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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 Medicine 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
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
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 Medicine 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
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 Medicine 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
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 Medicine 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 Medicine 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
How to address weight regain after bariatric surgery in an individualized way. 如何以个性化的方式解决减肥手术后的体重恢复问题。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-05-12 DOI: 10.1007/s11154-023-09806-4
Ricardo V Cohen, Tarissa Bz Petry

Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.

减肥手术是治疗肥胖最有效的方法。作为一种慢性和进行性疾病,对手术的减肥反应会因个体而异。因此,手术后可能会出现体重减轻或恢复不足的情况,但缺乏标准的定义。体重回升和/或体重减轻不足有不同的机制,如遗传、不适应的饮食行为和指数操作选择不当等。体重恢复或体重减轻不足的患者应接受多学科团队的个性化综合评估。这可能有助于识别原因并指导单独的适当治疗。减肥手术后体重减轻和/或体重恢复不足的患者的选择包括术后并发症的修复、转为另一种手术、结果不一致的内镜治疗以及饮食/行为咨询。翻修和改建手术的并发症发生率高于初次手术。尽管没有针对该适应症的标准药理学方案,但这些新药物似乎有效且安全地促进了体重恢复的减轻,甚至在选定的患者达到稳定期之前对其具有辅助作用。这篇综述旨在总结体重恢复/体重减轻不足患者的最佳方法,并提出一种算法来定制减肥手术后的方法和治疗方案。
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引用次数: 1
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 Medicine 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
Genetics and epigenetics in the obesity phenotyping scenario. 肥胖表型场景中的遗传学和表观遗传学。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-04-10 DOI: 10.1007/s11154-023-09804-6
Khanh Trang, Struan F A Grant

Obesity is a common complex trait that elevates the risk for various diseases, including type 2 diabetes and cardiovascular disease. A combination of environmental and genetic factors influences the pathogenesis of obesity. Advances in genomic technologies have driven the identification of multiple genetic loci associated with this disease, ranging from studying severe onset cases to investigating common multifactorial polygenic forms. Additionally, findings from epigenetic analyses of modifications to the genome that do not involve changes to the underlying DNA sequence have emerged as key signatures in the development of obesity. Such modifications can mediate the effects of environmental factors, including diet and lifestyle, on gene expression and clinical presentation. This review outlines what is known about the genetic and epigenetic contributors to obesity susceptibility, along with the albeit limited therapeutic options currently available. Furthermore, we delineate the potential mechanisms of actions through which epigenetic changes can mediate environmental influences and the related opportunities they present for future interventions in the management of obesity.

肥胖是一种常见的复杂特征,会增加患各种疾病的风险,包括2型糖尿病和心血管疾病。环境和遗传因素的结合影响肥胖的发病机制。基因组技术的进步推动了与该疾病相关的多个遗传基因座的鉴定,从研究重症病例到研究常见的多因素多基因形式。此外,对不涉及潜在DNA序列变化的基因组修饰的表观遗传学分析结果已成为肥胖发展的关键标志。这种修饰可以介导包括饮食和生活方式在内的环境因素对基因表达和临床表现的影响。这篇综述概述了已知的肥胖易感性的遗传和表观遗传学因素,以及目前可用的治疗选择,尽管有限。此外,我们描述了表观遗传学变化介导环境影响的潜在作用机制,以及它们为未来肥胖管理干预提供的相关机会。
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引用次数: 1
Advancing precision public health for obesity in children. 促进儿童肥胖的精准公共卫生。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-04-14 DOI: 10.1007/s11154-023-09802-8
Jennifer L Baker, Lise G Bjerregaard

Worldwide, far too many children and adolescents are living with the disease of obesity. Despite decades of public health initiatives, rates are still rising in many countries. This raises the question of whether precision public health may be a more successful approach to preventing obesity in youth. In this review, the objective was to review the literature on precision public health in the context of childhood obesity prevention and to discuss how precision public health may advance the field of childhood obesity prevention. As precision public health is a concept that is still evolving and not fully identifiable in the literature, a lack of published studies precluded a formal review. Therefore, the approach of using a broad interpretation of precision public health was used and recent advances in childhood obesity research in the areas of surveillance and risk factor identification as well as intervention, evaluation and implementation using selected studies were summarized. Encouragingly, big data from a multitude of designed and organic sources are being used in new and innovative ways to provide more granular surveillance and risk factor identification in obesity in children. Challenges were identified in terms of data access, completeness, and integration, ensuring inclusion of all members of society, ethics, and translation to policy. As precision public health advances, it may yield novel insights that can contribute to strong policies acting in concert that ultimately lead to the prevention of obesity in children.

在世界范围内,有太多的儿童和青少年患有肥胖症。尽管采取了几十年的公共卫生举措,但许多国家的发病率仍在上升。这就提出了一个问题,即精准的公共卫生是否是预防青少年肥胖的一种更成功的方法。在这篇综述中,目的是回顾儿童肥胖预防背景下的精确公共卫生文献,并讨论精确公共卫生如何推进儿童肥胖预防领域。由于精准公共卫生是一个仍在发展的概念,在文献中无法完全识别,因此由于缺乏已发表的研究,无法进行正式审查。因此,使用了对精确公共卫生进行广泛解释的方法,并总结了儿童肥胖研究在监测和风险因素识别以及使用选定研究进行干预、评估和实施方面的最新进展。令人鼓舞的是,来自多种设计和有机来源的大数据正以新的创新方式使用,以提供更精细的儿童肥胖监测和风险因素识别。确定了数据访问、完整性和整合方面的挑战,确保社会所有成员的参与、道德规范和政策转化。随着精准公共卫生的发展,它可能会产生新的见解,有助于制定强有力的政策,最终预防儿童肥胖。
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引用次数: 1
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Reviews in Endocrine & Metabolic Disorders
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