,< >,,,
Area
>,@;
pmo
lG,
'nsulin-lucose
*on"obese Obese loF 'AA Obese high 'AA
7/24/2019 4.curs 2 diabet-2
20/39
'ntra"abdominal Adiposit1 (isceralObesit1) Accentuates /1slipidemia
Po&iot M et a&* Diabetes./2;'/.+24-3'*
:>;
@?
>
7/24/2019 4.curs 2 diabet-2
21/39
Abdominal Obesit12 'ncreases the5is. of /eveloping 01pe < /iabetes
in Jomen
KL> L>DLH L?D@> @>>D@? @?>DH> H>>DH?: MH?:
;+eninerea noii greuti
4revenirea recTtigului ponderal
Controlul celorlali factori de risc cardiovascular
Controlul complicaiilor G Co"morbiditii
465OA*A C# O67'0A06
7/24/2019 4.curs 2 diabet-2
37/39
+A*A-6+6*0 '*06-5A0
Chirurgie
6valuare clinic
'storicul obezitii'storia familial
6!amen clinic'+C0alie
0ensiunea arterial
6!amen de urin
6valuarea
" riscului-motivaiei dea slbi
tabilirea deobiectiveponderale
+odificricomportamentale
/iet
Activitatefizic
+anagement integrat2'mplicarea familiei Rn
optimizarea stilului de via
5ealizareaobiectivelorponderale
*erealizareaobiectivelorponderaleU
5isc crescut
+eninerea-reutii
Barmacoterapie
4 - Vopelman,
AO5/A56 065A46#0'C8
7/24/2019 4.curs 2 diabet-2
38/39
TTerapieerapie::
+#ptimi+area stilului de via-#ptimi+area stilului de via-
+.armacoterapie.armacoterapie
//ducaieducaie0 terapeutic- 1/TP20 terapeutic- 1/TP2
33onitori+areonitori+are 4 periodic-4 periodic-
//valuarevaluare 0 anual- a calit-ii 5ngri6irii0 anual- a calit-ii 5ngri6irii
3etode: Programele 7T/3/83etode: Programele 7T/3/8
3+
7/24/2019 4.curs 2 diabet-2
39/39
05A06-''6 +A*A-6+6*0##' 4O*/65A
, D 7
89,-
9:;