Mr. Zhang, 38, is1.74m tall and weighs 8 1 kg, and works as a copywriter in a company. Sitting activities (meeting, computer and TV, driving) last for 6 to 8 hours every day, with little exercise and no diet control. Last year, in the physical examination, it was found that the blood triglyceride and cholesterol exceeded the normal value, the fasting blood sugar was high, and there was moderate fatty liver, and the body fat accounted for 3 1% of the body weight. The doctor made the following diagnosis: diabetes, mild obesity, excessive body fat, mixed hyperlipidemia, fatty liver, low level of maximum oxygen intake and cardiac function in the normal range, and high risk factors of coronary heart disease. According to this case, I was given.

Conditioning scheme:

First, health risks are sorted out

Mr. Zhang is currently facing the following health risks:

1, BMI is overweight, body fat rate exceeds the standard, and slightly obese.

Mr. Zhang's BMI has reached 26.8, which belongs to the overweight range, and belongs to the upper position in the overweight range. It is mild obesity to calculate the obesity with the height standard weight. Overweight is often accompanied by high body fat rate. For example, Mr. Zhang's body fat rate has reached 3 1%, while that of normal men is around 15%. This can easily lead to the metabolic disorder of the three major nutrients in the body. Mr. Zhang's weight loss is closely related to the high fasting blood sugar, blood triglyceride and total cholesterol.

In addition, as a part of human endocrine system, high body fat will also cause endocrine system disorder, aggravate metabolic imbalance, and make more fat accumulate in internal organs in a vicious circle, increasing the risk of inflammatory imbalance of internal organs. For men, inflammatory imbalance may also cause abnormal nucleic acid metabolism in the body and increase the risk of hyperuricemia.

If weight management is not carried out in time, then obesity will continue to increase the burden on the cardiovascular system and cause serious health problems, such as coronary heart disease, hypertension, gout and so on. Obesity can also aggravate respiratory inflammation, which is closely related to snoring and sleep apnea syndrome, easily causing fatigue, headache, lack of oxygen and personality changes, and increasing the probability of sudden death in sleep at night.

2, diabetes, hyperlipidemia and other metabolic abnormalities.

Mr. Zhang's fasting blood glucose has reached 8.23mmol/L, which is higher than the criterion of diabetes 7. 1mmol/L, and diabetes can be diagnosed. The harm of diabetes is enormous. At present, long-term diabetes will induce many complications, including chronic injuries to eyes, kidneys, cardiovascular system and nerves. In addition, diabetes itself is not only a problem of "too much sugar", but also an important factor is that the ability of normal cells to use sugar has declined. Insulin resistance, the inducing factor of type 2 diabetes, will make cells in a state of hidden hunger and unable to use glucose normally, leading to excessive glucose accumulation in the blood, which will promote insulin secretion to be more vigorous, and the pancreas will easily fail due to overwork in the future.

Mr. Zhang's triglyceride, total cholesterol and low-density lipoprotein are all on the high side, belonging to mixed hyperlipidemia. Abnormal metabolism of blood lipids will cause excessive accumulation of fat in the blood, increase blood viscosity, block blood flow and increase the burden on the heart. In addition, the high level of low-density lipoprotein indicates that the amount of "bad" cholesterol in the blood is increasing, the blood cleaning ability can't keep up, and the risk of atherosclerosis will increase.

In addition, hyperglycemia and hyperlipidemia are also likely to increase blood pressure on blood vessels and induce hypertension, thus increasing the risk of stroke.

3. Moderate fatty liver

Abnormal fat metabolism can also cause abnormal accumulation of fat in the liver. Mr. Zhang has suffered from moderate fatty liver, that is, the fat content in the liver has exceeded 10%. If Mr. Zhang does not have the problem of excessive drinking, then this fatty liver belongs to nonalcoholic fatty liver, and moderate fatty liver will seriously affect the liver function, and the liver is the most important center for substance metabolism and detoxification, and the decline of liver function will seriously affect human health.

Fatty liver will gradually evolve into hepatic fibrosis if maintenance is not strengthened, and then it will further evolve into cirrhosis after about 10 years, and 50% of patients with cirrhosis will turn into liver cancer. Liver cirrhosis itself is also prone to serious complications such as hepatic ascites, massive hemorrhage of digestive tract, liver failure and hepatorenal syndrome, which are life-threatening.

In addition, the liver function is damaged, which also shows that the gastrointestinal tract has been damaged, the liver and intestine have the function of circulation and mutual cooperation, and Mr. Zhang's digestive system is not good enough, so it needs timely intervention and adjustment.

4. Eating without restraint

Diet is a very important factor in the development of chronic diseases. Indiscriminate diet will lead to unbalanced nutrient intake, usually excessive intake of carbohydrate and fat, while insufficient intake of trace elements and decreased digestive function will also reduce the body's ability to digest and absorb protein. These will cause chronic inflammation of the body, and eventually aggravate the occurrence and development of chronic diseases.

5, sedentary and less exercise, the maximum oxygen intake and the low level of cardiac function in the normal range.

Sedentary and less exercise, coupled with uncontrolled diet, are easy to consume excessive energy, but the food with high nutritional density is not eaten enough, and the body does not consume much. The calories eaten can easily be converted into fat, which aggravates the problems of fatty liver and hyperlipidemia. Exercise can enhance the body's metabolism, reduce inflammation and improve the ability of cardiovascular system. However, Mr. Zhang's maximum oxygen intake and cardiac function are at a low level within the normal range, indicating that the cardiopulmonary function is not good enough, and the exercise amount should be improved step by step.

In order to control the above health risks, Mr. Zhang needs the following health management objectives:

1, lose weight, reduce BMI to normal range, and reduce body fat rate to normal range.

Losing weight can greatly help Mr. Zhang control or even reverse the development of chronic diseases, including

At present, Mr. Zhang's BMI index is 26.8, the first goal can be set at 25, and the second goal is less than 24, reaching the normal range. Later, Mr. Zhang can continue to work hard to optimize BMI to achieve an ideal body shape of about 22.

At present, Mr. Zhang's body fat rate is 3 1%, while that of men is about 15%. The first goal is to reduce the body fat rate to less than 25%, and the second goal is to reduce the body fat rate to less than 20%, and finally achieve a normal body fat rate within 15%.

2. Manage blood sugar and keep fasting blood sugar below 7.1mmol/L.

Diabetes is largely eaten by us, so managing blood sugar will require Mr. Zhang to carefully cooperate with the diet management plan, control blood sugar, and keep the fasting blood sugar below 7.1mmol/L. Of course, he also needs to take medicine according to the doctor's advice during the period.

3. Manage blood lipids and reduce the indexes of triglycerides and cholesterol.

Hyperlipidemia will lead to a higher incidence of cardiovascular diseases, the risk of atherosclerosis will increase, and the risk of coronary heart disease will also be high. In order to reduce these health risks, Mr. Zhang needs to manage blood lipids, lower the indexes of triglycerides and cholesterol, take drugs according to the doctor's advice during the management period, and manage his diet at the same time.

The emergence of blood lipid problems is directly related to our diet. Our cholesterol is not only synthesized from the fat in food, but also carbohydrates (that is, sugars, including starch). When there are more white rice flour in our diet, it will also increase cholesterol production, and the cholesterol produced by refined carbohydrate staple foods such as white rice flour is more harmful to cardiovascular system, because the low-density lipoprotein cholesterol particles they produce are relatively small. Moreover, when the body lacks the protection of antioxidant nutrients such as vitamin E, it is easy to be oxidized and deteriorated in the blood, which is a risk factor for inducing vascular plaque.

Second, the diet management plan

1, control the total amount of staple food, enrich the variety of staple food, mainly staple food with low glycemic index.

Mr. Zhang's daily staple food should be controlled at around 1 fist per meal, which can ensure that the total daily staple food weight is around 150g, which is a relatively suitable level. At the same time, the staple food of this 1 fist should be composed of whole grains, miscellaneous grains, beans and potatoes as far as possible, so as to better balance the postprandial blood sugar. In addition, there is a great individuation of carbohydrate intake in diabetic patients, so it is necessary to carefully cooperate with the weighing of grams of staple food and the detection of postprandial blood sugar, and find the law after recording.

Whole grain staple food is also what we often call whole grains, such as black rice, brown rice, oats, buckwheat, quinoa and so on. It should be noted that instant oatmeal is a refined grain, and its ability to raise blood sugar is also very high, so it is best to control the amount appropriately. It is best to buy rice grains as staple foods. Such grains are rich in dietary fiber. Although they need to be soaked for a long time to cook delicious, their ability to control blood sugar is the best.

Miscellaneous beans include all kinds of red beans, mung beans, peas and broad beans. These "small snacks" that we think are healthy are actually staple foods, which can completely replace white rice and flour in dinner, and they also contain some plant proteins, which are very good dietary supplements. Miscellaneous grains include our common corn, lotus root and pumpkin. Usually, we all think they are "vegetables". In fact, they have more starch content, so they can provide more energy for the body. At the same time, they are rich in dietary fiber and B vitamins, which can provide a stronger sense of fullness, even if the total amount of a fist is full, and they are more energetic and easier to concentrate, because they can make blood sugar more stable.

The last part of the staple food is called potato, which is tuber food, such as potato, yam, sweet potato and so on. The staple food of each meal can be controlled in the size of one's fist. Considering that Mr. Zhang's gastrointestinal tract may be damaged, it is suggested to use half rice (generally white rice, half coarse grains) at first. The coarse grains porridge can be made thicker, as long as it is soft and rotten, so as to avoid the stomach discomfort caused by too hard grains after meals.

Generally, the size of a bowl can be measured with your own fist, just put it in a small bowl with your own fist. Every meal is guaranteed to have such a staple food. You don't have to deliberately not eat staple food, but choose high-quality staple food. As long as you have rich dietary fiber, the ability of raising blood sugar of staple food will not be so high, the ability of stabilizing blood sugar will be better, and you can maintain a long-term satiety.

It is especially important to remind that you should never use whole grains to beat and paste, or make whole grains soybean milk, and don't drink whole grains juice sold in the market, because once whole grains are made into this pulp and paste, the dietary fiber in it is interrupted, the starch is dissolved in water, the digestion speed is very fast, and the ability to raise blood sugar is also very high. At the same time, protein in soybean milk will be diluted, which is equivalent to the nutrition of rice soup, and its nutritional value will be reduced.

If you can't accept the change of staple food in a short time, you can buy special rice noodles specially for diabetics. These rice noodles are specially made by high technology. Although they keep the form of white rice and noodles, they have strong management effect on blood sugar, which can help Mr. Zhang manage the level of blood sugar.

2. Increase the intake of high-quality protein and enhance satiety.

High-quality protein foods are essential raw materials for our bodies. protein is needed for muscle growth and cell repair. Without protein, there would be no life. Muscle is the key for us to develop lean physique. The raw materials for muscle repair can keep our body at a high basal metabolic rate (basal metabolism is like the basic power consumption when the mobile phone is on standby, the higher the basal metabolism, the easier it is to consume the food we eat, and the less likely it is for people to gain weight), so that we can lose weight while sitting.

Healthy weight loss needs nutrition, among which protein is an essential component, and protein foods need to be added in three meals. High-quality protein comes from fish, meat, eggs, milk and beans (soybeans). The daily protein requirement of men is 65g, so the amount of protein food per meal needs to reach 1 fist. Among them, milk refers to all dairy products, but because milk has the effect of stimulating insulin secretion, it is recommended that Mr. Zhang eliminate it.

Fish includes all aquatic products and seafood. Fish, shrimp, crabs and shellfish are all good sources of protein, and they won't gain weight. Meat is red, white and lean meat of all livestock, such as chicken, duck, cow, sheep and pork. It should be noted that the thin parts must be selected, such as chicken and duck, because there is a lot of subcutaneous fat in poultry. Beef, mutton and pork should also choose lean parts, paying special attention to the highest fat content of pork, and it is best to choose the loin and ribs.

Eggs refer to all kinds of eggs. Mr. Zhang doesn't have to worry about the relationship between cholesterol and blood lipids, so he doesn't dare to eat egg yolk. There is no problem with 1-2 eggs a day. It is more suitable to adjust the food types in the staple food part to reduce blood lipids. Protein of eggs is easy to digest, and it is good to cook eggs or make custard.

3. Increase the intake and variety of vegetables.

Vegetables are high-density nutritious foods that are easily overlooked by many men. They can provide essential vitamins, minerals and many phytonutrients, and they are very low in calories, so they are very suitable for eating during healthy weight loss.

Each meal of vegetables is allocated two fists, and the types of vegetables need to be diversified. The simplest way is to judge by color. The vegetables of these two fists should be eaten into a rainbow, one fist with dark green leaves, and the other fist with other vegetables of various colors, such as eggplant, tomatoes, carrots, white radishes, mushrooms, kelp and so on.

It should be noted that some vegetables actually mainly provide starch, which belongs to the staple food category. They should be excluded from these two fists and cannot be counted. The specific types are listed in the staple food section below. In addition, vegetables must be introduced into breakfast, which is very helpful for Mr. Zhang to balance blood sugar and blood lipid.

4. Choose good oil to replace unhealthy grease.

Fat is not all bad. Our body needs fat, but it needs high-quality fat, and fat can help the body to diminish inflammation. However, in our daily kitchen oil, a large part of oil is pro-inflammatory, including peanut oil, soybean oil, sunflower oil, corn oil, etc., while another kind of oil that helps the body to diminish inflammation is rarely eaten.

This kind of oil is also an essential fatty acid for the body. They are rich in flax seeds, chia seeds, quinoa and other crops. You can buy some linseed oil and perilla oil to eat cold dishes. Staple foods such as purple potatoes, sweet potatoes and beibei pumpkins are very delicious. You can also sprinkle chia seeds on them when drinking soybean milk. High-quality fish oil is also rich in anti-inflammatory fat, so fish must be steamed or cooked lightly as far as possible to avoid it.

These anti-inflammatory oils can not only help our body to repair, but also increase the content of high-density lipoprotein in the blood. These high-density lipoproteins are scavengers of blood vessels, and they will recycle the unused cholesterol from cells all over the body to the liver for other purposes, instead of letting them go bad in blood vessels, thus reducing the risk of cardiovascular system problems.

During the period of healthy weight loss, eating these high-quality oils in moderation and reducing or temporarily stopping the economic oil that we used to eat can help our bodies to repair faster and better achieve the goal of health management.

5. Pay attention to cooking methods

During the period of health management, the fried and roasted food should be shielded as much as possible, cooking and stir-frying should be used more, salt should be reduced, and nutrients in food should be preserved as much as possible.

6. Optional nutrition intervention measures

Patients with type 2 diabetes have severe insulin resistance, accompanied by serious nutritional deficiency and malnutrition. In addition to routine diet management, it is best to add special nutritional intervention measures to increase the supply of nutrients. Usually, comprehensive vitamin and mineral supplements can be selected to improve basic nutrition, so that cells can eat more abundant raw materials and improve the metabolic level. At the same time, increase the intake of chromium, which is an important nutrient for glucose tolerance, which can help improve the sensitivity of insulin and help diabetic patients alleviate insulin resistance.

Iii. Life management plan

1, exercise regularly, and choose acceptable exercise methods.

Exercise suitable for your physical ability can reduce inflammation, promote blood circulation, increase cardiopulmonary function, increase muscles and promote metabolism. Since Mr. Zhang has a large weight base at present, it is necessary to pay attention to avoid damaging his knees during exercise. You can choose to wear a healthy bracelet, take a walk or Tai Chi, or consult an experienced personal trainer. As long as you exercise moderately and not excessively, exercise is very helpful to your health, especially to alleviate the poor blood circulation and weakened cardiopulmonary function caused by sedentary. However, we must be careful not to get hurt by sports, such as warm-up exercises, and pay more attention to nutrition intake.

2. Go to bed early and get up early, and work and rest regularly.

Relaxation and meditation can help our body to relieve stress. Going to bed early and getting up early conforms to the law of biological clock, can help the gastrointestinal tract to recuperate according to biological rhythm, and is conducive to the repair of the gastrointestinal tract. During health management, try not to stay up late.

3, three meals regularly, chew slowly, don't look at the phone, don't work.

When eating, if you eat too fast, or if you are distracted from watching TV, brushing your mobile phone or working, then the secretion of gastric acid will be affected, which in turn will reduce the digestive ability of your stomach. Without sufficient gastric acid, protein foods are difficult to be completely decomposed and absorbed, and the body can't get enough nutrition. Therefore, when eating, each bite should be chewed 20 times, and a meal should be eaten for 30 minutes. When eating, the order of eating is also particular. Follow the order of soup-vegetable-meat-rice. First drink a small bowl of soup that warms the stomach (if any), then eat vegetables and meat, and finally eat staple food, so that you can eat more satiety without eating too much staple food.

The above is the analysis and conditioning plan for Mr. Zhang's physical examination report.