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Common chronic Common chronic diseases diseases
Diabetes, hypertension and heart Diabetes, hypertension and heart disease disease
A holistic view of healthA holistic view of healthProfessor Professor NormanNorman N N.. Chan Chan
Dept of Medicine and TherapeuticsDept of Medicine and Therapeutics
Faculty of Medicine CUHKFaculty of Medicine CUHK
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Causes of death in Hong KongCauses of death in Hong Kong
• Causes of death– Cancer– Heart disease– Stroke– Pneumonia– Injury and poisoning– kidney disease– Septicaemia– Chronic liver disease
• Common conditions in clinics– diabetes mellitus– respiratory diseases– high blood pressure– high blood fat– skin conditions– musculo-skeletal
problems
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Changing demographicsChanging demographics
• Ageing society– expected survival
• >75 years in men • >80 years in women
• Energy abundance– overeating– unhealthy dietary habits– reduced physical activity
• Psychosocial stress
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Cardiovascular SystemCardiovascular System
• Heart– acts a pump to deliver oxygen and nutrients to various parts of
the body
• Blood vessels– network to distribute nutrients to different parts of the body to
maintain function
– to remove waste products from different parts of body to kidney, lung (CO2) and gut for excretion
• Blockage of blood vessels – cell death
– loss of function
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Cardiovascular disease Cardiovascular disease
• Stroke – loss of brain function (e.g. one sided weakness, difficulty of speech,
death)
• Coronary heart disease– 3 vessels supplying the heart muscle– heart attack - pump failure (low blood pressure, shortness of breath,
irregular heart rate, death)
• Peripheral vascular disease– poor healing of skin, leg ulcers and amputation
• Kidney failure– accumulation of waste products
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Silent conditionsSilent conditions
• High blood pressure– 10% of population– normal <140/90 mmHg
• High blood glucose– 10% of population– normal 4-7 mmol/l
• High blood fat– 10% of population– normal: total cholesterol <6.1 mmol/l ; LDL-C (bad <4.1
mmol/l and HDL-C (good >1.1 mmol/l)
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What is health?What is health?
• A physical, psychological, social state of well being
• a resource which enhances our quality of life
• a lifelong process and attributable not only to the health care system, but also to lifestyles, environment, education and socioeconomic factors
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Modernization/Westernization Modernization/Westernization
• Individuality
• Industrialization
• Food abundance
• Physical inactivity
• Psychosocial stress
• Longevity
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Energy BalanceEnergy Balance
Energy intake(food intake)
Energy expenditure(physical activity)
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Insulin and stress hormonesInsulin and stress hormones
• Insulin– facilitates fat and glucose storage in muscle, liver and fat cells– Inadequate insulin action:
• High blood glucose and high blood fat levels• Damage of blood vessels • Organ damage and loss of function
• Stress hormones– facilitates energy expenditure– increase blood glucose and fat levels– flight and fright reaction– increase blood pressure– enhance salt retention
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What is stressWhat is stress
Control Demand
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Stress versus EustressStress versus Eustress
High demand
poor control
PleasureRelaxation
Emotion
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HomeostasisHomeostasis
Oxidativestress
(glucosefree fatty acids)
Anti-oxidants(vitamins, fish oils)
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How to strike a balanceHow to strike a balance
Indulgence vs
rights
Self controlvs
roles
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Can we change our health?Can we change our health?
GeneticsEnvironment
Lifestyle modification
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Emotional intelligenceEmotional intelligence
• Awareness
• Analysis
• Ability
• Accountability• Action
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Healthy life styleHealthy life style• Good
– normal body weight• body mass index (BMI<23-24 kg/m2)
– regular exercise• 30 minutes at least 2-3 times per
week
– high fibre, low fat diet– antioxidants (e.g. fish, fruits,
vegetables, red wine)– cessation of smoking– happy
• Bad– obesity (BMI)
• >23 kg/m2 (overweight)• >25 kg/m2 (obese I)• >30 kg/m2 (obese II)
– lack of exercise– high fat, low fat, high salt, low
fibre intake– smoking– unhappy (stress)– family history
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The objective of education is to change behaviour
Health, like wealth, has to be earnedThe best way is the middle way
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20002000 年世界衛生組織年世界衛生組織亞太區體重指標新指引亞太區體重指標新指引
分類 體重指標 (BMI) =
過輕 <18.5正常 18.5 - 22.9過重 23 - 24.9肥胖 一級 25 - 29.9肥胖 二級 > 30
重量 ( 千克 )
高度 ( 米 )2
* 體重指標越高,患上相關疾病的機會越高資料來源 : Asia - Pacific Obesity Guideline 2000
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BMI cutoffs in Hong Kong Chinese
0
1
2
3
4
5
6
22 23 24 25 26 27 28 29 30
BMI (kg/m2)
ODDS
RAT
IO
DiabetesHypertensionDyslipidaemiaAlbuminuria
0
1
2
3
4
5
6
22 23 24 25 26 27 28 29
BMI (kg/m2)
DiabetesHypertensionDyslipidaemiaAlbuminuria
Men Women
Ko et al., 1999
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香港的肥胖問題香港的肥胖問題 **體重指標( BMI ) > 25 的肥胖人口比例• 男性 : 38%• 女性 : 34%
體重指標 ( BMI ) >23.5 的過重人口比例• 男性 : 58%• 女性 : 49%
* 根據 95 - 96 年香港大學的研究報告
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腰圍是中央(腹腔)肥胖的一個指腰圍是中央(腹腔)肥胖的一個指標標
腰圍超過 80 cm (32 寸 ) = 肥胖 腰圍超過 90 cm (36 寸 ) = 肥胖
cm亞洲女性 亞洲男性
* 腰圍越闊,腹腔脂肪越多,患上相關疾病的機會越高
2000 年 2 月新指引
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肥胖症對身體造成的傷害肥胖症對身體造成的傷害肺動脈高血壓
睡眠窒息症
冠心病
心衰竭
心律不齊
突然心臟死亡
中風
乳癌
關節炎
痛風
肝/膽疾病
靜脈曲張
二型糖尿病
子宮癌
直腸癌
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肥胖和死亡危機肥胖和死亡危機American Cancer Society Study of 750,000
Men and Women
2.5
2.0
1.5
0020 25 30 35 40
BMI
相對死亡率
心血管及膽囊疾病糖尿病
非常低 低 中度 高 非常高
男性女性
身體密度指數Reprinted from Gray. Med Clin North Am. 1989;73(1):1-13, based on statistical information from Lew et al. J Chron Dis. 1979;32:563-576.
消化系統及呼吸系統
1.0
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Keys to SuccessKeys to Success• Disease Vs Beauty• Prevention is the very first
step• Life-long commitment• Realistic goals• Multidisciplinary• Progressive & steady
weight loss• Motivations• Active self-participation
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糖尿病的病理糖尿病的病理• 缺乏胰島素缺乏胰島素• 對胰島素的反應失調對胰島素的反應失調• 影響血液中糖份轉化及儲存影響血液中糖份轉化及儲存
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糖尿病的危疾因素糖尿病的危疾因素
1. 1. 過重或肥胖 過重或肥胖 (( 最容易被改善最容易被改善 ))2. 2. 缺乏運動缺乏運動3. 3. 年齡年齡4. 4. 家族遺傳家族遺傳5. 5. 精神壓力精神壓力6. 6. 血壓高血壓高7. 7. 血脂、膽固醇高血脂、膽固醇高
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糖尿病引致的併發症糖尿病引致的併發症
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體重控制體重控制只需減輕 只需減輕 5-10% 5-10% 的體重便可的體重便可 ::
• 令膽固醇和三酸甘油酯降低令膽固醇和三酸甘油酯降低• 令血壓下降令血壓下降• 改善糖尿病人血糖控制改善糖尿病人血糖控制• 減低患上與肥胖相關疾病減低患上與肥胖相關疾病• 全面降低死亡機會全面降低死亡機會
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體重管理體重管理飲食
運動 藥物
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均衡飲食
確進 糖尿及內分泌專科中心
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食餐中的脂肪卡路里比例食餐中的脂肪卡路里比例一般人食餐的比例一般人食餐的比例
澱粉質40- 50
%
蛋白質15- 20 %
脂肪40%
理想食餐的比例理想食餐的比例
澱粉質45- 55
%
蛋白質15- 20 %
脂肪30%
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高脂肪食物會引致肥胖高脂肪食物會引致肥胖
2. 一般人容易進食過多高脂食物 的原因 : 高脂食物較美味 高脂食物不需太多嘴嚼 高脂食物不容易令人飽肚
脂肪 蛋白質和澱粉質能量9 kcal / g
能量4 kcal / g
1. 脂肪的能量是蛋白質和澱粉質的兩倍多
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體重管理體重管理運動運動• 能促進胰島素的作用,降低血糖能促進胰島素的作用,降低血糖• 減少體內的脂肪,使身體結實減少體內的脂肪,使身體結實• 促進血液循環,強化心臟促進血液循環,強化心臟• 幫助肺功能,增加氧氣幫助肺功能,增加氧氣• 放鬆精神壓力放鬆精神壓力• 增加良性膽固醇增加良性膽固醇• 降低血脂肪降低血脂肪
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體重管理體重管理運動運動• 要持之以恆要持之以恆• 最好每天 最好每天 30 30 分鐘以上帶氧運動分鐘以上帶氧運動• 不要太劇烈不要太劇烈• 要量力而為要量力而為
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體重管理體重管理 藥物藥物
• 必須經醫生診斷
• 與食物和運動配合
• 以安全和幫助治療肥胖相關的疾病為原則
• 停用後 , 體重也不應立即回升
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體重控制處方藥物體重控制處方藥物•甲狀腺荷爾蒙 - 非認可減肥藥物•利尿劑 - 非認可減肥藥物 •輕瀉劑 - 非認可減肥藥物
•胃口抑制藥 ( 安非他命類 , Phentermine, Sibutramine)
•脂肪酵素抑制劑 (Xenical 賽尼可 )
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藥理 - 抑制從胰臟分泌的脂肪酵素的作用,令三成 食物脂肪無法分解,排出體外
藥物脂肪酵素抑制劑 (Xenical 賽尼可 )
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藥物藥物 脂肪酵素抑制劑 脂肪酵素抑制劑 (Xenical(Xenical 賽尼賽尼可可 ))
效用及好處效用及好處::
• 根據國際臨床實驗顯示,在 根據國際臨床實驗顯示,在 6-86-8 個月期間,數千位病人平均個月期間,數千位病人平均減輕了減輕了 10 % 10 % 體重體重
• 不入血不上腦,沒有任何中樞神經系統的副作用,高血壓及不入血不上腦,沒有任何中樞神經系統的副作用,高血壓及心臟病人士亦可服用心臟病人士亦可服用
• 能有效控制及改善糖尿、血壓、血脂及心臟病能有效控制及改善糖尿、血壓、血脂及心臟病
• 身體排出不被分解的脂肪,有助改善飲食習慣身體排出不被分解的脂肪,有助改善飲食習慣
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成功控制體重:成功控制體重:• 不要操之過急不要操之過急• 每週最多減一公斤每週最多減一公斤• 要配合運動要配合運動• 配合飲食配合飲食• 持之以恆持之以恆• 遵照醫生指示下服食控制體重藥物遵照醫生指示下服食控制體重藥物