慢性病环境因素分析.ppt

* * And here is our model again, with inactivity and also endocrine disruption linked to obesity. Inactivity and inflammation: Nicklas BJ, You T, Pahor M. Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training. CMAJ. 2005 Apr 26;172(9):1199-209. Review. Straczkowski M, Kowalska I, Dzienis-Straczkowska S, Stepién A, Skibińska E, Szelachowska M, Kinalska I. Changes in tumor necrosis factor-alpha system and insulin sensitivity during an exercise training program in obese women with normal and impaired glucose tolerance. Eur J Endocrinol. 2001 Sep;145(3):273-80. 3. Tsukui S, Kanda T, Nara M, Nishino M, Kondo T, Kobayashi I. Moderate-intensity regular exercise decreases serum tumor necrosis factor-alpha and HbA1c levels in healthy women. Int J Obes Relat Metab Disord. 2000 Sep;24(9):1207-11. * * Now we turn our attention to that part of the model that looks at socioeconomic factors: poverty, inadequate health care, violence, and depression. It is well-known that income and health status are directly related. Some people are poor because they aren’t healthy, but many more people are unhealthy because they are poor, or grew up poor. Social and economic conditions are powerful predictors of stress levels, health status, disease risk and life expectancy.(1) (1) Adler N, Rehkopf D. U.S. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health 2008;29:235-252 * Depression is associated with higher levels of inflammatory cytokines.(1) and an increased risk of cardiovascular disease and Alzheimer’s disease. Low socioeconomic status is associated with higher C-reactive protein (a marker of inflammation) in the overwhelming majority of studies that examine the relationship. This association persists after adjustment for race and other demographic variables.(2) The association is most marked in people living near or below income poverty levels. People with lower socioeconomic status