K17a - Obesitas
-
Upload
bella-andriani -
Category
Documents
-
view
27 -
download
7
description
Transcript of K17a - Obesitas
![Page 1: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/1.jpg)
OBESITASOBESITAS
PUGUD SAMODROPUGUD SAMODROSUB BAGIAN ENDOKRIN METABOLIKSUB BAGIAN ENDOKRIN METABOLIK
BAGIAN ILMU PENYAKIT DALAMBAGIAN ILMU PENYAKIT DALAMFKIKFKIK UNSOED/RSUD Prof. Dr. MARGONO UNSOED/RSUD Prof. Dr. MARGONO SOEKARJOSOEKARJO
PURWOKERTOPURWOKERTO
![Page 2: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/2.jpg)
![Page 3: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/3.jpg)
PendahuluanPendahuluan Obesitas asal kata ob = akibat dariObesitas asal kata ob = akibat dari esum = makanesum = makan obesitas = akibat dari makanobesitas = akibat dari makan Definisi obesitas :Definisi obesitas : suatu keadaan dimana ditemukan adanya suatu keadaan dimana ditemukan adanya
kelebihan lemak dalam tubuhkelebihan lemak dalam tubuh Obesitas ~ indeks massa tubuh (IMT)Obesitas ~ indeks massa tubuh (IMT)
![Page 4: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/4.jpg)
Proyeksi Peningkatan Prevalensi Obesitas
05
101520253035404550
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Population percentageWith BMI 30 kg/m2
USA
AustraliaEngland
Mauritius
Brazil
Source : IOTF unpublished
![Page 5: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/5.jpg)
Energy Production and Energy Balance
Carbohydrate
Fat
Basal metabolism
Thermic effectof food
Protein
Physicalactivity
Adaptivethermogenesis
![Page 6: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/6.jpg)
PENYEBAB OBESITASMasukan makanan meningkat tajam : makanan tidak sehat (junk food) banyak tersedia, harganya murah, rasanya enak dan didukung iklan yang menarik
Kurangnya aktivitas fisik : baik dalam bekerja maupun bermain, aktivitas fisik semakin berkurang
![Page 7: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/7.jpg)
MENGAPA OBESITAS MENGAPA OBESITAS DIPERMASALAHKAN ??DIPERMASALAHKAN ??
Meningkatkan morbiditas dan mortalitasMeningkatkan morbiditas dan mortalitas Penyakit Jantung Koroner (PJK)Penyakit Jantung Koroner (PJK) HipertensiHipertensi Diabetes Tipe 2Diabetes Tipe 2 KankerKanker OsteorthritisOsteorthritis Gout (Rematik Asam Urat), dllGout (Rematik Asam Urat), dll
Menimbulkan masalah sosial : kurang PDMenimbulkan masalah sosial : kurang PD
![Page 8: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/8.jpg)
Medical Complications of ObesityMedical Complications of Obesity
Coronary heart disease
Pulmonary disease:Abnormal PFTsObstructive sleep apneaHypoventilation syndrome
Gall bladder disease
Gynecological abnormalities:Abnormal mensesInfertilityPCOS
Gout
Stroke
Diabetes
Osteoarthritis
Cancer:Breast, uterus, cervixColon, esophagus, pancreasKidneyProstate
Liver disease:SteatosisNASHCirrhosis Hypertension
Dyslipidemia
Phlebitis
Cataracts
Skin
Borrowed from S. Klein
![Page 9: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/9.jpg)
Medical Complications of ObesityMedical Complications of Obesity
Coronary heart disease
Pulmonary disease:Abnormal PFTsObstructive sleep apneaHypoventilation syndrome
Gall bladder disease
Gynecological abnormalities:Abnormal mensesInfertilityPCOS
Gout
Stroke
Diabetes
Osteoarthritis
Cancer:Breast, uterus, cervixColon, esophagus, pancreasKidneyProstate
Liver disease:SteatosisNASHCirrhosis Hypertension
Dyslipidemia
Phlebitis
Cataracts
Skin
Borrowed from S. Klein
![Page 10: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/10.jpg)
DiagnosisDiagnosis IMT = IMT = BB (Kg)BB (Kg) TB (mTB (m22)) Klasifikasi BB WHO 1998 (orang Eropa/USA)Klasifikasi BB WHO 1998 (orang Eropa/USA) WHO 2000 (orang Asia)WHO 2000 (orang Asia) Klasifikasi berdasar distribusi lemak :Klasifikasi berdasar distribusi lemak : 1. ginekoid ( lemak >> tu bag bawah tubuh/gluteus)1. ginekoid ( lemak >> tu bag bawah tubuh/gluteus) 2. android (obesitas sentral/visceral) 2. android (obesitas sentral/visceral) lemak >> tu bag perutlemak >> tu bag perut berhub erat risiko penyakit kardiovaskulerberhub erat risiko penyakit kardiovaskuler (sindroma metabolik) (sindroma metabolik)
![Page 11: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/11.jpg)
Insulin ResistanceLiver
Muscle
Adiposetissue FPG
IFG
Hyperglicaemia
Pancreas
FFA
HDL
Hypertension
TG
Atherosclerosis
Compensation NGT
IGTDecompensation I
DMHyperinsulinemiaHyperinsulinemia Decompensation II
GeneticFetal malnutrition
Hyperinsulinaemia
GeneticEnvirontment
Obesity
SHK, Sept 2006
![Page 12: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/12.jpg)
Obesitas sentralObesitas sentral Diukur dgn : - CT scanDiukur dgn : - CT scan - MRI- MRI - lingkar pinggang (waist circum- lingkar pinggang (waist circum ference)ference) pria > 90 cm,wanita > 80 cmpria > 90 cm,wanita > 80 cm ( Asia )( Asia )
![Page 13: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/13.jpg)
UKURAN LINGKAR PINGGANG
. . . . . .
cm
. . . . . cm
< 80 cm normal > 80 cm risiko tinggi
< 90 cm normal > 90cm risiko tinggi
Obesitas Sentral lebih berbahaya daripada Obesitas Perifer risiko penyakit lebih tinggi
PENTING !!Lingkar Pinggang >>>menimbulkan berbagai masalah kesehatan karena :• bertambahnya IMT• distribusi lemak sentral (Obesitas Sentral)
![Page 14: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/14.jpg)
Subcutaneous fat
Abdominal muscle layer
Intra-abdominal fat
Abdominal Adiposity:Abdominal Adiposity:The Critical Adipose DepotThe Critical Adipose Depot
M. Davidson, MD.
Is this correct?
![Page 15: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/15.jpg)
PENGUKURAN LINGKAR PINGGANG/PERUT
TULANG RUSUK PALING BAWAH
TULANG PANGGUL
![Page 16: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/16.jpg)
Central AdiposityCentral Adiposity
![Page 17: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/17.jpg)
Global Global cardiometabolic riskcardiometabolic risk
![Page 18: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/18.jpg)
Klasifikasi BB utk orang Eropa Klasifikasi BB utk orang Eropa (WHO 1998)(WHO 1998)
Klasifikasi IMT (kg/mKlasifikasi IMT (kg/m22) Risiko morbiditas) Risiko morbiditasKurus <18,5 rendahKurus <18,5 rendahNormal 18,5-24,9 sedangNormal 18,5-24,9 sedangKegemukan Kegemukan >> 25 25 pre-obes 25-29,9 meningkatpre-obes 25-29,9 meningkat obes I 30-34,9 sedangobes I 30-34,9 sedang obes II 35-39,9 beratobes II 35-39,9 berat obes III obes III >> 40 sangat berat 40 sangat beratWHO Obesity : Preventing and Managing the Global Epidemic, Geneva, WHO Obesity : Preventing and Managing the Global Epidemic, Geneva,
WHO 1998.WHO 1998.
![Page 19: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/19.jpg)
Klasifikasi BB utk orang Asia Klasifikasi BB utk orang Asia (WHO 2000)(WHO 2000)
Klasifikasi IMT (kg/mKlasifikasi IMT (kg/m22) Risiko morbiditas) Risiko morbiditasKurus <18,5 rendahKurus <18,5 rendahNormal 18,5-22,9 sedangNormal 18,5-22,9 sedangKegemukan Kegemukan >> 23 23 pre-obes 23-24,9 meningkatpre-obes 23-24,9 meningkat obes I 25-29,9 sedangobes I 25-29,9 sedang obes II > 30 beratobes II > 30 berat The Asia Pasific Perspective. Redifining Obesity and its treatment, 2000The Asia Pasific Perspective. Redifining Obesity and its treatment, 2000
![Page 20: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/20.jpg)
Penanganan obesitas berdasarkan Penanganan obesitas berdasarkan IMTIMT
nilai IMT pengobatannilai IMT pengobatan18,5-24,9 tidak diterapi, hanya diet & OR18,5-24,9 tidak diterapi, hanya diet & OR25-29,9 diet rendah kalori & OR25-29,9 diet rendah kalori & ORTanpa komorbid Tanpa komorbid 25-29,9 obat-obatan,diet hipokalori,OR25-29,9 obat-obatan,diet hipokalori,ORDgn komorbidDgn komorbid30-39,9 obat-obatan dan behaviour mo-30-39,9 obat-obatan dan behaviour mo- dificationdification>> 40 bedah bila obat-obatan gagal 40 bedah bila obat-obatan gagal
![Page 21: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/21.jpg)
Faktor – faktor komorbidFaktor – faktor komorbid HipertensiHipertensi Penyakit kardivaskulerPenyakit kardivaskuler DislipidemiaDislipidemia HiperinsulinemiaHiperinsulinemia DM tipe 2DM tipe 2 Sleep apnea / obesity hypoventilation syndromeSleep apnea / obesity hypoventilation syndrome OsteoartritisOsteoartritis InfertilitasInfertilitas Kondisi lain : GERD, inkontinensi urin tipe stres,lo-Kondisi lain : GERD, inkontinensi urin tipe stres,lo- wer extremity venous stasis diseasewer extremity venous stasis disease
![Page 22: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/22.jpg)
Clinical Clinical MeasureMeasure
WHOWHO(1998)(1998)
EGIREGIR(1999)(1999)
ATP IIIATP III(2001)(2001)
AACEAACE(2003)(2003)
IDFIDF(2005)(2005)
Insulin Insulin ResistanceResistance
IGT,IFG,T2DM or IGT,IFG,T2DM or Lower insulin sensitivityLower insulin sensitivity
Plus any 2 of the followingPlus any 2 of the following
Plasma Insulin Plasma Insulin > 75> 75thth percentile percentilePlus any 2 of the Plus any 2 of the
followingfollowing
None, But any 3 ofNone, But any 3 of the following 5 the following 5
FeaturesFeatures
IGT or IFG plus any IGT or IFG plus any of following based onof following based on
clinical judgementclinical judgement
NoneNone
Body Body WeightWeight
Men : WHR > 0.90Men : WHR > 0.90Women : WHR > 0.85Women : WHR > 0.85
And/or BMI > 30 kg/mAnd/or BMI > 30 kg/m22
WC WC >>94 cm in men94 cm in menOrOr
>>80 cm in women80 cm in women
WC WC >> 102 cm in men 102 cm in menOrOr
>> 88 cm in women 88 cm in women
BMI BMI >> 25 kg/m 25 kg/m22 Increase WC Increase WC (population specific)(population specific)Plus any 2 of the Plus any 2 of the followingfollowing
LipidLipid TG> 150 mg/.dl or TG> 150 mg/.dl or HDL-C<35 mg/dl in menHDL-C<35 mg/dl in menOr < 39 mg/dl in womenOr < 39 mg/dl in women
TG TG >>150 mg/dl & 150 mg/dl & oror
HDL-C < 39 mg/dlHDL-C < 39 mg/dlIn men or womenIn men or women
TG> 150 mg/.dl or TG> 150 mg/.dl or HDL-C<40 mg/dl in menHDL-C<40 mg/dl in menOr < 50 mg/dl in womenOr < 50 mg/dl in women
TG> 150 mg/.dl or TG> 150 mg/.dl or HDL-C<40 mg/dl in HDL-C<40 mg/dl in
menmenOr < 50 mg/dl in Or < 50 mg/dl in
womenwomen
TG> 150 mg/.dl or TG> 150 mg/.dl or HDL-C<40 mg/dl in menHDL-C<40 mg/dl in menOr < 50 mg/dl in womenOr < 50 mg/dl in women
Blood Blood PressurePressure
>> 140/90 mmHg 140/90 mmHg >> 140/90 mmHg 140/90 mmHg or non hypertensionor non hypertension
>> 130/85 mmHg 130/85 mmHg 130/85 mmHg130/85 mmHg >> 130 mmHg systolic or 130 mmHg systolic or >> 85 mmHg diastolic or 85 mmHg diastolic orNon hypertention RxNon hypertention Rx
GlucoseGlucose IGT, IFG or T2DMIGT, IFG or T2DM IGT or IFGIGT or IFG(but not diabetes)(but not diabetes)
> 110 mg/dl> 110 mg/dl(Include diabetes)(Include diabetes)
FPG FPG >>110 mg/dl (2001)110 mg/dl (2001)FPG FPG >> 100 mg/dl (2004) 100 mg/dl (2004)
IGT or IFGIGT or IFG(but not diabetes)(but not diabetes)
> 100 mg/dl> 100 mg/dl(include diabetes) (include diabetes)
OtherOther MicroalbuminuriaMicroalbuminuria Other features of Other features of Insulin resistanceInsulin resistance
(PCOS,T2DM etc)(PCOS,T2DM etc)
Previous Criteria Proposed for Clinical Diagnosis ofMetabolic Syndrome
(Grundy et al, 2005)
![Page 23: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/23.jpg)
2323
IDF Definitionof MetS
• Present of Visceral obesity (men ≥ 90 cm, women ≥ 80 cm – WC).-
• And at least 2 of the following :- FPG ≥ 100 mg/dl (or T2DM).-- TG ≥ 150 mg/dl.-- HDL-C < 40 mg (men), <50mg (women).-- BP ≥ 130 systolic or ≥ 85 diastolic.-
![Page 24: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/24.jpg)
2424
High waist grith → Visceral obesity → Metabolic Syndrome
Metabolic Syndrome
Inflammation & thrombosis markers :hsCRPCytokines (TNF, IL-6) PAI-1Fibrinogen
Glucose-insulin homeostasis :Insulin resistanceHyperinsulinemiaHyperglycemiaIGT/IFG
Lipoprotein-lipid profile:TriglyceridesHDL-colesterolapo BSmall, dense LDLPostprandial hyperlipidemia
front
back
![Page 25: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/25.jpg)
JARINGAN ADIPOSA/JARINGAN LEMAKJARINGAN ADIPOSA/JARINGAN LEMAK
tempat menyimpantempat menyimpan kelebihan energikelebihan energi
mengeluarkan berbagai mengeluarkan berbagai protein yang disebutprotein yang disebut
ADIPOSITOKINADIPOSITOKIN yang berfungsiyang berfungsi mengaturmengatur keseimbangankeseimbangan energienergi
JARINGAN ADIPOSA
SEL ADIPOSIT
![Page 26: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/26.jpg)
AdipocytokinesAdipocytokines
![Page 27: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/27.jpg)
Factors Released From Factors Released From AdipocytesAdipocytes
![Page 28: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/28.jpg)
2828
Adiponectin(AdipoQ, Acrp30, GBP28)
• Adiponectin merupakan adipositokin yang secara ekslusif diproduksi oleh sel adiposit.-
• Adiponectin memiliki efek yang baik karena terlibat dalam mempertahankan keseimbangan metabolisme gula dan lemak, meningkatkan sensitivitas insulin dan menurunkan inflamasi
![Page 29: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/29.jpg)
Adiponectin
InsulinSensitivity
↓ FFA Influx
↓ VascularInflammation↓ Glucose ↓ TG
InsulinSensitivity
FFA Oxidation
AdiposeTissue
FFA Oxidation
↓ TG
(Ouchi N, et al, Curr Opin in Lipidol 2003)
KERJA ADIPONEKTINKERJA ADIPONEKTIN
![Page 30: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/30.jpg)
3030
Inflammation
CVD T2DM
ADIPONECTIN
![Page 31: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/31.jpg)
Adiponectin Hypothesis for insulin resistance, the metabolic syndrome, and atherosclerosis
J Clin Invest, 2006.-
Hypoadiponectinemia
Insulin Resistance
ATHEROSCLEROSIS
Metabolic Syndrome
Genetic factorAdiponectin gene
polymorphism
Lifestyle ChangesHigh-fat Diet,
Sedentary Lifestyle
Hyperlipidemia HypertensionT2DM
![Page 32: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/32.jpg)
Obesity promotes the parallel progression of insulin resistance to type 2 diabetes and endothelial
dysfunction to atherosclerosis
Endocrin, 2003.-
InsulinResistance
MetabolicSyndrome
Impaired GlucoseTolerance
Type 2Diabetes Atherosclerosis
Atherosclerosis
Atherosclerosis
EndothelialDysfunction
Visceral Adiposity
Proinflammatorymileu
Adiponectin
![Page 33: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/33.jpg)
3333
Visceral FatAccumulation
T2DM
Hypertension
Atherosclerosis
CHF
NASHCancers
Genetic Variations
MetS ADIPONECTIN
Conclusion :
![Page 34: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/34.jpg)
Obat-obatanObat-obatan OrlistatOrlistat hambat enzim lipase (absorbsi lemak)hambat enzim lipase (absorbsi lemak) MazindolMazindol hambat sinapsis reuptake norepinefrin & dopahambat sinapsis reuptake norepinefrin & dopa minmin Dietil propionDietil propion Leptin rekombinanLeptin rekombinan Terapi gen masa depanTerapi gen masa depan
![Page 35: K17a - Obesitas](https://reader035.fdocument.pub/reader035/viewer/2022081422/577cc37d1a28aba711962131/html5/thumbnails/35.jpg)
Terimakasih Terimakasih
Terima kasih