老年性肥胖

老年性肥胖的病因和发病机制还不清楚。现在最常用的评估和诊断肥胖的方法是体重指数（BMI）。肥胖对老年人的主要危害是引心血管疾病和糖尿病等并发症。因此治疗的目的就是通过降低体重来减少并发症。治疗主要饮食饮食控制和适当的运动,但有时也需要药物治疗,其中赛尼可可能是治疗老年人肥胖的一个较理想药物。     

肥胖的药物疗法

肥胖的治疗除饮食治疗与运动疗法外，药物治疗可作为肥胖治疗的一种辅助手段。药物治疗适用于：（1）经过12周低脂饮食、有规律的运动和行为改变等治疗减重〈2kg。（2）因易饥和明显多食引起的肥胖。（3）有与肥胖相关的疾病如糖耐量降低、高血压、高血脂等。（4）有肥胖的严重并发症存在如睡眠呼吸暂停综合征、严重的骨关节炎、返流性食管炎等。治疗肥胖的理想药物应能有效地减轻体重，副作用小，无成瘾性，且有助于调整生活方式。目前常用减肥药物有两大类。     

肥胖的药物疗法

肥胖的治疗除饮食治疗与运动疗法外，药物治疗可作为肥胖治疗的一种辅助手段。药物治疗适用于：（１）经过１２周低脂饮食、有规律的运动和行为改变等治疗减重＜２kg。（２）因易饥和明显多食引起的肥胖。（３）有与肥胖相关的疾病如糖耐量降低、高血压、高血脂等。（４）有肥胖的严重并发症存在如睡眠呼吸暂停综合征、严重的骨关节炎、返流性食管炎等。治疗肥胖的理想药物应能有效地减轻体重，副作用小，无成瘾性，且有助于调整生活方式。目前常用减肥药物有两大类。１中枢神经作用减肥药１．１肾上腺素能受体激动剂芬特明、安非拉酮：为安…     

儿童高血压是否需要治疗

儿童高血压的治疗同成年人一样，包括非药物治疗和药物治疗两个方面。非药物治疗是基础治疗手段，无论是何种情况下的高血压，都必须重视和开展非药物疗法。非药物治疗的要点主要是养成良好生活方式及克服不良生活习惯。如肥胖儿童要注意节制饮食，增加活动和体育锻炼，以达到降低或控制体重的目的。[第一段]     

胰高血糖素样肽-1受体激动剂治疗肥胖的研究进展

肥胖对公共健康的威胁日益严重,使患者生活质量降低,死亡风险增加。药物治疗可以帮助肥胖患者减轻体重,且有助于降低体重反弹的风险,从而减少肥胖相关并发症。胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)受体激动剂(glucagon-like peptide-1 receptor agonists,GLP-1RAs)促进胰岛素分泌,并以葡萄糖依赖的方式减少了胰高血糖素的分泌,使胃排空延迟、肠道运动性降低,并且可以激活下丘脑的神经通路和食欲调节区域,使食欲下降、食物摄入减少,从而治疗肥胖。本研究通过对GLP-1RAs治疗肥胖的机制、临床试验、安全性和耐受性、主要不良反应、禁忌证及优势等进行综述,旨在为肥胖的治疗提供理论依据。     

运动对老年人身体构成的影响

用Futrex－5000（A）型体脂分析仪对266例老年人的身体构成进行测试，并探讨运动水平对体脂、瘦体重和体液的影响。结果表明：男女中度运动组的体脂百分比明显低于低度运动组，体液和瘦体重（或瘦体重百分比）则显著高于低度运动组。长期参加中度的体育活动可以降低老年人的体脂，有利于预防和治疗与肥胖有关的各种疾病。     

运动对老年人身体构成的影响

用Futrex-5000(A)型体脂分析仪对266例老年人的身体构成进行测试，并探讨运动水平对体脂、瘦体重和体液的影响。结果表明：男女中度运动组的体脂百分比明显低于低度运动组，体液和瘦体重(或瘦体重百分比)则显高于低度运动组。长期参加中度的体育活动可以降低老年人的体脂，有利于预防和治疗与肥胖有关的各种疾病。     

控制体重对于肥胖儿童哮喘药物治疗疗效的影响

目的:探讨体重控制对于肥胖儿童哮喘药物治疗疗效的影响.方法:将仙居县中医院收治的89例肥胖儿童哮喘患者分为两组,实验组给予哮喘药物治疗(GINA方案)同时采用肥胖综合干预措施控制体重,对照组给予单纯GINA方案治疗,比较两组患儿在哮喘预后和呼吸功能状况改善等临床疗效指标方面的差异.结果:综合干预措施能够有效地控制肥胖患儿的体重,实验组体重控制有效率明显高于对照组(P＜0.05).与对照组相比,实验组患儿哮喘完全控制率、显效率和总有效率均明显增加(P＜0.05),同时肺功能改善明显(P＜0.05).结论:控制体重对于改善儿童哮喘药物治疗的临床预后具有重要作用.     

老年高血压的治疗

老年人在美国迅速增加,高血压在西方国家是流行病。本文将研究老年高血压的治疗方法。 一、高血压的非药物疗法:过度肥胖的老年高血压患者,适当地降低体重,许多人能降低血压。减少食盐的摄入也可降低某些人的血压,还可减少急性心衰。     

运动和营养干预在老年人肌肉衰减性肥胖中的应用

随着人口老龄化的加剧，肌肉衰减综合征和肥胖备受关注，严重影响老年人的日常生活。患有肌肉衰减性肥胖的老年人的生活质量降低，跌倒风险增高，甚至造成死亡。本文就运动和营养干预在老年人肌肉衰减性肥胖中的应用进行综述,旨在为老年人肌肉衰减性肥胖的研究和临床治疗提供新思路。     

Secondary prevention in elderly survivors of heart attacks

More than 200,000 elderly patients survive myocardial infarctions each year. Thus, the achievement of even minimal decreases in reinfarction and mortality rates will benefit large numbers of patients. Secondary prevention strategies include smoking cessation; the control of hyperlipidemia, obesity and diabetes; the management of hypertension and stress; exercise; the use of drugs such as beta blockers and aspirin, and increased attention to general health.     

Hypertension in the elderly

As many as forty percent of Canadians over age sixty-five have blood pressure readings of 160/90 or higher. They are at greater risk for stroke, congestive heart failure, myocardial infarction and sudden death. Hypertension appears to be an exaggeration of the normal circulatory changes of aging--increased systemic vascular resistance and a slight decrease in cardiac output at rest and during exercise. The major trials of treatment for hypertension have included subsets of elderly hypertensives who have enjoyed about the same overall benefit from treatment as younger subjects. Two treatment trials specifically for elderly hypertensives also show that treating systolic-diastolic hypertension does more good than harm. Isolated systolic hypertension appears to be a risk factor of equal magnitude to systolic/diastolic hypertension. Although it is possible to treat isolated systolic hypertension, the definitive clinical trial comparing mortality and morbidity in treated and untreated groups is not yet published. Thiazides, while inexpensive and effective antihypertensives for the elderly, are relatively contraindicated in as many as half. Other classes of drugs, particularly calcium channel blockers, can be effective alternatives. Many, if not most, elderly hypertensives will be prescribed more than one type of antihypertensive in addition to other types of drugs. The possibility of drug interactions as well as the danger of overly rapid blood pressure reduction must be kept in mind.     

Drug treatment of obesity

Use of drugs for the treatment of obesity is regarded more skeptically than drug use in other chronic disease; this view, however, may be inappropriate. Anorexiant drugs, the major class of drugs currently available for treating obesity, differ in several important ways, including whether they act on noradrenergic or serotonergic systems and in their potential for abuse. New approaches to drug treatment of obesity include thermogenic agents and drugs acting on the digestive system and hormones.     

Battling insulin resistance in elderly obese people with type 2 diabetes: bring on the heavy weights

Exercise improves insulin resistance and has beneficial effects in preventing and treating type 2 diabetes. However, aerobic exercise is hindered in many type 2 diabetic patients because of advancing age, obesity, and other comorbid conditions. Weight lifting or progressive resistance training (PRT) offers a safe and effective exercise alternative for these people. PRT promotes favorable energy balance and reduced visceral fat deposition through enhanced basal metabolism and activity levels while counteracting age- and disease-related muscle wasting. PRT improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles. PRT also alleviates symptoms of anxiety, depression, and insomnia in individuals with clinical depression and improves exercise tolerance in individuals with cardiac ischemic disease and congestive heart failure; all of these aspects are relevant to the care of diabetic elders. Moreover, PRT is safe and well accepted in many complex patient populations, including very frail elderly individuals and those with cardiovascular disease. The greater feasibility of using PRT over aerobic exercise in elderly obese type 2 diabetic individuals because of concomitant cardiovascular, arthritic, and other disease provides a solid rationale for investigating the global benefits of PRT in the management of diabetes.     

Dyslipidemia and glucose dysregulation in overweight and obese patients

Inactivity and a sedentary lifestyle contribute to overweight, obesity, and cardiometabolic risk. Overweight and obesity can lead to metabolic abnormalities, insulin resistance, type 2 diabetes mellitus (DM), lipid disorders, and cardiovascular disease. Diet and exercise can effectively reverse overweight and obesity and their related comorbidities. Modest weight loss (5%-10%) and modest physical activity (30 minutes a day) are first-line recommendations for the prevention of type 2 DM. Clinical trials have demonstrated that insulin sensitivity can be improved and type 2 DM can be prevented through lifestyle modification and pharmacologic therapy, including antiobesity drugs, antidiabetic drugs, statins, and antihypertensive drugs. The endocannabinoid system plays an important role in regulating metabolism through its effects on food intake at the level of the hypothalamus and on body composition through peripheral effects on adipose tissue.     

Implications of the biology of weight regulation and obesity on the treatment of obesity

PURPOSE: The purposes of this article are to provide a brief review of the complex biology of weight regulation and obesity, to explain some of the effects of diet and exercise on the biology of weight regulation and obesity, and to propose a coherent way to assess and treat people related to weight and obesity. DATA SOURCES: Scientific publications, clinical guidelines, and government sources. CONCLUSIONS: Obesity is a complex problem requiring an understanding of how interventions interact with the biology of weight regulation in people who are obese. Promoting health in obese people requires a focus on improving insulin sensitivity. IMPLICATIONS FOR PRACTICE: Helping individuals maintain normal weight throughout life is important in order to keep the long- and short-term weight signals in balance and reflective of true energy requirements. Exercise is associated with loss of total and abdominal adipose tissue and improved insulin sensitivity. Diets inducing gradual weight loss are less likely to stimulate appetite. Diets should include antioxidants to neutralize the increase in free radical production associated with obesity and exercise. Other interventions in the treatment of obesity may include treating sleep deficits and the dysregulated endocannabinoid system.     

运动疗法的进展与差距

运动疗法是防治心、脑、肺疾病的重要方法之一,同时对这些疾病的危险因素(高血压、高脂血症、糖尿病和肥胖)也有确切的治疗作用。本文介绍了国内康复医学界运动疗法的进展与先进国家的差距以及对其改进提高和完善的一些设想。     

老年糖尿病患者院外发生低血糖的相关因素分析

目的探讨老年糖尿病患者院外发生低血糖的原因,以指导今后临床、门诊、社区的糖尿病教育工作,为出院的糖尿病患者的随访管理提供指导性建议。方法选择2010年1~12月曾在本院住院的老年糖尿病患者,3个月内密切随访,将曾发生低血糖事件的46名糖尿病患者纳入分析,通过频数分析得出老年糖尿病患者院外发生低血糖的原因。结果 46名患者在本院住院期间通过血糖控制和糖尿病教育,患者各项糖脂代谢指标均较住院前明显降低(P0.05和P0.01)。频数分析显示,老年糖尿病患者院外低血糖的危险因素主要与饮食、药物、疾病、运动、血糖监测等几方面相关。结论老年糖尿病患者院外发生低血糖事件主要与患者饮食不当、不合理用药、合并全身疾病病情复杂、不合理运动、未进行血糖监测等有关。在今后糖尿病的教育中应注重个体化的糖尿病教育,并对患者进行出院后的定期电话随访及指导,以减少低血糖事件。     

Exercise therapy for heart failure

In chronic heart failure of CAD, therapeutic approach will be available either with drugs or exercise. With exercise, coronary risk factors such as BP, lipid, DM and obesity will be controlled. In addition, ischemia will also be controlled by decreasing oxygen demand related to BP and HR, and with increasing oxygen supply by increased ECNOS gene expression, collateral formation and regression of coronary stenosis. Infarct size is also reported to be decreased by increasing MnSOD in the cell by exercise. Prognosis of CHF is also good in various evidence of exercise therapy. Recent advances of molecular biology have revealed various mechanisms of exercise effect. Thus, exercise if properly prescribed without provoking ischemia will be basically and clinically effective therapy for patients with CHF.