浙江大学医学院：肥胖与糖尿病和基因（PPT讲稿）

如x学营命 肥胖与糖尿病和基因 张成宁 zhangxianning@zju.edu.cn Tel:13105819271:88208367 Office: C303, Teaching building 2017/04

肥胖与糖尿病和基因 张咸宁 zhangxianning@zju.edu.cn Tel：13105819271; 88208367 Office: C303, Teaching Building 2017/04

Narayan Km, et al. Lifetime risk for Diabetes mellitus in the united states JAM42003;290(14):1884-1890 It has been estimated that one in every three individuals (one in two minorities) born in the us in the year 2000 will develop diabetes in their lifetime, mainly due to the epidemic of obesity

Narayan KM, et al. Lifetime Risk for Diabetes Mellitus in the United States. JAMA 2003; 290 (14): 1884–1890 • It has been estimated that one in every three individuals (one in two minorities) born in the US in the year 2000 will develop diabetes in their lifetime, mainly due to the epidemic of obesity

Demmer rt, et al. Prevalence of diagnosed and undiagnosed type 2 diabetes mellitus among Us adolescents, results from the continuous nHANES, 1999-2010 AmJ Epidemiol 2013 178(7):1106-1113 Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% and 0.369, respectively, indicating that T2DM accounted for 43% of all cases Further, undiagnosed T2DM prevalence was.12%, representing 34% of T2DM cases. T2DM accounts for approximately half of adolescent dia betes in the us. and one-third of these cases are undiagnosed

Demmer RT, et al. Prevalence of diagnosed and undiagnosed type 2 diabetes mellitus among US adolescents: results from the continuous NHANES, 1999-2010. Am J Epidemiol 2013; 178(7): 1106-1113 • Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% and 0.36%, respectively, indicating that T2DM accounted for 43% of all cases. Further, undiagnosed T2DM prevalence was 0.12%, representing 34% of T2DM cases. T2DM accounts for approximately half of adolescent diabetes in the US, and one-third of these cases are undiagnosed

Energy intake Energy storage 合 Energy expenditure

肥胖( obesity):体内脂肪积聚过多导致的一种 由多种因素引起的慢性代谢性疾病。患者常因过 多摄食或机体代谢发生改变而导致体内脂肪积聚 过多,体重增加,并引起病理生理方面的改变。 体重指数≥28.0kg/m2 The increasing prevalence of obesity worldwide (an approximate doubling in the last 30 years) 单纯性肥胖患者全身脂肪分布比较均匀,没有 内分泌紊乱现象,也无代谢障碍性疾病,其家 族往往有肥胖病史

肥胖（obesity）:体内脂肪积聚过多导致的一种 由多种因素引起的慢性代谢性疾病。患者常因过 多摄食或机体代谢发生改变而导致体内脂肪积聚 过多，体重增加，并引起病理生理方面的改变。 体重指数 ≥ 28.0 kg/m² • The increasing prevalence of obesity worldwide (an approximate doubling in the last 30 years) • 单纯性肥胖患者全身脂肪分布比较均匀，没有 内分泌紊乱现象，也无代谢障碍性疾病，其家 族往往有肥胖病史

Obesity: a Disorder of Energy Homeostasis(体内稳态) 体内稳态:机体保持体内环境相对稳定的倾向 和机制。正常机体在神经系统和体液以及免疫 系统的调控下,使得各个器官、系统的协调活 动,共同维持内环境的相对稳定状态 体重指数 body mass index(BMI):一个以身 体重量为主的判断营养状况的指标 BMI=体重(kg)身高(m2) 中国人的BMI正常范围:185~239kg/m2, 24.0~27.9kg/m2为超重,≥28.0kg/m2为肥胖, 低于185kg/m2为低体重

Obesity: a Disorder of Energy Homeostasis（体内稳态） • 体内稳态：机体保持体内环境相对稳定的倾向 和机制。正常机体在神经系统和体液以及免疫 系统的调控下，使得各个器官、系统的协调活 动，共同维持内环境的相对稳定状态 • 体重指数body mass index（BMI）：一个以身 体重量为主的判断营养状况的指标。 BMI = 体重(kg) /身高²(m²) • 中国人的BMI正常范围：18.5～23.9 kg/m²， 24.0～27.9 kg/m²为超重，≥28.0 kg/m²为肥胖， 低于18.5 kg/m²为低体重

TABLE 90-1 Prevalence of Overweight(BMI >95th percentile) for American Children 6-19 years of Age Years Age 6-11 years Age 12-19 years 1963-19703 4.2 4.6 1971-1974 4.0 6.1 1976-1980 6.5 5.0 1988-1994 11.3 10.5 1999-2000 15.1 14.8 2001-2002 163 16.7 2003-2004 188 17.4 2005-2006 15.1 7.8 2007-2008 19.6 18.1 1963-1965 data are for 6-11- year-old children, and 1966-1970 data are for 12-17(not 12-19)-year-old children Data obtained from References(412 )and( 5

肥胖的遗传率:40%60% 遗传率( heritable!y,k2):遗传因素在 多基因遗传病发生因素中所占的比例 遗传率愈大,表明遗传因素对病因的 贡献愈大

肥胖的遗传率：40%~60% • 遗传率（heritability，h 2）：遗传因素在 多基因遗传病发生因素中所占的比例 • 遗传率愈大，表明遗传因素对病因的 贡献愈大

疾病 遗传率 精神分裂症 80 哮喘 80 唇裂士腭裂 76 麻疹 16

疾病 遗传率 精神分裂症 80% 哮喘 80% 唇裂 ±腭裂 76% 麻疹 16%

遗传率h2: The proportion of the causation of a character that is due to genetic causes MZ DZ 100--CDZ If Cmz>> cpz then h is high(approaches 1) If c Mz- Cpz then his low(approaches 0 C= concordance发病一致性(same, identical) MZ=同卵双生子 DZ=异卵双生子

遗传率 (h 2 ): The proportion of the causation of a character that is due to genetic causes CMZ -- CDZ • h 2 = ----------------------- 100 -- CDZ • If cMZ >> cDZ then h 2 is high (approaches 1) • If cMZ = cDZ then h 2 is low (approaches 0) C = concordance发病一致性（same，identical） MZ = 同卵双生子 DZ = 异卵双生子