湘雅儿科精品课件-CHILDREN OBESITY.ppt

Liqun liu CHILDREN OBESITYDepartment Of Pediatrics第五章第六节（2）中南大学儿科学教研室PURPOSE AND REQUIREMENTTo master the diagnosis and treatment of children obesity.To be familiar with the etiology and pathophysiology of children obesity.To be familiar with the clinical manifestation of children obesity.肥胖症（肥胖症（ObesityObesity）是由于能量摄入长期超过人体的消耗，使体内脂肪过度积聚、体重超过一定范围的一种营养障碍性疾病。定 义分类单纯性肥胖症(Simple obesity)继发性肥胖症 (Secondary obesity)Excessive intake of nutrients Inadequate exercise Inherit factors The others ETIOLOGYSIMPLE OBESITY影响小儿健康活动不便易感染，甚至出现心肺功能不全心理障碍成年期并发症高血压(Hypertension)冠心病(Coronary heart disease)糖尿病(Diabetes)胆石症(Cholelithiasis)痛风(gout)危 害 性病理生理 营养素摄入 机体消耗 多余的能量转化为脂肪 人体脂肪细胞数量 人体脂肪细胞体积 肥胖病理生理 肥 胖脂肪代谢蛋白质 代谢内分泌 变化高脂血症尿酸 糖尿病 肥胖骨质病 男性性功能低下女性月经不调 不孕动脉硬化冠心病高血压胆石症痛风CLINICAL MANIFESTATIONSAges:it often occurs in the 1st yr of life,at 5 6 yr of age,and during adolescence.SymptomsGood appetite,be fond of sweetmeats and diet fry Fatigue,panting,and the Pickwickian syndromePsychologic obstacle 体征(signs)体脂丰满，分布均匀皮肤紫纹(purple striae)扁平足和膝外翻 (The flatfoot and genu valgum)男性阴茎(penis)隐藏在脂肪组织中CLINICAL MANIFESTATIONSDIAGNOSISThe odds of weight and height standards-Children with weight is 20%more than the mean value of the same sex and height.Mild:20%-29%Mid:30%-39%Severe:40%-59%Very serious:60%DIAGNOSIS Body mass index(BMI):It is the odds of weight and the square of height.standards Children with BMIs at the 95th percentile or more for age and sex or whose BMIs are more than 30 should be considered overweight.鉴别诊断 伴肥胖的遗传性疾病Prader-Willi syndromeLaurence-Moon-Biedl syndromeAlstrom syndrome 伴肥胖的内分泌疾病甲状腺功能减退症(hypothyroidism)肾上腺皮质增生症(Hyperadrenocorticism)鉴别诊断肥胖儿（体脂分布均匀）肥胖儿（体脂分布均匀）Cushings syndrome（满月脸）（满月脸）治 疗 原则减少热能性食物摄入增加机体对热能的消耗TREATMENT Modification of diet and caloric contentvThe diet contains high-quality proteins,low fats,low carbohydrates vThe diet contains as much bulk as possiblevSufficient vitamins and minerals supplementation vDevelop the good habits of diet TREATMENTDefinition and use of appropriate exercises programBehavior modification for the child(including psychotherapy)Gene therapyDrug treatmentIt is unsuitable for childrenHungry or half-hungry treatment is forbidden Fast weight loss(less than 3 months)is forbidden Drug、food or drink on weight loss is forbidden Surgical or physical treatment is forbidden contradicationsTREATMENT