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生活方式和心血管健康赵冬首都医科大学附属北京安贞医院北京心肺血管疾病研究所人类经历了几十万年的发展才走到今天,而每个个体的生命至多只有百年。如果按目前中国人平均期望寿命计算，每个人从出生开始拥有生命的总天数是26645天。生活方式50%医疗服务10%OtherCVD健康的决定因素个体遗传20%环境因素20%康环境健健康生命的基本要素其他脏器心脏肾脏肺脏脑肝脏血管饮食运动心理健康不嗜酒不吸烟血压血脂血糖体重/腰围健康生活方式要素●大多数时间心情舒畅●建立健康饮食习惯●建立规律体力活动的习惯●不吸烟，不嗜酒●尽量远离不健康的生活环境如何做到在大多数时间心情舒畅？●学会从乐观和善意的角度看待问题●在珍爱亲人的同时珍爱自己●学会宽容●学会交流的方式●把心情舒畅和减少过度的心理压力作为自己重要的生活能力什么是健康饮食习惯的标准？●吃什么？●吃多少？●怎么吃？吃什么?●碳水化合物类（主要是粮食）●蛋白质类（肉类、蛋、奶、植物蛋白）●脂肪类（肥肉、各种烹调油）●无机盐类（钠、钾、钙、镁、铁等）●维生素●水ChineseDietaryPagoda--2007.12ChineseNutritionSociety,MinistryofHealthofChina,ChineseDietaryGuidelines,1997Exercise6000-stepwalkOil25~30gramSalt6gramMilk/milkproducts300gramSoybeansandnut30~50gramShrimpandfish50~100gramMeatandpoultry50~75gramEggs25~50gramFruit200~400gramVegetable300~500gramGrain,batataandpeas250~400gramWater1200ml盐6g/天水：约1500ml/天0.418-290.435-47-2410-295816-8172-19-3-90-80-70-60-50-40-30-20-1001020304050607080总死亡心血管病脑卒中冠心病糖尿病(%)CaiHEpidemiology200718:393-401进食蔬菜较多组进食水果较多组进食肉类较多组****中国女性饮食习惯与死亡率关系的研究结果1-25-301-19-10-40-30-20-1001020CHDeventCHDdeath(%)PereiraMAArchInternMed.2004164:370-6食蔬菜较多组饮食习惯和冠心病发病和死亡的关系研究：10项研究荟萃分析结果食水果教多组食谷物较多组****ChangingDietaryPatterninYoungGeneration中国人平均食盐摄入量13.213.913.313.91210.912.411.412.7051015202530总计城市农村198219922002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.2002322310.3319.3306.7276.2251.9285.6302316.10100200300400500600TotalUrbanRural198219922002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.200211%17%中国人平均蔬菜摄入量24.449.280.1324569.435.668.337.40100200300TotalUrbanRural198219922002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.200246%2%中国人平均水果摄入量14.929.536.925.641.64440.725.818.2050100150TotalUrbanRural198219922002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.2002173%71%中国人平均食用油摄入量怎么吃?●慢吃●心情舒畅●尽量不加佐餐的咸菜和酱豆腐●避免过热过烫●避免进食过期食品，尽量进食新鲜食品●避免过饱●公勺或公筷如何做到规律体力运动？●重视规律的体力运动（每天30分钟）●设法创造体力活动的机会●设法使体力活动成为快乐的事情健康生活方式要素●大多数时间心情舒畅●建立健康饮食习惯●建立规律体力活动的习惯●不吸烟，不嗜酒●尽量远离不健康的生活环境康环境健健康生命的基本要素其他脏器心脏肾脏肺脏脑肝脏血管饮食运动心理健康不嗜酒不吸烟血压血脂血糖体重/腰围正常体重保持正常体重：BMI：体重/身高2=24腰围：男性=90女性=85血压和高血压•正常血压:低于120/80mmHg•高血压:收缩压=140,或舒张压=90mmHg•如果已经有高血压或偏高的血压怎么办？血脂和血脂异常血糖和血糖异常•正常血糖:空腹：5.6mmol/L(100mg/dl)餐后两小时：7.8mmol/L(140mg/dl)糖尿病：空腹：=7mmol/L(126mg/dl)餐后两小时：11.1mmol/L(200mg/dl)•如果发现血糖高或已有糖尿病怎么办？饮食和高血压关系的研究介绍GlobalBurdenofHypertensioninAdultPopulationin2000and2025(%)PatriciaMKearneyLancet2005365:217-23Theestimatedtotalnumberofadultswithhypertensionintheworldwide20002025972million1.56billionEstimatedCostsforHypertensionTreatmentintheWorldwideIfanti-hypertensiondrugwouldcost$1/dayonaverage:Then:20002025●$972million/day●$1.65billion/day●$354.8billion/year●$602.3billion/yearJinLingTangBMJ2005330:610-1Canwepreventordelaythedevelopmentofhypertension?OrWeonlytreatthehypertensionafteritoccur?EstablishedRiskfactorsforHypertension●Diet:●RaceHighsodium●GeneticfactorsLowpotassium●AgeOmega-3polyunsaturatedfatDietarypatterns●Overweightandobesity●Alcohol●Lackofphysicalactivity●Stress●Smoking●SleepdisordersModifiedRiskFactorsUnmodifiedRiskFactorsTheChangesofDailyConsumptionofSaltinUrbanandRuralAreasofChinafrom1982to2002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.20026%4.4%Chinanationaldietaryguideline:dailysaltconsumption:6g/dayTheChangesofDailyConsumptionofFruitsinUrbanandRuralAreasofChinafrom1982to2002(g/day/person)ReportofChinaNationalNutritionandHealthStatusSurvey.200246%2%Chinanationaldietaryguideline:dailyfruitconsumption:150g/dayHypertensioninChina(FourthNationalSurveyofNutritionandHealthStatusinChina)200millions15%PrevalenceratesMenWomen(million)WangLongde.ReportofNationalSurveyofNutritionandHealthStatus2002100millions20%13%18%NumbersofhypertensionNewHypertensionPatientsinChinabyTimeBasedonIncreasedRatefrom1991to20025454545/Year454545/Month15151/Day631/Hour11/minite1/5secondsTherelationshipbetweensaltandbloodpressurewerestudiedIn10079menandwomenaged20-59sampledfrom52centresaroundworld.Sodiumexcretionrangedfrom0.2mmol/20h(Brazil)to242mmol/24h(China)IntersaltcooperationresearchgroupBMJ,1988297:319-28IntersaltcooperationresearchgroupBMJ,1988297:319-28FJHeJHumanHypertension2002;16:761-770HypertensiveMedian24urinarysodiumreducedfrom9.5gto5.1gSBPnetchange:-4.96±0.40mmHg(95%CI:-5.75to-4.17)NormotensiveMedian24urinarysodiumreducedfrom9.1g/dayto4.8g/daySBPnetchange:-2.03±0.27mmHg(95%CI:-2.56to-1.56)Observationalstudy√□WelldesignedRCT√□Metaanalysis√□FJHeJHumanHypertension2002;16:761-770Additionalpotassiumintake:median75mmol/dayinamediandurationof5weeks.SBPnetchange:-4.85mmHg(95%CI:-6.95to-2.74)in28trialsnoantihypertensivedrug.DBPnetchange:-2.71mmHg(95%CI:-4.61to-0.83)in28trialsnoantihypertensivedrug.Observationalstudy√□WelldesignedRCT√□Metaanalysis√□JohannaGeleijnseJofHypertension2002;20:1493-1499Observationalstudy√□WelldesignedRCT√□Metaanalysis√□JohannaGeleijnseJofHypertension2002;20:1493-1499FrankM.SacksTheNewEngJofMed344:3-10Observationalstudy√□WelldesignedRCT√□Metaanalysis□FrankM.SacksTheNewEngJofMed344:3-10FrankM.SacksTheNewEngJofMed344:3-10LawrenceJAppelJAMA2005;294:2455