panorama actual y epidemiología de la obesidad - seedo · obesidad: la epidemia del siglo xxi 1.9...

Panorama actual y epidemiología de la obesidadDra. Mònica Bulló

Unidad de Nutrición Humana: prevención y epigenéticaUniversitat Rovira i Virgili (URV)-IISPV-CIBER

Outline

1. Background. Prevalence and incidence of overweight/obesity

2. Morbidity/Mortality

3. Screening

4. Interventions

5. Future research efforts

BackgroundPrevalence/Incidence

OBESIDAD: La epidemia del siglo XXI

1.9 billones de adultos con sobrepeso (39%)650 millones con obesidad (13%)

41 millones de niños < 5años con sobrepeso340 millones de niños > 5años con sobrepeso

Prevalence of overweight among adults, aged 18+, 1975-2016Men

Women

Prevalence of obesity in 1975 (distribution by country)


Prevalence of obesity among adults, aged 18+, 1975-2016

Men

Women



Prevalence of overweight among children and adolescents, 1975-2016

Prevalence of obesity among children and adolescents, 1975-2016

1994. Gutiérrez-Fisac JL et al. Med Clin (Barc)

1994;102:10-3. Datos autorreportados extraídos de

la Encuesta Nacional de Salud

1997. Aranceta J et al. Prevalencia de la obesidad

en España: estudio SEEDO 97. Med Clin (Barc)

1998;111:441-5. Mediciones antropométricas

población 25-60 años

Sobrepeso y obesidad: situación en España

2000. Aranceta J et al. Prevalencia de la obesidad

en España: resultados de estudio SEEDO 2000.

Med Clin (Barc) 2003; 120(16):608-612. Población

25-60 años

Obesidad (≥30) SobrepesoPrevalencia global: 14,5% 39,5%

Mujeres: 15,75% 32,0%Varones: 13,39% 45,0%

Obesidad: 24,4%Sobrepeso: 46,4%

Obesidad: 21,4%Sobrepeso: 32,5%

Estudio ENRICAGutiérrez-Fisac JL, et al. Obes Rev 2012

11.991 personas en el periodo de

junio de 2008 a octubre de 2010

39,4% sobrepeso

22,9% obesidad

Sobrepeso y obesidad: situación en España

Estudio ENPEEstudio transversal en muestrarepresentativa de la población noinstitucionalizada de entre 25 y 64años (n=3.801) entre 2014-2015

Prevalencia de sobrepeso 39,3%Prevalencia de obesidad 21,6%Prevalencia obesidad abdominal: 33,4%

Sobrepeso y obesidad infantil: evolución en España

Estudio enKid

3.534 varones y mujeres de entre2 y 24 años (423 niños entre 6-9años) (1998-200)

14,5% sobrepeso15,9% obesidad

7.659 niños y niñas de 6-9años distribuidos encentros escolares de todaslas CC.AA entre 2010-2011.




Prevalence and sociodemographic correlates of overweight and obesity in a large Pan-European cohort of preschool children and their families: the ToyBox studyYannis Manios....(Luis A Moreno) et al. Nutrition, May 2018

7554 preschool children (3.5-5.5 years) and their parents participated in the ToyBox-study. Children's weight and height were

measured, while parents self-reported their weight, height and family sociodemographic data in questionnaires

Prevalence of overweight/obesity (IOTF

criteria) among preschool children from the six

countries participating in the ToyBox-study

* p<0.001, for differences of % obesity levels across the six European

countries (Greece>Poland, Belgium, Germany). ** p<0.001, for

differences of %overweight/obesity levels across the six European

countries (Greece>Bulgaria, Spain, Poland, Belgium, Germany;

Bulgaria>Germany; Spain>Germany

Prevalence of childhood overweight/obesity by parental weight status in the total sample and in the six countries participating in the

ToyBox-study

Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-

based surveys with 1·9 million participants

Regina Guthold, at al. Lancet Glob Health 2018

Data from 358 population-based surveys across 168 countries, reporting the prevalence of insufficient physical activity, which includedphysical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 minof vigorous-intensity physical activity per week, or any equivalent combination of the two)

Country prevalence of insufficient physical activity in men and in women in 2016

Trends in insufficient physical activity forthree income groups from 2001 to 2016

Morbidity/mortalityEffects on population health

Medical complications of obesity

Alzeheimer

http://www.commed.vcu.edu/Chronic_Disease/Obesity/2013/progressobesitryPrev.pdf

Physical Health, Psychosocial, and functional consequences of Obesity over the Life Course

http://www.commed.vcu.edu/Chronic_Disease/Obesity/2013/progressobesitryPrev.pdf

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment.

Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration.Lancet Diabetes Endocrinol. 2014

After accounting for multicausality, 63% of deaths from these diseases in 2010 were attributable to the combined

effect of 4 metabolic risk factors, compared with 67% in 1980. The mortality burden of high BMI and glucose nearlydoubled from 1980 to 2010

Data from 68.5 million persons among children and adults between 1980 and 2015.

Since 1980, the prevalence of obesity hasdoubled in more than 70 countries.

The rate of increase in childhood obesity inmany countries has been greater than therate of increase in adult obesity.

High BMI accounted for 4.0 million deathsglobally (more than 2/3 were due to CVD).

Global Disability-Adjusted Life-Years and Deaths Associated with a High BMI (1990–2015).

Number of global disability-adjusted life-years related to a high BMI amongadults according to the cause and the level of BMI in 1990 (Panel A) and in2015 (Panel B) and the number of global deaths (in millions) related to highBMI in 1990 (Panel C) and in 2015 (Panel D). The two vertical lines mark theBMI thresholds for overweight (25-29) and for obesity (≥30). The percentagesindicate the proportion of the total number of disability-adjusted life-years ordeaths that were contributed by each of the listed disorders.

1st. CVD2nd. CKD

1st. CVD2nd. T2D

Cancer and obesity

Obesity and neurodegenerative disorders

Obesity

Damage to the central nervous systemApoptosis or cell necrosis

Alteration of the synaptic plasticity

Neurodegenerativedisorders

Insulin resistance Type 3 diabetes

Hazard ratios per 5-kg/m2 increase in BMI for dementia was 1.16 (95% confidence interval 1.05–1.27) when BMI was assessed >20 years before dementia diagnosis.

Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals

O’Brien PD, et al. Lancet Neurol 2017; 16:465-77

Kiwimaki M et al. Alzeheimers Dement 2018

Data from 1.349.857 dementia-free participants from 39 cohort studies

The influence of obesity and weight gain on quality of life according to the SF-36 for individuals of the dynamic follow-up cohort of the University of Navarra Barcones-Moleroa, et. Revista Clínica Española 2018

10,033 participants of the dynamic cohort of the Follow-up Program of the Unversity of Navarra (SUN cohort). The quality of life was measuredwith the SF-36 questionnaire

Physical function, generalhealth and the physicalcomponent summary wereinferior in individuals withexcess weight and obesity

The Obesity Paradox ....or reverse epidemiology

Do we reallyneed to loseweight?

Obesity Paradox Does ExistHainer V et al. Diabetes Care 2013

PLOS ONE 2015

Forest plot showing individual and pooled relative risks of all-

cause mortality with 95% confidence intervals across 12

randomized clinical trials of weight loss interventions

15 RCT, duration ≥ 18 months, 17,186 participants

Intentional weight loss may

be associated with

approximately a 15%

reduction in all-cause

mortality.

Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 DiabetesThe Look AHEAD Research Group

N Engl J Med. 2013 Jul 11; 369(2): 145–154.

Intensive lifestyle intervention focused on weight loss did notreduce cardiovascular events in overweight or obese adults withtype 2 diabetes.

5,145 OW/OB individuals with T2D randomized either to an intensive lifestyle intervention which promoted weight loss throughdecreased calorie intake and increased physical activity, or diabetes support and education. Planned follow-up of 13.5y (maximumachieved 9.6y)

Cumulative Hazard Curves for the Primary Composite End Point.

Baja en grasa

DietMed+ Restricción calórica+ Actividad física+ Intervención conductual

DietMed

Pérdida peso mantenimiento a largo plazo CVD

In red you can see the recruiter centers of the PREDIMED I, and in green the new recruiters centers of PREDIMED PLUS project.

Hospital Txagorritxu, Vitoria

Facultad de Medicina, Universidad de Navarra

IDIBAPS, Hospital Clínic, BarcelonaIMIM, BarcelonaHospital de Bellvitge, BarcelonaHospital Clínic, Barcelona

Facultad de Farmacia y Ciencias, Universidad de Navarra

Facultad de Medicina de Reus, Universitat Rovira i Virgili

Facultad de Medicia, Universidad de Málaga

Hospital Universitario Virgen de la Victoria de Málaga

Hospital Son Dureta, Palma de Mallorca

Universitat de les Illes Balears

Facultad de Medicina, Universitat de València

Universitat

Jaume I,

Castellón

Universidad de Córdoba

Instituto de la Grasa

CSIC, Sevilla

Universidad de las

Palmas de Gran

Canaria

Hospital Ramón y Cajal, MadridCSIC, Madrid

Hospital Clínico de Madrid

Universitat de Jaén

Facultad de Medicina, Universidad Miguel Hernández,

Sant Joan d'Alacant (Alicante)

23 Recruiting centresPREDIMED 1 centres

New centres

CENTROS RECLUTADORES

Universitat de León

DISEÑO Y MÉTODOS

Participantes elegiblesn= 9677

Aleatorizaciónn= 6874

Grupo de Intervención Grupo control(DietMed)DietMed hipocalórica

+Promoción de la AF

+Soporte conductual

Criterios de elegibilidad:55-75 a (60-75 M)IMC: 27-40 kg/m2

Cumplir ≥ 3 criterios del SMSin ECV previa

< 25% diabéticos

n = 3406 n = 3468

PROTOCOLO DE INTERVENCIÓN

Cribado

Seguimiento

GRUPO DE INTERVENCIÓN (DietMed hipocalórica + AF + soporte conductual)

3 M 6 M 9 MInicio

Aleatorizacióm

1er Año*

GRUPO CONTROL (DietMed)

1 M 2 M 4 M 5 M 7 M 8 M 10 M 12 M

Individual + sesión grupal

Rodaje

4 semanas

Individual + sesión grupal + contacto telefónico

6 MInicio 1er Año y años sucesivos

* De los 2-6 años para el Grupo de intervención:Después del primer año y en cada uno de los años restantes del ensayo, los participantes asistirán a: una sesión individual trimestral y una sesión de grupo mensual y dos llamadas telefónicas trimestral

Effect of a lifestyle intervention program with energy-restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: One-year results of the PREDIMED-Plus trial

Salas-Salvadó J et al, Diabetes Care 2018

Intervention vs control

Variable Between-group differences

Intention-to-treat

n=626P value

Per protocol analysis

n=584P value

Change in body weight (kg)

At month 6 -1.9 (-2.4 to -1.4) <0.001 -2.0 (-2.5 to -1.4) <0.001

At month 12 -2.5 (-3.2 to -1.9) <0.001 -2.6 (-3.2 to -1.9) <0.001

Change in body weight (%)

At month 6 -2.2 (-2.8, -1.6) <0.001 -2.2 (-2.8, -1.6) <0.001

At month 12 -3.0 (-3.6, -2.3) <0.001 -3.0 (-3.7, -2.3) <0.001

Change in BMI (kg/m2)

At month 6 -0.7 (-0.9 to -0.5) <0.001 -0.7 (-0.9 to -0.5) <0.001

At month 12 -1.0 (-1.2 to -0.7) <0.001 -1.0 (-1.2 to -0.7) <0.001

Changes in weight loss at 6 and 12 months according to the intervention groupIntervention vs Control

Variable Between-group difference

Intention-to-treat (MI) P value Completers-only P value

Waist circumference (cm)

6-month change -2.1 (-2.9 to -1.3) <0.001 -2.2 (-3.1 to -1.4) <0.001


Glucose (mmol/L)

6-month change -0.21 (-0.37 to -0.03) 0.02 -0.20 (-0.38 to -0.03) 0.02


HbA1c (%)*



Insulin (pmol/L)†


HOMA-IR index‡


Total cholesterol (mmol/L)

6-month change 0.02 (-0.10 to 0.13) 0.76 0.04 (-0.08 to 0.16) 0.49


HDL cholesterol (mmol/L)

6-month change 0.03 (0.01 to 0.06) 0.02 0.03 (0.01 to 0.06) 0.02

12- month change 0.06 (0.03 to 0.09) <0.001 0.06 (0.03 to 0.09) <0.001

LDL cholesterol (mmol/L)



Total cholesterol/HDL cholesterol ratio

6-month change -0.07 (-0.18 to 0.04) 0.19 -0.06 (-0.17 to 0.05) 0.28

12 month change -0.16 (-0.28 to -0.03) 0.01 -0.14 (-0.26 to -0.02) 0.02

Triglycerides (mmol/L)

6-month change -0.07 (-0.16 to 0.02) 0.13 -0.08 (-0.18 to 0.01) 0.09


Values expressed as mean (95% CI) unless otherwise indicated

Changes in adiposity and CVD risk factors according to the intervention group

ScreeningAre we defining obesity well?

Body fat distribution is more predictive of all‐cause mortality than overall adipositySung Woo Lee et al. Diabet, Obes and Metab 2018

36 656 participants who underwent abdominal computed tomography (CT)‐measured body fat. 253 deaths in a 5.7 y follow-up.

Increased subcutaneous fat area (SFA) was associated with decreased all‐cause mortality, whereas an increased visceral fat area (VFA) and visceral‐to‐subcutaneous fat area (VSR) were related to increased all‐cause mortality.

Kaplan–Meier survival curve of tertiles of subcutaneous fat area (SFA) and visceral‐to‐subcutaneous fat area ratio (VSR)

Joint association between body fat and its distribution with all-cause mortality: A data linkage cohort study based on NHANES (1988-2011)Bin Dong et al, PLOS One 2018

Data linkage cohort study included 16,415 participants (8554 females) aged 18 to 89 years from National Health and Nutrition Examination Survey III. A total of 4,999 deaths occurred during 19-year follow-up.

Association between body fat percentatge and waist-hip ratio with hazardratio of all-cause mortality in males and females, NHANES 1988-2011

Solid lines and dash lines represent the hazard ratios and their 95% conficence intervals after adjusting for baseline age and ethnicity25% 35%

New indexes of body fat distribution and sex-specific risk of total and cause-specific mortality: a prospective cohort study. Bin Dong et al, PLOS One 2018

Data from the German population based KORA Augsburg cohortstudy. 6670 men and 6637 women aged 25 to 74 years with afollow-up period of 15.4 years were included.

Association between BMI, BAI, WC, WHR, and WHtR andthe outcomes all-cause-, CVD-, and cancer mortality usingcubic smoothing splines in men

Body Adiposity Index (hip circumference ÷ height1.5)

New indexes of body fat distribution and sex-specific risk of total and cause-specific mortality: a prospective cohort study. Bin Dong et al, PLOS One 2018

Data from the German population based KORA Augsburg cohortstudy. 6670 men and 6637 women aged 25 to 74 years with afollow-up period of 15.4 years were included.

Association between BMI, BAI, WC, WHR, and WHtR andthe outcomes all-cause-, CVD-, and cancer mortality usingcubic smoothing splines in women

Central obesity reflects higher all-cause and CVD-mortality risk particularly in women. BAI (bodyadiposity index) and WHtR seem to be valid as riskpredictors for all-cause and especially CVDmortality in men

¿Estamos clasificando bien al paciente obeso?

IMC= peso (Kg)/ talla (m)2

n=6123

Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity.

20,1-24,9% / 30,1-34,9% (men/women)

≥25% /≥35% (men/women)

r=0.78r=0.87p<0.001

29%

80%

Gómez-Ambrosi J et al Int J Obes 2012Criterios de clasificación del sobrepeso y la obesidad

From the overweight to the overfat(del IMC al % de masa muscular)

Estimated number and percentage of overfatand underfat adults and children worldwide(based on 2014 world population numbers of 7.2billion).

1Includes obese and overweight and other populations listed above (items 1–5). The 62%number does not include item 6 (children). 2 Includes 666 million adults due to starvation,plus 10.8 million chronically ill people who were cachexic at time of death in 2008 (with thehigh range including 70 million with eating disorders). 3World population of 7.2 billionminus overfat plus underfat.

Not only the amount, also fat distribution makes the difference

INFLAMMATION....others?

Characterization of different fat depots in NAFLD using inflammation-associated proteome, lipidome and metabolome

Lovric A et et al, Sci Rep, Sept 2018

Heatmap visualization based on Spearman correlationbetween variables of interest (column wise) and lipidome(row wise).

Colour key indicates strength of a relationship: blue color – negativerelationship, red colour – positive relationship. *Significant relationship afterFDR correction and significance level of 0.05.

Different metabolic signatures for different fat depots were identified

InterventionsPrimary, secondary, tertiary, community-level

La obesidad es una enfermedad multifactorial

Efecto HALO

Lee B, et al. Nutrition Reviews Vol. 75(S1):94–106

Tratamiento integral de la obesidadEl objetivo general del tratamiento integral consiste no solo en la reducción exitosa del peso y la grasa corporal, sino en lamodificación del estilo de vida para que la pérdida de peso se mantenga a lo largo de los años.

Manejo NutricionalManejo de la actividad física y el ejercicio

Manejo psicológicoManejo farmacológico y/o quirúrgico

Mejor conocimiento y definición de la patología

1. 2.

Creación ambientesaludable

3.

Prevención primaria de la obesidad

Facilitar el acceso a alimentos saludablesPublicidad de los alimentos, etiquetadoControl del tamaño de las racionesAsequibilidad de alimentos saludablesPautas para las comidasTasas

Regulación del balance calórico y de nutrientespara prevenir la ganancia de peso corporal

AlimentaciónActividad física

Areas seguras para la práctica de la actividad físicaUrbanismo saludable

Tratamiento farmacológico de la obesidad

Dr Juanjo GorgojoSábado 20 de octubre 11:00-11:30

Tratamiento quirúrgico de la obesidad

Dra Nuria VilarrasaSábado 20 de octubre 8:30-9:00

Estrategias comunitarias

1. TO PROMOTE THE AVAILABILITY OF AFFORDABLE HEALTHY FOOD AND BEVERAGES

2. TO SUPPORT HEALTHY FOOD AND BEVERAGE CHOICES

3. TO ENCOURAGE BREASTFEEDING

4. TO ENCOURAGE PHYSICAL ACTIVITY OR LIMIT SEDENTARY ACTIVITY AMONG CHILDREN AND YOUTH

5. TO CREATE SAFE COMMUNITIES THAT SUPPORT PHYSICAL ACTIVITY

6. TO ENCOURAGE COMMUNITIES TO ORGANIZE FOR CHANGE

Future research effortsFilling in gaps, expanding on existing knowledge

Los factores implicados, hasta el momento, en la obesidad son:

Nutrigenómica-nutrición personalizada

Metabolómica de la obesidad

Microbiota intestinal

Epigenómica de la obesidad

¿Qué pasa cuando se estropea el reloj?

Gracias por su atención

On average, the prevalence of overfat adults and children indeveloped countries is extremely high, and substantiallygreater than that of overweight and obese individuals

Heymsfield SB, Wadden TA. N Engl J Med 2017;376:254-66

Sobrepeso y obesidad infantil: evolución en España



11,8% sobrepeso18,5% obesidad30,3%

12,1% sobrepeso14,5% obesidad(26,6%)

Estudio enKid 3.534 varones y mujeres de entre 2y 24 años (423 niños entre 6-9años) (1998-200)14,5% sobrepeso/15,9% obesidad

10.899 niños (5.532 niños y 5.367 niñas) de 6-9 años en 165 centros escolares detodas las CC.AA entre 2015-2016. Esta muestra es representativa del conjunto de lapoblación española para esos grupos de edad.

20,4 kg/m2

20 kg/m2

Sobrepeso y obesidad infantil: situación en España

panorama actual y epidemiología de la obesidad - seedo · obesidad: la epidemia del siglo xxi 1.9...

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