FEDME-EPIDEMIEN OG ALMEN PRAKSIS

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FEDME-EPIDEMIEN OG ALMEN PRAKSIS

• Thorkild I.A. Sørensen, Professor, Dr.Med.

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Figure 2. Histogram of the distribution of Body
Mass Index at conscription board examination for
the 5,531 men
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Figure 4. Kaplan Meier plots for the obese cohort
(grey line) and the randomly selected cohort
(black line)
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Figure 3. Cumulative hazard plot of the randomly
selected cohort versus the obese cohort
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Figure 5. Smoothing spline (5 d.f.) of the
association between BMI at conscription board
examination and all-cause mortality
The grey line illustrates the entire cohort and
the black line illustrates the sub-cohort with
information on education and intelligence test
score (with 95 confidence limits)
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CHD events
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Association between BMI z-scores at ages 7-13 y
and adult CHD among boys
From Baker et al. NEJM 20073572329-2337
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Association between BMI z-scores at ages 7-13 y
and adult CHD among girls
From Baker et al. NEJM 20073572329-2337
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Mortality by Weight Change in 19751981 among
Those Reporting Trying to Lose Weight in 1975
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Mortality by Weight Change in 19751981 among
Those with No Intention to Lose Weight in 1975
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Waist circumference
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Waist circumference and all-cause mortality
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BMI and all-cause mortality
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Body composition, waist circumference, and
mortality in men and women aged 50-64 Yrs
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• Differential effects of body mass components
• This series of studies supported by other
  studies strongly suggest that the body
  compartments have different impact on health,
  even measured crudely as total mortality
• More abdominal fat mass is harmful
• More peripheral fat mass is beneficial
  
• More lean body mass (to some level) is
  beneficial
• It is likely that the net effect on mortality
• of these body compartments depends on
• their relative size and effect by size.

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Multiple predictors of childhood obesity But
are they also modifiable causes?

• Genetic variation
• Maternal prepregnancy weight
• Gestational weight gain
• Smoking during pregnancy
• Birth weight (for given gestational age and
  length)
• Duration of breast feeding
• Age at start of complementary feeding
• Protein intake
• Growth during infancy
• Duration of sleep
• Mother-child relationships
• Sugary soft drink intake
• Physical activity
• Television viewing
• Adiposity rebound

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Heritability estimates for relative weight from
birth to age 18 of Swedish twin pairs
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• The obesity epidemic is affecting the school-boys
  much earlier than the draftees and obviously
  before the economic growth began!
• Also, the environmental changes driving the
  epidemic did not affect individuals at any of
  these ages equally.
• Note that the changes ocurred about 10 years
  later in the about 10-year-older young men.

Year of measurement
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• The trends coincides by year of birth
• Implies that the environmental changes driving
  the epidemic operate around the time of birth
  the individuals may become susceptible within the
  first years of life.
• This susceptibility may contribute along with the
  genes to the well known tracking of obesity over
  the ages.

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Odds ratio for obesity by parental support
perceived by the teacher
p0.2
p0.3
plt0.0001
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Odds ratio for obesity by appearance at school
health exa
plt0.0001
p0.4
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Year of birth, about 20 years before examination
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Obesity in Danish young men
http//www.forsvaretsuddannelser.dk/ForsvaretsDagO
gVaernepligt/Pages/bmi.aspx
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How much is a z-score increase in BMI?