“ overweight ” and cardiovascular diseases 22 nd december 2015 peringatan hari ibu (ke-87),...
TRANSCRIPT
![Page 1: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/1.jpg)
“Overweight” and CardioVascular diseases
22nd December 2015Peringatan Hari Ibu (ke-87),
Dharma Wanita Persatuan KJRIOsaka, Jepang
Hokusetsu General HospitalEdhi Sudjono Gunawan. M.D.,
Ph.D.( 医学博士 黄俊 貴文)
![Page 2: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/2.jpg)
Obesity, a growing problem in the nation
• Elly Burhaini Faizal, The Jakarta Post, Jakarta | National | Thu, April 05 2012, 10:17 AM
• Undernutrition in early life – Increases the risk of overnutrition in later life
• Children with undernutrition in their early lives are more susceptible to infectious diseases, which may lead to death
![Page 3: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/3.jpg)
Obesity trends and determinants in Indonesia
• Department of Agricultural Economics and Rural Development, Georg-August-University of Goettingen, Platz der Goettinger Sieben 5, 37073 Goettingen, Germany
• Over the past 20 years, obesity has increased remarkably in Indonesia across all population groups, including rural and low income strata
• The problem is particularly severe among women • Nutrition awareness and education campaigns, combined
with programs to support leisure time exercise especially for women, seem to be most promising to contain the obesity pandemic
![Page 4: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/4.jpg)
IRIN humanitarian news and analysis
• JAKARTA, 5 June 2013 (IRIN) – • The Indonesian Ministry of Health reports
– Non-communicable diseases • Strokes, hypertension and diabetes • Replaced communicable diseases • As the leading cause of death in the country
• Deaths from non-communicable diseases – 41% (1995)– 60% (2007)
![Page 5: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/5.jpg)
• Communicable disease – An infectious disease transmissible – Direct contact – Indirect contact (vector)
• Noncommunicable diseases (NCDs) – Chronic diseases, are not passed from person to person. – Long duration and slow progression – The 4 main types of noncommunicable diseases
• Cardiovascular diseases (like heart attacks and stroke) • Cancers• Chronic respiratory diseases (chronic obstructed pulmonary disease and
asthma)• Diabetes
![Page 6: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/6.jpg)
• Dr. Elvina Karyadi, the director for the Micronutrient Initiative in Indonesia– People in Jakarta don't have time to exercise and people
go by car – People also like junk food and snacking– They say they don't have time to prepare healthy food – Starting from childhood, parents give children money
• They can buy their own food instead of preparing them a meal
– This is a change of lifestyle
![Page 7: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/7.jpg)
![Page 8: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/8.jpg)
Effects of obesity on women's health• Overweight and obesity are associated with elevated
mortality from all causes in both men and women– The risk of death rises with increasing weight
• Obesity, especially abdominal obesity, is central to the metabolic syndrome and is strongly related to polycystic ovary syndrome (PCOS) in women
• Obese women are particularly susceptible to diabetes, and diabetes, in turn, puts women at dramatically increased risk of cardiovascular disease (CVD).
• Obesity increases the risk of several major cancers in women – Postmenopausal breast cancer and endometrial cancer
![Page 9: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/9.jpg)
Obesity and cardiovascular disease
• Overweight may develop – Hypertension, diabetes and atherosclerosis. – These conditions
• High risk of cardiovascular disease
– Central obesity/Abdominal obesity
![Page 10: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/10.jpg)
CardioVascular ? Disease
![Page 11: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/11.jpg)
Cardiovascular disease• A diseases that involve the heart or blood vessels • Includes coronary artery diseases (CAD)
– Angina (penyempitan pembuluh darah jantung)
– Myocardial infarction (heart attack)
• Other CVDs – Stroke, hypertensive heart disease, rheumatic heart
disease, cardiomyopathy, atrial fibrillation, congenital heart disease, endocarditis, aortic aneurysms, peripheral artery disease and venous thrombosis
![Page 12: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/12.jpg)
CardioVascular ? Disease
![Page 13: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/13.jpg)
The underlying mechanisms
• Depending on the disease• Coronary artery disease, stroke, and peripheral
artery disease, aneurysm involve atherosclerosis. – Caused by high blood pressure, smoking, diabetes, lack
of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption
• Rheumatic heart disease may follow untreated streptococcus throat infection
![Page 14: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/14.jpg)
Cardiovascular disease
1. Coronary disease
2. Aortic Aneurysm
3. Cerebrovascular disease
4. Perpheral artery disease
5. Thrombosis/Embolism
and Sudden death
![Page 15: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/15.jpg)
![Page 16: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/16.jpg)
![Page 17: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/17.jpg)
Sudden death Causes
• Coronary artery disease is the leading cause of sudden cardiac arrest
• Many other – Cardiac– Non-cardiac conditions
![Page 18: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/18.jpg)
• Cardiac– Coronary artery disease– Myocardial infarction– Non-ischemic heart disease
• Cardiomyopathy, cardiac rhythm disturbances (arrythmia)• Hypertensive heart disease (Tekanan darah tinggi)• Congestive heart failure (Gagal Jantung)
• Non Cardiac– Bleeding
• Gastrointestinal bleeding, aortic rupture, or intracranial hemorrhage
– Overdose, drowning and pulmonary embolism– Cardiac arrest can also be caused by poisoning
Sudden death
![Page 19: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/19.jpg)
Cardiovascular disease
1. Coronary disease
2. Aortic Aneurysm
3. Cerebrovascular disease
4. Peripheral artery disease (PAD)
5. Thrombosis/Embolism
and Sudden death
![Page 20: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/20.jpg)
1. Coronary artery disease ⇒ MI
![Page 21: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/21.jpg)
Therapy of Coronary artery disease
![Page 22: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/22.jpg)
Stent(PCI = percutaneous coronary intervention)
![Page 23: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/23.jpg)
PCI = percutaneous coronary intervention
![Page 24: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/24.jpg)
Unstable Angina Clinical Presentation • Ischemic pain• heaviness, tightness, aching, fullness, or burning of the
chest, epigastrium, or arm or forearm (usually the left)• Involve the lower jaw, neck, or shoulder • Associated symptoms :
– dyspnea, generalized fatigue, diaphoresis, nausea and vomiting– flulike symptoms, lightheadedness or abdominal pain
• The intensity of pain does not correlate with diagnosis or prognosis
• Elderly and female patients are more likely to present with atypical signs and symptoms
![Page 25: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/25.jpg)
2. Aortic aneurysm
![Page 26: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/26.jpg)
Aneurysm• An aneurysm or aneurism
– from Greek:"dilation", "to dilate“– localized – Blood-filled balloon-like bulge in the wall of
a blood vessel• Risk factors
– Diabetes, obesity, hypertension, tobacco use,alcoholism, high cholesterol, copper deficiency, increasing age, and tertiary syphilis and TBC infection
![Page 27: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/27.jpg)
Therapy
![Page 28: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/28.jpg)
Abdominal aneurysm
![Page 29: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/29.jpg)
Case Study• Oct 12th 2015, 21p.m.
• Chest discomfort
• chest pain
• Emergency unit– Lab:Normal limit
– BP 185/102
• Chest Rontgent
• Inpatient recommended– Rejected
![Page 30: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/30.jpg)
Aortic aneurysm rupture• Oct 13th, 07 a.m.
• Brushing teeth
• She felt down suddenly (Collaps)
• Emergency services called and Cardiopulmonary resuscitation start
• 08:14 a.m. confirmed death
• R-1, R-2, R-3
![Page 31: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/31.jpg)
Aortic aneurysm Symptoms• Many aneurysms do not have symptoms• Detected during a routine physical exam or
– X-ray evaluation for another disorder• Symptoms occur
– When the aneurysm grows/disrupts the wall of the aorta• Symptoms depend on the size and location
– Pain in the abdomen or in the lower back– Constant pain occurring over hours or days– Sudden onset of severe stabbing pain– Unusual sensation of pulsing in the abdomen– Cough, shortness of breath (thoracic aortic aneurysm)– Fainting, Chest pain
![Page 32: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/32.jpg)
Subarachnoid haemorahge
• 66 years old man• 2 days ago
– Headeche
– Vomit
– General malaise
• Walking to Hospital• BP 207/85• Concious
• SAH.wmv
3. Cerebrovascular disease
![Page 33: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/33.jpg)
SAH (Subarachnoid haemorrhage)
• acute nontraumatic headache – maximum intensity within 1 hour– “Worst headache of my life"
• 30-40% of patients are at rest at the time of SAH
• The remaining 60-70% of cases – Physical or emotional strain– Defecation, coitus, and head trauma
![Page 34: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/34.jpg)
![Page 35: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/35.jpg)
SAH Prodromal events• Signs and symptoms
– Ruptured cerebral aneurysm (10-50% of cases.)– 10-20 days prior to rupture
• The most common symptoms– Headache (48%)– Dizziness (10%)– Orbital pain (7%)– Diplopia (4%), Visual loss (4%)– Sensory or motor disturbance (6%)– Seizures (4%), Dysphasia (2%), Ptosis (3%)
![Page 36: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/36.jpg)
• Prodromal signs and symptoms– Sentinel leaks
• Headaches, nausea, vomiting, photophobia, malaise, neck pain.
• These symptoms may be ignored by the physician
– Mass effect (aneurysm expansion)
– Emboli
![Page 37: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/37.jpg)
Cerebrovascular disease
• 92 years old woman
• Fall down, Head injury
• Headeache, nausea, vomiting
• Right Intracranial haemorrhage
• (Epidural hematoma)
(head injury)
• Sarcopenia
![Page 38: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/38.jpg)
Cerebrovascular disease,
• 47 years old woman• Past history : Iron Defficiency Anemia• 28th Oct 2015
– Suddenly fall down and feel dysarthria• 29th Oct 2015 night
– Numbness left hand and leg • 30th Oct 2015 Emergency department
– No sign of paralysis, walking to hospital– BP 182/104– Head MRI exam– 脳梗塞( DWI).wmv 脳梗塞( MRA 1 ) .wmv– 脳梗塞( MRA-2).wmv 脳梗塞(頚動脈-1) .wmv
Cerebrovascular infarct (Stroke)
![Page 39: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/39.jpg)
Internal carotid artery oclusion
![Page 40: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/40.jpg)
4. Peripheral artery disease (PAD)
• Narrowing of the arteries – Other than the heart or brain
• classic symptom – Leg pain when walking, resolves with rest– Intermittent claudication
• Other symptoms – Skin ulcers, bluish skin, cold skin, or poor nail and hair growth in
the affected leg – Complications
• Infection or tissue death • May require amputation
• 50% are without symptoms
![Page 41: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/41.jpg)
Symptom Screening
![Page 42: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/42.jpg)
Therapy of Peripheral artery disease
![Page 43: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/43.jpg)
Peripheral artery disease• 72 Years old Man (Inpatient caused by Osteomyelitis)
– Diabetes Mellitus
– Hypercholesterol, Hyperlipidemia
– Hypertension
• Bilateral Leg PAD
![Page 44: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/44.jpg)
5. Pulmonary embolism
• Inhospital caused by lower extremities infection
• Oct 6th 22 p.m. – Suddenly
– Chest pain, dyspnea
– Cold sweat
• ECG: look like Angina or MI
• PE- 造影01 .wmv• PE ー造影2 .wmv• PE ー造影3 D.wmv
![Page 45: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/45.jpg)
A former minister for health in Indonesia,
• The rates of infectious diseases have gone down, while non-communicable diseases have gone up tremendously
• The non-communicable diseases are not included in our health insurance schemes
![Page 46: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/46.jpg)
90% of CVD : preventable
• Prevention of atherosclerosis by decreasing risk factors– Healthy eating, exercise
– Avoid tobacco smoke
– Limiting alcohol intake
– Treating high blood pressure and diabetes
– Treating people who have strep throat with antibiotics can decrease the risk of rheumatic heart disease
– Avoid or reduce exposure to air pollution
![Page 47: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/47.jpg)
Cardiovascular disease = Obesity only?
1. Visceral fat (abdominal fat) – Body fat that exists in the abdomen
– Surrounds the internal organs
2. Cholesterol Ratio– L/H Ratio
3. Air Pollution
![Page 48: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/48.jpg)
Cardiovascular disease = Obesity only?
Air Pollution = PM2.5
![Page 49: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/49.jpg)
Air pollution• Currently, PM2.5 is the major focus• short- and long-term exposure
– Increased rate of atherosclerosis and inflammation– Effects on cardiovascular disease– Estimated 8–18% CVD mortality risk – Women had a higher relative risk coronary artery disease than
men did – 5 days of exposure, a rise in Blood pressure– Irregular heart rhythm, reduced heart rate variability, and heart
failure – Artery thickening– Increased risk of acute myocardial infarction
![Page 50: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/50.jpg)
Respiratory system
![Page 51: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/51.jpg)
Others effects PM2.5
• Irritation of the eyes, nose and throat• Coughing, chest tightness and shortness of breath• Reduced lung function• Irregular heartbeat• Asthma attacks• Lung Cancer• Premature death in people with heart or lung
disease
![Page 52: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/52.jpg)
Reduce exposure to PM2.5
• When outdoor levels of PM2.5 are elevated,
– Going indoors
• Limit indoor and outdoor activities that produce fine particles – Burning candles indoors/open burning outdoors
– Avoid strenuous activity in areas where fine particle levels are high
– Tobacco (Passive smoking)
• Air purifier
![Page 53: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/53.jpg)
PM 2.5 Concentration expected
![Page 54: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/54.jpg)
![Page 55: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/55.jpg)
1. Visceral fat, or abdominal fatHas significant impact on metabolism
![Page 56: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/56.jpg)
• Affects blood pressure; blood lipid levels, cardiac rhythm • Interferes with ability to use insulin effectively, disturb
neurohormonal function ect
![Page 57: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/57.jpg)
LiverIntestine
FatTG
TG
2. Cholesterol
![Page 58: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/58.jpg)
1. “Scour" the walls of blood vessels
2. Cleaning out excess cholesterol (plaques that cause CAD)
3. Carried to the liver
• Processed into bile
• Secreted into the intestines and out of the body
HDL
![Page 59: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/59.jpg)
3. Cholesterol ratio
• Cholesterol ratio• Total cholesterol/HDL
• Total cholesterol• High-density lipoprotein, HDL (good cholesterol), • + Low-density lipoprotein, LDL (bad cholesterol), • + 20 percent of triglycerides• a type of fat carried in blood
![Page 60: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/60.jpg)
Total Cholesterol/HDL Ratio (U.S.A) LDL/HDL Ratio (Japan)
![Page 61: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/61.jpg)
Cholesterol ratio : Total cholesterol/HDL• An optimal ratio 3.5 ~ 1• A higher ratio : a higher risk of heart disease• Non-HDL cholesterol
– Total cholesterol ー HDL cholesterol – All the "bad" types of cholesterol– Higher numbers mean a higher risk of heart disease
• Ratio of 5 : average risk of heart disease for men– Ratio 9.6 : double the risk
• Women, a 4.4 ratio : average risk for heart disease– A ratio 3.3 : roughly half the average risk– Ratio 7 : double the risk for heart disease– Because their HDL levels are often higher
![Page 62: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/62.jpg)
Cholesterol ratio : Total cholesterol/HDL• HDL < 40 mg/dL
– Increased risk of CAD – Normal total cholesterol and LDL cholesterol levels
• HDL 40 ― 60 mg/dL : considered "normal" – Do not very much affect the risk of CAD
• HDL > 60 mg/dL – Reduced risk of heart disease
L/H ratio– <1.5 Good condition– >2.0 accumulation of cholesterol, Probability of atherosclerosis– >2.5 Risk for Plaque and CardioVascular disease
![Page 63: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/63.jpg)
Target HDL cholesterol level
At risk Desirable
Men < 40 mg/dL
(1.0 mmol/L)
≧60 mg/dL
(1.6 mmol/L)
Women < 50 mg/dL
(1.3 mmol/L)
≧60 mg/dL
(1.6 mmol/L)
![Page 64: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/64.jpg)
How can We Increase Our HDL Levels?
• Aerobic exercise• Lose weight• Stop smoking • Cut out the trans fatty acids• Alcohol : one or two drinks /day • Increase the Monounsaturated Fats In Your Diet • Add soluble fiber to your diet • Other dietary means to increasing HDL • What About A Low-Fat Diet? • What About Drugs?
![Page 65: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/65.jpg)
Trans fatty acid
• Made through the chemical process of hydrogenation of oils
• Margarine, crackers, cookies, and snack foods
• Abundance in many deep-fried foods • Raise the 'bad' (LDL) cholesterol • Lower the 'good' (HDL) cholesterol levels• Increase the risk of heart disease
![Page 66: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/66.jpg)
Increase in HDL levels
• Removing trans fatty acids • Monounsaturated fats : canola oil, avocado oil, olive oil
– Without increasing the total cholesterol• Soluble fibers : fruits, vegetables
– Reduction in LDL cholesterol– Increase HDL cholesterol
• Cranberry juice • Fish and other foods containing omega-3 fatty acids
– Increase HDL levels. In postmenopausal women – (but not, apparently, in men or pre-menopausal women)
![Page 67: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/67.jpg)
Regular aerobic exercise increase your HDL level
• Walking, jogging or bike riding• duration > intensity
– At least 20 minutes (though 40 would be better)
– At least 3 ~ 4 times/week
• Raises your heart rate for 20 to 30 minutes at a time– THR (Target heart zone)
![Page 68: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/68.jpg)
Low-fat diet
• Reduces HDL - rather than increases - HDL levels – Not specifically caused by “not enough fat”
– But, is caused by consuming too many carbohydrates
• The American Heart Association and the American College of Cardiology – Stopped recommending low-fat diets for heart disease
prevention
• Low-carb diets - and not low-fat diets – – Can increase HDL levels
![Page 69: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/69.jpg)
• Drug therapy for raising HDL cholesterol levels • Disappointment • Statins
– Has proven highly successful in reducing LDL – Not very effective at increasing HDL levels
• Niacin : drug therapy for raising HDL levels. – One of the B vitamins – The amount of niacin needed are so high – Raising HDL levels with niacin
• No improvement in cardiovascular outcomes– Treatment with niacin
• Increased risk of stroke, diabetic complications
![Page 70: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/70.jpg)
Healty eating and exercise = Lose weight
• BMI : (kg/m2)– weight (kilograms) : the square of height in meters
• BMI score– Underweight :< 18.5 – Healthy weight : 18.5 ー 24.9– Overweight : 25 ー 29.9 – Obese : 30 ー 39.9– Severely obese > 40
![Page 71: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/71.jpg)
Waist circumference Another indicator of your risk of developing health problems
• USA– Men > 94cm
– Women > 80cm
• Japan– Men > 85cm
– Women > 90cm
![Page 72: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/72.jpg)
Lose weight too fast ⇒ Rebound
• Lose weight at a safe rate of 0.5kg to 1kg / week • A daily calorie : 1,900kcal for men
– 1,400kcal for women
• Losing weight faster – Increase the risk of health problems
– Malnutrition, gallstones, feel tired and unwell • 1 Kg = ? Calories = ?cm waist circumference
• Caloric needs (simple guide)– Body weight (Kg)× 25〜30 Kcal– Adult women ± 1500 Kcal/day
![Page 73: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/73.jpg)
Caloric needs (simple guide)
• Calorie need/kg– Desk work (Low active) 25~30 kcal– Standing work or work outside
• (Moderate active) 30~35 kcal
– Hard work (Active) 35~40 kcal
![Page 74: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/74.jpg)
Conclusion = Live well
![Page 75: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/75.jpg)
Live well• Eat well
– Good fats• Monounsaturated fats :avocados, nuts and seeds • Polyunsaturated fats, including Omega-3s, : fatty fish• Good vegetarian sources of polyunsaturated fats : walnuts
– Bad fats• Trans fats, margarines, candies, cookies, snack foods, fried foods
• Exercise• Avoid / reduce polution
– PM2.5 of 880 ug/m3 (city with high pollution)– Smoking area 700 ~ 800 ug/mg3
![Page 76: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/76.jpg)
Fat composition recommndedSaturated fat Unsaturated fat
Trans fat Monounsaturated
Polyunsaturated
Omega-3 Omega-6
Source Animal fatMeat, milk
Chemical process Olive oilavocados
Fish, salmonBeans,sardine
Vegetable oil, nuts
intake Limit consumtion
Avoid, do not eat“hydorogenated oil”
RecommnededBad Chol↓Good chol ↑
Good fatBrain healthHelp metabolism
Good fatOver consumed caused health problem
![Page 77: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/77.jpg)
Food composition
![Page 78: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/78.jpg)
Case 1
2014/8/6 2014/11/12 2015/6/10 2015/10/20
T-Chol 209 228 254 123
T-G 550 261 351 186
HDL 37 40 41 27
LDL 120 149 166 57
Tchol/HDL 5.6 5.7 6.2 4.5
L/H ratio 3.2 3.7 4.0 2.1
![Page 79: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/79.jpg)
Case 22012/4/19 2014/10/17 2015/10/13
T-Chol 305 272 272
T-G 223 162 79
HDL 48 68 74
LDL 221 181 186
Tchol/HDL 6.4 4 3.6
L/H ratio 4.6 2.6 2.5
![Page 80: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/80.jpg)
Case 1 & 2
2014/8/6 2014/11/12 2015/6/10 2015/10/20
T-Chol 209
305
228
272
254 123
272
T-G 550
223
261
162
351 186
79
HDL 37
48
40
68
41 27
74
LDL 120
221
149
181
166 57
186
![Page 81: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/81.jpg)
Case 1
2014/8/6 2014/11/12 2015/6/10 2015/10/20
HDL 37 40 41 27
Tchol/HDL 5.6 5.7 6.2 4.5
L/H ratio 3.2 3.7 4.0 2.1
take madication Statin
Case 2
2012/4/19 2014/10/17 2015/10/13
HDL 48 68 74
Tchol/HDL 6.4 4 3.6
L/H ratio 4.6 2.6 2.5
didn’t take madication
3 ~ 4 times/week exercise + Low carb diet
![Page 82: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/82.jpg)
Metabolic syndrome• Waist circumference
– Man > 85cm Women > 90cm
• Trigliceride ・ HDL Cholesterol – TG >150mg/dl– HDL<40mg/dl– One or both
• Blood pressure – Systolic blood pressure >130m m Hg– Diastolic blood pressure > 85m m Hg– One or both
• Blood Sugar – Fasting blood sugar >110mg/dl
![Page 83: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/83.jpg)
Conclusion
BMR is the number of calories you would burn with NO activity
![Page 84: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/84.jpg)
Effect on BMR
![Page 85: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/85.jpg)
BMR (Simple guide) (Kcal)
Years/gender Man woman
50~69 old 21.5 x weight 20.7 x weight
30~49 old 22.3 x weight 21.7 x weight
18~29 old 24.0 x weight 23.6 x weight
15~17 old 27.0 x weight 25.3 x weight
![Page 86: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/86.jpg)
Conclusion
Meal TEF
(% of calories consumed)
Protein 20~30 %
Carbohydrates 5 ~10 %
Fat 0 ~ 3 %
![Page 87: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/87.jpg)
Exercise THR (Target heart zone)• First step : resting heart rate (RHR) • Before get out of bed in the morning,
– Take pulse for 1 full minute – Beats per minute (bpm)
• For a more accurate measurement – Take pulse for 3 mornings and take an average – A normal RHR for adults is between 60-100
• Use this number to find target heart rate zones – Karvonen formula
• Calculate a THR zone between 50% and 85% – Heart rate reserve
![Page 88: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/88.jpg)
Exercise
• Low Intensity - 50-60%
• Moderate Intensity - 60-70%
• Vigorous or High Intensity - 75-85%
• The Talk Test and Perceived Exertion– Can speak comfortably
• Around the low-middle range of THR zone
![Page 89: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/89.jpg)
To calculate the low end THR zone• 50% of heart rate reserve
• Max Heart Rate (MaxHR) = 206.9 - (0.67 x age)
• Heart Rate Reserve (HRR) = MaxHR - (resting heart rate)
• HRR x 50% = training range %
• Training range % + resting heart rate = low end of THR zone
• 35-year-old RHR of 60/m • 206.9 - (0.67 x 35) = 183.45
183.45 - 60 = 123.45123.45 x 50%= 62%62 + 60 = 122 bpm
• For this person,
– The low end THR starts at 122 bpm,
– A light, warm up pace
![Page 90: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/90.jpg)
calculating the high end (85%) of THR zone
• 85% of heart rate reserve
• Max Heart Rate (MaxHR) = 206.9 - (0.67 x age)
• Heart Rate Reserve (HRR) = MaxHR - (resting heart rate)
• HRR x 85% = training range %
• Training range % + RHR = high end of your THR zone
• 35 year old RHR 60 bpm
• 206.9 - (0.67 x 35) = 183.45 (MaxHR)
• 183.45 - 60 = 123.45 (HRR)
• 123.45 x 85%= 105 (training range % )
• 105 + 60 = 165 bpm (high end of THR zone )
• Training heart rate zone : 120-180 beats per minute
![Page 91: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/91.jpg)
Terima Kasih
![Page 92: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/92.jpg)
![Page 93: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/93.jpg)
![Page 94: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/94.jpg)
Cardiac rhythm
![Page 95: “ Overweight ” and CardioVascular diseases 22 nd December 2015 Peringatan Hari Ibu (ke-87), Dharma Wanita Persatuan KJRI Osaka, Jepang Hokusetsu General](https://reader036.vdocuments.net/reader036/viewer/2022062807/5697c01f1a28abf838cd1eab/html5/thumbnails/95.jpg)