Why Does My Sim Look Like A Silhouette?

L’attività fisica con la Nutrizione come prevenzione e trattamento all'obesità infantile

UNIVERSITA’ DEGLI STUDI DI FIRENZE
FACOLTA’ DI MEDICINA E CHIRURGIA
Corso di laurea specialistica in “Scienze della Nutrizione Umana”
Corso di “Medicina dello sport” Prof. Giorgio Galanti
Professore Ordinario in Medicina Interna Azienda Ospedaliera Careggi Firenze; Cattedra di Medicina dello Sport

Relazione di :
dott.ssa Simona Sampirisi

“l’obesità child "is one of the problems is steadily increasing and, in many European countries, one child in five is obese or overweight. A worrying fact is the persistence of childhood obesity in adulthood, leading to increased risk for salute1. The pediatric obesity is a worrying situation and difficult clinical management, which is characterized by the high prevalence and the occurrence of complications (diabetes mellitus, hypertension, dyslipidemia) ever earlier and important, about 25-50% of children maintains the obese overweight in old age adulta2 leading to increased health risks and inevitable ripercussione psicologica: infatti, l'obesità infantile comporta spesso una diminuzione dell'auto-stima e persino sindromi depressive".
Il fenomeno ha una rilevanza sia da un punto di vista epidemiologico che da un punto di vista economico inquanto l’umento degli individui in sovrappeso determina un continuo aumento dei costi sociali dovuti per il controllo delle complicanze che comporta tale patologia.
La prevenzione risulta essere oggi più importante che mai, bisogna comunicare e insegnare l’importanza della salute partendo da un’educazione alimentare associato allo sport e quindi un sano stile di vita. Le scuole sono l’ambiente più vicino ai bambini e ai genitori, la base di una buona educazione nasce dalla conoscenza and an awareness of what one meets with a disease like obesity ...

... For Obesity is defined as a generalized and excessive accumulation of fat in the subcutaneous tissue but also in other tissues and may be associated with alterations of metabolic parameters with physical problems of overload and psychological discomforts sociali3.
The World Health Organization warns that in the 'European Health Report 2002, report on health in Europe in 2002, published by WHO European Region, obesity is defined as a real epidemic that extends throughout the European Region. "In many European countries - it says - more than half of the population adult is above the threshold for "overweight" and about 20-30% of adults fall into the category of obese ("clinically obese ")...

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Obesity in childhood as a risk factor
Obesity is a major risk factor for a variety of diseases and medical conditions that include:
- and metabolic factors: hypertension, l ' hyperinsulinemia, glucose intolerance to type 2 diabetes, cardiovascular diseases, neurological disorders, some forms of cancer, gallstones
- Physical Factors: orthopedic conditions, asma.
- Fattori Psico-sociali: conseguenze emozionali, sociali e psicosociali immediate per il bambino e l’adolescente. Tra queste, anche quelle legate al bullismo in ambito scolastico, a sua volta associato a rischio di depressione e ansia. Inoltre, i bambini sovrappeso godono di autostima più bassa e sono riconosciuti e meno accettati tra i compagni di giochi e a scuola (aspetto determinante, questo, per il loro sviluppo sociale e psicologico). Infine, i bambini in sovrappeso-obesi, proprio per il ridotto livello di autostima, saranno maggiormente suscettibili a comportamenti negativi per la salute: consumo di alcol, fumo di sigaretta (Lobstein et al, 2004)9,10....

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periods at risk of developing childhood obesity
There are at least three times during the life of a subject in which there is a greater likelihood that obesity will arise: the first year of life, the aged between 4 and 6 years and puberty. Three are also periods of hyperplasia adipociti11. The adipose tissue may be increased by hyperplasia (increased number of fat cells) and / or hypertrophy (increase in the volume of them). In fact, excess food consumption determines, in the long run, an excess of body fat and the appearance of phenomena such as overweight and obesity ....

is ... dimostrato che uno stile di vita sedentario nell’infanzia favorisce lo sviluppo di malattie cardiovascolari , diabete e obesità in età adulta26. Una moderata attività fisica, come camminare o andare in bicicletta offre sostanziali benefici per la salute: secondo l'Organizzazione Mondiale della Sanità, bambini > 2 anni dovrebbero impegnarsi in un’attività fisica moderata- intensa per almeno 30 minuti , tutti i giorni o più giorni alla settimana. Per attività fisica moderata-intensa, s'intende l’intensità degli esercizi che è stata definita in base alla frequenza cardiaca e che in generale quella moderata consiste in 30 minuti di jogging ad una andatura controllata, mentre quella intensa consiste in 30 minutes of running or shooting.
sedentary habits after school (abuse of television and computers), diminish the effectiveness of education in physical activity during school hours.

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Inactivity is a factor that greatly contributes to maintaining the child obesity

recommendation of the sports best suited to the age and IBM
In children of school age a kind of exercise program provides structured:

- BMI 17-20: Children (3-11 aa) overweight. Are recommended aerobic activities against gravity, such as walking, stair climber or treadmill exercise, participate in sports such as tennis, martial arts, skiing, indoor gym, swim, dance, dance aerobics.

- BMI 19-24: Children (3-11 aa): obese. Recommended aerobic activities: first, not against gravity, like swimming, bicycling, or aerobic training load (strength), aerobic dance specifically for the upper limbs, the arm ergometer (crank), bicycle and gear lying interspersed with frequent rest . BMI ≥ 24.1: Children (3-11 aa): severely obese. May be given a weekly specialist supervision.

- BMI ≥ 24.1: Children (3-11 aa) severely obese. May be given a weekly specialist supervision.

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Nutritional intervention:
The diet therapy is only one component of obesity treatment, even in childhood. The goal of treatment is to change the bad behavior of the lifestyle, improve diet, increase physical activity and decrease inactivity, ensuring growth fisiologica34, 35.36.
The nutritional intervention should be performed in patients with:
- Overweight in the presence of complications or risk factors
- Obesity, with or without complicanze37
And 'take priority a diet therapy program only when the children and family appear willing to make the necessary changes in the style of vita38.
approach started early (between 2-3 years old) seems to give longer lasting results (American Academy of Pediatrics, 40).

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The therapeutic strategy includes:

1) in the presence of a single mistake detected food: the correction of the same without necessarily changing the overall eating pattern;
2) in the presence of excessive caloric intake: l ' adopting a balanced eating pattern normocaloric age with gradual reduction of foods high caloric density and high fat content.
3) in the presence of a lifestyle characterized by physical inactivity: the development of appropriate physical activity can rebalance the energy balance;
4) in the presence of established clinical complication, usually associated with obesity in middle-high grade : the adoption of a moderately low-calorie, balanced diet pattern, given in line with the recommendations dietetiche39, 40,41,42,43: for low-calorie balanced diet means a pattern characterized by: a lower energy intake (30% reduction calories than the recommended energy requirements) and distribution of calories among macronutrients similar to normal, distributed among 5 meals, giving preference protein (15-20%), especially with reduction of lipid proportion (25-30%). The relatively high protein portion tends to maintain a normal intake in grams per kilogram of protein to prevent negativity of nitrogen balance. The purpose of this diet is to gradually reduce the weight of the boy, but manifestly, used to a proper diet. The distribution of the meals must be made in 5 events with food, and includes: 15% of calories at breakfast, in the presence of fruit and vegetables a day, two small snacks that provide energy to 10-15%, 35-40% at lunch , 30% at dinner.

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dietary recommendations to prevent obesity Infant

The Royal College of Paediatrics in 2002 published the following dietary recommendations in the prevention of child obesity scolare53:

1) healthy and balanced diet, not monotonous, which alternate daily food since all active adequate to prevent deficiencies of nutrients, with a contribution of 10-15% protein, 28-30% fat and 60% carbohydrates.

2) Avoid excessive calorie intake, but eating in relation to what you consume and give the child time to eat with confidence to foster a sense of satiety. The energy requirement varies according to age, sex, the physical shape, height and type of activity taking place.

3) Give a proper distribution of the meals and calories in the day with a breakfast in the division by 15%, 5% in the snack, lunch 40%, 10% and 30% in the tea with the meal, and avoid foods out more meal.

4) Give a proper distribution of nutrients through the rotation of the different foods with the reduction of protein and animal fat, simple carbohydrates with an appreciation of complex carbohydrates. It is also recommended adequate intake of fiber through the use of fruits, vegetables and legumes, presented in a visually pleasing (at least 5 servings per day) a lower salt intake, the use of plain water rather than sugary drinks and cooking methods that require little fat.

5) Proper nutrition education can not be separated from the reduction of sedentary behavior and the increase in exercise, particularly those carried out in the open air, with a reduction, then, sedentary lifestyles, and especially the hours spent watching TV.

Reason For Short Period

Le “Statine” as lipid-lowering drugs

Bachelor Science of Human Nutrition "
" Pharmacology "Professor Raimondi

report Simona Sampirisi

Cholesterol is a lipid molecule sterol, but not a fatty alcohol is due to the presence of the hydroxyl group in position 5 '. E 'typical animal organisms, especially of vertebrates and is present in all tissues and in greater quantities in the brain, bile and blood. Cholesterol is a major component (~ 20%) of the "Cell membrane: its importance is due to the fact that it helps to make the waterproof membrane to small molecules soluble in water but also maintains the flexible membrane in a wide temperature range . (Arteriosclerosis and cholesterol, Dr. K. Lehnert, a specialist in gynecology, Westrnohe, Biologische Medizin, 2 / 91. P.1-4) and ("LE KNOWLEDGE OF THE POPULATION ON CHOLESTEROL DIABETIC SERVICE pertaining to diabetes "A. Margiotta, MR ANNA M, MC BONACINA; Unit of Diabetology and Metabolic Diseases, the Hospital of Tradate (VA), Azienda Ospedaliera "Ospedale Circolo di Busto Arsizio, p. 97-100) ...
... The structure of cholesterol makes it hydrophobic and therefore poorly soluble and is absorbed through the intestinal bile salts. Cholesterol synthesis takes place mainly in the liver (endogenous cholesterol), even if at a number of other organs (adrenal gland, testis, aorta, etc...) Cholesterol is instead excreted in the bile, and then converted into bile acids in bile salts (cholesterol from gallstones can be obtained in pure crystalline) ...
... Cholesterol is important for our body because:
spoke in the formation and repair of cell membranes
is the precursor of vitamin D, steroid hormones and sex hormones (such as androgens, testosterone, estrogen and progesterone)
It is contained in hemoglobin
is the precursor of bile salts.
Since very little water-soluble cholesterol to be conveyed in the blood needs of carriers, which differ depending on the density. The density is inversely proportional to size: chylomicrons are particles larger and less dense, while high density lipoprotein (HDL) are the smallest and most dense (Barter P et al, N Engl J Med 2007; 357: 1301-1310):

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chylomicrons: they are among the least dense lipoprotein, triglycerides, and many contain a small percentage of cholesterol. As their triglycerides come from what you eat, chylomicrons increase in the blood after meals. The chylomicrons transport cholesterol and triglycerides absorbed in the intestine to peripheral tissues.

lipoprotein (VLDL) contain too many triglycerides, but the type synthesized in the liver (endogenous), and not from the meal as chylomicrons. The cholesterol content in VLDL is endogenous type, and is the 5-10 per cent of VLDL particles, which transport it to peripheral tissues. ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona. Page 1-2).

intermediate-density lipoprotein (IDL) have fewer triglycerides compared to chylomicrons or VLDL, and a relatively high cholesterol content. The IDL is formed when VLDL lose their triglycerides in the blood during the passage. Such as VLDL, IDL represents an element of the transition in the transport of cholesterol to peripheral tissues and its return to the liver. ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona. Page 1-2).

Low density lipoprotein (LDL): contengono ancora meno trigliceridi rispetto alle VLDL o alle IDL, ma la più elevata concentrazione di colesterolo tra tutte le lipoproteine. Le LDL trasportano direttamente il colesterolo ai tessuti periferici e al fegato. Per questa ragione costituiscono quello che comunenemente viene chiamato “colesterolo cattivo”, ovvero la forma più dannosa in cui il colesterolo si trova nel corpo umano. (“Effetto della dieta sulla eterogeneità strutturale e funzionale delle lipoproteine plasmatiche”, Bicchiega V,Ferretti G, Bacchetti T, Curatola G; Istituto di Biochimica, Scuola di Specializzazione in Scienza dell’Alimentazione, Facoltà di Medicina e Chirurgia, Università di Ancona. Pag 1-2).
HDL high-density lipoproteins: mainly consist of phospholipids and proteins, with small amounts of triglycerides (5%) and small amounts of cholesterol (25%). The HDL account for approximately 25 percent of blood cholesterol. Their function is to collect and recycle free cholesterol. They are also a source of cholesterol to the endocrine tissue, using it to synthesize hormones. For this reason, HDL is commonly called "good cholesterol", as they eliminate excess cholesterol from the circulation and the address to the tissues that are able to metabolize (also called lipoproteins are in fact garbage). ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona . Page 1-2).

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Statins are more effective than other lipid-lowering drugs in reducing LDL cholesterol levels but less effective than fibrates in reducing triglycerides. However, statins reduce cardiovascular events and mortality associated with it regardless of the initial levels of cholesterol. These drugs should essere considerate per tutti i pazienti, compresi gli anziani, con malattia cardiovascolare sintomatica come per esempio quelli affetti da coronaropatia, malattia occlusiva arteriosa (vasculopatia periferica, ictus non emorragico o attacco ischemico transitorio) o diabete mellito (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guida all'uso dei farmaci 4, Copyright © Elsevier Masson srl 2007). La morbilità e mortalità cardiovascolare ha una prevalenza crescente con l’aumentare dell’età, raggiungendo i valori più elevati nelle fasce di età più avanzata, infatti nel soggetto anziano il rischio cardiovascolare viene spesso trascurato perché in età Advanced polypathology is often a situation of multi-drug therapy that may be difficult or inappropriate to add other therapeutic drugs to increase the stock of the elderly. The study conducted by Heart Protection Study (HPS) has demonstrated for the first time the effectiveness of statins in the prevention of major vascular events in elderly subjects. This study of secondary prevention was conducted for 5 years in 20,000 high-risk vascular patients with hypercholesterolemia aged 40-80 years, suffering from coronary heart disease (CHD), peripheral arterial disease and / or diabetes mellitus. The high abundance of elderly subjects allowed for the first time to assess the real impact of a statin, simvastatin, vascular morbid events more typical of the age's most advanced, particularly stroke (stroke).

In patients with diabetes mellitus the risk of developing cardiovascular disease depends on the time elapsed from the onset of diabetes, the complications, age, and concomitant risk factors (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guide to the use of drugs 4, Copyright © 2007 Elsevier Masson Srl). Statin therapy should be considered in all patients with both diabetes mellitus (type 1 and 2) older than 40 years and is in younger patients and that treatment should be considered if they are present: a organ damage, poor glycemic control (HbA1c greater than 9%), low levels of HDL cholesterol, elevated triglycerides, hypertension or family history of early cardiovascular events.
Statins can be used for the prevention of:

- cardiovascular events in asymptomatic patients with increased risk. Individuals with risk of cardiovascular events in 10 years of 20% or more benefit from statin therapy regardless of plasma levels of cholesterol and the use of statins should be associated with changes in lifestyle and other measures that reduce the risk of cardiovascular events. Treatment with statins should be considered even if the relationship between the concentration of total cholesterol and HDL is greater than 6. (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guide to the use of drugs 4, Copyright © 2007 Elsevier Masson Srl).

- "Ischemic stroke: statins have a protective effect against ischemic stroke in general on cerebrovascular disease, with obvious consequences related to the system of dispensation of these drugs is currently governed by Note 13 of the CUF ("THE POINT OF VIEW ON statins", * Giancarlo Berni, Stefano Santoni **, Antonio Salvetti °, Mario Montagnani ° °, ^ Andrea Messori, Gian Franco Gensini ^ ^. * Director of the Unit of Internal Medicine Company "Careggi" Firenze, ** General Practitioner in Florence, ° Director, Department of Internal Medicine, University of Pisa, ° · Prof. Associate Professor of Clinical Pathophysiology, University of Siena, ^ Hospital Pharmacist Company "Careggi", Florence; ^ ^ Director of the Institute of Clinical Medicine, University of Florence. TUSCANY MEDICAL October 2003).

- Action vasoprotective antiaterosclerotica and "especially in situations characterized by the presence of high values \u200b\u200bof trigliceridi.

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Le indicazioni della C.U.F. spiegano che le statine sono farmaci impiegati per la prevenzione secondaria cioè volte a ridurre la frequenza di casi esistenti della malattia in pazienti che hanno già manifestato la patologia. Le conoscenze sulle statine e sui loro meccanismi di azione sono indubbiamente progredite negli ultimi anni, tuttavia, le informazioni disponibili oggi non sono poi tanto diverse rispetto a quelle già note. Oggi, alla luce della nuove acquisizioni, si potrebbe ipotizzare un ampliamento dei limiti prescrittivi in termini di prevenzione sia primaria che secondaria ma si ritiene che la prevenzione primaria con le statine risulti ancora un’area caratterizzata da certezze minori.

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InterazioniLa capacity of a single cytochrome P450 to metabolize multiple drugs is the factor responsible for the large number of metabolic interactions that occur in clinical practice. The inhibition of metabolizing enzymes cause an increase in plasma levels of the drug in question and then an increase and a prolongation of their action. Statins, whose metabolism is inhibited, have a narrow therapeutic margin, which leads to clinically significant consequences. In addition to its therapeutic margin and the dose of the inhibitor, the extent of toxic effects depends on the importance of the pathway being inhibited and inhibited the enzyme, which in this case, è il solo o principale responsabile della biotrasformazione del farmaco, si hanno conseguenze gravi. All'interno della stessa classe vi sono grosse differenze riguardo all'affinità delle diverse statine ai vari citocromi P450, ciò che rappresenta il maggior potenziale d'interazione. Ad eccezione della pravastatina, che presenta caratteristiche idrofile e viene eliminata per la maggior parte in forma invariata attraverso i reni, le altre statine sono lipofile e vengono metabolizzate nel fegato dai citocromi P450 3A4 e 2C9.

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Succo di pompelmo: il consumo di succo di pompelmo dovrebbe essere evitato o limitato quando si assumono simvastatina, lovastatina o atorvastatina, soprattutto ad alte dosi, poiché può inhibit their metabolism in the intestine, mediated by CYP3A4 and thus result in increased plasma concentration of statins ("Safety profile of statins," Luisa Zanolla, Clinical Cardiology, Hospital of Verona. YEAR XIV - No. 48 - Published quarterly in February 2007).

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Editorial by O'Connor (Arch of Intern Med, 2006) clearly indicates that the lack of adherence to treatment by patients is the source of unnecessary health care costs, unnecessary adverse events and unnecessary deaths, so is necessary to educate patients to keep the treatment of life-saving drugs which are statin and seek a positive suggesting their complicity such as medicine and suspend to suspend them. The study of Wei (Heart, 2002), on adherence to statin treatment and rehospitalization in patients 6 years post-myocardial infarction, it is clear that the consistency chiaramennte treatment is associated with a lower risk of reinfarction. Report from the National Cholesterol Education Program (NCEP, year?), For the lipid-lowering treatment, show that despite the evidence of the benefits obtained by the reduction of LDL cholesterol, we are still far from optimal treatment, both in patients receiving both in terms of adherence to long-term care.
From Report found that:
- less than 50% of people in need of lipid-lowering treatment (pharmacological and / or diet) for cardiovascular (CV) risk, following treatment;
- less than 50% of people at high risk for CV is in drug treatment;
- only 1 / 3 treaties reaches the ideal LDL and less than 1 / 5 keep it;
- about 50% of people in treatment is still under treatment after 6 months and 12 months after the share drops to 20-30%, which is still more puzzling when you consider that it takes 6-12 months Almemo benefits because the treatment ports ("I keep 'THE CURE" Reading and discussion of the literature on statins Claudio Bettel; ULSS 20 Group C - District 4