The Public Health Aspects of Noncommunicable Diseases
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อ้วนและอ้วนลงพุง พญ. วรรณี นิธิยานันท์
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The Public Health Aspects of Noncommunicable Diseases
- 4. 懰oªœÂ¨³°oªœ¨Š¡»Š„ε¨´ŠÁž}œž{®µµ›µ¦–»…š¸Éε‡´…°Šž¦³Áš«Åš¥ œ°„‹µ„ÂœªÃœo¤ š¸ÉÁ¡·É¤…¹Êœ°¥nµŠ˜n°ÁœºÉ°ŠÂ¨oª 懰oªœÂ¨³°oªœ¨Š¡»Š¥´ŠnŠŸ¨„¦³š˜n°»…£µ¡ ‡»–£µ¡¸ª·˜ ¦ª¤š´ÊŠ Á«¦¬“„·‹Â¨³´Š‡¤°¥nµŠ„ªoµŠ…ªµŠ ·ÉŠÁ®¨nµœ¸ÊÁž}œš¸Éž¦³‹´„¬r´—šµŠ—oµœª·µ„µ¦ ¤¸„µ¦œÎµÁœ° “„µ¦ ‹´—„µ¦ž{®µ£µª³œÊε®œ´„Á„·œÂ¨³Ã¦‡°oªœ” Äœš¸Éž¦³»¤¤´µ»…£µ¡Â®nŠµ˜·‡¦´ÊŠš¸É Ó Ž¹ÉŠ¤¸¤˜·¦´ …o°Áœ°Â¨³Å—o—εÁœ·œ„µ¦˜n° …–³œ¸Ê¥»š›«µ˜¦r„µ¦‹´—„µ¦ž{®µ£µª³œÊε®œ´„Á„·œÂ¨³Ã¦‡°oªœÅ—o¦´ ‡ªµ¤Á®Èœ°‹µ„‡–³¦´“¤œ˜¦¸Â¨oªÂ¨³„ε¨´Š‹´—šÎµÂŸœ—εÁœ·œŠµœ ž{‹‹´¥š¸ÉnŠŸ¨Ä®oÁ„·—懰oªœÂ¨³°oªœ¨Š¡»Š¤¸®¨µ„®¨µ¥ —´Šœ´Êœ„µ¦‹´—„µ¦ž{®µ‹ÎµÁž}œ˜o°Š¤¸ œÃ¥µ¥Â¨³¥»š›«µ˜¦rš¸É‡¦°‡¨»¤š»„—oµœÁ¡ºÉ°Ä®o¦¦¨»Ÿ¨˜µ¤Ážjµ®¤µ¥ Á‡¦º°…nµ¥‡œÅš¥Å¦o¡»ŠÅ—o —εÁœ·œ„µ¦¦–¦Š‡rÄ®o´Š‡¤Åš¥˜¦³®œ´„™¹Šž{®µÃ¦‡°oªœÂ¨³°oªœ¨Š¡»Š Ä®o¦´¦¼o¨³Á…oµÄ‹„µ¦žj°Š„´œ ¨³Â„oÅ…—oª¥®¨´„ 3 °. ‡º° °µ®µ¦ °°„„ε¨´Š„µ¥ ¨³ °µ¦¤–r ץŗo¦´„µ¦œ´œ»œ‹µ„εœ´„Šµœ „°Šš»œœ´œ»œ„µ¦¦oµŠÁ¦·¤»…£µ¡ (.) „µ¦—εÁœ·œŠµœ¤¸Ÿ¨´¤§š›·Í˜n¥´Š°¥¼nÄœªŠ‹Îµ„´— ®œ´Šº° Á¨n¤œ¸ÊÁž}œnªœ®œ¹ÉŠ…°ŠÃ‡¦Š„µ¦ Ž¹ÉŠ¦ª¦ª¤…o°¤¼¨ª·µ„µ¦ Ÿ¨„¦³š—oµœ˜nµŠÇ ª·›¸‹´—„µ¦š¸É¤¸„µ¦ —εÁœ·œŠµœoµŠÂ¨oª ¡¦o°¤…o°Áœ°Âœ³µŠž¦³„µ¦ ¦ª¤™¹Š„µ¦žj°Š„´œÂ¨³¦´„¬µŸ¼oš¸É¤¸Ã¦‡°oªœÂ¨³°oªœ ¨Š¡»Š Á¡ºÉ°ÄoÁž}œÂ®¨nŠ…o°¤¼¨Îµ®¦´Ÿ¼oš¸ÉœÄ‹®¦º°˜o°Š„µ¦—εÁœ·œŠµœÁ¡ºÉ°‹´—„µ¦ž{®µÃ¦‡°oªœÂ¨³ °oªœ¨Š¡»Š …°…°‡»–Ÿ¼oœ·¡œ›rš»„šnµœš¸ÉÅ—oÁ¦¸¥Á¦¸¥ŠÁœºÊ°®µ‹œ®œ´Šº°¤¸‡ªµ¤¤¼¦–r¦³—´®œ¹ÉŠ ¦ª¤š´ÊŠ ¦µª·š¥µ¨´¥°µ¥»¦Â¡š¥r®nŠž¦³Áš«Åš¥ Äœ¡¦³¦¤¦µ¼ž™´¤£r ¨³ . š¸Éœ´œ»œ„µ¦‹´—šÎµÂ¨³ ‹´—¡·¤¡r ®ª´ŠÁž}œ°¥nµŠ¥·ÉŠªnµ®œ´Šº°Á¨n¤œ¸Ê‹³Á„·—ž¦³Ã¥œr˜µ¤¤‡ª¦Â„nŸ¼oš¸ÉÁ„¸É¥ª…o°Š®¦º°„µ¦œÎµÅžÄo Äœš»„¦³—´ ª¦¦–¸ œ·›·¥µœ´œšr ¦¦–µ›·„µ¦
- 5. ‹»¦¸¡¦ ‡Šž¦³Á¦·“ ¡.., ª.ª.(„»¤µ¦Áª«µ˜¦r), °.ª.(Áª«µ˜¦ržj°Š„´œ Â…œŠ»…£µ¡‹·˜»¤œ) Ceritifcate of Attendance, 2nd WHO-IUMSP International Seminar on the Public Health Aspects of Noncommunicable Diseases, University of Lausanne, Switzerland œµ¥Â¡š¥rεœµ„µ¦¡·Á«¬ εœ´„æ‡Å¤n˜·—˜n° „¦¤‡ª‡»¤Ã¦‡ „¦³š¦ªŠµ›µ¦–»… ´¥µ —¸Ã¦‹œªŠ«r ¡.., ª.ª.(°µ¥»¦«µ˜¦r), °.ª.(°µ¥»¦«µ˜¦r˜n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤) Certificate, Fellowship in Diabetes and Endocrinology University of Newcastle Upon Tyne, United Kingdom «µ˜¦µ‹µ¦¥r‡¨·œ·„µ…µÃ¦‡˜n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤ £µ‡ª·µ°µ¥»¦«µ˜¦r ¤®µª·š¥µ¨´¥¦´Š·˜ ®œnª¥˜n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤ „¨»n¤Šµœ°µ¥»¦«µ˜¦r 抡¥µµ¨¦µª·™¸ „¦¤„µ¦Â¡š¥r „¦³š¦ªŠµ›µ¦–»… žµ‹¦¸¥r °´—»¨¨µ„µŽ·¤ œ··˜ž¦·µÁ°„ ª·š¥µ¨´¥ª·š¥µ«µ˜¦rµ›µ¦–»… ‹»¯µ¨Š„¦–r¤®µª·š¥µ¨´¥ ¦»nŠ´¥ ªœÅ¥³„¼¨ Ph.D. (Exercise Physiology), Wollongong University, Australia M.Sc. (¦¸¦ª·š¥µ) ¤®µª·š¥µ¨´¥¤®·—¨ B.Sc. („µ¥£µ¡Îµ´—) ¤®µª·š¥µ¨´¥¤®·—¨ Certificate, Human Thermoregulatory Research, University Wollongong, Australia Certificate, Biomedical Instrument, Purdue University, Indiana, USA Certificate, Chest Physical Therapy, New York University, USA Certificate, Spinal Orthosis, New York University, USA Certificate, Lower Limb Prosthesis, New York University, USA ¡´œ˜¦¸ Ÿ¼onª¥«µ˜¦µ‹µ¦¥r —¦. ª·š¥µ¨´¥ª·š¥µ«µ˜¦r¨³Áš‡ÃœÃ¨¥¸„µ¦„¸¯µ ¤®µª·š¥µ¨´¥¤®·—¨
- 6. Á¦ª—¸ ‹Š»ª´•œr Ph.D. (Food, Nutrition and Dietetics) Ÿ¼onª¥«µ˜¦µ‹µ¦¥r µ…µÃ£œª·š¥µ £µ‡ª·µÃ£œª·š¥µ ‡–³µ›µ¦–»…«µ˜¦r ¤®µª·š¥µ¨´¥¤®·—¨ ¨´——µ Á®¤µ³»ª¦¦– ªš.., ¡.., ª.ª.(„»¤µ¦Áª«µ˜¦r), ª.ª.(„»¤µ¦Áª«µ˜¦r㜵„µ¦) M.Sc.(Human Nutrition) ¦°Š«µ˜¦µ‹µ¦¥r £µ‡ª·µ„»¤µ¦Áª«µ˜¦r ‡–³Â¡š¥«µ˜¦r ¤®µª·š¥µ¨´¥Š…¨µœ‡¦·œš¦r ª–·µ „·‹ª¦¡´•œr .—.(㜵„µ¦µ›µ¦–»…) Diplomate (Community Nutrition), University of Indonesia, Indonesia Ceritifcate, Nutrition Epidemiology and Statistics, University of Queensland, Australia Certificate, International Visitor’s Programme of the North Karelia Project National Public Health Institute, Helsinki, Finland œ´„㜵„µ¦Îµœµ„µ¦¡·Á«¬ εœ´„㜵„µ¦ „¦¤°œµ¤´¥ „¦³š¦ªŠµ›µ¦–»… ª·´¥ Á°„¡¨µ„¦ ¡.., °.ª.(Áª«µ˜¦ržj°Š„´œ), °.ª.(Áª«µ˜¦r‡¦°‡¦´ª) Ph.D. (Epidemiology) University of North Carolina at Chapel Hill, USA ¦°Š«µ˜¦µ‹µ¦¥r εœ´„Šµœ«¼œ¥rÁª«µ˜¦r»¤œ ‡–³Â¡š¥«µ˜¦r 抡¥µµ¨¦µ¤µ›·—¸ ¤®µª·š¥µ¨´¥¤®·—¨ εœ´„ŠµœÎµ¦ª‹»…£µ¡ž¦³µœÅš¥ ª¦¦–¸ œ·›·¥µœ´œšr ¡.., °.ª.(°µ¥»¦«µ˜¦r), °.ª.(°µ¥»¦«µ˜¦r懘n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤) °.ª.(Áª«µ˜¦r‡¦°‡¦´ª) Diplomate, American Board of Internal Medicine Diplomate, Subspecialty Board of Endocrinology and Metabolism «µ˜¦µ‹µ¦¥r µ…µÃ¦‡˜n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤ £µ‡ª·µ°µ¥»¦«µ˜¦r ‡–³Â¡š¥«µ˜¦r«·¦·¦µ¡¥µµ¨ ¤®µª·š¥µ¨´¥¤®·—¨
- 7. «»£ª¦¦– ¼¦–¡·¦ ¡.., ª.ª.(°µ¥»¦«µ˜¦r), ª.ª.(°µ¥»¦«µ˜¦r懘n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤) Certificate, Fellowship in Nutrition Support and Obesity Medicine °µ‹µ¦¥r ®œnª¥˜n°¤Å¦ošn° £µ‡ª·µ°µ¥»¦«µ˜¦r ‡–³Â¡š¥«µ˜¦r ¤®µª·š¥µ¨´¥Á¸¥ŠÄ®¤n °£´œ¸ »µª¦„»¨ ¡.., ª.ª.(°µ¥»¦«µ˜¦r), ª.ª.(°µ¥»¦«µ˜¦r懘n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤) °.ª.(Áª«µ˜¦r‡¦°‡¦´ª) Certificate, Research Fellow in Human Nutrition, South Western Medical Center Dallas, Texas, USA ¡´œÁ°„¡·Á«¬ ¦°Š«µ˜¦µ‹µ¦¥r µ…µÃ¦‡˜n°¤Å¦ošn°Â¨³Á¤Âš°¨·Ž¹É¤ £µ‡ª·µ°µ¥»¦«µ˜¦r ®œnª¥Ã£œµ„µ¦ ¨³®œnª¥˜n°¤Å¦ošn° „°Š°µ¥»¦„¦¦¤ 抡¥µµ¨¡¦³¤Š„»‘Á„¨oµ °»¤µ¡¦ »š´«œrª¦ª»•· ¡.., ª.ª.(„»¤µ¦Áª«µ˜¦r), °.ª.(„»¤µ¦Áª«µ˜¦r㜵„µ¦) ¦°Š«µ˜¦µ‹µ¦¥r £µ‡ª·µ„»¤µ¦Áª«µ˜¦r ‡–³Â¡š¥«µ˜¦r抡¥µµ¨¦µ¤µ›·—¸ ¤®µª·š¥µ¨´¥¤®·—¨ °´Š«·œ´œšr °·œš¦„ε®Š ‡.—.(„µ¦«¹„¬µœ°„¦³Ã¦ŠÁ¦¸¥œ), ªš.¤.(»…«¹„¬µ), ¡¥..(„µ¦¡¥µµ¨Â¨³Ÿ—»Š‡¦¦£r) Vocational Education, UTS, Australia Ÿ¼onª¥«µ˜¦µ‹µ¦¥r ¦°ŠŸ¼o°Îµœª¥„µ¦™µ´œª·‹´¥¡§˜·„¦¦¤«µ˜¦r iµ¥‹´—„µ¦‡ªµ¤¦¼o¨³„·‹„µ¦¡·Á«¬ ™µ´œª·‹´¥¡§˜·„¦¦¤«µ˜¦r ¤®µª·š¥µ¨´¥«¦¸œ‡¦·œš¦ª·Ã¦•
- 8. ‡ÎµœÎµ „ Ÿ¼oœ·¡œ›r … šš¸É 1 Á„–”r„ε®œ—¨³„¨Å„„µ¦Á„·—°oªœÂ¨³°oªœ¨Š¡»Š 1 ª¦¦–¸ œ·›·¥µœ´œšr šš¸É 2 ¦³µ—ª·š¥µ…°Š£µª³°oªœÂ¨³°oªœ¨Š¡»ŠÄœž¦³Áš«Åš¥ 9 ª·´¥ Á°„¡¨µ„¦ šš¸É 3 µÁ®˜»…°Š°oªœÂ¨³°oªœ¨Š¡»Š 16 «»£ª¦¦– ¼¦–¡·¦ šš¸É 4 ž{®µ»…£µ¡‹µ„°oªœÂ¨³°oªœ¨Š¡»Š 30 ª¦¦–¸ œ·›·¥µœ´œšr šš¸É 5 Ÿ¨„¦³š‹µ„°oªœÂ¨³°oªœ¨Š¡»Š 45 ª¦¦–¸ œ·›·¥µœ´œšr ¨³ žµ‹¦¸¥r °´—»¨¨µ„µŽ·¤ šš¸É 6 懰oªœÂ¨³°oªœ¨Š¡»ŠÄœÁ—Ȅ¨³ª´¥¦»nœ: ž{‹‹´¥š¸ÉšÎµÄ®oÁ„·—¨³ž{®µ—oµœ»…£µ¡ 57 ¨´——µ Á®¤µ³»ª¦¦– šš¸É 7 œÃ¥µ¥Â¨³¤µ˜¦„µ¦žj°Š„´œ°oªœÂ¨³°oªœ¨Š¡»ŠÄœÁ—Ȅ¨³ª´¥¦»nœ 71 °»¤µ¡¦ »š´«œrª¦ª»•· ¨³ ¨´——µ Á®¤µ³»ª¦¦– šš¸É 8 œÃ¥µ¥Â¨³¤µ˜¦„µ¦žj°Š„´œ°oªœÂ¨³°oªœ¨Š¡»ŠÄœŸ¼oÄ®n: °»ž¦¦‡Â¨³‡ªµ¤ÎµÁ¦È‹ 101 ª–·µ „·‹ª¦¡´•œr šš¸É 9 ®¨´„„µ¦ ª·›¸„µ¦ ¨³Ážjµ®¤µ¥…°Š„µ¦‡ª‡»¤œÊε®œ´„˜´ª 116 ‹»¦¸¡¦ ‡Šž¦³Á¦·“ šš¸É 10 㜵„µ¦Á¡ºÉ°žj°Š„´œÂ¨³¦´„¬µ°oªœÂ¨³°oªœ¨Š¡»Š 128 Á¦ª—¸ ‹Š»ª´•œr
- 9. šš¸É 11 „µ¦°°„„ε¨´ŠÁ¡ºÉ°¦´„¬µÂ¨³žj°Š„´œ°oªœÂ¨³°oªœ¨Š¡»Š 138 ¦»nŠ´¥ ªœÅ¥³„¼¨ šš¸É 12 „µ¦Ä®o‡Îµž¦¹„¬µ ¦oµŠÂ¦Š‹¼ŠÄ‹ ¦ŠŸ¨´„—´œÁ¡ºÉ°ž¦´Áž¨¸É¥œ¡§˜·„¦¦¤Äœ„µ¦žj°Š„´œ 151 ¨³¦´„¬µ°oªœÂ¨³°oªœ¨Š¡»Š °´Š«·œ´œšr °·œš¦„ε®Š šš¸É 13 ¥µÂ¨³„µ¦Ÿnµ˜´—¦´„¬µ°oªœÂ¨³°oªœ¨Š¡»Š 188 ´¥µ —¸Ã¦‹œªŠ«r šš¸É 14 „µ¦‡ŠœÊε®œ´„˜´ªš¸É¨—¨ŠÅ¤nÄ®oÁ¡·É¤…¹Êœ®¨´Š„µ¦¨—œÊε®œ´„ 194 °£´œ¸ »µª¦„»¨ šš¸É 15 š¦»žÂ¨³…o°Áœ°Âœ³ 201 ª¦¦–¸ œ·›·¥µœ´œšr ¨³ žµ‹¦¸¥r °´—»¨¨µ„µŽ·¤
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- 14. 5 Á¡« ¡ªnµÁ¡«µ¥¤¸Å…¤´œÄœn°Ššo°Š¤µ„„ªnµÁ¡«®·Š19 ÄœŸ¼oµ¥Á¤ºÉ°œÊε®œ´„…¹Êœ¨´„¬–³ °oªœ‹³Áž}œÂ°oªœš¸É¡»Š (android type of obesity) nªœŸ¼o®·ŠÅ…¤´œ‹³³¤š¸É³Ã¡„¨³˜oœ…µ ¨´„¬–³Áž}œ°oªœš¸Énªœ¨nµŠ (gynoid type of obesity) ±°¦räœÁ¡«µ¥˜ÉεĜµ¥¼Šª´¥ ¡ªnµµ¥¼Šª´¥š¸É¤¸¦³—´±°¦räœÁšÃ˜Á˜°Ã¦œÄœÁ¨º°— ˜Éε‹³¤¸¨´„¬–³…°Š„¨»n¤°µ„µ¦Á¤Âš°¨·‡ (metabolic syndrome) Áž}œnªœÄ®n ¦³—´±°¦r䜚¸É˜Éε ÁºÉ°ªnµnªœ®œ¹ÉŠ°›·µ¥Å—o‹µ„¦³—´Ã„¨¼¨·œš¸É‹´„´±°¦räœÄœÁ¨º°— (sex hormone-binding globulin) ¨—¨Š ˜n¦³—´±°¦räœÁšÃ˜Á˜°Ã¦œ°·¦³ÄœÁ¨º°— (free circulating testosterone blood level) ¨—¨ŠÁnœ„´œ °¸„nªœ®œ¹ÉŠ°µ‹Áž}œŸ¨‹µ„„µ¦Áž¨¸É¥œÂž¨Š…°Šž{‹‹´¥°ºÉœ20,21 Ánœ ±°¦räœÁ¨Èž˜·œ ®¦º°¦¸ ÁŽÈžÁ˜°¦rš¸É¦´±°¦räœÁ¡«µ¥ (androgen receptor) ®¦º°Á°œÅŽ¤rÄœ„¦³ªœ„µ¦¦oµŠ±°¦räœÁ¡« µ¥ (steroidogenic enzymes) šÎµÄ®o¤¸¦°Á°ªÄ®n¨³„¨»n¤°µ„µ¦Á¤Âš°¨·‡ µ¥š¸É¤¸£µª³…µ—®¦º° ¡¦n°Š±°¦räœÁ¡«‹³¡¨´„¬–³Á—¸¥ª„´œ °¨„°±°¨r …o°¤¼¨šµŠ¦³µ—ª·š¥µ ¡ªnµ„µ¦—ºÉ¤Á‡¦ºÉ°Š—ºÉ¤š¸É¤¸Â°¨„°±°¨rÄœž¦·¤µ–Á„·œ„ε®œ— ¨³˜n°ÁœºÉ°ŠšÎµÄ®o¤¸Å…¤´œ³¤Äœn°Ššo°Š¤µ„…¹Êœ22,23 ×¥ÁŒ¡µ³°¥nµŠ¥·ÉŠ„µ¦—ºÉ¤Á¸¥¦r22 œnµ‹³°›·µ¥ ‹µ„„µ¦Áž¨¸É¥œÂž¨Š…°Š±°¦räœÁ¨Èž˜·œ„´°³—·ÃžÁœÈ‡˜·œ Ž¹ÉŠ¡‹µ„„µ¦«¹„¬µÄœ®œ¼š—¨°Š24 ˜nŤn ´¤¡´œ›r„´„µ¦Á„·—£µª³—ºÊ°°·œŽ¼¨·œ25 °µ®µ¦µŠž¦³Á£š ¡ªnµ„µ¦„·œ°µ®µ¦š¸É¤¸Å¥°µ®µ¦ (dietary fiber) ¼Š ¤¸—´œ¸‡ªµ¤®ªµœ (glycemic index) ˜É娳ž¦·¤µ–‡µ¦rÃűÁ—¦˜ (glycemic load) œo°¥ nª¥žj°Š„´œ„µ¦Á¡·É¤…°Š œÊε®œ´„¨³¦°Á°ª26.27 „µ¦—ºÉ¤Á‡¦ºÉ°Š—ºÉ¤š¸ÉŸ¤œÊε˜µ¨ (soft drink) ¨³œÊεŸ¨Å¤ož¦³‹Îµ ª´œ¨³ 2 „oª šÎµÄ®oœÊε®œ´„…¹ÊœÂ¨³°oªœÅ—o ×¥ÁŒ¡µ³°¥nµŠ¥·ÉŠœÊε˜µ¨¢¦»p„Ø‹µ„…oµªÃ¡— (high fructose corn syrup) Ž¹ÉŠœ·¥¤ÄoÄœ°»˜µ®„¦¦¤Á‡¦ºÉ°Š—ºÉ¤¦¦‹»…ª—®¦º°„¦³žl°Š Á¡·É¤„µ¦Á„ȳ¤Å…¤´œÄœn°Ššo°Š28-30 „µ¦¼»®¦¸É …o°¤¼¨šµŠ¦³µ—ª·š¥µ¡ªnµµ¥Â¨³®·Šš¸ÉÁ‡¥¼»®¦¸É®¦º°„ε¨´Š¼»®¦¸É¤¸Å…¤´œ Äœn°Ššo°Š³¤Á¡·É¤…¹Êœ22,31 Ÿ¼oš¸É¼»®¦¸Éž¦³‹Îµnªœ®œ¹ÉŠ¤¸ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥Å¤n¤µ„ ˜n…o°¤¼¨š¸É¤¸ ¥´ŠÅ¤n°—‡¨o°Š„´œš´ÊŠ®¤—31-33 ‡ªµ¤Ÿ·—ž„˜·šµŠ¡´œ›»„¦¦¤ ÁºÉ°ªnµ‡ªµ¤Ÿ·—ž„˜·šµŠ¡´œ›»„¦¦¤Áž}œž{‹‹´¥®œ¹ÉŠš¸ÉÁ„¸É¥ª…o°Š „´œÊε®œ´„˜´ªÂ¨³„µ¦³¤Å…¤´œÄœ¦nµŠ„µ¥ ×¥¤¸ž’·´¤¡´œ›r„´·ÉŠÂª—¨o°¤ °µ‹Áž}œ‡ªµ¤Ÿ·—ž„˜· …°Š¥¸œš¸É´¤¡´œ›r„´°oªœÃ—¥˜¦Š34 ¥¸œ°ºÉœ ®¦º°¥¸œš¸É‡ª‡»¤¤—»¨¡¨´ŠŠµœ…°Š¦nµŠ„µ¥ (¦µ¥¨³Á°¸¥— Á¡·É¤Á˜·¤ÄœµÁ®˜»…°Š°oªœÂ¨³°oªœ¨Š¡»Š) ×¥¦»ž œÊε®œ´„ nªœ¼Š ¨³¦°Á°ª Áž}œ…o°¤¼¨š¸Éª´—Å—oŠnµ¥Â¨³ÄoÁž}œÁ„–”r„ε®œ—£µª³ °oªœÂ¨³°oªœ¨Š¡»Šš´ÉªÃ¨„ 宦´‡œÅš¥Ÿ¼oÄ®n°·Š…o°¤¼¨…°ŠµªÁ°Á¸¥ ˜o°Š„µ¦Šµœª·‹´¥Á¡·É¤Á˜·¤Á¡ºÉ° ¥ºœ¥´œªnµ¦°Á°ªš¸ÉÁ®¤µ³¤…°Šµ¥Åš¥‡ª¦˜É優nµ 85 ÁŽœ˜·Á¤˜¦ 宦´Á—È„Åš¥Äo„¦µ¢°oµŠ°·Š„µ¦ Á‹¦·Á˜·Ã˜œÊε®œ´„˜µ¤‡ªµ¤¼Š®¦º°‡ªµ¤¥µª˜´ª…°ŠÁ—È„Åš¥°µ¥» 1 ª´œ ™¹Š 19 že …°Š„¦³š¦ªŠ µ›µ¦–»… ž{‹‹´¥£µ¥ÄœÂ¨³·ÉŠÂª—¨o°¤®¨µ¥°¥nµŠnŠÁ¦·¤Ä®oœÊε®œ´„¨³¦°Á°ªÁ¡·É¤…¹Êœ‹œÁ„·—£µª³ °oªœÂ¨³°oªœ¨Š¡»Š
- 15. 6 Á°„µ¦°oµŠ°·Š 1. Lee SY, Gallagher D. Assessment methods in human body composition. Curr Opin Clin Nutr Metab Care. 2008; 11: 566-72. 2. Global data base on Body Mass Index. http://apps.who.int/bmi/index.jsp?introPage=intro_5.html 3. Aekplakorn W, Pakpeankitwatana V, Lee CMY, et al. Abdominal obesity and coronary heart disease in Thai men. Obesity 2007; 15: 1036-42. 4. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne. 5. Šnµ —µ¤µ¡Š¬r, ¨´——µ Á®¤µ³»ª¦¦–, »œš¦¸ ¦´˜œ¼Á°„. ‡ªµ¤Áž}œ¤µÂ¨³ž{®µÃ¦‡°oªœÄœÁ—È„. Äœ: 懰oªœÄœÁ—È„: ÂœªšµŠžj°Š„´œ —¼Â¨¦´„¬µ ¨³¢gœ¢¼. »¦·¥Á—ª š¦·žµ˜¸, »œš¦¸ ¦´˜œ¼Á°„, ¦¦–µ›·„µ¦. ™µ´œ»…£µ¡Á—Ȅ®nŠµ˜·¤®µ¦µ·œ¸ „¦¤„µ¦Â¡š¥r „¦³š¦ªŠµ›µ¦–»…. ´¥Á‹¦·, „¦»ŠÁš¡¤®µœ‡¦ 2551: 1-17. 6. Onat A, Avci GS, Barlan MM, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. Int J Obes Relat Metab Disord 2004; 28:1018-25. 7. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-5. 8. ÂœªšµŠÁªž’·´˜·„µ¦žj°Š„´œÂ¨³—¼Â¨¦´„¬µÃ¦‡°oªœ ™µ´œª·‹´¥Â¨³ž¦³Á¤·œÁš‡ÃœÃ¨¥¸šµŠ „µ¦Â¡š¥r „¦¤„µ¦Â¡š¥r „¦³š¦ªŠµ›µ¦–»…. »¤œ»¤®„¦–r„µ¦Á„¬˜¦Â®nŠž¦³Áš«Åš¥ 2553. 9. Aekplakorn W, Pakpeankitwatana V, Lee CMY, et al. Abdominal obesity and coronary heart disease in Thai men. Obesity 2007; 15: 1036-42. 10. Janssen I, Kartzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004; 79: 379-84. 11. Aekplakorn W, Cheepudomwit S, Bunnag P, et al. A risk score for predicting incident diabetes in the Thai population. Diabetes Care 2006; 29: 1872-7. 12. Kolditz CI, Langin D. Adipose tissue lipolysis. Curr Opin Clin Nutr Metab Care 2010; 13: 377-81. 13. De Feo P, Di Loreto C, Lucidi P, et al. Metabolic response to exercise. J Endocrinol Invest 2003; 26: 851-4.
- 16. 7 14. Borer KT, Wuorinen E, Ku K, Burant C. Appetite responds to changes in meal content, whereas ghrelin, leptin, and insulin track changes in energy availability. J Clin Endocrinol Metab 2009; 94: 2290-8. 15. Klaus S. Adipose tissue as a regulator of energy balance. Curr Drug Targets 2004; 5: 241- 50. 16. Cypess AM, Kahn CR. The role and importance of brown adipose tissue in energy homeostasis. Curr Opin Pediatr 2010; 22: 478-84. 17. Virtanen K, Lidell M, Orava J, et al. Functional brown adipose tissue in healthy adults. N Engl J Med 2009; 360: 1518-25. 18. Hansen JC, Gilman AP, Odland JØ. Is thermogenesis a significant causal factor in preventing the "globesity" epidemic? Med Hypotheses 2010; 75: 250-6. 19. Blouin K, Boivin A, Tchernof A. Androgens and body fat distribution. J Steroid Biochem Mol Biol 2008; 108: 272-80. 20. Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. metabolic syndrome and erectile dysfunction. J Androl 2009; 30: 10-22. 21. Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril 2006; 85: 1319- 40. 22. Molenaar EA, Massaro JM, Jacques PF, et al. Association of lifestyle factors with abdominal subcutaneous and visceral adiposity: the Framingham Heart Study. Diabetes Care 2009; 32: 505-10. 23. Ferreira MG, Valente JG, Gonçalves-Silva RM, Sichieri R. Alcohol consumption and abdominal fat in blood donors. Rev Saude Publica 2008; 42: 1067-73. 24. Pravdova E, Macho L, Fickova M. Alcohol intake modifies leptin, adiponectin and resistin serum levels and their mRNA expressions in adipose tissue of rats. Endocr Regul 2009; 43: 117-25. 25. Risérus U, Ingelsson E. Alcohol intake, insulin resistance, and abdominal obesity in elderly men. Obesity 2007; 15: 1766-73. 26. Du H, van der A DL, Boshuizen HC, et al. Dietary fiber and subsequent changes in body weight and waist circumference in European men and women. Am J Clin Nutr 2010; 91: 329-36. 27. Romaguera D, Angquist L, Du H, et al. Dietary determinants of changes in waist circumference adjusted for body mass index - a proxy measure of visceral adiposity. PLoS One 2010; 5(7): e11588.
- 17. 8 28. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010; 33: 2477-83. 29. Fung TT, Malik V, Rexrode KM, Manson JE, Willet WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009; 89: 1037- 42. 30. Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose- sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009; 119: 1322-34. 31. Koster A, Leitzmann MF, Schatzkin A, et al. The combined relations of adiposity and smoking on mortality. Am J Clin Nutr 2008; 88: 1206-12. 32. Caks T, Kos M. Body shape, body size and cigarette smoking relationships. Int J Public Health 2009; 54: 35-9. 33. Chouraki V, Wagner A, Ferrières J, et al. Smoking habits, waist circumference and coronary artery disease risk relationship: the PRIME study. Eur J Cardiovasc Prev Rehabil 2008; 15: 625-30. 34. Fawcett KA, Barroso I. The genetics of obesity: FTO leads the way. Trends Genet 2010; 26: 266-74.
- 18. 9 ª·´¥ Á°„¡¨µ„¦ °Š‡r„µ¦°œµ¤´¥Ã¨„ Å—o—Š…o°¤¼¨‡ªµ¤»„…°Š£µª³œÊε®œ´„Á„·œÂ¨³°oªœÄœ 90 ž¦³Áš« (Global Data on Body Mass Index) ¡ªnµ‡ªµ¤»„…°Š£µª³œÊε®œ´„Á„·œ (body mass index, BMI •25 „„./¤.2 ) Äœž¦³Áš«˜nµŠÇ ¤¸˜´ÊŠÂ˜n˜É優nµ¦o°¥¨³ 5 Äœž¦³Áš«Áª¸¥—œµ¤Â¨³°·œÁ—¸¥ ‹œ„¦³š´ÉŠ¼Š „ªnµ¦o°¥¨³ 50 Äœž¦³Áš«®¦´“°Á¤¦·„µ Seychelles œ·ªŽ¸Â¨œ—r ¨³°°Á˜¦Á¨¸¥ 宦´‡ªµ¤»„…°Š £µª³œÊε®œ´„Á„·œÂ¨³°oªœÄœž¦³µœ…°ŠµŠž¦³Áš«Äœšª¸žÁ°Á¸¥—´ŠÂ—ŠÄœ˜µ¦µŠš¸É 1 Ž¹ÉŠ™·˜·œ¸Ê¤¸ …o°‹Îµ„´—Äœ„µ¦Áž¦¸¥Áš¸¥¦³®ªnµŠž¦³Áš« ÁœºÉ°Š‹µ„˜n¨³ž¦³Áš«¤·Å—oÁ„È…o°¤¼¨ÄœnªŠÁª¨µÁ—¸¥ª„´œ ª·›¸„µ¦Á„È…o°¤¼¨ ¨³„¨»n¤°µ¥»š¸É¤¸„µ¦Îµ¦ª‹¤¸‡ªµ¤Â˜„˜nµŠ„´œ ˜n…o°¤¼¨œ¸Êµ¤µ¦™Â—Š™µœ„µ¦–r …°Šž{®µÃ¦‡°oªœÄœÂ˜n¨³ž¦³Áš« ÄœnªŠÁª¨µ—´Š„¨nµª1,2 ˜µ¦µŠš¸É 1. ‡ªµ¤»„£µª³œÊε®œ´„Á„·œÂ¨³‡ªµ¤»„懰oªœÄœž¦³µ„¦Á°Á¸¥ BMI •25 „„./¤.2 BMI •30 „„./¤.2 ž¦³Áš« že ‡«. š¸É妪‹ °µ¥» µ¥ ®·Š ¦ª¤ µ¥ ®·Š ¦ª¤ „´¤¡¼µ 2005 15-49 9.6 ‹¸œ 2002 18+ 19.1 18.8 2.4 3.4 ±n°Š„Š 1995/6 25-74 38 34 5 7 °·œÁ—¸¥ 2005/6 15-49 9.3 12.6 1.3 2.8 °·œÃ—œ¸ÁŽ¸¥ 2000 20+ 11.5 21.9 1.3 4.5 ¸Éž»iœ 2004 15-100 27.3 19.9 23.2 2.8* 3.3* 3.1* Á„µ®¨¸Ä˜o 2005 20+ 35.2 28.3 31.8 1.7* 3.0** 2.4** ¤µÁ¨ÁŽ¸¥ 1996 18+ 24.1 29.0 4.0 7.6 Áœžµ¨ 2006 15-49 8.7 1.1 ¢d¨·žždœr 1998 20+ 17.0 23.3 16.9 2.1 4.4 3.3 ·Š‡Ãž¦r 2004 18-69 35 29.9 32.5 6.4 7.3 6.9 Řo®ª´œ 1993-6 20+ 24.7 25.1 25.8 2.4 5.9 21.1 Åš¥ 2004 18+ 22.4 34.3 4.7 9.1 Áª¸¥—œµ¤ 2001/2 19+ 4.4 6.6 http://iotf.org/database/documents/GlobalPrevalenceofAdultObesity20thJanuary2010.pdf *…o°¤¼¨že 2001, **…o°¤¼¨ že 1998 宦´™·˜·Äœž¦³Áš«Åš¥ ¤oªnµ‡ªµ¤»„懰oªœ¥´ŠÅ¤nÁš¸¥Ášnµ‡œÄœÂ™˜³ª´œ°°„„¨µŠ ¥»Ã¦ž ¨³°Á¤¦·„µ ˜nÂœªÃœo¤‡ªµ¤»„…°ŠÃ¦‡°oªœ¤¸Á¡·É¤…¹Êœ˜µ¤¨Îµ—´ ¨³‡ªµ¤»„Ťnœo°¥Åž„ªnµ º··Õè 2
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- 22. 13 ¦¼žš¸É 6. ‡ªµ¤»„…°Š£µª³°oªœ¨Š¡»ŠÄœž¦³µ„¦Åš¥°µ¥» 15 že…¹ÊœÅž ‹ÎµÂœ„˜µ¤£µ‡ ‡ªµ¤°oªœ„´Á«¦¬“µœ³ Á¤ºÉ°¡·‹µ¦–µ‡ªµ¤»„…°Š£µª³°oªœ ‹ÎµÂœ„˜µ¤Á…˜ž„‡¦°ŠÂ¨³˜µ¤¦³—´„µ¦«¹„¬µ ¤oªnµ ‡ªµ¤»„…°Š£µª³°oªœ…°ŠŸ¼oš¸É°µ«´¥ÄœÁ…˜Á¤º°Š¤¸¤µ„„ªnµÁ…˜œš °¥nµŠÅ¦„Șµ¤ …o°¤¼¨„µ¦Îµ¦ª‹ „. µ¥ …. ®·Š ¦¼žš¸É 7. ‡ªµ¤»„…°Š£µª³°oªœ‹ÎµÂœ„˜µ¤¦³—´„µ¦«¹„¬µÄœÁ¡«µ¥ („) ¨³®·Š (…)
- 23. 14 »…£µ¡ž¦³µœÅš¥¡ªnµ ´—nªœ…°Š„µ¦Á¡·É¤…¹Êœ…°Š£µª³°oªœÄœœš„ε¨´ŠÁ¡·É¤…¹Êœ¤µ„ ¨³ ÂœªÃœo¤‡ªµ¤Â˜„˜nµŠÄœ‡ªµ¤»„…°ŠÃ¦‡°oªœ ¦³®ªnµŠ¦³—´„µ¦«¹„¬µ¤¸‡ªµ¤Â˜„˜nµŠ„´œ¨—¨Š ‹µ„ ¦¼žš¸É 7 ¡ªnµ‡ªµ¤»„…°Š£µª³°oªœ¤¸‡ªµ¤Â˜„˜nµŠ¦³®ªnµŠÁ¡« ץĜÁ¡«µ¥ ‡ªµ¤»„Á¡·É¤…¹Êœ˜µ¤ ¦³—´„µ¦«¹„¬µš¸ÉÁ¡·É¤…¹Êœ Äœ…–³š¸ÉÄœÁ¡«®·Šœ´Êœ‡ªµ¤»„…°Š£µª³°oªœ¤¸ÂœªÃœo¤¨—¨ŠÁ¤ºÉ°¦³—´ „µ¦«¹„¬µÁ¡·É¤…¹Êœ3,4 ‡ªµ¤»„…°ŠÃ¦‡Áµ®ªµœ ‡ªµ¤—´œÃ¨®·˜¼Š ¨³£µª³Å…¤´œŸ·—ž„˜· ÄœŸ¼oš¸É¤¸Ã¦‡°oªœ ‹µ„…o°¤¼¨„µ¦Îµ¦ª‹»…£µ¡ž¦³µœÅš¥‡¦´ÊŠš¸É 4 že 2552 ÄœÁ¦ºÉ°Š‡ªµ¤»„…°ŠÃ¦‡Áµ®ªµœ ‡ªµ¤—´œÃ¨®·˜¼Š ¨³£µª³Å…¤´œŸ·—ž„˜·Äœ‡œš¸É°oªœÂ¨³Äœ‡œš¸ÉŤn°oªœ ¡ªnµÄœ„¨»n¤‡œ°oªœ (BMI •25 „„./¤.2 ) ¤¸‡ªµ¤»„…°ŠÃ¦‡Áµ®ªµœ ¦o°¥¨³ 11.1 ‡ªµ¤—´œÃ¨®·˜¼Š¦o°¥¨³ 31.6 ¨³Å…¤´œ ‡°Á¨Á˜°¦°¨¼Š (total cholesterol •240 ¤„./—¨.) ¦o°¥¨³ 27.3 Å…¤´œ triglyceride ¼Š (•150 ¤„./ —¨.) ¦o°¥¨³ 49.6 ¨³ £µª³ HDL-C ˜Éε (<40 ¤„./—¨.) ¦o°¥¨³ 36.2 (˜µ¦µŠš¸É 3) Ž¹ÉŠ‡ªµ¤»„…°ŠÃ¦‡ ¨³£µª³Á®¨nµœ¸Ê¼Š„ªnµ‡œš¸É¤¸ BMI <25 „„./¤.2 Ž¹ÉŠ¡ªnµ¤¸Ã¦‡Â¨³£µª³—´Š„¨nµª¦o°¥¨³ 4.6, 15.9, 15.3, 29.5 ¨³ 24.7 ˜µ¤¨Îµ—´ ˜µ¦µŠš¸É 3. Áž¦¸¥Áš¸¥‡ªµ¤»„ (¦o°¥¨³) …°ŠÃ¦‡Áµ®ªµœ ‡ªµ¤—´œÃ¨®·˜¼Š ¨³¦³—´Å…¤´œÄœ Á¨º°—Ÿ·—ž„˜·Äœž¦³µ„¦Åš¥š¸É°oªœÂ¨³Å¤n°oªœ æ‡Áµ®ªµœ 懇ªµ¤ —´œÃ¨®·˜¼Š ¦³—´ ‡°Á¨Á˜°¦°¨ ÄœÁ¨º°— •240 ¤„./—¨. ¦³—´Å˜¦„¨¸ ÁŽ°Å¦—rÄœ Á¨º°— •150 ¤„./—¨. ¦³—´Á°—¸Â°¨ ‡°Á¨Á˜°¦°¨ ÄœÁ¨º°— <40 ¤„./—¨. BMI •25 „„./¤.2 11.1 31.6 27.3 49.6 36.2 BMI <25 „„./¤.2 4.6 15.9 15.3 29.5 24.7 ¦»ž ÂœªÃœo¤…°Š£µª³œÊε®œ´„Á„·œÂ¨³Ã¦‡°oªœÄœž¦³µ„¦Åš¥ÄœnªŠ 20 žeš¸ÉŸnµœ¤µ Á¡·É¤…¹Êœ°¥nµŠ ¦ª—Á¦Èª ¨³‹³¤¸ÂœªÃœo¤Á¡·É¤…¹Êœ˜n°Åž ®µ„ž{‹‹´¥š¸ÉÁ„¸É¥ª…o°Š„´£µª³°oªœœ¸Ê¥´ŠÅ¤nÅ—o¦´„µ¦Â„oÅ…°¥nµŠ Á¡¸¥Š¡° ž{‹‹´¥š¸ÉnŠŸ¨Ä®oÁ¡·É¤…¹Êœœ¸Ê Á„¸É¥ª…o°Š„´‡ªµ¤Á‹¦·šµŠÁ«¦¬“„·‹´Š‡¤Â¨³šµŠÁš‡ÃœÃ¨¥¸ šÎµ Ä®o‡ªµ¤Áž}œ°¥¼n…°Šž¦³µœ¤¸‡ªµ¤³—ª„µ¥¤µ„…¹Êœ °µ®µ¦„µ¦„·œ°»—¤¤¼¦–r¤µ„…¹Êœ ×¥ÁŒ¡µ³°µ®µ¦ž¦³Á£šÅ…¤´œ¼Š ˜n¤¸„·‹„¦¦¤šµŠ„µ¥¨—¨Š šÎµÄ®o¦nµŠ„µ¥Å—o¦´¡¨´ŠŠµœ¤µ„„ªnµš¸É ÄoÅž ‹¹ŠšÎµÄ®o¤¸„µ¦³¤Â¨³¤¸œÊε®œ´„˜´ªÁ¡·É¤…¹Êœ Ž¹ÉŠž{®µÁ¦ºÉ°ŠœÊε®œ´„Á„·œÂ¨³°oªœÄœž¦³Áš«Åš¥¤¸ ‡ªµ¤»„Ťnœo°¥„ªnµž¦³Áš«°ºÉœÇ ÄœÁ°Á¸¥ Ánœ ¸Éž»iœ Á„µ®¨¸ ¨³ž¦³Áš«‹¸œ ™µœ„µ¦–r£µª³°oªœ œ¸Ê‹³nŠŸ¨Ä®ož¦³µœ¤¸‡ªµ¤Á¸É¥Š˜n°Ã¦‡Á¦ºÊ°¦´Š Å—o„n æ‡Áµ®ªµœ 懇ªµ¤—´œÃ¨®·˜¼Š ¨³Ã¦‡ ¦³®´ªÄ‹Â¨³®¨°—Á¨º°—Á¡·É¤…¹Êœ —´Šœ´Êœ„µ¦¦oµŠÁ¦·¤»…£µ¡¦³—´¤®£µ‡ Ánœ—oµœœÃ¥µ¥ ¨³ „µ¦ž¦´ž¦»Š·ÉŠÂª—¨o°¤ Äœ¦³—´ž¦³µ„¦ (population–based approach) ¦ª¤š´ÊŠ„µ¦¦oµŠÁ¦·¤
- 24. 15 »…£µ¡¦³—´ž{‹Á‹„ (individual approach) Å—o„n„µ¦ž¦´Áž¨¸É¥œ¡§˜·„¦¦¤…°Šž¦³µœÄœÁ¦ºÉ°Š„µ¦ „·œ°µ®µ¦š¸ÉÁ®¤µ³¤ ¨³nŠÁ¦·¤Ä®o¤¸„·‹„¦¦¤šµŠ„µ¥š¸ÉÁ¡¸¥Š¡°‹¹ŠÁž}œ·ÉŠš¸É˜o°Š—εÁœ·œ„µ¦Ä®o¤¸‡ªµ¤ Á…o¤Šª—¤µ„…¹Êœ˜n°Åž Á°„µ¦°oµŠ°·Š 1. http://iotf.org/database/documents/GlobalPrevalenceofAdultObesity20thJanuary2010.pdf 2. Global data base on Body Mass Index. http://apps.who.int/bmi/index.jsp?introPage=intro_5.html 3. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne. 4. Aekplakorn W, Mo-Suwan L. Prevalence of obesity in Thailand. Obes Rev. 2009; 10: 589- 92. 5. Aekplakorn W, Hogan MC, Chongsuvivatwong V, Tatsanavivat P, Chariyalertsak S, Boonthum A, Tiptaradol S, Lim SS. Trends in obesity and associations with education and urban or rural residence in Thailand. Obesity (Silver Spring) 2007; 15: 3113-21. 6. ª·´¥ Á°„¡¨µ„¦ (¦¦–µ›·„µ¦). ¦µ¥Šµœ„µ¦Îµ¦ª‹»…£µ¡ž¦³µœÅš¥Ã—¥„µ¦˜¦ª‹¦nµŠ„µ¥ ‡¦´ÊŠš¸É 4 ¡.«. 2551-2552. œœš»¦¸: εœ´„ŠµœÎµ¦ª‹»…£µ¡ž¦³µœÅš¥ / ™µ´œª·‹´¥¦³ µ›µ¦–»…; 2553.
- 25. 16 «»£ª¦¦– ¼¦–¡·¦ 懰oªœÂ¨³°oªœ¨Š¡»Š¤¸Á®˜»‹µ„ 3 ž{‹‹´¥®¨´„‡º° „µ¦‡ª‡»¤‡ªµ¤¤—»¨…°Š¡¨´ŠŠµœ ¡§˜·„¦¦¤„µ¦—ε¦Š¸ª·˜ ¨³¡´œ›»„¦¦¤ Äœ¦³¥³ 2-3 š«ª¦¦¬š¸ÉŸnµœ¤µ Å—o¤¸„µ¦«¹„¬µ®µµÁ®˜» …°Š‡ªµ¤Ÿ·—ž„˜·šµŠ¥¸œš¸ÉšÎµÄ®o°oªœ ¨³¡Ãž¦˜¸œ®¦º°±°¦r䜚¸É‡ª‡»¤‡ªµ¤¤—»¨…°Š¡¨´ŠŠµœ ×¥‡ª‡»¤‡ªµ¤®·ª®¦º°‡ªµ¤°·É¤®¨µ¥œ·— ¤—»¨…°Š¡¨´ŠŠµœ1 neuropeptides ¨³ neurotransmitter ‹µ„¤°Š¦nª¤„´´µ–‹µ„£µ¥œ°„¤¸Ÿ¨¦nª¤„´œ˜n° „µ¦‡ª‡»¤¤—»¨…°Š¡¨´ŠŠµœ ×¥¡ªnµ®¨µ¥´µ–‡ª‡»¤š´ÊŠ„µ¦¦·Ã£‡°µ®µ¦ (energy intake) ¨³„µ¦œÎµÁ°µ¡¨´ŠŠµœÅžÄo (energy expenditure) ×¥ peptide š¸É‡ª‡»¤‡ªµ¤°¥µ„°µ®µ¦¤¸ ˜µ¦µŠš¸É 1. —Š¥¸œš¸É¤¸šµšÄœ„µ¦‡ª‡»¤œÊε®œ´„1 Gene influencing weight control Gene Model Tissue Body weight Food intake Energy expenditure Leptin Leptin receptor MC4 receptor MC3 receptor Melanin concentrating hormone (MCH) GPR7 Perilipin ASP (C3) Neuropeptides B and W Acetyl CoA Carboxylase NO synthase PKA RII beta Beta adrenergic receptor Uncoupling protein Cidea Stearoyl CoA desaturase ob/ob db/db MC4-/- MC3-/- MCH-/- GPR7-/- P1-/- C3-/- GPR7-/- Acc 2-/- NOS-/- RII-/- Beta AR 1,2,3-/- UPC1-/- Cidea-/- Scd-/- Adipose Brain Brain Brain Brain Brain Adipose Adipose Brain Widely Adipose All BAT BAT Liver n n n l p n p p n p n p n l l p n n n l n n n n n l l l l l n p p p n n p n n p n p n p l n n º··Õè 3
- 26. 17 šµš˜n°„µ¦œÎµÁ°µ¡¨´ŠŠµœÅžÄo ÄœšµŠ˜¦Š„´œ…oµ¤ ‡º° peptide š¸É„¦³˜»oœÄ®o„·œÁ¡·É¤…¹Êœ‹³¨—„µ¦ œÎµÁ°µ¡¨´ŠŠµœÅžÄo šÎµÄ®o¤¸„µ¦³¤¡¨´ŠŠµœÁ¡·É¤…¹Êœ …–³š¸É peptide š¸É¥´¥´ÊŠ„µ¦„·œ°µ®µ¦‹³Á¡·É¤ „µ¦œÎµÁ°µ¡¨´ŠŠµœÅžÄo —´Š˜µ¦µŠš¸É 1 Neuropeptide Äœ hypothalamus š¸É¤¸šµšÄœ„µ¦‡ª‡»¤œÊε®œ´„¤¸®¨µ¥œ·— Ánœ neuropeptide Y (NPY), agouti-related peptide (AGRP), melanin-concentrating hormone (MCH), galanin, E-endorphin, dynorphin, enkephalin ¨³ orexins …–³š¸É peptide š¸É¥´¥´ÊŠ„µ¦„·œ°µ®µ¦ Å—o„n D-melanocyte-stimulating hormone (D-MSH), cocaine-amphetamine responsive transcript (CART), corticotrophin-releasing hormone, urocortin, neurotensin ¨³ neuromedin ´µ–‹µ„šµŠÁ—·œ°µ®µ¦‡º° gut peptide ®¨µ¥œ·—¤¸Ÿ¨˜n°„µ¦‡ª‡»¤œÊε®œ´„ Å—o„n cholecystokinin (CCK) š¸É¦oµŠ‹µ„šµŠÁ—·œ°µ®µ¦nªœ˜oœ duodenum ¨³ jejunum ¤¸šµšÄœ„µ¦ ¥´¥´ÊŠ‡ªµ¤°¥µ„°µ®µ¦ 宦´ peptide YY (PYY) ¦oµŠ‹µ„šµŠÁ—·œ°µ®µ¦nªœž¨µ¥ Á¡ºÉ°¥´¥´ÊŠ„µ¦ Á‡¨ºÉ°œ…°Š°µ®µ¦°°„‹µ„„¦³Á¡µ³ (gastric emptying) ¨³¥´Šµ¤µ¦™Ÿnµœ blood brain barrier Åž¤¸ Ÿ¨˜n° arcuate nucleus šÎµÄ®o¥´¥´ÊŠ„µ¦„·œ nªœ glucagon-like peptide 1 (GLP1) ¨³ oxynto- modulin ™¼„¦oµŠ‹µ„¨ÎµÅo¨³¤°Š ×¥Áž}œŸ¨Ÿ¨·˜…°Š preproglucagon gene Á¡ºÉ°Åž¥´¥´ÊŠ„µ¦„·œ Gut peptide Á¡¸¥Š˜´ªÁ—¸¥ªš¸ÉšÎµÄ®o°¥µ„°µ®µ¦¤µ„…¹Êœ‡º° ghrelin š¸É¦oµŠ‹µ„„¦³Á¡µ³°µ®µ¦ ¨³Åž¤¸Ÿ¨˜n°ÁŽ¨¨rž¦³µšÄœ arcuate nucleus ´µ–‹µ„¦°œ°„ (peripheral signal) ‡º°‹µ„Áoœž¦³µšÁª„´ (vagus nerve) nŠ ´µ–Åž¥´Š dorsal motor nuclear ¨³ nucleus of solitary tract šÎµÄ®o˜°œ°Š˜n° ghrelin ¨³ MSH œ°„‹µ„œ¸Ê vagus nerve ¥´Š¦´…o°¤¼¨…°Š fatty acid oxidation Äœ˜´ Ž¹ÉŠ¤¸Ÿ¨˜n°‡ªµ¤°¥µ„ °µ®µ¦ ×¥™oµ…ªœ„µ¦ oxidation œ¸Ê™¼„¥´¥´ÊŠ‹³šÎµÄ®o°¥µ„°µ®µ¦Á¡·É¤…¹Êœ ¦¼žš¸É 1. —Š„µ¦šÎµŠµœ…°Š±°¦räœÁ¨Èž˜·œÄœ¦³ž¦³µš1 Leptin Released to circulation Cross blood brain barrier to act on neurons in arcuate nucleus through leptin receptor Act on MC4-R and MC3-R Stimulate POMC neurons, nD-MSH Decrease feeding and increase energy expenditure
- 27. 18 ±°¦r䜰·œŽ¼¨·œ¤¸šµšÄœ„µ¦¥´¥´ÊŠ‡ªµ¤°¥µ„°µ®µ¦ ¨³¡ªnµÁŽ¨¨rž¦³µšÄœ arcuate ¤¸ insulin receptor ¨³˜°œ°Š˜n° insulin —´Šœ´ÊœœÊε®œ´„˜´ª‹³™¼„‡ª‡»¤Ã—¥ž’·´¤¡´œ›r…°Š ´µ–˜nµŠÇ ‹µ„¨ÎµÅo¨³¤°Š°¥nµŠŽ´Žo°œ Á¨Èž˜·œ (Leptin) Áž}œ±°¦r䜚¸É¦oµŠ‹µ„ÁŽ¨¨rÅ…¤´œ ™¼„nŠŸnµœ blood brain barrier Åž¥´ŠÁŽ¨¨r ž¦³µšÄœ arcuate ×¥ÁŒ¡µ³ÁŽ¨¨rš¸É¦oµŠ preproopiomelanocortin (POMC) Á¨Èž˜·œšÎµÄ®oÁŽ¨¨r¦oµŠ POMC ¨³ POMC gene product ‡º° D-MSH ¤µ„…¹Êœ ÅžšÎµŠµœŸnµœšµŠ melanocortin-4 receptor ¨³ melanocortin-3 receptor Á¡ºÉ°Á¡·É¤ energy expenditure ¨³¨—„µ¦„·œ°µ®µ¦ (¦¼žš¸É 1) ¡§˜·„¦¦¤„µ¦—ε¦Š¸ª·˜ (Life style) µÁ®˜»…°ŠÃ¦‡°oªœÁ„·—‹µ„„µ¦„·œ¤µ„Á„·œÅž (overeating) ®¦º°„µ¦¤¸„·‹„¦¦¤šµŠ„µ¥œo°¥¨Š (under-activity) ¥´ŠÁž}œš¸É™„Á™¸¥Š„´œ ˜n¤¸…o°¤¼¨ªnµ¡¨´ŠŠµœš¸É¦·Ã£‡Ã—¥¦ª¤š´ÊŠ‹µ„°µ®µ¦Â¨³Á‡¦ºÉ°Š—ºÉ¤ ¨—¨ŠÄœnªŠ 20 žeš¸ÉŸnµœ¤µ2,3 ˜n„·‹„¦¦¤šµŠ„µ¥°´œÁž}œœ·´¥„Ȩ—¨Š°¥nµŠ¤µ„ ¤µ„„ªnµ„µ¦¨—„µ¦ ¦·Ã£‡°µ®µ¦4,5 šÎµÄ®o°»´˜·„µ¦–r…°ŠÃ¦‡°oªœÁ¡·É¤…¹Êœ 懰oªœÁž}œŸ¨‹µ„ž{‹‹´¥šµŠ¡§˜·„¦¦¤ ¦nª¤„´¡´œ›»„¦¦¤ ·ÉŠÂª—¨o°¤ ¦¸¦ª·š¥µ ´Š‡¤Â¨³ ª´•œ›¦¦¤ Ž¹ÉŠšÎµÄ®oÁ„·—‡ªµ¤Å¤n¤—»¨…°Š¡¨´ŠŠµœš¸¨³œo°¥ÄœÁª¨µš¸ÉŸnµœ¤µ šÎµÄ®o¤¸„µ¦³¤¡¨´ŠŠµœ nªœÁ„·œÄœ¦¼ž…°ŠÅ…¤´œ ¤oªnµ¡´œ›»„¦¦¤‹³¤¸šµšÎµ‡´Äœ„µ¦‡ª‡»¤œÊε®œ´„˜´ª °Š‡r„µ¦°œµ¤´¥ è„Å—o¦»žªnµ6 ž{‹‹´¥šµŠ¡´œ›»„¦¦¤Â¨³·ÉŠÂª—¨o°¤ ×¥ÁŒ¡µ³„µ¦—εÁœ·œ¸ª·˜Â…µ—„µ¦°°„„ε¨´Š „µ¥ ¦nª¤„´„µ¦¦´ž¦³šµœ°µ®µ¦¤µ„Á„·œÅžÁž}œµÁ®˜»®¨´„…°Š„µ¦Á¡·É¤°»´˜·„µ¦–r…°ŠÃ¦‡°oªœ°¥nµŠ ¤µ„¤µ¥Äœ 2 š«ª¦¦¬š¸ÉŸnµœ¤µ …–³š¸É„µ¦„·œ°µ®µ¦°µ‹Å¤nÅ—oÁ¡·É¤…¹ÊœÄœÂŠn…°Š¡¨´ŠŠµœ ˜nnªœž¦³„°…°Š°µ®µ¦š¸É„·œ Áž¨¸É¥œÂž¨ŠÅž¤µ„ ×¥¡ªnµ°µ®µ¦š¸É¦·Ã£‡¤¸¡¨´ŠŠµœ˜n°ž¦·¤µ–š¸É¦·Ã£‡ (energy dense) Á¡·É¤…¹Êœ ¤µ„ ¤¸‡ªµ¤®ªµœ¤µ„…¹ÊœÂ¨³Ÿnµœ…ªœ„µ¦Ÿ¨·˜¤µ„…¹Êœ ¤¸œÊε˜µ¨¤µ„…¹ÊœÂ˜nÄ¥°µ®µ¦¨—¨Š ¤¸ž¦·¤µ– Å…¤´œÃ—¥¦ª¤¨—¨Š ˜n¤¸Å…¤´œ°·É¤˜´ªÂ¨³Å…¤´œš¦µœrÁ¡·É¤…¹Êœ „·œ°µ®µ¦˜µ¤›¦¦¤µ˜·Ánœ Ÿ´„ Ÿ¨Å¤o ¨—¨Š7 ¡§˜·„¦¦¤„µ¦„·œ°µ®µ¦¤¸šµš¤µ„˜n°„µ¦Á„·—懰oªœ ×¥¤¸„µ¦„·œ°µ®µ¦¤µ„Á„·œ ÁœºÉ°Š‹µ„°µ®µ¦¦µ‡µ™¼„ °µ®µ¦¤¸¡¨´ŠŠµœ¼Š ¤¸¦oµœ°µ®µ¦¤µ„¤µ¥Ä®oÁ¨º°„„·œ ¤¸°µ®µ¦Ä®oÁ¨º°„ ¤µ„¤µ¥ÄœÂ˜n¨³¤ºÊ° ¨³ž¦·¤µ–°µ®µ¦˜n°‹µœ¤µ„…¹Êœ (large portion size) °µ®µ¦‹µœ—nªœ (fast food) ¨³°µ®µ¦³—ª„ŽºÊ° Ž¹ÉŠ¤¸¡¨´ŠŠµœ¼ŠÂ˜n¤¸‡»–‡nµšµŠÃ£œµ„µ¦˜Éε ¤¸Ä®oÁ¨º°„ŽºÊ°¤µ„¤µ¥ ¦ª¤™¹Š¡§˜·„¦¦¤š¸ÉÁž¨¸É¥œÂž¨ŠÅžÄœª´œ®¥»— šÎµÄ®o¤¸œÊε®œ´„…¹ÊœÅ—o¤µ„ ×¥ÁŒ¡µ³Äœ‡œ°oªœ ¤¸„µ¦„·œ °µ®µ¦¤µ„…¹ÊœšÎµÄ®oÅ—o¦´¡¨´ŠŠµœ¼Š…¹Êœ ˜n¦o°¥¨³…°ŠÅ…¤´œš¸É¦·Ã£‡Áš¸¥„´¡¨´ŠŠµœš¸É¦·Ã£‡„¨´ ¨—¨Š8 —´Šœ´ÊœÅ…¤´œÄœ¦nµŠ„µ¥Å¤nÅ—o™¼„‡ª‡»¤Ã—¥°µ®µ¦Å…¤´œ9 šÎµÄ®o°›·µ¥Å—oªnµ°µ®µ¦Å…¤´œ˜Éε ®¦º°Å¦oÅ…¤´œÂ˜n¤¸¡¨´ŠŠµœÁšnµ„´°µ®µ¦Å…¤´œÁ˜È¤nªœÅ¤nnª¥Äœ„µ¦¨—œÊε®œ´„10 „µ¦°°„„ε¨´Š„µ¥Å¤nªnµ‹³Áµ®¦º°®œ´„Á¡¸¥ŠÄ— ¤¸Ÿ¨˜n°„µ¦œÎµ¡¨´ŠŠµœÅžÄo¨³¤—»¨…°Š ¡¨´ŠŠµœ ž{‹‹»´œ¤¸Áš‡ÃœÃ¨¥¸¤µ„¤µ¥¤µnª¥Äœ„µ¦—ε¦Š¸ª·˜ Ánœ ¤¸¥µœ¡µ®œ³ ¨·¢˜r ´œÅ—Á¨ºÉ°œ remote control „µ¦—¼š¸ª¸Â¨³Äo‡°¤¡·ªÁ˜°¦r¤µ„…¹ÊœšÎµÄ®o¤¸„·‹„¦¦¤šµŠ„µ¥¨—¨Š ‹¹Š¤¸Ã¦‡°oªœ¤µ„…¹Êœ ¤o‹³¤¸‡œ°°„„ε¨´Š„µ¥¤µ„…¹ÊœÂ˜n¥´ŠÅ¤n¤—»¨„´„µ¦¤¸¸ª·˜š¸É¤¸„·‹„¦¦¤šµŠ„µ¥ÄœnªŠÁª¨µ°ºÉœš¸É œo°¥¨Š (sedentary lifestyle) ¨³„µ¦¦·Ã£‡š¸É¤µ„…¹Êœ
- 28. 19 …o°¤¼¨‹µ„ National Health Interview Survey11 ¡ªnµ‡œš¸ÉÁ‡¥°°„„ε¨´Š„µ¥°¥nµŠ®œ´„ ‹³ ¨—„µ¦°°„„ε¨´Š„µ¥¨Š‹µ„°µ¥» 12 že Åž‹œ°µ¥» 21 že ×¥¨—¨Š¤µ„nªŠ°µ¥» 15-18 že ¨³ 18-29 že …o°¤¼¨‹µ„„µ¦Îµ¦ª‹»…£µ¡ž¦³µœÅš¥Ã—¥„µ¦˜¦ª‹¦nµŠ„µ¥‡¦´ÊŠš¸É 4 ¡.«.2551-2552 ¡ªnµ„¨»n¤š¸É ¤¸‡ªµ¤Á¸É¥Šš¸É‹³Áž}œÃ¦‡°oªœ‡º° °µ¥»š¸É¤µ„…¹ÊœÃ—¥ÁŒ¡µ³nªŠ°µ¥» 45-59 že Á¡«®·Š „¨»n¤š¸É°¥¼nÄœÁ…˜ Áš«µ¨ ×¥ÁŒ¡µ³Äœ£µ‡„¨µŠÂ¨³„¦»ŠÁš¡¤®µœ‡¦12 Drewnorski ¨³‡–³13 ¡ªnµ Ÿ¼o®·Š¤¸Ã¦‡°oªœ¤µ„„ªnµŸ¼oµ¥Ã—¥´¤¡´œ›r„´„µ¦¤¸¦µ¥Å—oœo°¥ ¨³¤¸„µ¦«¹„¬µ˜Éε Ž¹ÉŠ˜¦Š„´…o°¤¼¨…°Š National Health Interview Survey11 ¨³¡ªnµ°µ®µ¦š¸É¤¸ ¡¨´ŠŠµœ¼Š¤¸Ÿ¨„¦³š˜n°¡¨´ŠŠµœ¦ª¤š¸É„·œÁ…oµÅž ×¥°µ®µ¦š¸É¤¸¡¨´ŠŠµœ¼ŠšÎµÄ®o¡¹Š¡°Ä‹Â¨³Å¤n°·É¤ šÎµÄ®o„·œÁ¡·É¤…¹Êœ …–³š¸É°µ®µ¦š¸É¤¸œÊεÁž}œnªœž¦³„°¤µ„ šÎµÄ®o¦¼o¹„°·É¤Á¦Èª…¹Êœ šÎµÄ®oÅ—o¡¨´ŠŠµœ¦ª¤ ¨—¨Š ×¥š¸É°µ®µ¦š¸É¤¸¡¨´ŠŠµœ¼Š °µ‹¤¸Å…¤´œ œÊε˜µ¨ ®¦º°ÂžjŠÁž}œ°Š‡rž¦³„°®¨´„ Ánœ °µ®µ¦‹µœ —nªœ °µ®µ¦ªnµŠ …°Š®ªµœ Ž¹ÉŠ‹³¤¸¦µ‡µ™¼„„ªnµ°µ®µ¦š¸É¤¸¡¨´ŠŠµœ˜Éε Ánœ Ÿ´„ Ÿ¨Å¤o Brary GA ¨³‡–³14 ¡ªnµ¤¸„µ¦„·œœÊεÁºÉ°¤…oµªÃ¡—š¸É¤¸œÊε˜µ¨¢¦»p„ؼŠ (high-fructose corn syrup: HFCS) Äœž¦·¤µ–š¸É¤µ„…¹Êœ¤µ„„ªnµ 1000% Äœ¦³®ªnµŠže 1970 ™¹Šže 1990 Ž¹ÉŠ¡ªnµ¢¦»p„ ØÁž}œµ¦š¸ÉÄ®o¡¨´ŠŠµœ¤µ„„ªnµ 40% …°Šµ¦Ä®o‡ªµ¤®ªµœÄœÁ‡¦ºÉ°Š—ºÉ¤Äœž{‹‹»´œ šÎµÄ®oÁ„·—æ‡ °oªœ¦³µ— Ž¹ÉŠ¢¦»p„Ø‹³¤¸„µ¦¥n°¥ „µ¦—¼—Ž¹¤ ¨³„µ¦ÁŸµŸ¨µ¡¨´ŠŠµœÂ˜„˜nµŠ‹µ„„¨¼Ã‡ ×¥ ¢¦»p„ØŤn„¦³˜»oœ„µ¦®¨´ÉŠ°·œŽ¼¨·œ®¦º°„µ¦¦oµŠ leptin Ž¹ÉŠÁž}œ˜´ª®¨´„Äœ„µ¦‡ª‡»¤„µ¦¦·Ã£‡°µ®µ¦ ¨³œÊε®œ´„˜´ª „µ¦„·œ°µ®µ¦š¸É¤¸¢¦»p„ؼŠ °µ‹šÎµÄ®oÅ—o¦´¡¨´ŠŠµœ¦ª¤Á¡·É¤…¹Êœ šÎµÄ®o¤¸œÊε®œ´„˜´ª Á¡·É¤…¹ÊœÅ—o ‡œš¸É„·œÁ‡¦ºÉ°Š—ºÉ¤š¸É¤¸‡ªµ¤®ªµœ¤µ„ °µ‹šÎµÄ®oÅ—o¡¨´ŠŠµœ¦ª¤Á„·œÅž¤µ„—oª¥Ánœ„´œ ¡¨´ŠŠµœnªœÁ„·œ‹³™¼„³¤Áž}œÅ…¤´œ (triaceylglycerols) ³¤ÅªoÄœÁœºÊ°Á¥ºÉ°Å…¤´œ (adipose tissue) ×¥ÁœºÊ°Á¥ºÉ°Å…¤´œ¤¸®œoµš¸É®¨´„Á¡ºÉ°Á„ȳ¤¡¨´ŠŠµœ Á¤ºÉ°¡¨´ŠŠµœš¸É„·œÁ…oµÅž¤µ„Á„·œ ¨³—¹Š ¡¨´ŠŠµœš¸É³¤ÅªoÅžÄoÁ¤ºÉ°‡ªµ¤˜o°Š„µ¦¡¨´ŠŠµœ¤µ„„ªnµš¸É¦·Ã£‡Á…oµÅž15 ¡¨´ŠŠµœnªœÁ„·œÁ¡¸¥ŠÂ‡n 10 „·Ã¨Â‡¨°¦¸É/ª´œ µ¤µ¦™šÎµÄ®oœÊε®œ´„˜´ªÁ¡·É¤…¹Êœ 0.45 „·Ã¨„¦´¤/že ™oµÁ„·—˜n°ÁœºÉ°ŠÁž}œÁª¨µ 10 že „Ȥ¸ ‡ªµ¤Îµ‡´šµŠ‡¨·œ·„Å—o œÊε®œ´„š¸ÉÁ¡·É¤…¹ÊœÄœŸ¼oÄ®nšÎµÄ®oÁ„·— adipocyte hypertrophy Ž¹ÉŠ‹ÎµÁž}œ 宦´„µ¦¤¸¸ª·˜™oµ…µ—‡¨œ°µ®µ¦15 ˜nŤn¤¸ž¦³Ã¥œrÁ¤ºÉ°¤¸°µ®µ¦Ä®oÁ¨º°„¤µ„¤µ¥ …–³Á—¸¥ª„´œ ÁŽ¨¨rÅ…¤´œ (adipocyte) ¥´ŠšÎµ®œoµš¸ÉÄœ¨´„¬–³…°Š˜n°¤Å¦ošn° ×¥„µ¦¦oµŠ±°¦räœÂ¨³ž{‹‹´¥š¸ÉšÎµÄ®o Á‹¦·Á˜·Ã˜Ž¹ÉŠ‡ª‡»¤„µ¦ÁŸµŸ¨µÅ…¤´œÃ—¥ŸnµœšµŠ„¨Å„¥o°œ„¨´ (feedback mechanism) ×¥ ±°¦r䜘´ª®œ¹ÉŠš¸É‡ª‡»¤‡º° leptin16 Ž¹ÉŠ™¼„‡oœ¡Äœže 1994 ×¥ leptin ‹³™¼„¦oµŠ‹µ„ÁŽ¨¨rÅ…¤´œ Áž}œ´—nªœš¸É´¤¡´œ›r„´ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥ ¥·ÉŠ¤¸ÁŽ¨¨rÅ…¤´œ¤µ„‹³¦oµŠ leptin Å—o¤µ„17 懰oªœ ‹¹Š´¤¡´œ›r„´„µ¦¤¸¦³—´…°Š leptin Äœ„¦³ÂÁ¨º°—Á¡·É¤…¹Êœ18 „µ¦„·œ°µ®µ¦¤¸Ÿ¨˜n°¦³—´ leptin ×¥ ¡ªnµ„µ¦‹Îµ„´—°µ®µ¦Äœ¦³¥³Áª¨µ´ÊœÇ ‹³¨—¦³—´ leptin Å—o19 Äœ®œ¼ leptin ‹³šÎµÄ®o¨—¡¨´ŠŠµœš¸É„·œ ¨³Á¡·É¤„µ¦Äo¡¨´ŠŠµœ20 —´Šœ´Êœ‹¹ŠÁºÉ°ªnµ‡œ°oªœ‹³¤¸ leptin resistance17 ˜n¡ªnµ leptin ŤnÅ—o¤¸ šµš˜n°„µ¦Á„·—懰oªœÄœ‡œ ¥„Áªoœ‡œš¸É¤¸ genetic mutatin ˜n°„µ¦¦oµŠ leptin Ž¹ÉŠ¡Å—oœo°¥¤µ„
- 29. 20 ¡´œ›»„¦¦¤ („¦¦¤¡´œ›»r) ¤¸®¨´„“µœªnµ„¦¦¤¡´œ›»ršÎµÄ®oÁ„·—懰oªœ ÁœºÉ°Š‹µ„‡œÄœ‡¦°‡¦´ª…°Š‡œ°oªœ‹³¤¸Å…¤´œ ³¤Á¡·É¤…¹Êœ (increase adiposity) ×¥¤¸‡ªµ¤Á¸É¥ŠÁ¡·É¤ 3-7 ÁšnµÄœµ˜·¡¸Éœo°Š ¨³¤¸„µ¦ž¦³¤µ–ªnµ „¦¦¤¡´œ›»r¤¸nªœ¦´Ÿ·—°˜n°Ã¦‡°oªœ 40-70%21 …o°¤¼¨‹µ„„µ¦«¹„¬µ‡¼n —¡ªnµ„¦¦¤¡´œ›»r¤¸Ÿ¨˜n° ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥¤µ„„ªnµÃ¦‡°ºÉœÇ ×¥¡ªnµ¤¸Ÿ¨˜n° BMI 0.5-0.7, ˜n° body fat distribution 0.71-0.86, ˜n° total body fat 0.75-0.8, ˜n° skin fold thickness ¨³ waist circumference 0.72- 0.82, ¨³˜n° waist-hip ratio 0.36-0.61, ˜n° cognitive restraint of eating 0.59, ˜n° emotional eating 0.6, ¨³˜n° uncontrol eating 0.4522 ‡ªµ¤´¤¡´œ›r…°Š„¦¦¤¡´œ›»r˜n°„µ¦Á„·—„µ¦³¤Å…¤´œ œ´œ»œÁ¦ºÉ°Ššµš…°Š¥¸œÂ˜nŤn°„ªnµ‹Îµœªœ…°Š¥¸œÂ¨³¥¸œÅž¤¸Ÿ¨°¥nµŠÅ¦˜n°·ÉŠÂª—¨o°¤ „µ¦«¹„¬µšµš…°Š¡´œ›»„¦¦¤˜n°Ã¦‡°oªœ¡ªnµ  —šo‹³¤¸œÊε®œ´„Ä„¨oÁ‡¸¥Š„´œ¤µ„„ªnµ  —Áš¸¥¤š¸É°µ¥» 20 že ¨³¡ªnµ¨¼„»›¦¦¤¤¸œÊε®œ´„š¸É´¤¡´œ›r„´œÊε®œ´„…°Š¡n°Â¤nš¸Éšo‹¦·Š ץŤn ¤¸‡ªµ¤´¤¡´œ›r„´œÊε®œ´„…°Š¡n°Â¤n»›¦¦¤š¸ÉÁ¨¸Ê¥Š—¼„´œ¤µÁ¨¥ Maes ¨³‡–³23 ž¦³¤µ–„µ¦ªnµ ž{‹‹´¥šµŠ„¦¦¤¡´œ›»rnŠŸ¨ 50-90% ˜n°‡ªµ¤Â˜„˜nµŠ…°Š—´œ¸¤ª¨„µ¥ ž’·´¤¡´œ›r¦³®ªnµŠ„¦¦¤¡´œ›»r¨³·ÉŠÂª—¨o°¤¤¸šµš˜n°„µ¦Á„·—懰oªœ Bouchard ¨³ ‡–³24 —ŠÄ®oÁ®Èœªnµ‹Îµœªœ…°ŠœÊε®œ´„¨³Å…¤´œš¸ÉÁ¡·É¤…¹Êœ ¦ª¤™¹Š„µ¦„¦³‹µ¥˜´ª…°ŠÅ…¤´œš¸ÉÁ¡·É¤…¹Êœ ‹µ„„µ¦„·œš¸É¤µ„Á„·œ‹³¤¸‡ªµ¤Á®¤º°œ„´œÄœ‡¼n —šo¤µ„„ªnµÂ —Áš¸¥¤ „¨Å„®œ¹ÉŠš¸ÉnŠ°„ªnµ ¥¸œ (genotype) ¤¸Ÿ¨„¦³š˜n°œÊε®œ´„˜´ª‡º°¤¸Ÿ¨Äœ„µ¦‡ª‡»¤„µ¦Äo¡¨´ŠŠµœ (energy expenditure) ¤¸ „µ¦ž¦³¤µ–ªnµ‡ªµ¤Â˜„˜nµŠ…°Š energy expenditure ×¥ž¦³¤µ– 40% ץŤnœ´„µ¦°°„„ε¨´Š „µ¥°¥nµŠ®œ´„Áž}œŸ¨‹µ„¥¸œ23 °¥nµŠÅ¦„Șµ¤°»´˜·„µ¦–r…°ŠÃ¦‡°oªœš¸ÉÁ¡·É¤…¹Êœ°¥nµŠ¦ª—Á¦ÈªÄœÃ¨„ ˜³ª´œ˜„nŠ°„ªnµž{‹‹´¥šµŠ„¦¦¤¡´œ›»rŤnµ¤µ¦™Áž}œž{‹‹´¥®¨´„Äœ„µ¦šÎµÄ®oÁ„·—…¹Êœ ÁœºÉ°Š‹µ„„µ¦ Áž¨¸É¥œÂž¨ŠšµŠ¡´œ›»„¦¦¤Äœž¦³µ„¦‹Îµœªœ¤µ„ŤnÅ—oÁ„·—…¹ÊœÄœ¦³¥³Áª¨µ´ÊœÇ …–³š¸Éž{‹‹´¥šµŠ ¡§˜·„¦¦¤Â¨³·ÉŠÂª—¨o°¤¤¸Ÿ¨¤µ„…¹Êœ ¨³¡ªnµž{‹‹´¥šµŠ·ÉŠÂª—¨o°¤¤¸Ÿ¨˜n°—´œ¸¤ª¨„µ¥¤µ„…¹Êœ ×¥¡ªnµ¡¸Éœo°Š˜nµŠµ¥Á¨º°—š¸É°µ¥»Ä„¨oÁ‡¸¥Š„´œ ¨³™¼„Á¨¸Ê¥Š¤µ—oª¥„´œ˜´ÊŠÂ˜nÁ¨È„Ç ‹³¤¸—´œ¸¤ª¨„µ¥ Ä„¨oÁ‡¸¥Š„´œ šÎµÄ®o‡·—ªnµÃ¦‡°oªœš¸É¦³µ—°¥¼nÄœž{‹‹»´œÁž}œŸ¨‹µ„ž’·´¤¡´œ›r¦³®ªnµŠž{‹‹´¥šµŠ ·ÉŠÂª—¨o°¤Â¨³¡§˜·„¦¦¤„´‡ªµ¤Á¸É¥Š‹µ„šµŠ¡´œ›»„¦¦¤25 ž{‹‹»´œ¤¸¥¸œš¸É´¤¡´œ›r„´Ã¦‡°oªœ (genetic syndrome associated with obesity) ×¥šÎµÄ®o¤¸ ¨´„¬–³ÁŒ¡µ³…°ŠÃ¦‡¤µ„„ªnµ 25 ¥¸œ Ánœ Prader Willi, Aistrom, Bardet-Biedl ¨³°ºÉœÇ ¨³¤¸ nonsyndromic forms of obesity ‹µ„‡ªµ¤Ÿ·—ž„˜·…°Š¥¸œ Lep, LepR, MC4R, POMC ¨³°ºÉœÇ ˜n ¡ªnµ‡ªµ¤Ÿ·—ž„˜·…°Š¥¸œ˜´ªÄ—˜´ª®œ¹ÉŠ Áž}œµÁ®˜»nªœœo°¥…°Š„µ¦Á„·—懰oªœÁšnµœ´Êœ 懚µŠ¡´œ›»„¦¦¤š¸É´¤¡´œ›r„´Ã¦‡°oªœ26, 27 µ¤µ¦™ÂnŠÅ—oÁž}œ 2 „¨»n¤ ‡º° 1. 懰oªœ„¦¦¤¡´œ›»rš¸É¡¦nª¤„´„µ¦¡´•œµ„µ¦oµ„ªnµª´¥ (Obesity associated with development delay) 2. 懰oªœ„¦¦¤¡´œ›»rš¸ÉŤn¤¸‡ªµ¤Ÿ·—ž„˜·…°Š„µ¦¡´•œµ„µ¦˜µ¤ª´¥ (Obesity not associated with development delay)
- 30. 21 ˜µ¦µŠš¸É 2. —ŠÁ„–”r„µ¦ª·œ·‹Œ´¥Ã¦‡ Prader-Willi syndrome Diagnostic criteria for Prader-Willi syndrome Major criteria x Neonatal and infantile hypotonia, with poor suck and subsequent improvement with age x Feeding problems with poor weight gain in infancy, needing gavage or other special feeding techniques x Weight gain (rapid onset 1 to 6 years old) that leads to central obesity x Characteristic facial features, including narrow bifrontal diameter, almond-shaped palpebral fissures, and turned-down mouth x Hypogonadism/hypogenistalism: genital hypoplasia (small labia minora and clitoris in females, and hypoplastic scrotum in males); incomplete and delayed puberty; and infertility x Developmental delay/mild to moderate mental retardation/multiple learning disabilities x Hyperphagia/obsession with food x Chromosome 15q11-q13 abnormality Minor criteria x Reduced fetal movement and infantile lethargy, which improves with age x Characteristic behavioral problems, including temper tantrums, obsessive-compulsive behavior, stubbornness, rigidity, stealing, and lying x Sleep disturbance or apnea x Short stature for family by 15 years of age x Hypopigmentation x Small hands and feet for height and age x Narrow hands with straight ulnar border x Eye abnormalities, including esotropis and myopia x Thick viscous saliva x Speech articulation defect x Skin picking Additional features x High pain threshold x Decreased vomiting x Altered temperature sensitivity x Scoliosis and kyphosis x Early adrenarche x Osteoporosis x Unusual skill with jigsaws x Normal neuromuscular studies (e.g., muscle biopsy and electromyography)
- 31. 22 懰oªœ„¦¦¤¡´œ›»rš¸É¡¦nª¤„´„µ¦¡´•œµoµ„ªnµª´¥ Å—o„n 1. Prader-Willi Syndrome (PWS) Á„·—‹µ„ deletion ®¦º° disruption …°Š paternally imprinted gene ®¦º° gene œ proximal long arm …°Š chromosome 15 ¡ªnµ‡œš¸ÉÁž}œ PWS ‹³¤¸¦³—´ fasting plasma ghrelin ¼ŠÁž}œ 4.5 Ášnµ…°Š‡œ°oªœš¸ÉŤnÁž}œ PWS šÎµÄ®oÁ„·—£µª³„·œ‹» (hyperphagia) °µ„µ¦Â—Š¡˜´ÊŠÂ˜nÁž}œšµ¦„Äœ‡¦¦£r šµ¦„Á‡¨ºÉ°œÅ®ªœo°¥ (fetal activity ¨—¨Š), ¤¸ hypotonia, mental retardation, short stature, hypogonadotropic hypogonadism ¨³ obesity šµ¦„š¸ÉÁž}œ PWS ‹³¤¸ prenatal growth retardation Á¨È„œo°¥ šÎµÄ®o¤¸œÊε®œ´„¦„‡¨°—˜Éε‡º° ž¦³¤µ– 2.8 „·Ã¨„¦´¤ ¤¸ hyporeflexia ¨³ poor feeding ÁœºÉ°Š‹µ„¤¸ž{®µÄœ„µ¦„¨ºœÂ¨³„µ¦—¼—œ¤ (sucking reflex) ˜o°ŠÅ—o¦´‡ªµ¤nª¥Á®¨º°Äœ„µ¦—¼—œ¤‹œ°µ¥» 3-4 Á—º°œ ¨³ž{®µ‹³®¤—ŞĜ 6 Á—º°œ ¡°°µ¥» 12-18 Á—º°œ ‹³¤¸£µª³„·œ‹» ¨³¤¸¡§˜·„¦¦¤„·œ·ÉŠ…°Šš¸ÉŤnÄn°µ®µ¦ (pica eating) Äœ ª´¥Á—È„‹³¤¸„µ¦Á‹¦·Á˜·Ã˜oµ ¤¸¤ª¨„¨oµ¤ÁœºÊ°œo°¥ ¨³¤¸ž¦·¤µ–Å…¤´œ¤µ„Á®¤º°œ‡œš¸É…µ—±°¦räœ Á‹¦·Á˜·Ã˜ (growth hormone) Á—È„µ¥‹³¤¸ hypoplasia …°Š external genitaria ¦ª¤š´ÊŠ micropenis …–³š¸ÉÁ—È„®·Š‹³¤¸ hypoplasia …°Š labia minora ¤¸£µª³ early aderenache ˜n¤¸ gonadal maturation oµ ®¦º°Å¤n¤¼¦–r ‹µ„ hypogonadotropic hypogonadism „µ¦ª·œ·‹Œ´¥Ã—¥°µ«´¥°µ„µ¦Â—ŠšµŠ‡¨·œ·„×¥˜o°ŠÅ—o‡³Âœœ°¥nµŠœo°¥ 8.5 ‡³Âœœ ×¥ 1 major criteria Å—o 1 ‡³Âœœ …–³š¸É 1 minor criteria Å—o 0.5 ‡³Âœœ (˜µ¦µŠš¸É 2) „µ¦¦´„¬µÄ®o‡ÎµÂœ³œÎµÁ¦ºÉ°Š°µ®µ¦¡¨´ŠŠµœ˜Éε¦nª¤„´„µ¦°°„„ε¨´Š„µ¥°¥nµ¤ÉεÁ¤° Ä®o„µ¦ —¼Â¨°¥nµŠÄ„¨o·— ‹Îµ„´—°µ®µ¦Â¨³ÁŠ·œÄo‹nµ¥ ¨³Ä®oŸ¼ožiª¥Â¨³‡¦°‡¦´ªÅ—o¦´‡ÎµÂœ³œÎµ—oµœ‹·˜Ä‹Â¨³ ¡§˜·„¦¦¤°¥nµŠÁ®¤µ³¤ „µ¦Ä®o¥µ¨—œÊε®œ´„š¸É¨—‡ªµ¤°¥µ„°µ®µ¦°µ‹Å¤nÅ—oŸ¨ „µ¦Ä®o growth hormone ÄœÁ—È„š¸ÉÁž}œ PWS šÎµÄ®o°´˜¦µ„µ¦Á‹¦·Á˜·Ã˜—¸…¹Êœ final high ¼Š…¹Êœ nª¥¨—ž¦·¤µ–Å…¤´œ ¨³Á¡·É¤¤ª¨„¨oµ¤ÁœºÊ° Á¡·É¤„µ¦ÁŸµŸ¨µÅ…¤´œ ¨³„µ¦œÎµÁ°µ¡¨´ŠŠµœÅžÄo ¥µ clomiphene citrate šÎµÄ®o¦³—´ LH, testosterone ¨³ urirary gonadotropin ž„˜· šÎµÄ®oÁ„·—„µ¦¦oµŠÁžd¦r¤ž„˜·Â¨³Áž}œ ®œ»n¤µªÅ—o 2. Fragile X syndrome Áž}œÃ¦‡ž{µ°n°œ„¦¦¤¡´œ›»rš¸É¡Å—on°¥š¸É»— ×¥Ÿ¼ožiª¥‹³¤¸ž{µ°n°œžµœ„¨µŠ™¹Š¦»œÂ¦Š (moderate to severe mental retardation), macro-orchidism, large ears, macrocephaly, prominent jaw ×¥¤¸‡µŠ¥ºÉœ ¨³ high-pitched jocular speech ÄœÁ—È„‹³¤¸„µ¦Äo£µ¬µÅ¤n—¸Â¨³¤¸ ž{®µ—oµœ¡§˜·„¦¦¤ Ÿ¼ožiª¥‹³¤¸£µª³°oªœ¤µ„ ¤¸®œoµ„¨¤ ¤º°ÁšoµÁ¨È„¨³„ªoµŠ ¨³¤¸ regional skin hyperpigmentation „µ¦ª·œ·‹Œ´¥‡º°„µ¦˜¦ª‹¡ fragile X locus Äœ FMR1gene „µ¦¦´„¬µÁ¦ºÉ°Š‡ªµ¤ Ÿ·—ž„˜·šµŠ¡§˜·„¦¦¤°µ‹Äo¥µ clonidine, valproate ¨³ carbamazepine nª¥ 3. Bardet-Biedl syndrome (BBS) Áž}œÃ¦‡š¸É™nµ¥š°— autosomal-recessive ×¥¤¸ central obesity, mental retardation, dysphormic extremities (syndactyly, brachydactyly ®¦º° polydactyly), retinal dystrophy ®¦º°
- 32. 22 懰oªœ„¦¦¤¡´œ›»rš¸É¡¦nª¤„´„µ¦¡´•œµoµ„ªnµª´¥ Å—o„n 1. Prader-Willi Syndrome (PWS) Á„·—‹µ„ deletion ®¦º° disruption …°Š paternally imprinted gene ®¦º° gene œ proximal long arm …°Š chromosome 15 ¡ªnµ‡œš¸ÉÁž}œ PWS ‹³¤¸¦³—´ fasting plasma ghrelin ¼ŠÁž}œ 4.5 Ášnµ…°Š‡œ°oªœš¸ÉŤnÁž}œ PWS šÎµÄ®oÁ„·—£µª³„·œ‹» (hyperphagia) °µ„µ¦Â—Š¡˜´ÊŠÂ˜nÁž}œšµ¦„Äœ‡¦¦£r šµ¦„Á‡¨ºÉ°œÅ®ªœo°¥ (fetal activity ¨—¨Š), ¤¸ hypotonia, mental retardation, short stature, hypogonadotropic hypogonadism ¨³ obesity šµ¦„š¸ÉÁž}œ PWS ‹³¤¸ prenatal growth retardation Á¨È„œo°¥ šÎµÄ®o¤¸œÊε®œ´„¦„‡¨°—˜Éε‡º° ž¦³¤µ– 2.8 „·Ã¨„¦´¤ ¤¸ hyporeflexia ¨³ poor feeding ÁœºÉ°Š‹µ„¤¸ž{®µÄœ„µ¦„¨ºœÂ¨³„µ¦—¼—œ¤ (sucking reflex) ˜o°ŠÅ—o¦´‡ªµ¤nª¥Á®¨º°Äœ„µ¦—¼—œ¤‹œ°µ¥» 3-4 Á—º°œ ¨³ž{®µ‹³®¤—ŞĜ 6 Á—º°œ ¡°°µ¥» 12-18 Á—º°œ ‹³¤¸£µª³„·œ‹» ¨³¤¸¡§˜·„¦¦¤„·œ·ÉŠ…°Šš¸ÉŤnÄn°µ®µ¦ (pica eating) Äœ ª´¥Á—È„‹³¤¸„µ¦Á‹¦·Á˜·Ã˜oµ ¤¸¤ª¨„¨oµ¤ÁœºÊ°œo°¥ ¨³¤¸ž¦·¤µ–Å…¤´œ¤µ„Á®¤º°œ‡œš¸É…µ—±°¦räœ Á‹¦·Á˜·Ã˜ (growth hormone) Á—È„µ¥‹³¤¸ hypoplasia …°Š external genitaria ¦ª¤š´ÊŠ micropenis …–³š¸ÉÁ—È„®·Š‹³¤¸ hypoplasia …°Š labia minora ¤¸£µª³ early aderenache ˜n¤¸ gonadal maturation oµ ®¦º°Å¤n¤¼¦–r ‹µ„ hypogonadotropic hypogonadism „µ¦ª·œ·‹Œ´¥Ã—¥°µ«´¥°µ„µ¦Â—ŠšµŠ‡¨·œ·„×¥˜o°ŠÅ—o‡³Âœœ°¥nµŠœo°¥ 8.5 ‡³Âœœ ×¥ 1 major criteria Å—o 1 ‡³Âœœ …–³š¸É 1 minor criteria Å—o 0.5 ‡³Âœœ (˜µ¦µŠš¸É 2) „µ¦¦´„¬µÄ®o‡ÎµÂœ³œÎµÁ¦ºÉ°Š°µ®µ¦¡¨´ŠŠµœ˜Éε¦nª¤„´„µ¦°°„„ε¨´Š„µ¥°¥nµ¤ÉεÁ¤° Ä®o„µ¦ —¼Â¨°¥nµŠÄ„¨o·— ‹Îµ„´—°µ®µ¦Â¨³ÁŠ·œÄo‹nµ¥ ¨³Ä®oŸ¼ožiª¥Â¨³‡¦°‡¦´ªÅ—o¦´‡ÎµÂœ³œÎµ—oµœ‹·˜Ä‹Â¨³ ¡§˜·„¦¦¤°¥nµŠÁ®¤µ³¤ „µ¦Ä®o¥µ¨—œÊε®œ´„š¸É¨—‡ªµ¤°¥µ„°µ®µ¦°µ‹Å¤nÅ—oŸ¨ „µ¦Ä®o growth hormone ÄœÁ—È„š¸ÉÁž}œ PWS šÎµÄ®o°´˜¦µ„µ¦Á‹¦·Á˜·Ã˜—¸…¹Êœ final high ¼Š…¹Êœ nª¥¨—ž¦·¤µ–Å…¤´œ ¨³Á¡·É¤¤ª¨„¨oµ¤ÁœºÊ° Á¡·É¤„µ¦ÁŸµŸ¨µÅ…¤´œ ¨³„µ¦œÎµÁ°µ¡¨´ŠŠµœÅžÄo ¥µ clomiphene citrate šÎµÄ®o¦³—´ LH, testosterone ¨³ urirary gonadotropin ž„˜· šÎµÄ®oÁ„·—„µ¦¦oµŠÁžd¦r¤ž„˜·Â¨³Áž}œ ®œ»n¤µªÅ—o 2. Fragile X syndrome Áž}œÃ¦‡ž{µ°n°œ„¦¦¤¡´œ›»rš¸É¡Å—on°¥š¸É»— ×¥Ÿ¼ožiª¥‹³¤¸ž{µ°n°œžµœ„¨µŠ™¹Š¦»œÂ¦Š (moderate to severe mental retardation), macro-orchidism, large ears, macrocephaly, prominent jaw ×¥¤¸‡µŠ¥ºÉœ ¨³ high-pitched jocular speech ÄœÁ—È„‹³¤¸„µ¦Äo£µ¬µÅ¤n—¸Â¨³¤¸ ž{®µ—oµœ¡§˜·„¦¦¤ Ÿ¼ožiª¥‹³¤¸£µª³°oªœ¤µ„ ¤¸®œoµ„¨¤ ¤º°ÁšoµÁ¨È„¨³„ªoµŠ ¨³¤¸ regional skin hyperpigmentation „µ¦ª·œ·‹Œ´¥‡º°„µ¦˜¦ª‹¡ fragile X locus Äœ FMR1gene „µ¦¦´„¬µÁ¦ºÉ°Š‡ªµ¤ Ÿ·—ž„˜·šµŠ¡§˜·„¦¦¤°µ‹Äo¥µ clonidine, valproate ¨³ carbamazepine nª¥ 3. Bardet-Biedl syndrome (BBS) Áž}œÃ¦‡š¸É™nµ¥š°— autosomal-recessive ×¥¤¸ central obesity, mental retardation, dysphormic extremities (syndactyly, brachydactyly ®¦º° polydactyly), retinal dystrophy ®¦º°
- 33. 23 pigmentary retinopathy, hypogonadism ®¦º° hypogenitalism ¨³¤¸Å˜¦¼ž¦nµŠ®¦º°„µ¦šÎµŠµœ Ÿ·—ž„˜·Åž Áž}œ‡ªµ¤Ÿ·—ž„˜·Â heterogenous …°Š¥¸œÄœ 8 ˜ÎµÂ®œnŠ‡º° 11q13(BBS1), 16q21(BBS2), 3p13-p12(BBS3), 15q22.3-q23(BBS4), 2q31(BBS5), 20p12(BBS6), 4q27(BBS7) ¨³ 14q32.11(BBS8) ×¥‡ªµ¤Ÿ·—ž„˜·…°ŠÃ‡¦Ã¤ÃŽ¤ 3 šÎµÄ®oÁ„·— polydactyly …°Šš´ÊŠ 4 ¦³¥µŠ‡r …–³š¸É‡ªµ¤Ÿ·—ž„˜·…°ŠÃ‡¦Ã¤ÃŽ¤ 15 šÎµÄ®oÁ„·— polydactyly …°Š¤º° 2 …oµŠ ¨³¤¸£µª³°oªœ¦»œÂ¦Š ˜´ÊŠÂ˜n¦„ …–³š¸É‡ªµ¤Ÿ·—ž„˜·…°ŠÃ‡¦Ã¤ÃŽ¤ 16 ŤnšÎµÄ®o°oªœ ž{‹‹»´œ„µ¦ª·œ·‹Œ´¥Ã¦‡œ¸Ê°µ«´¥°µ„µ¦ ¨³°µ„µ¦Â—Š „µ¦¦´„¬µÄ®o¦´„¬µ˜µ¤°µ„µ¦š¸ÉŸ·—ž„˜· Ánœ¤¸œ·ÊªÁ„·œ Âœ³œÎµÄ®o˜´—°°„˜´ÊŠÂ˜n…ªže ¦„ ÁšoµŸ·—¦¼ž¦nµŠÄ®oÄn¦°ŠÁšoµš¸ÉÁ®¤µ³¤ ˜¦ª‹˜µÁ¡ºÉ°®µ‡ªµ¤Ÿ·—ž„˜·Â¨³Â„oÅ… 4. Böjeson-Forssman-Lehmann syndome Áž}œÃ¦‡š¸É¤¸£µª³ž{µ°n°œžµœ„¨µŠ™¹Š¦»œÂ¦Š, epilepsy, hypogonadism, obesity with marked gynecomastia, swelling of subcutaneous tissue of face, narrow palpebral fissures ¨³ ®¼Ä®n˜n¦¼ž¦nµŠŸ·—ž„˜· Á„·—‹µ„‡ªµ¤Ÿ·—ž„˜·…°Š¥¸œš¸É˜ÎµÂ®œnŠ xq26-q27 ¨³¤¸ gene zinc-finger (plant hormeodomain-like finger:PHF6) Äœ‡¦°‡¦´ª…°Š‡œš¸ÉÁž}œÃ¦‡œ¸Ê 5. Wilson-Turner Syndrome ™nµ¥š°— X-linked-recessive ×¥¤¸£µª³ obesity, gynecomastia, speech difficulties, emotional lability, tapering fingers ¨³ small feet ¦nª¤„´ mental retardation ×¥‡ªµ¤Ÿ·—ž„˜· …°Š¥¸œ°¥¼nš¸É Xp21.1-q22 6. Cohan syndrome ¤¸„µ¦™nµ¥š°— autosomal-recessive ×¥¤¸ nonprogressive mild-to-severe psychomotor retardation, motor clumsiness, microcephaly, characteristic facial features, childhood hypotonia ¨³ joint laxity, progressive retinochoroidal dystrophy, myopia, intermittent isolated neutropenia ¨³ cheerful disposition ×¥ specific facial feature ž¦³„°—oª¥ high-arched ®¦º° wave-shaped eyelids, long, thick eyelashes, thick eyebrows, promiment root of nose, short philtrum, small or absent lobule of ears, thick hair ¨³ low hairline, narrow hands and feet, ¨³ mild syndactyly ×¥˜o°Š˜¦ª‹ ¡ retinocharoidal dystrophy Á¤°Äœ„µ¦ª·œ·‹Œ´¥Ã¦‡ µ¥˜µ‹³Â¥n¨Š˜´ÊŠÂ˜nÁ—È„ ˜n‹³¦»œÂ¦ŠÄœnªŠ °µ¥» 40 že °µ‹¤¸˜µ°—Å—o ‡ªµ¤Ÿ·—ž„˜·°¥¼nš¸É¥¸œœÃ‡¦Ã¤ÃŽ¤ 8q21.3-q22.1 7. Albright hereditary osteodystrophy ¤¸£µª³ short stature, obesity, round facies, brachydactyly ¨³ ectopic soft-tissue ossification (osteoma cutis) ¨³ mild developmental delay ‡ªµ¤Ÿ·—ž„˜·™nµ¥š°— autosomal-dominant Á„·—‹µ„ germ line mutation Äœ GNAS1 šÎµÄ®o¨—¦³—´Â¨³„µ¦šÎµŠµœ…°Š GsD protein ‡ªµ¤Ÿ·—ž„˜·…°Š GNAS1 š¸É™nµ¥š°—¤µ‹µ„¤n šÎµÄ®oÁ„·—懜¸Ê¦nª¤„´£µª³—ºÊ°˜n° ±°¦r䜮¨µ¥Ç ˜´ª Ánœ parathyroid hormone šÎµÄ®oÁ„·—£µª³ pseudohypoparathyroidism type 1A
- 34. 25 Áž}œŸ¼oÄ®nš¸É˜´ªÁ˜¸Ê¥ ¤¸‹Îµœªœ T cell ¨³„µ¦šÎµŠµœ…°Š T cell Ÿ·—ž„˜·šÎµÄ®oÁ„·—懘·—ÁºÊ°Å—on°¥ ¡ £µª³ sleep apnea Å—on°¥ ª·œ·‹Œ´¥ congenital leptin deficiency Å—o ×¥„µ¦˜¦ª‹Å¤n¡ leptin Äœ Á¨º°— ¦nª¤„´¡ ob gene ¨³ª·œ·‹Œ´¥ leptin receptor deficiency Å—o×¥¡¤¸°µ„µ¦Â—ŠÁ®¤º°œ congenital leptin deficiency ˜n¤¸¦³—´ leptin Äœ„¦³ÂÁ¨º°—¼Š¤µ„Ç Ÿ¼ožiª¥„¨»n¤œ¸Ê‹³˜°œ°ŠÅ—o—¸˜n°„µ¦Ä®o recombinant human leptin Œ¸— subcutaneously š»„ ª´œšÎµÄ®oœÊε®œ´„˜´ªÂ¨³ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥¨—¨Š ×¥Äo…œµ—¥µÁ¦·É¤˜oœ 0.01 ¤„./„„.…°ŠœÊε®œ´„ „¨oµ¤ÁœºÊ°Ã—¥šÎµÄ®o‡ªµ¤°¥µ„°µ®µ¦¨—¨Š „·œœo°¥¨Š ¨³¨—¡¨´ŠŠµœš¸É„·œ¨ŠÅ—o¤µ„™¹Š 84% šÎµÄ®o Á„·— pubertal development Áž}œž„˜· ¤¸ secondary sexual characteristics ¨³¤¸ gonadrotropin Á¡·É¤ ¤¸„µ¦Á¡·É¤¦³—´…°Š FT4 FT3 ¨³ TSH …¹ÊœÁ¨È„œo°¥ 5. Partial leptin deficiency in heterozygote carriers „µ¦¤¸¦³—´ leptin Á¡·É¤…¹ÊœÁ¡¸¥ŠÁ¨È„œo°¥¤¸Ÿ¨˜n°‡ªµ¤°¥µ„°µ®µ¦Â¨³œÊε®œ´„˜´ª°¥nµŠ¤µ„ Äœ heterozygote carrier …°Š leptin deficiency ‹³¤¸¦³—´ leptin ˜É優nµš¸É‡µ—ŪoÁ¤ºÉ°Áš¸¥„´ž¦·¤µ– …°ŠÅ…¤´œÄœ¦nµŠ„µ¥ ¨³‡œ„¨»n¤œ¸Ê‹³¤¸°»´˜·„µ¦–r…°ŠÃ¦‡°oªœ¼Š„ªnµž¦³µ„¦š´ÉªÅžš¸É°µ¥» Á¡« ¨³ ÁºÊ°µ˜·Á—¸¥ª„´œ ¨³¤¸´—nªœ…°ŠÅ…¤´œÄœ¦nµŠ„µ¥¤µ„„ªnµ„¨»n¤‡ª‡»¤š¸É¤¸‡ªµ¤¼ŠÂ¨³œÊε®œ´„¨³ ÁºÊ°µ˜·Á—¸¥ª„´œ Äœ„¨»n¤œ¸Ê„µ¦Ä®o leptin ¦´„¬µ‹³nª¥¨—ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥¨ŠÅ—o 6. Complete POMC deficiency Á„·—‹µ„ congenital proopiomelanocortin (POMC) gene deficiency Ž¹ÉŠÁ„·—‹µ„ mutation …°Š POMC gene  compound heterozygote ®¦º° homozygous š¸ÉÅž¦„ªœ„µ¦Á„·— POMC translational initiation Ÿ¼ožiª¥š»„‡œ‹³¤µ—oª¥ hypoglycemia ‹µ„ ACTH deficiency ˜´ÊŠÂ˜n°µ¥»œo°¥Ç šÎµÄ®oÁ„·—£µª³ hypoglycemia, prolong jaundice, susceptibility to infection ¨³ neonatal death Å—o Ž¹ÉŠ‹³˜°œ°ŠÅ—o—¸˜o°Š„µ¦Ä®o glucocorticoid replacement ˜nÄœš¸É»—‹³Á„·—懰oªœ¦»œÂ¦Š ˜µ¤¤µ‹µ„„µ¦„·œ¤µ„Á„·œ (hyperphagia) ×¥‹³¤¸£µª³°oªœÂ¤o‹³…µ— glucocorticoid Ž¹ÉŠÁž}œ£µª³š¸É ¤´„‹³šÎµÄ®oœÊε®œ´„˜´ª¨—¨Š ¨´„¬–³ÁŒ¡µ³…°Š‡œš¸É¤¸Ã¦‡œ¸Ê ‡º° ¤¸ isolated ACTH deficiency, hyperphagia ¨³ severe early-onset obesity 7. POMC haploinsufficiency ¡ªnµ‡œš¸É…µ— POMC allele 1 ˜´ª „ȚεĮoÁ„·—懰oªœÅ—o ×¥¤¸ point mutation Äœ POMC ¦ª¤š´ÊŠ mutation Äœ D ¨³ E-MSH 8. POMC mutations affecting specific melanocortin peptides 8.1 missense mutations š¸ÉÅž¤¸Ÿ¨˜n° POMC gene š¸ÉÅž encode melanocortin peptide Á„·—Áž}œ E-MSH / E-endorphin fusion protein Åž‹´„´ melanocortin 4 receptor (MC4R) ˜nÅž activate receptor Å—oŤn—¸ °µ‹šÎµÄ®oÁ„·—‡ªµ¤Á¸É¥ŠÄœ„µ¦Á„·—懰oªœ¼Š…¹Êœ ˜nŤn highly penetrant ‹œšÎµÄ®oÁ„·—懰oªœ„¦¦¤¡´œ›»r 8.2 Herterozygous of missense variant in the region encoding E-MSH, Tyr 221 Cys šÎµÄ®oÅž activate ¨³‹´„´ MC4R Ťn—¸ (Á„·— MC4R deficiency) Á—È„‹³¤¸ hyperphagia ¨³Á¡·É¤
- 35. 26 linear growth —Šªnµ E-MSH ¤¸šµšÄœ„µ¦‡ª‡»¤‡ªµ¤¤—»¨…°Š¡¨´ŠŠµœ Ž¹ÉŠ„µ¦Ä®o E-MSH analogue Äœ®œ¼š—¨°ŠÅ—ož¦³Ã¥œr ¨³°µ‹œÎµ¤µÄož¦³Ã¥œrÄœ‡œš¸É…µ— E-MSH Å—o 9. Genetic variation at the POMC locus and common obesity ǦäΤ 2p22 Ž¹ÉŠÁž}œ˜ÎµÂ®œnŠš¸É¦oµŠ POMC gene ¤¸šµš˜n° common obesity ¨³ obesity-related traits ¤¸®¨´„“µœªnµ¤¸‡ªµ¤´¤¡´œ›r„´œ¦³®ªnµŠ¦³—´…°Š leptin Äœ„¦³ÂÁ¨º°— „´ 2p22 ¨³¡ªnµ POMC gene ¤¸šµšÄœ„µ¦‡ª‡»¤¤—»¨¡¨´ŠŠµœ…°Š¤œ»¬¥r „µ¦¤¸‡ªµ¤Ÿ·—ž„˜· …°Š POMC locus °µ‹šÎµÄ®oÁ¸É¥Š˜n°„µ¦Á„·—懰oªœ ×¥ŸnµœšµŠ gene-environment interaction 10. Mulation in prohormone convertase1 (PC1) PC1 ¨³ PC2 ¡Å—oÄœ neuroendocrine tissue ¨³šÎµŠµœÃ—¥šÎµÄ®o peptide ˜nµŠÇ active Ánœ proinsulin, proglucagon ¨³ POMC PC1 ‹³™¼„¦oµŠÃ—¥Áž}œ inactive precursor ‹µ„œ´Êœ™¼„ autocatalytic Ä®oÁ„·—Áž}œ active 66-kDa isoform š¸É³¤ÅªoÄœ mature secretory granules ‡œš¸É¤¸ compound heterozygote PC1 mutation šÎµÄ®oŤnµ¤µ¦™Á„·— maturation …°Š inactive propeptide form of PC1 Ÿ¼ožiª¥‹³¤µ—oª¥ severe early-onset obesity, hypogonadotropic hypogonadism, postprandial hypoglycemia, hypocortisolemia ¨³ impaired processing POMC ¨³ proinsulin ¨³°µ‹¤¸ small intestinal dysfunction —´Š˜µ¦µŠš¸É 3 ˜µ¦µŠš¸É 3. —Š¨´„¬–³Â¨³‡ªµ¤Ÿ·—ž„˜·…°Š Prohormone Convertase-1 (PC-1) deficiency Clinical features Affected prohormone conversion Obesity Hypogonadotropic hypogonadism Hypoadrenalism Reactive hypoglycemia/impaired glucose tolerance Intestinal malabsorption POMC-MSH ProGnRH-GnRH POMC-ACTH Proinsulin-insulin Proglucagon-GLP1 and GLP2 11. Human MC4R deficiency mutations Äœ MC4R Äœ¤œ»¬¥ršÎµÄ®oÁ„·—懰oªœ„¦¦¤¡´œ›»r ×¥¤¸°»´˜·„µ¦–r…°Š„µ¦Á„·— MC4R mutation 0.5% ÄœŸ¼oÄ®n°oªœ ‹œ™¹Š 6% ÄœÁ—È„š¸É°oªœ¦»œÂ¦Š Äœ°´Š„§¬Â¨³¥»Ã¦ž¡ªnµ 1-2.5% …°Š‡œš¸É¤¸—´œ¸¤ª¨„µ¥ >30 „„./¤2 ‹³¤¸ mutation Äœ MC4R ¥ºœ¥´œªnµ MC4R deficiency Áž}œ®œ¹ÉŠÄœÃ¦‡°oªœ„¦¦¤¡´œ›»rš¸É¡Å—on°¥š¸É»— ×¥ homozygotes ‹³°oªœ¤µ„„ªnµ heterozygotes ‡œš¸É¤¸Ã¦‡œ¸Ê‹³¤¸£µª³ hyperphagia ˜´ÊŠÂ˜n°µ¥»…ªže ¦„ ¤¸„µ¦Á¡·É¤ž¦·¤µ–Å…¤´œÄœ¦nµŠ„µ¥ ¨³Á¡·É¤¤ª¨„¨oµ¤ÁœºÊ° ¨³‡ªµ¤®œµÂœnœ…°Š„¦³—¼„‹œ—¼Áž}œ ‡œÃ‡¦ŠÄ®n ‹³¤¸ linear growth Á¦Èª¤µ„Äœª´¥Á—È„ šÎµÄ®o˜´ª¼Š„ªnµ‡œš´ÉªÅž ‹µ„„µ¦¤¸¦³—´ fasting insulin ¼Š„ªnµÁ—È„š¸É°µ¥» Á¡« ¨³—´œ¸¤ª¨„µ¥š¸ÉÁšnµ„´œ ÁœºÉ°Š‹µ„¤¸ hyperinsulinemia ˜n°µ„µ¦ ˜nµŠÇ ‹³—¸…¹ÊœÁ¤ºÉ°°µ¥»¤µ„…¹Êœ
- 36. 27 ¦»ž µÁ®˜»…°ŠÃ¦‡°oªœÁ„·—‹µ„ž’·´¤¡´œ›r…°Š·ÉŠÂª—¨o°¤š´ÊŠÄœÂŠn„µ¦¦·Ã£‡°µ®µ¦¡¨´ŠŠµœÁ„·œ „µ¦¤¸„·‹„¦¦¤šµŠ„µ¥¨—¨Š „µ¦Š—»®¦¸É ¥µµŠœ·— ¦nª¤„´‡ªµ¤Ÿ·—ž„˜·šµŠ„¦¦¤¡´œ›»r ¤¸Ÿ¨Ä®o ¡¨´ŠŠµœš¸É„·œ¤µ„„ªnµ¡¨´ŠŠµœš¸É¦nµŠ„µ¥œÎµÅžÄo Á„·—¡¨´ŠŠµœ³¤Äœ¦¼ž…°ŠÅ…¤´œÄœ¦nµŠ„µ¥ ‹œÁž}œ µÁ®˜»Ä®oÁ„·—æ‡Âš¦„Žo°œ˜nµŠÇ ˜µ¤¤µ Á°„µ¦°oµŠ°·Š 1. Maratos-Flier E. and Bachman ES. Appetite regulation and thermogenesis. In: DeGroot LJ and Jameson JL, editor. Endocrinology 5th edition, Philadelphia, Elsevier Saunders, 2006:839-53. 2. Food Standards Agency & Department of Health. Krebs J, Johnson M. National Diet and Nutrition Survey: adults aged 19-64 years. Vol. 5. London: HMSO; 2004. p. 1-142 3. National Food Survey. Household food expenditure and consumption and nutrient intake 1974-2007. 2007 4. Kimm SY, Glynn NW, Obarzanek E, et al. Relation between the changes in physical activity and body-mass index during adolescence: a multicentre longitudinal study. Lancet 2005; 366: 301–7. 5. Sothern MS. Obesity prevention in children: physical activity and nutrition. Nutrition 2004; 20: 704–8. 6. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. June 3–5, 1997. WHO/NUT/NCD/98.1, i-xv, 1–276. 1998. Geneva, Switzerland: World Health Organization. Available at: http://dosei.who.int/uhtbin/cgisirsi/Wed 7. Gardner DS and Rhodes P. Developmental origin of obesity: programming of food intake or physical activity? Adv Exp Med Biol 2009; 646: 83–93. 8. Daily dietary fat and total food-energy intakes: Third National Health and Nutrition Examination Survey, Phase 1, 1988–91. MMWR Morb Mortal Wkly Rep 1994; 43: 116–25. 9. Willett WC. Is dietary fat a major determinant of body fat? Am J Clin Nutr 1998; 67: S556– S562. 10. Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum 1990; 20: 34–41. 11. Caspersen CJ, Pereira MA, Curran KM. Changes in physical activity patterns in the United States, by sex and cross-sectional age. Med Sci Sports Exerc 2000; 32: 1601–9.
- 37. 28 12. εœ´„ŠµœÎµ¦ª‹»…£µ¡ž¦³µœÅš¥. ¦µ¥Šµœ„µ¦Îµ¦ª‹»…£µ¡ž¦³µœÅš¥Ã—¥„µ¦˜¦ª‹ ¦nµŠ„µ¥ ‡¦´ÊŠš¸É 4 ¡.«. 2551-2552. œµ¥Â¡š¥rª·´¥ Á°„¡¨µ„¦ ¦¦–µ›·„µ¦. ¦·¬´šÁ—°³ „¦µ¢d Ä Ž·¨Á˜È¤r ‹Îµ„´—. œœš»¦¸ 2553. ®œoµ 127-134. 13. Drewnowski A and Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 2004; 79: 6–16. 14. Bray GA, Nielsen SJ and Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79: 537-43. 15. Fruhbeck G, Gomez-Ambrosi J, Muruzabal FJ, Burrell MA. The adipocyte: a model for integration of endocrine and metabolic signaling in energy metabolism regulation. Am J Physiol Endocrinol Metab 2001; 280: E827–E847. 16. Zhang Y, Proenca R, Maffei M, et al. Positional cloning of the mouse obese gene and its human homologue. Natur 1994; 372: 425–32. 17. Caro JF, Sinha MK, Kolaczynski JW, et al. Leptin: the tale of an obesity gene. Diabetes 1996; 45: 1455–62. 18. Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 1996; 334: 292–95. 19. Racette SB, Kohrt WM, Landt M, Holloszy JO. Response of serum leptin concentrations to 7 days of energy restriction in centrally obese African Americans with impaired or diabetic glucose tolerance. Am J Clin Nutr 1997; 66: 33–7. 20. Jequier E. Leptin signaling, adiposity, and energy balance. Ann NY Acad Sci 2002; 967: 379–88. 21. Allison DB, Faith MS, Nathan JS. Risch's lambda values for human obesity. Int J Obes Relat Metab Disord 1996; 20: 990–9. 22. Chung WK and Leibel RL. Considerations regarding the genetics of obesity. Obesity (Silver Spring). 2008; 16 (Suppl 3): S33–S39. 23. Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet 1997; 27: 325–51. 24. Bouchard C, Tremblay A, Despres JP, et al. The response to long-term overfeeding in identical twins. N Engl J Med 1990; 322: 1477–82. 25. Racette SB, Deusinger SS, Deusinger RH. Obesity: overview of prevalence, etiology, and treatment. Physical Therapy 2003; 83: 276-88.
- 38. 29 26. Farooqi S, O’Rahilly S. Genetic syndrome associated with obesity. In: DeGroot LJ and Jameson JL, editor. Endocrinology 5th edition, Philadelphia, Elsevier Saunders, 2006: 867-75. 27. Farooqi S and O’Rahilly S. Genetics of Obesity in Humans. Endocrine Reviews 2006; 27: 710–18.
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