?! (laterral

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Title: ?! (laterral

1
? ?????????!

????
????
????

2
??????????????????

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????????
???????????
?????
?????????
?? \ ???????

3
???? (1)

???????,??????????,?????????,?????????,????????
?

4
???? (2)

????????,????????????,???????????
???????????,???????????

5
???? (3)

??????????????????????,??????????????,???????,????
?,??????

6
?????

??????????????,?????????,???????????????

7
???????

?????
????????
???????????

8
???????

1. ???
???????????????????,
????????????????
????????????????????,????????,????????????,??????

9
???????

2. ???
????? ???????.
?????????????.
??????????????,????????????.
????????.

10
???????

3. ???
??????????.
???????????.

11
???????

4. ????
????,?????????????????????,????????

????

13
????????
14
??????
15
????

????????????????(??)
BMI??24--??????27--??
???BMI(Body Mass Index,??????)?
????????????????,???????????????(??)????(??)??????
BMI???????160??,??50??,BMI??501.61.619.53
??????????????!?????????!
??????,???!
??gt90??(?35.5?),??gt80??(31.5?)????
??????
??????(BMI)(kg/m2)
????BMIlt18.5
????18.5?BMI?24
? ? 24?BMI?27
???? 27?BMI?30
???? 30?BMI?35
???? BMI?35

16
?????

BMI.
BIA??????(Bioelectric Impedence
Analysis)
???(?gt0.9, ?gt0.85)
???????
???,?????
MRI,C-T,??X????

17
??????????

????
?????????????????
????????
? 60?70
??? 15?20
??? 5? 6
?? 13?20
?????????
?? 15?18
?? 20?25
???????????????,?????????.

18
?????

??
????????20
?? ??30 ??.
????????25
?? ??35 ????.
????????30
?? ??40 ????

19
BM I

????????????,????????,?????????

20
??????

BIA??????
BIA??????(Bioelectric Impedence Analysis)
???? (????????,???????????)
????Fat free Mass(????????)/??????.
??,??????????????????????
????????,????????????????
???????????????
?BIA????????????????,??????????.
?????????????(?????,????,??????)
???????,???????????,???????.
???????????????????.

21
?????????

1??????????
2?????????
3?????????????
4???????????
5?????????
6?????

22
??????

??_________________??____?___?___?
?___?___??___________
????______________________________________________
??___________
??_________
???????___________
????____________????___________???_________
???_________
???????___________________________________________
____________
?????____________??____________?????____________
? ?? _______ (??) _______ ? ?? _______ (??)
_______
????________________????_______________????_______
_______
????________________???_______________????________
______
___________________________________________
___________________________
?????????
1. ???????????
?? 66 13.7 x _______kg 5.0x_______cm
--6.8 x _______y _________kcal
??665 9.6 x _______kg 1.8 x
_______cm--4.7 x _______y__________kcal
2. ??????????
????????_________x 0.3, 0.35, 0.4
__________kcal
3. ??????????
??????????_____________kcal
4. ??????????????? ???????? ????????

23
???

??????????3???6.6?.
??????4???1.6???.

24
????

??????,?????.
???????????????????,????,????????.
?????????????,???????????????????
???????????,????.
???????????????,????????100?120?.?????????210?????
.????????????????.
??????????????????????,????????.
???????????????,??????????????.
??????
???????????????,??????????????250??.
??????,??????????,?????????????.????????????.????
???????,????????????????.

25
? ? ?

? ?
??????????
?????3-5??
????????
??????????
???,???,???

26
???(??)?

????
????
??? 10-20 ?
????
????
???

27
??????

????????
????????
?????
?????????,?????
??????????
?????
?????????

28
ANTIOBESITY

?????
1??(????????????)
2???
???????(???????)
1?????3-6??,?????!
2??????????????
3???????????????

29
? ? ? ?
30
?????????

1??????????
??Norepinephrine??? - Amphetamin
??Serotonin??? - Prozac
Adrenergic? Serotonergic??
Sibutramine (Reductril)
Ephedrine
Caffeine
Aspirin
2? ???????(Lipolysis, Thermogenesis)
Beta3- Adrenergic recepter Ephedrine
Cold stimulation
Local irritation

31
???????

??????????
???
??,??,??.
??
??????, ???????????
??.
.

32
?????????

3???(???)????
Glyciby
Metformin
Psyllium
Xenical
4?Hormone
Growth Hormone
5???
Leptin
GENE

33
Cold Stimulation
34
??????
35
??????????

??(laterral area)
?? ?? ???
???? - ??
???(Ventromedial area)
?????? - ??
???? ??
??? - ??
???????
???????

36
Biochemical Mechanism
37
Biochemical Mechanism II(??????)
38
???????

Noradrenergic drugs
Serotonergic drugs
Serotonergic and adrenergic drugs
Dopamine
Histamine
Nutrient partitioning

39
Noradrenergic drugs

phentermine?diethylpropion?benzphetamine?phendimet
razine?
phenylpropanolamine ephedrine
Mechanism Release NE and DA or increase
reuptake of NE and DA .
Example
1. Amphetamine
Derivatives of B - phenethylamine
Reduce their abuse potential.
Retain their appetite-suppressing
effect.
2. PPA
Acts on the alpha 1-adrenergic receptors
located in the paraventricular nucleus .
A vasoconstrictor and is present in many
decongestants.

40
??????
41
Serotonergic drugs

Serotonin Receptor 5HT2C 5HT1B/D
1. Enhances serotonin release from the
neuron and acts as an
agonist for 5-HT receptors reduce
food intake .
2 Thermogenesis lipolysios.
Side effect Dysphoria
Fenfluramine
Dexfenfluramine
Fluoxetine (Prozac)

42
Serotonergic and adrenergic drugs

Sibutramine (Meridia. Reductile)
Inhibits the reuptake of serotonin and
norepinephrine.
Dose-related response for the first 24 weeks of
the study, with doses ranging from 5 mg to 30 mg.
Because sibutramine is metabolized by the
cytochrome P-450 enzyme system, it may interfere
with the metabolism of erythromycin and
ketoconozole.

43
Reductil

Initial dose 10mg/day.
If BW losslt 2Kg within 2 mos 15mg/day.
Maximal 30mg/day.
If BW loss within 5 stop the medicine.
Combine with PPA or Prozac or
antihypertension
drug ?
Combine with Xenical
Indication BMIgt30kg/m2 pt
BMIgt27kg/m2 Type 2
DM.

44
?????

Studies in mice have revealed that at least 5
genes have links with weight control and obesity
obese gene
codes for leptin, a hormone produced
predominantly by white adipose tissue but also
found in the stomach wall and placenta.
Discovered 5 years ago, leptin is considered to
be an important feedback signal from adipose
cells to the weight-regulating region in the
hypothalamus. Here it inhibits the secretion of
neuropeptide Y, a substance that is a potent
stimulator of appetite
diabetes - this gene codes for a receptor protein
that responds to leptin and triggers a reduction
in appetite and increase in metabolism
fat - codes for an enzyme that processes insulin
tubby - function currently unknown
agouti - function currently unknown.
Comparable genes have been found in the human

45
?????????

Orlistat (Xenical ???)
A gastrointestinal lipase inhibitor that reduces
dietary
fat absorption by about 30.
Not significantly absorbed .
Side effects are related to the blockage of
triglyceride digestion in the intestine .
Increase in fiber in the diet or the use of
psyllium products may abate or prevent some of
the gastrointestinal side effects.

46
?????????

Sympathomemotic Effect in
Thermogenesis and Lipolysis
Ephedrine/Caffeine

47
Adrenoceptors

Sympathe System Adrenal System
? ?
Synapse NA Circulatory Adr
?
Alpha Beta 1 Beta2 Beta3
____________
Cardiac
Pressure
CNS
__________
Tremer
__________________
LIPOLYSIS
___________
Protein synthesis

48
Beta 3- Adrenoceptor

Recognition of the difference between
adrenoceptors
Beta1 receptor predominantly a cardiac
receptor
Beta2 receptor the target for beta
blockers which is in the lungs (the
target of
bronchodilating beta agonists) and also found in
uterus and
skeletal muscle.
B3 receptor stimulating metabolism and
peripheral burning of fat
1.Express primarily in adipose tissue.
2.Regulate noradrenaline-induced changes in
energy
metaboolism and thermogenesis.
3.Also expresssed in smooth muscle of the GI
tract, gall bladder, and
heart Functionn is not well
undersstood.

49
Aspirin as a promoter of ephedrine-induced
thermogenesis potential use in the treatment of
obesityAG Dulloo and DS Miller

Chronic administration of aspirin to
obese mice had no effect on energy balance and
body composition. In contrast, ephedrine
increased energy expenditure by 9 and reduced
body weight and body fat by 18 and 50,
respectively obesity, however, was reduced but
not reversed. In the presence of both ephedrine
and aspirin, increase in energy expenditure found
during treatment with ephedrine alone was
doubled, and the obese group lost greater than
75 of body fat obesity was reversed. These
studies indicate that although aspirin
administered alone has no influence on energy
balance it can markedly potentiate thermogenic
properties of ephedrine, effects which led to a
normalization of body composition of the obese to
that of the lean. Such ephedrine-aspirin
mixtures, often found in over-the-counter
preparations for asthma and bronchial disorders,
could be put to new use as aids for treatment of
human obesity.

50
???????

Glycoby
- ???a-glucosidase ???
- ?Actinoplanes utabensis?????????

51
? ?

Psyllium
????????? (Psyllium husk)
???????????,
?????????????
????????????????????
????????????????????
???????, ??????4,????????(LDH)
????? 7, ?????????????
????, ??????????????????
(Eur J Clin Nutr 1994 Aug48(8)595-597)

52
???

?????( Chitin)
?????????????????????????????,????????????????
????????????????????,??????????????????????,??????
????,???????????
???????????

?
53
???

OLESTRA1997?FDA????????

54
? Chromium

? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ? ? ? ? ?
? ? ,
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
? ? ?
? ? ? ? ? ? , ? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ?
? ? ?
? ? ( receptor ), ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ?
? ? ? ? ?
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ( anabolic
reaction ), ? ?
? ? ? ? ? ? ( catabolic reaction ), ? ? ? ? ? ? ?
? ? ? ? ? ?
? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ? ? ? ? ?
? ?
? ? ? ? ? ? ? ? ? ? ? ( 2 ? ) ? ? ? ? ? ? ? ? ? ?
? ? ?
??????? (??? Trivalent chromium)
???????? picoline ????? chromium
picolinate(?????????)?
Chromium polynicotinate

55
LEPTIN???

A fat-regulating hormone.
A 16-kD protein , regulation of body weight by
inhibiting food intake and stimulating energy
expenditure.
Regulation of body weight by inhibiting food
intake and stimulating energy expenditure.
The LEP gene is the human homolog of the gene
(ob) mutant in the mouse 'obese' phenotype.
Leptin is secreted by fat cells, or adipocytes,
the amount of leptin in the bloodstream depends
on the amount of body fat a person has stored.
Leptin levels also rise after a meal and then
gradually drop, prompting the person to eat
again..
Many cells in the body carry receptors for
leptin, including those in an area of the brain
called the hypothalamus that controls appetite
and eating behaviour .

56
????

Benzphetamine, Phendimetrazine, Mazindol-Increase
NE release and block
serotonin uptake.
phentermine increases the release of
nor-adrenaline and dopamine from the nerve
terminals, and also
inhibits their uptake.
Diethylpropion action and side-effects are
similar to phentermine and this drug has a
high potential for
abuse and addiction.
Remove from the markets
Fen-fen(fenfluramine ) - block reuptake of
serotonin into the neuron .( Valvular disease?)
dexfluramine - enhances serotonin release from
the neuron and acts as an agonist
for
5-hydroxytryphtophan receptors.

57
??????

Lopid effective ?
Int J Obes Relat Metab Disord 2001
Aug25(8)1136-43 Effect of a six month
gemfibrozil treatment and dietary recommendations
on the metabolic risk profile of visceral obese
men.Dumont M, Mauriege P, Bergeron J, Despres
JP, Prud'homme D.
Conjugated Linoleic Acid (CLA) -
Conjugated linoleic acid reduces body
fat mass in overweight and obese humansBlankson
H, Stakkestad JA, Fagertun H, Thom E, Wadstein J,
Gudmundsen
JOURNAL OF NUTRITION 130 (12) 2943-2948
DEC 2000
???? -
?????????????????,?????????,???????.
Gymnema Sylvestre ????????????
????????????????,???????????????????,????
???????,?????????
DHA -Docosahexaenoic acid
HCA(Hydroxy Citric Acid) -
????????????, ??????ATP Citrate
lyase???,????????, ??????(glycolysis)?????,??,????
?????,??????????,??????????? .