肥胖外刊(肥胖2020)

临床肝胆病杂志 2025年01月10日 10:46 0

文章目录：

1、外刊精读｜J Hepatol：严重肥胖患者的肝脂质重塑表现为脂肪变性，而不发生非酒精性脂肪性肝炎
2、经济学人｜解读肥胖难题
3、外刊精读｜J Hepatol：内质网应激诱导FOXA3表达进而导致非酒精性脂肪性肝病

外刊精读｜J Hepatol：严重肥胖患者的肝脂质重塑表现为脂肪变性，而不发生非酒精性脂肪性肝炎

肥胖症常导致非酒精性脂肪肝疾病(NAFLD)，可从简单的脂肪变性[非酒精性脂肪肝(NAFL)]发展为非酒精性脂肪性肝炎(NASH)。某些脂质亚型的积累与代谢和肝脏疾病的恶化有关，然而，在从无NAFL进展到NAFL然后到NASH的过程中的特定变化尚未解决。

来自澳大利亚的多中心研究人员描述了肥胖症中NAFLD恶化的肝脏、脂肪组织和血浆脂肪体，并评估了血浆脂质作为NAFLD的生物标志物的效用。

从181例接受减肥手术的患者中获得静脉血液、肝脏、内脏和皮下脂肪组织样本。NAFLD的严重程度通过组织学方法进行评估。采用液相色谱-串联质谱法进行脂质体分析。

研究结果显示，随着脂肪病的增加，肝脂脂体表现出显著变化，即三酰基甘油、二酰基甘油和神经鞘脂类增加，后者包括神经酰胺、二氢神经酰胺、己烯基神经酰胺和GM3神经节苷类。随着肝脂质的增加，血浆脂质也增加，与肝脂质有很强的相关性。脂肪组织脂肪体与NAFLD不相关。与NAFL相比，肝脂质水平无显著变化。在常规标记物中添加血浆脂质变量可显著提高NASH的诊断准确性（AUROC=0.667 vs 0.785，P=0.025）。

总体而言，这些数据详细描述了随着NAFLD恶化而发生的脂质组学变化，显示出脂肪变性显著变化，而NASH没有其他变化。肝脂质组的改变与血浆中相似的变化平行。血浆脂质作为肥胖症中NAFLD的非侵入性生物标志物的潜在用途值得进一步研究。

摘译自：Geraldine J. Ooi, Peter J. Meikle, et.al.Hepatic lipidomic remodeling in severe obesity manifests with steatosis and does not evolve with nonalcoholic steatohepatitis. Journal of Hepatology (2021)

吉林大学第一医院感染病中心肝病科

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经济学人｜解读肥胖难题

A wide spread problem

一个普遍的问题

The difficulty of losing weight is captured in a new model

新模式解读减肥难题

The answer to obesity is obvious: eat less and exercise more. However, years of exhortation have failed to persuade most of those affected actually to do this. In particular, it is much harder to shift surplus lard once it has accumulated than it is to avoid putting it on in the first place.

减肥的办法很明显：少吃，多运动。好几年的忠告并没有说服大多数肥胖之人践行这一点。尤其是与避免累积脂肪相比，转化多余的累积脂肪要困难得多。

Oddly, though, a convenient mathematical model describing this fact has yet to be widely adopted. But a paper in this week's Lancet, by Kevin Hall of America's National Institutes of Health and his colleagues, aims to change that.

不过，奇怪的是讲述这个事实的一个简易数学模式却没有被普通采用。然而，多但是美国国家卫生研究所的凯文•霍尔及其同事在本周《柳叶刀》上发布的一篇论文旨在改变这种情况。

The conventional rule for slimming, espoused by both the NIH and Britain's National Health Service, has the benefit of simplicity: cut 500 calories each day and lose half a kilo a week. Most experts, though, acknowledge that this rule is too blunt as it fails to account for shifts in the body's metabolism as the kilos pile on.

美国国家卫生研究所和英国国家卫生服务共同支持的传统瘦身法具有简单的优势：每天减少500卡路里，每周可减少一斤。不过大多数专家都承认，这种方法过于死板，没有考虑到体重增加时体内新陈代谢的变化。

Dr Hall's model tries to do this. It also accounts for baseline characteristics that differ from person to person. Fat and muscle, for example, respond differently to shifts in diet, so the same intake will have one effect on a podgy person and another on a brawny one.

霍尔博士的模式就是要努力克服这一缺陷。该模式还将不同人之间的基本特点考虑在内。比如，脂肪和肌肉对饮食变化的反应是不一样的，因此同样的摄入量对矮胖子和壮汉的影响也是不一样的。

The result is a more realistic assessment of what someone needs to do to get slim. According to the old version, for example, abstaining from a daily 250-calorie bottle of cola would lead to the loss of 35kg over three years. Dr Hall's model predicts an average loss of just 11kg.

结果是对一个人要瘦身必须要做的事情进行了更加现实的评估。比如，根据旧模式，每天少喝一罐250卡路里的可乐，三年体重就可以减轻35公斤。而霍尔博士的模式预测只能平均减少11公斤。

Furthermore, it also acknowledges that a dieter's weight will eventually reach a plateau—far more realistic than the old advice, which implied, incorrectly, that weight loss will continue steadily.

此外，它还承认节食者的体重最终将到达稳定阶段—比原来的建议要现实得多，原来的建议暗示体重将稳步下降，这是不正确的。

Gaining weight is easy.

增加体重很容易。

A surprisingly small imbalance, just ten extra calories a day, has driven the 9kg jump in the average American's weight over the past 30 years.

非常小的不均衡，不过每天多10卡路里，已经让美国人的平均体重在过去30年内飙升了9公斤。

The reason reversing such gains is hard is that servicing this extra flesh means a person's maintenance diet creeps up with his weight—and so does his appetite. That 9kg increase implies a daily maintenance diet that has 220 more calories in it than three decades ago. Returning to the average of the past means reversing every one of those 220 calories. Half-measures will result in a new equilibrium, but one that is still too heavy.

恢复原来体重很困难的原因是，为增加的体重提供服务意味着一个人保持体能的饮食与其体重一起增加了，其胃口也增加了。这增加的9公斤意味着每天保持体能的饮食中的卡路里比30年前多220多卡路里。恢复到原来的平均水平意味着每个人要减少220卡路里。减少一半就会达成一种新的平衡，这种平衡仍然会太重。

For example, a 23-year-old man who is 170cm tall should weigh 70kg, and be eating 2,294 calories a day. If he actually weighs 110kg he will be eating 3,080 calories to maintain his extra flesh and he thus needs to make a permanent cut of 786 calories from his daily diet if he is to get back to the 70kg desideratum.

比如，一位23岁、升高1.7米的男士的标准体重应该是70公斤，每天摄入2294卡路里。如果他的实际体重是110公斤，那么他必须摄入3080卡路里才能承受额外的负担。

If he cuts less than this he will lose some weight, but eventually his intake will match the maintenance level for what he now weighs, and without further cuts his weight will stabilise. Someone who weighs 90kg, by contrast, need cut only 435 calories a day to get to his target—a far more manageable proposition.

因此如果他要恢复到70公斤的需要，他必须每天减少固定的786卡路里。如果他减少的卡路里比这个少，他会减少一些体重，但是最终他的摄入量会与他当前的体重匹配，如果不进一步减少，他的体重将稳定下来。相比之下，体重90公斤的人只需每天减少435卡路里就可以达到他的目标—这是一个要好办得多的建议。

In principle, the heavier person could make the necessary cuts in stages—reducing his daily intake again and again as he lost weight. In practice, that would take a will of iron, and the few people who have such willpower rarely get fat in the first place.

原则上，体重较重的人可以分阶段进行必要的节食—在他体重减轻时，不断减少日常的摄入量。实际上，这需要非常坚定的意志，有这种意志的人几乎根本就不会变胖。

The lesson, then, is to stay, rather than become, slim. Not easy, in a world whose economic imperative is to satisfy every appetite, but perhaps a little more urgent now Dr Hall has put numbers on it.

因此，教训就是保持苗条而不是变苗条。在一个经济动力就是满足每项欲望的世界里，这并非易事，但是目前霍尔博士用具体数字对它进行了说明，这样或许更加紧迫了些。

重点单词：

equilibrium [,ikwɪ'lɪbrɪəm] n.平衡,均衡,平静

brawny['brɔni]adj.<非正>健壮的;严重肿胀的;顽强的

blunt[blʌnt]adj.钝的,不锋利的,直率的 vt. 使迟钝

exhortation [,ɛgzɔr'teʃən] n. 敦促;极力推荐;（正式的）演讲;（宗教仪式中的）劝诫

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