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Phenotyping the obesities: reality or utopia? 肥胖现象化:现实还是乌托邦?
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-08-04 DOI: 10.1007/s11154-023-09829-x
Piero Portincasa, Gema Frühbeck

In this thematic issue on phenotyping the obesities, prominent international experts offer an insightful and comprehensive collection of articles covering the current knowledge in the field. In order to actually capture all the polyhedral determinants of the diverse types of obesity, the granularity of the phenotypic information acquired must be expanded in the context of a personalized approach. Whilst the use of precision medicine has been successfully implemented in areas like cancer and other diseases, health care providers are more reluctant to embrace detailed phenotyping to guide diagnosis, treatment and prevention in obesity. Given its multiple complex layers, phenotyping necessarily needs to go beyond the multi-omics approach and incorporate all the diverse spheres that conform the reality of people living with obesity. Potential barriers, difficulties, roadblocks and opportunities together with their interaction in a syndemic context are analyzed. Plausible lacunae are also highlighted in addition to pointing to the need of redefining new conceptual frameworks. Therefore, this extraordinary collection of state-ofthe-art reviews provides useful information to both experienced clinicians and trainees as well as academics to steer clinical practice and research in the management of people living with obesity irrespective of practice setting or career stage.

在这期关于肥胖表型的专题文章中,著名的国际专家提供了一系列富有洞察力和全面的文章,涵盖了该领域的当前知识。为了真正捕捉不同类型肥胖的所有多面体决定因素,必须在个性化方法的背景下扩大所获得的表型信息的粒度。虽然精准医疗的使用已经在癌症和其他疾病等领域成功实施,但医疗保健提供者更不愿意采用详细的表型来指导肥胖的诊断、治疗和预防。鉴于其多个复杂层面,表型必然需要超越多组学方法,并纳入符合肥胖患者现实的所有不同领域。分析了潜在的障碍、困难、障碍和机会,以及它们在综合征背景下的相互作用。除了指出有必要重新定义新的概念框架外,还强调了看似有缺陷的地方。因此,这组非同寻常的最新综述为经验丰富的临床医生、受训人员以及学者提供了有用的信息,以指导肥胖患者管理的临床实践和研究,无论其实践环境或职业阶段如何。
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引用次数: 0
Physical activity and exercise for weight loss and maintenance in people living with obesity. 体育活动和锻炼有助于肥胖患者的减肥和维持体重。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-05-05 DOI: 10.1007/s11154-023-09805-5
Jean-Michel Oppert, Cécile Ciangura, Alice Bellicha

Physical activity and exercise training programs are integral part of a comprehensive obesity management approach. In persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight loss compared to the absence of training. However the magnitude of effect remains modest amounting to only 2-3 kg additional weight loss on average. Comparable effects have been observed for total fat loss. Exercise training, specifically aerobic training, is also associated with decreased abdominal visceral fat as assessed by imaging techniques, which is likely to benefit cardiometabolic health in persons with obesity. Based on data from controlled trials with randomization after prior weight loss, the evidence for weight maintenance with exercise training is as yet not conclusive, although retrospective analyses point to the value of relatively high-volume exercise in this regard. Resistance (i.e. muscle-strengthening) training is specifically advised for lean mass preservation during weight loss. Given the relatively limited effect of exercise training on weight loss as such, the changes in physical fitness brought about by exercise training cannot be overlooked as they provide major health benefits to persons with obesity. Aerobic, as well as combined aerobic and resistance training, increase cardiorespiratory fitness (VO2max) while resistance training, but not aerobic training, improves muscle strength even in the absence of a significant change in muscle mass. Regarding the overall management strategy, adherence in the long term to new lifestyle habits remains a challenging issue to be addressed by further research.

体育活动和运动训练计划是全面肥胖管理方法的组成部分。对于超重或肥胖的人来说,与没有训练相比,运动训练,特别是有氧(即耐力)训练,与显著的额外体重减轻有关。然而,影响的幅度仍然不大,平均只增加了2-3公斤的体重。已经观察到总脂肪减少的类似效果。通过成像技术评估,运动训练,特别是有氧训练,也与腹部内脏脂肪减少有关,这可能有利于肥胖者的心脏代谢健康。根据先前减肥后随机对照试验的数据,运动训练维持体重的证据尚不确凿,尽管回顾性分析指出了相对大容量运动在这方面的价值。阻力(即肌肉强化)训练特别建议在减肥期间保持瘦体重。鉴于运动训练对减肥的影响相对有限,运动训练带来的体能变化不容忽视,因为它们对肥胖者的健康有重大益处。有氧训练以及有氧和阻力联合训练可以提高心肺功能(VO2max),而阻力训练(而不是有氧训练)可以提高肌肉力量,即使在肌肉质量没有显著变化的情况下也是如此。关于整体管理策略,长期坚持新的生活习惯仍然是一个有待进一步研究解决的具有挑战性的问题。
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引用次数: 2
Relevance of body composition in phenotyping the obesities. 肥胖表型中身体成分的相关性。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-03-17 DOI: 10.1007/s11154-023-09796-3
Laura Salmón-Gómez, Victoria Catalán, Gema Frühbeck, Javier Gómez-Ambrosi

Obesity is the most extended metabolic alteration worldwide increasing the risk for the development of cardiometabolic alterations such as type 2 diabetes, hypertension, and dyslipidemia. Body mass index (BMI) remains the most frequently used tool for classifying patients with obesity, but it does not accurately reflect body adiposity. In this document we review classical and new classification systems for phenotyping the obesities. Greater accuracy of and accessibility to body composition techniques at the same time as increased knowledge and use of cardiometabolic risk factors is leading to a more refined phenotyping of patients with obesity. It is time to incorporate these advances into routine clinical practice to better diagnose overweight and obesity, and to optimize the treatment of patients living with obesity.

肥胖是世界范围内最广泛的代谢改变,增加了心脏代谢改变的风险,如2型糖尿病、高血压和血脂异常。体重指数(BMI)仍然是对肥胖患者进行分类的最常用工具,但它并不能准确反映身体肥胖。在这篇文献中,我们回顾了传统和新的肥胖表型分类系统。身体成分技术的准确性和可及性更高,同时对心脏代谢危险因素的了解和使用也在增加,这将导致肥胖患者的表型更加精细。现在是时候将这些进展纳入常规临床实践,以更好地诊断超重和肥胖,并优化肥胖患者的治疗了。
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引用次数: 0
Individualised prescription of medications for treatment of obesity in adults. 治疗成人肥胖的个性化药物处方。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-05-18 DOI: 10.1007/s11154-023-09808-2
Samantha Hocking, Priya Sumithran

Obesity continues to increase in prevalence globally, driven by changes in environmental factors which have accelerated the development of obesity in individuals with an underlying predisposition to weight gain. The adverse health effects and increased risk for chronic disease associated with obesity are ameliorated by weight loss, with greater benefits from larger amounts of weight reduction. Obesity is a heterogeneous condition, with the drivers, phenotype and complications differing substantially between individuals. This raises the question of whether treatments for obesity, specifically pharmacotherapy, can be targeted based on individual characteristics. This review examines the rationale and the clinical data evaluating this strategy in adults. Individualised prescribing of obesity medication has been successful in rare cases of monogenic obesity where medications have been developed to target dysfunctions in leptin/melanocortin signalling pathways but has been unsuccessful in polygenic obesity due to a lack of understanding of how the gene variants associated with body mass index affect phenotype. At present, the only factor consistently associated with longer-term efficacy of obesity pharmacotherapy is early weight loss outcome, which cannot inform choice of therapy at the time of medication initiation. The concept of matching a therapy for obesity to the characteristics of the individual is appealing but as yet unproven in randomised clinical trials. With increasing technology allowing deeper phenotyping of individuals, increased sophistication in the analysis of big data and the emergence of new treatments, it is possible that precision medicine for obesity will eventuate. For now, a personalised approach that takes into account the person's context, preferences, comorbidities and contraindications is recommended.

肥胖在全球范围内的流行率持续上升,这是由环境因素的变化所驱动的,这些因素加速了有潜在体重增加倾向的个体肥胖的发展。与肥胖相关的不良健康影响和慢性病风险增加通过减肥得到改善,大量减肥带来更大的好处。肥胖是一种异质性疾病,不同个体的驱动因素、表型和并发症有很大差异。这就提出了一个问题,即肥胖的治疗,特别是药物治疗,是否可以根据个人特征进行靶向治疗。这篇综述考察了在成年人中评估这一策略的基本原理和临床数据。肥胖药物的个性化处方在罕见的单基因肥胖病例中取得了成功,这些病例的药物已被开发用于治疗瘦素/黑素皮质素信号通路的功能障碍,但在多基因肥胖中却没有成功,因为缺乏对与体重指数相关的基因变异如何影响表型的了解。目前,唯一与肥胖药物治疗的长期疗效一致的因素是早期减肥结果,这不能在药物开始时告知治疗的选择。将肥胖治疗与个体特征相匹配的概念很有吸引力,但尚未在随机临床试验中得到证实。随着越来越多的技术允许对个体进行更深入的表型分析,大数据分析的复杂性增加,以及新治疗方法的出现,治疗肥胖的精准药物可能会出现。目前,建议采用一种个性化的方法,考虑患者的背景、偏好、合并症和禁忌症。
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引用次数: 1
Applying psycho-behavioural phenotyping in obesity characterization. 在肥胖表征中应用心理行为表型。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-06-01 DOI: 10.1007/s11154-023-09810-8
Lucía Camacho-Barcia, Ignacio Lucas, Romina Miranda-Olivos, Susana Jiménez-Murcia, Fernando Fernández-Aranda

Individual differences in obesity, beyond being explained by metabolic and medical complications, are understood by alterations in eating behaviour which underlie psychological processes. From this psychological perspective, studies have identified several potential characteristic features at the psycho-behavioural level that could additionally explain the maintenance of chronic excess weight or the unsuccessful results of current treatments. To date, despite the growing evidence, the heterogeneity of the psychological evidence associated with obesity has made it challenging to generate consensus on whether these psycho-behavioural phenotypes can be a complement to improve outcomes of existing interventions. For this reason, this narrative review is an overview focused on summarizing studies describing the psycho-behavioural phenotypes associated with obesity. Based on the literature, three psychological constructs have emerged: reward dependence, cognitive control, and mood and emotion. We discuss the clinical implications of stratifying and identifying these psycho-behavioural profiles as potential target for interventions which may ensure a better response to treatment in individuals with obesity. Our conclusions pointed out a considerable overlap between these psycho-behavioural phenotypes suggesting bidirectional interactions between them. These findings endorse the complexity of the psycho-behavioural features associated with obesity and reinforce the need to consider them in order to improve treatment outcomes.

肥胖的个体差异,除了可以用代谢和医疗并发症来解释外,还可以通过心理过程中饮食行为的改变来理解。从这个心理学角度来看,研究已经确定了心理行为层面的几个潜在特征,这些特征可以进一步解释长期超重的维持或当前治疗的失败结果。迄今为止,尽管有越来越多的证据,但与肥胖相关的心理证据的异质性使得人们很难就这些心理行为表型是否可以作为改善现有干预措施结果的补充达成共识。因此,这篇叙述性综述的重点是总结描述与肥胖相关的心理行为表型的研究。在文献的基础上,出现了三种心理结构:奖赏依赖、认知控制、情绪和情绪。我们讨论了将这些心理行为特征分层并确定为干预措施的潜在目标的临床意义,这些干预措施可以确保肥胖患者对治疗有更好的反应。我们的结论指出,这些心理行为表型之间有相当大的重叠,这表明它们之间存在双向相互作用。这些发现认可了与肥胖相关的心理行为特征的复杂性,并加强了考虑这些特征以改善治疗结果的必要性。
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引用次数: 1
Towards precision medicine in bariatric surgery prescription. 减肥手术处方中的精准医学。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-05-02 DOI: 10.1007/s11154-023-09801-9
Sofia S Pereira, Marta Guimarães, Mariana P Monteiro

Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.

肥胖是一种复杂的、多因素的慢性疾病。减肥手术是一种安全有效的治疗肥胖和肥胖相关疾病的干预措施。然而,手术后的体重减轻可能是高度异质的,并且不是完全可预测的,尤其是在干预后的长期内。在这篇综述中,我们介绍并讨论了患者相关和手术相关因素的可用数据,这些因素以前被指定为减肥手术结果的假定预测因素。此外,我们对现有证据进行了批判性评估,在建议和决定进行哪种减肥手术时,可以考虑哪些因素。一些与患者相关的特征被确定为对减肥手术后的体重减轻有潜在影响,包括年龄、性别、人体测量、肥胖合并症、饮食行为、遗传背景、循环生物标志物(微小RNA、代谢产物和激素)、心理和社会经济因素。然而,这些因素都不足以作为预测因素。总的来说,毫无疑问,在我们渴望精准医学之前,对更好地了解减肥干预后体重增加、减肥失败和体重恢复的社会生物学驱动因素的需求还没有得到满足。针对特定减肥手术干预的术前因素和有效性测量的机器学习模型,将能够更准确地识别体重增加和体重减轻的决定因素之间的因果关系。然后,可以创建用于临床实践的人工智能算法来预测对减肥手术干预的反应,这将最终推动减肥手术处方的精准医学。
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引用次数: 4
Contribution of the microbiome for better phenotyping of people living with obesity. 微生物组对肥胖患者更好表型的贡献。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-04-29 DOI: 10.1007/s11154-023-09798-1
Agostino Di Ciaula, Leonilde Bonfrate, Mohamad Khalil, Gabriella Garruti, Piero Portincasa

Obesity has reached epidemic proportion worldwide and in all ages. Available evidence points to a multifactorial pathogenesis involving gene predisposition and environmental factors. Gut microbiota plays a critical role as a major interface between external factors, i.e., diet, lifestyle, toxic chemicals, and internal mechanisms regulating energy and metabolic homeostasis, fat production and storage. A shift in microbiota composition is linked with overweight and obesity, with pathogenic mechanisms involving bacterial products and metabolites (mainly endocannabinoid-related mediators, short-chain fatty acids, bile acids, catabolites of tryptophan, lipopolysaccharides) and subsequent alterations in gut barrier, altered metabolic homeostasis, insulin resistance and chronic, low-grade inflammation. Although animal studies point to the links between an "obesogenic" microbiota and the development of different obesity phenotypes, the translational value of these results in humans is still limited by the heterogeneity among studies, the high variation of gut microbiota over time and the lack of robust longitudinal studies adequately considering inter-individual confounders. Nevertheless, available evidence underscores the existence of several genera predisposing to obesity or, conversely, to lean and metabolically health phenotype (e.g., Akkermansia muciniphila, species from genera Faecalibacterium, Alistipes, Roseburia). Further longitudinal studies using metagenomics, transcriptomics, proteomics, and metabolomics with exact characterization of confounders are needed in this field. Results must confirm that distinct genera and specific microbial-derived metabolites represent effective and precision interventions against overweight and obesity in the long-term.

肥胖在全世界和所有年龄段都已达到流行病的比例。现有证据表明,多因素发病机制涉及基因易感性和环境因素。肠道微生物群作为外部因素(即饮食、生活方式、有毒化学物质)与调节能量和代谢稳态、脂肪生产和储存的内部机制之间的主要接口发挥着关键作用。微生物群组成的变化与超重和肥胖有关,致病机制涉及细菌产物和代谢产物(主要是内源性大麻素相关介质、短链脂肪酸、胆汁酸、色氨酸分解代谢产物、脂多糖),以及随后肠道屏障的改变、代谢稳态的改变、胰岛素抵抗和慢性,低度炎症。尽管动物研究指出了“致肥胖”微生物群与不同肥胖表型发展之间的联系,但这些结果在人类中的转化价值仍然受到研究之间的异质性、肠道微生物群随时间的高度变化以及缺乏充分考虑个体间混杂因素的稳健纵向研究的限制。然而,现有证据强调,存在几个易肥胖的属,或者相反,易瘦和代谢健康表型的属(例如,Akkermansia muciniphila,Faecalibacterium属、Alistipes属和Roseburia属的物种)。该领域需要使用宏基因组学、转录组学、蛋白质组学和代谢组学对混杂因素进行进一步的纵向研究。结果必须证实,不同的属和特定的微生物衍生代谢产物代表了长期有效和精确的超重和肥胖干预措施。
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引用次数: 5
Precision nutrition in the context of bariatric surgery. 减肥手术背景下的精确营养。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-03-17 DOI: 10.1007/s11154-023-09794-5
Maite Aguas-Ayesa, Patricia Yárnoz-Esquíroz, Laura Olazarán, Javier Gómez-Ambrosi, Gema Frühbeck

Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.

减肥手术(BS)是治疗严重肥胖最有效的长期治疗方法。这篇综述总结了BS前后的主要营养缺乏,以及目前避免这些营养缺乏的饮食和补充建议。同样,我们回顾了近年来被证明与术后体重减轻及其后续维持有关的所有方面,如激素变化、饮食模式、食物偏好的变化、对建议的遵守和随访、遗传因素和微生物群等。尽管有这些知识,但BS后营养缺乏和体重恢复是经常发生的。有必要继续在这一领域进行研究,以便根据患者的个人特征制定更准确的建议。更深入地了解WL及其维持所涉及的因素的作用也是一个主要目标。这将为肥胖患者开发精确的治疗方法和营养,优化他们在BS后的益处。
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引用次数: 3
Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management. 肥胖表型与心血管风险:从病理生理学到临床管理。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-06-26 DOI: 10.1007/s11154-023-09813-5
Alberto Preda, Federico Carbone, Amedeo Tirandi, Fabrizio Montecucco, Luca Liberale

Obesity epidemic reached the dimensions of a real global health crisis with more than one billion people worldwide living with obesity. Multiple obesity-related mechanisms cause structural, functional, humoral, and hemodynamic alterations with cardiovascular (CV) deleterious effects. A correct assessment of the cardiovascular risk in people with obesity is critical for reducing mortality and preserving quality of life. The correct identification of the obesity status remains difficult as recent evidence suggest that different phenotypes of obesity exist, each one associated with different degrees of CV risk. Diagnosis of obesity cannot depend only on anthropometric parameters but should include a precise assessment of the metabolic status. Recently, the World Heart Federation and World Obesity Federation provided an action plan for management of obesity-related CV risk and mortality, stressing for the instauration of comprehensive structured programs encompassing multidisciplinary teams. In this review we aim at providing an updated summary regarding the different obesity phenotypes, their specific effects on CV risk and differences in clinical management.

肥胖流行病达到了真正的全球健康危机的程度,全世界有超过10亿人患有肥胖。多种肥胖相关机制导致结构、功能、体液和血液动力学改变,并对心血管(CV)产生有害影响。正确评估肥胖人群的心血管风险对于降低死亡率和保持生活质量至关重要。肥胖状况的正确识别仍然很困难,因为最近的证据表明,存在不同的肥胖表型,每种表型都与不同程度的CV风险有关。肥胖的诊断不能仅仅依赖于人体测量参数,而应该包括对代谢状态的精确评估。最近,世界心脏联合会和世界肥胖联合会提供了一项管理肥胖相关心血管风险和死亡率的行动计划,强调建立包括多学科团队在内的全面结构化计划。在这篇综述中,我们旨在提供关于不同肥胖表型、它们对CV风险的具体影响以及临床管理差异的最新总结。
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引用次数: 3
Precision nutrition for targeting pathophysiology of cardiometabolic phenotypes. 针对心脏代谢表型病理生理学的精确营养。
IF 8.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 Epub Date: 2023-07-05 DOI: 10.1007/s11154-023-09821-5
Christopher E Shannon, Méabh B Ní Chathail, Sinéad M Mullin, Andrew Meehan, Fiona C McGillicuddy, Helen M Roche

Obesity is a heterogenous disease accompanied by a broad spectrum of cardiometabolic risk profiles. Traditional paradigms for dietary weight management do not address biological heterogeneity between individuals and have catastrophically failed to combat the global pandemic of obesity-related diseases. Nutritional strategies that extend beyond basic weight management to instead target patient-specific pathophysiology are warranted. In this narrative review, we provide an overview of the tissue-level pathophysiological processes that drive patient heterogeneity to shape distinct cardiometabolic phenotypes in obesity. Specifically, we discuss how divergent physiology and postprandial phenotypes can reveal key metabolic defects within adipose, liver, or skeletal muscle, as well as the integrative involvement of the gut microbiome and the innate immune system. Finally, we highlight potential precision nutritional approaches to target these pathways and discuss recent translational evidence concerning the efficacy of such tailored dietary interventions for different obesity phenotypes, to optimise cardiometabolic benefits.

肥胖是一种异质性疾病,伴随着广泛的心脏代谢风险。传统的饮食体重管理模式没有解决个体之间的生物异质性问题,并且灾难性地未能应对肥胖相关疾病的全球流行。营养策略应该超越基本的体重管理,转而针对患者的特定病理生理学。在这篇叙述性综述中,我们概述了组织水平的病理生理过程,这些过程驱动患者异质性形成肥胖患者不同的心脏代谢表型。具体而言,我们讨论了不同的生理学和餐后表型如何揭示脂肪、肝脏或骨骼肌内的关键代谢缺陷,以及肠道微生物组和先天免疫系统的综合参与。最后,我们强调了针对这些途径的潜在精确营养方法,并讨论了最近关于这种针对不同肥胖表型的量身定制的饮食干预措施的有效性的转化证据,以优化心脏代谢益处。
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引用次数: 2
期刊
Reviews in Endocrine & Metabolic Disorders
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