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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

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Stilul de viaStilul de via- Fumatul -- Fumatul -

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Stilul de viaStilul de via- Stresul -- Stresul -

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Aport energeticAport energetic(caloric)(caloric)

ConsumConsumenergeticenergetic

Obezitatea = dezechilibru energeticObezitatea = dezechilibru energetic

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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

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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

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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

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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

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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

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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''

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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

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Circumferina taliei: se coreleaz cu obezitateaCircumferina taliei: se coreleaz cu obezitatea

visceralvisceral

:;;

;;

;

;?; @; >;; >

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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

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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

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'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

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%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

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'ntra"abdominal Adiposit1 (isceralObesit1) Accentuates /1slipidemia

Po&iot M et a&* Diabetes./2;'/.+24-3'*

:>;

@?

>

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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

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+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

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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+

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05A06-''6 +A*A-6+6*0##' 4O*/65A

, D 7

89,-

9:;