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Beyond glycemia: Comparing tirzepatide to GLP-1 analogues. 超越血糖:比较替西肽与GLP-1类似物。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-08-01 DOI: 10.1007/s11154-023-09825-1
John Andraos, Harleen Muhar, Shawn R Smith

Glucagon-like peptide-1 receptor analogs (GLP-1 RAs) have been an innovative and instrumental drug class in the management of both type 2 diabetes and obesity. Tirzepatide is a novel agent that acts as an agonist for both GLP-1 receptors and gastric inhibitory polypeptide (GIP) receptors, another incretin that lowers glucose and appetite. Although previous studies showed a lack of therapeutic benefit for GIP agonists, current studies show that the glucose lowering and weight loss effects of tirzepatide are at least as effective as GLP-1 RAs with a similar adverse effect profile. Some studies, though not conclusive, predict that tirzepatide may in fact be more potent than GLP-1 RAs at reducing weight. A thorough review of the studies that led to tirzepatide's approval allows for comparisons between tirzepatide and GLP-1 RAs; it also allows for predictions of tirzepatide's eventual place in therapy - an agent used preferentially over GLP-1 RAs in patients with or without diabetes desiring to lose weight.

胰高血糖素样肽-1受体类似物(GLP-1 RAs)已成为治疗2型糖尿病和肥胖的创新药物。替西肽是一种新型药物,作为GLP-1受体和胃抑制多肽(GIP)受体的激动剂,GIP是另一种降低葡萄糖和食欲的肠促胰岛素。尽管先前的研究表明GIP激动剂缺乏治疗益处,但目前的研究表明,替西肽的降糖和减肥效果至少与GLP-1 RAs一样有效,副作用相似。一些研究虽然没有结论性,但预测替西肽在减肥方面实际上可能比GLP-1 RAs更有效。通过对替西肽获批的研究进行全面审查,可以比较替西肽和GLP-1 RAs;它还可以预测替西帕肽在治疗中的最终地位——对于希望减肥的糖尿病患者或非糖尿病患者,替西帕肽比GLP-1 RAs更优先使用。
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引用次数: 0
Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis. 减肥手术前后维生素D的状况和补充:基于系统综述和荟萃分析的建议。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-09-04 DOI: 10.1007/s11154-023-09831-3
Andrea Giustina, Luigi di Filippo, Antonio Facciorusso, Robert A Adler, Neil Binkley, Jens Bollerslev, Roger Bouillon, Felipe F Casanueva, Giulia Martina Cavestro, Marlene Chakhtoura, Caterina Conte, Lorenzo M Donini, Peter R Ebeling, Angelo Fassio, Stefano Frara, Claudia Gagnon, Giovanni Latella, Claudio Marcocci, Jeffrey I Mechanick, Salvatore Minisola, René Rizzoli, Ferruccio Santini, Joseph L Shaker, Christopher Sempos, Fabio Massimo Ulivieri, Jyrki K Virtanen, Nicola Napoli, Anne L Schafer, John P Bilezikian

Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.

减肥手术与术后25(OH)维生素D水平(25(OHD))的降低和骨骼并发症有关。目前,减肥患者手术前和手术后的25(OH)D评估和维生素D补充指南仍然缺乏。这项工作的目的是系统分析已发表的关于25(OH)D状态和维生素D补充的经验,手术前和手术后,并在此基础上提出管理建议。术前,对包括2869名患者在内的18项研究进行了评估。25(OH)D定义的维生素D缺乏症的患病率
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引用次数: 0
Preoperative systemic inflammatory markers as prognostic factors in differentiated thyroid cancer: a systematic review and meta-analysis. 术前全身炎症标志物作为分化型甲状腺癌症预后因素:一项系统综述和荟萃分析。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-13 DOI: 10.1007/s11154-023-09845-x
Elena Russo, Mathilda Guizzardi, Luca Canali, Francesca Gaino, Andrea Costantino, Gherardo Mazziotti, Andrea Lania, Silvia Uccella, Luca Di Tommaso, Fabio Ferreli, Luca Malvezzi, Giuseppe Spriano, Giuseppe Mercante

Background: Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid tumors. However, the role of inflammation markers in differentiated thyroid carcinoma (DTC) is still uncertain.

Objective: This meta-analysis aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with DTC.

Methods: Studies investigating the association between survival and preoperative circulating inflammatory markers in DTC patients were included. The primary outcome was disease-free survival (DFS). Cumulative logarithms of the hazard ratio (log-HRs) with 95% CI were calculated through the inverse variance method using a random-effects model.

Results: A total of 7599 patients with a mean age of 48.89 (95% CI 44.16-53.63) were included. The estimated pooled log-HRs for DFS were 0.07 for NLR (95% CI -0.12-0.26; p = 0.43), -0.58 for LMR (95% CI -1.21-0.05; p = 0.06), and 0.01 (95% CI 0-0.01; p = 0.21) for PLR.

Conclusions: Our meta-analysis showed no association between NLR, PLR, LMR and DFS in DTC; however, more prospective data are needed to better define the association between inflammatory status and prognosis of DTC.

背景:炎症与肿瘤发展有关,循环炎症生物标志物已被认为是几种实体瘤复发的可能预测因素。然而,炎症标志物在分化型甲状腺癌(DTC)中的作用仍不确定。目的:本荟萃分析旨在评估中性粒细胞与淋巴细胞之比(NLR)、淋巴细胞与单核细胞之比(LMR)和血小板与淋巴细胞之比来评估DTC患者的预后价值。方法:研究DTC患者的生存率与术前循环炎症标志物之间的关系。主要结果是无病生存率(DFS)。95%置信区间的风险比(log HR)的累积对数通过使用随机效应模型的逆方差法计算。结果:共纳入7599名患者,平均年龄48.89岁(95%CI 44.16-53.63)。对于NLR,DFS的估计合并对数HR为0.07(95%CI-0.12-0.26;p = 0.43),LMR为-0.58(95%CI-1.21-0.05;p = 0.06)和0.01(95%CI 0-0.01;p = 0.21)。结论:我们的荟萃分析显示,DTC中NLR、PLR、LMR和DFS之间没有关联;然而,需要更多的前瞻性数据来更好地定义DTC的炎症状态和预后之间的关系。
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引用次数: 0
Exploring the role of the inflammasomes on prostate cancer: Interplay with obesity. 探讨炎症小体在前列腺癌症中的作用:与肥胖的关系。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-11 DOI: 10.1007/s11154-023-09838-w
Jesús M Pérez-Gómez, Antonio J Montero-Hidalgo, Antonio C Fuentes-Fayos, André Sarmento-Cabral, Rocio Guzmán-Ruiz, María M Malagón, Aura D Herrera-Martínez, Manuel D Gahete, Raúl M Luque

Obesity is a weight-related disorder characterized by excessive adipose tissue growth and dysfunction which leads to the onset of a systemic chronic low-grade inflammatory state. Likewise, inflammation is considered a classic cancer hallmark affecting several steps of carcinogenesis and tumor progression. In this regard, novel molecular complexes termed inflammasomes have been identified which are able to react to a wide spectrum of insults, impacting several metabolic-related disorders, but their contribution to cancer biology remains unclear. In this context, prostate cancer (PCa) has a markedly inflammatory component, and patients frequently are elderly individuals who exhibit weight-related disorders, being obesity the most prevalent condition. Therefore, inflammation, and specifically, inflammasome complexes, could be crucial players in the interplay between PCa and metabolic disorders. In this review, we will: 1) discuss the potential role of each inflammasome component (sensor, molecular adaptor, and targets) in PCa pathophysiology, placing special emphasis on IL-1β/NF-kB pathway and ROS and hypoxia influence; 2) explore the association between inflammasomes and obesity, and how these molecular complexes could act as the cornerstone between the obesity and PCa; and, 3) compile current clinical trials regarding inflammasome targeting, providing some insights about their potential use in the clinical practice.

肥胖是一种与体重相关的疾病,其特征是脂肪组织过度生长和功能障碍,导致全身慢性低度炎症状态的发作。同样,炎症被认为是癌症的一个经典标志,影响致癌和肿瘤进展的几个步骤。在这方面,已鉴定出被称为炎症小体的新型分子复合物,其能够对广泛的侮辱做出反应,影响几种代谢相关疾病,但它们对癌症生物学的贡献尚不清楚。在这种情况下,癌症(PCa)具有明显的炎症成分,患者通常是老年人,他们表现出与体重相关的疾病,肥胖是最常见的疾病。因此,炎症,特别是炎症小体复合体,可能是前列腺癌和代谢紊乱之间相互作用的关键因素。在这篇综述中,我们将:1)讨论每种炎症小体成分(传感器、分子衔接子和靶标)在前列腺癌病理生理学中的潜在作用,特别强调IL-1β/NF-kB途径以及ROS和缺氧的影响;2) 探讨炎症小体与肥胖之间的关系,以及这些分子复合物如何成为肥胖和前列腺癌之间的基石;以及,3)汇编关于炎症小体靶向的当前临床试验,提供关于其在临床实践中潜在用途的一些见解。
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引用次数: 0
Hypoprolactinemia. Does it matter? Redefining the hypopituitarism and return from a mumpsimus : "Absence of proof is not the proof of absence". Hypoprolactinemia。这有关系吗?对垂体功能减退的重新定义,从一种麻木状态中回归:“没有证据并不等于没有证据”。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-25 DOI: 10.1007/s11154-023-09847-9
Zuleyha Karaca, Kursad Unluhizarci, Fahrettin Kelestimur

Prolactin (PRL) is secreted by the lactotroph cells in the anterior pituitary gland which is under inhibitory control of dopamine. The mature human PRL has more than 300 physiological actions including lactation, reproduction, homeostasis, neuroprotection, behavior, water and electrolyte balance, immunoregulation and embryonic and fetal development. PRL is involved in the growth and development of mammary gland, preparation of the breast for lactation in the postpartum period, synthesis of milk, and maintenance of milk secretion. Abnormalities in the synthesis and secretion of PRL may result in hyperprolactinemia or hypoprolactinemia. Although hyperprolactinemia has been extensively investigated in the literature, because of the subtle or unclearly defined symptoms, hypoprolactinemia is a less-known and neglected disorder. Failure of lactation is a well-known clinical manifestation of hypoprolactinemia. Recent studies reveal that hypoprolactinemia may have some effects beyond lactation such as increased risk for metabolic abnormalities including insulin resistance, abnormal lipid profile, obesity and sexual dysfunction. Very low level of PRL is suggested to be avoided in patients receiving dopamin agonist treatment to prevent unwanted effects of hypoprolactinemia. Another important point is that hypoprolactinemia is not included in the classification of hypopituitarism. Anterior pituitary failure is traditionally classified as isolated, partial and complete (panhypopituitarism) hypopituitarism regardless of prolactin level. Therefore, there are two kinds of panhypopituitarism: panhypopituitarism with normal or high PRL level and panhypopituitarism with low PRL level. In this review, we present two personal cases, discuss the diagnosis of hypoprolactinemia, hypoprolactinemia associated clinical picture and suggest to redefine the classification of hypopituitarism.

催乳素(PRL)是由垂体前叶的乳营养细胞分泌的,受多巴胺的抑制控制。成熟的人类PRL具有300多种生理作用,包括泌乳、繁殖、稳态、神经保护、行为、水和电解质平衡、免疫调节以及胚胎和胎儿发育。PRL参与乳腺的生长发育、产后哺乳的乳房准备、乳汁的合成和乳汁分泌的维持。PRL合成和分泌异常可能导致高泌乳素血症或低泌乳素血症。尽管文献中对高泌乳素血症进行了广泛的研究,但由于症状微妙或不明确,低泌乳素血症是一种鲜为人知且被忽视的疾病。泌乳失败是众所周知的低泌乳素血症的临床表现。最近的研究表明,低泌乳素血症可能在哺乳期以外产生一些影响,如代谢异常的风险增加,包括胰岛素抵抗、血脂异常、肥胖和性功能障碍。建议接受多巴胺激动剂治疗的患者避免使用极低水平的PRL,以防止低泌乳素血症的不良影响。另一个重要的观点是低泌乳素血症不包括在垂体功能减退症的分类中。垂体前叶功能衰竭传统上分为孤立性、部分性和完全性(全垂体功能减退症)垂体功能减退,与泌乳素水平无关。因此,有两种全垂体功能减退症:PRL水平正常或高的全垂体功能低下症和PRL水平低的全垂体机能减退症。在这篇综述中,我们提出了两个个人病例,讨论了低泌乳素血症的诊断,低泌乳素症相关的临床图片,并建议重新定义垂体功能减退症的分类。
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引用次数: 0
Towards precision medicine in non-alcoholic fatty liver disease. 非酒精性脂肪肝的精准医学。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-07-21 DOI: 10.1007/s11154-023-09820-6
Sven M Francque

Non-Alcoholic Fatty Liver Disease (NAFLD) refers to the accumulation of lipid laden vacuoles in hepatocytes, occurring in the context of visceral adiposity, insulin resistance and other features of the metabolic syndrome. Its more severe form (NASH, Non-Alcoholic Steatohepatitis) is becoming the leading aetiology of end-stage liver disease and hepatocellular carcinoma, and also contributes to cardiovascular disease, diabetes and extrahepatic malignancy. Management is currently limited to lifestyle modification and optimisation of the metabolic co-morbidities, with some of the drugs used for the latter also having shown some benefit for the liver. Licensed treatment modalities are currently lacking. A particular difficulty is the notorious heterogeneity of the patient population, which is poorly understood. A spectrum of disease severity associates in a non-linear way with a spectrum of severity of underlying metabolic factors. Heterogeneity of the liver in terms of mechanisms to cope with the metabolic and inflammatory stress and in terms of repair mechanisms, and a lack of knowledge hereof, further complicate the understanding of inter-individual variability. Genetic factors act as disease modifiers and potentially allow for some risk stratification, but also only explain a minor fraction of disease heterogeneity. Response to treatment shows a large variation in treatment response, again with little understanding of what is driving the absence of response in individual patients. Management can be tailored to patient's preferences in terms of diet modification, but tailoring treatment to knowledge on disease driving mechanisms in an individual patient is still in its infancy. Recent progress in analysing liver tissue as well as non-invasive tests hold, however, promise to rapidly improve our understanding of disease heterogeneity in NAFLD and provide individualised management.

非酒精性脂肪肝(NAFLD)是指肝细胞中脂质液泡的积聚,发生在内脏肥胖、胰岛素抵抗和其他代谢综合征特征的情况下。其更严重的形式(NASH,非酒精性脂肪性肝炎)正在成为终末期肝病和肝细胞癌的主要病因,也会导致心血管疾病、糖尿病和肝外恶性肿瘤。目前,管理仅限于改变生活方式和优化代谢并发症,用于代谢并发症的一些药物也显示出对肝脏的一些益处。目前缺乏获得许可的治疗方式。一个特别的困难是众所周知的患者群体的异质性,人们对此知之甚少。疾病严重程度的谱以非线性的方式与潜在代谢因素的严重程度谱相关联。肝脏在应对代谢和炎症应激的机制以及修复机制方面的异质性,以及对这方面知识的缺乏,使对个体间变异性的理解进一步复杂化。遗传因素是疾病的调节剂,可能允许一些风险分层,但也只能解释疾病异质性的一小部分。对治疗的反应显示出治疗反应的巨大差异,同样,对个别患者缺乏反应的原因知之甚少。在饮食调整方面,可以根据患者的偏好进行管理,但根据患者个体疾病驱动机制的知识进行治疗仍处于初级阶段。然而,最近在分析肝组织和非侵入性测试方面取得的进展有望迅速提高我们对NAFLD疾病异质性的理解,并提供个性化管理。
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引用次数: 2
Towards an adiposity-related disease framework for the diagnosis and management of obesities. 肥胖相关疾病的诊断和管理框架。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-05-10 DOI: 10.1007/s11154-023-09797-2
Carolina M Perdomo, Icíar Avilés-Olmos, Dror Dicker, Gema Frühbeck

Obesity is a complex disease that relapses frequently and associates with multiple complications that comprise a worldwide health priority because of its rising prevalence and association with numerous complications, including metabolic disorders, mechanic pathologies, and cancer, among others. Noteworthy, excess adiposity is accompanied by chronic inflammation, oxidative stress, insulin resistance, and subsequent organ dysfunction. This dysfunctional adipose tissue is initially stored in the visceral depot, overflowing subsequently to produce lipotoxicity in ectopic depots like liver, heart, muscle, and pancreas, among others. People living with obesity need a diagnostic approach that considers an exhaustive pathophysiology and complications assessment. Thus, it is essential to warrant a holistic diagnosis and management that guarantees an adequate health status, and quality of life. The present review summarizes the different complications associated with obesity, at the same time, we aim to fostering a novel framework that enhances a patient-centered approach to obesity management in the precision medicine era.

肥胖是一种复杂的疾病,经常复发,并伴有多种并发症,由于其发病率不断上升,并与许多并发症(包括代谢障碍、机械病理和癌症等)相关,因此成为世界卫生的重中之重。值得注意的是,过度肥胖伴随着慢性炎症、氧化应激、胰岛素抵抗和随后的器官功能障碍。这种功能失调的脂肪组织最初储存在内脏库中,随后溢出,在肝脏、心脏、肌肉和胰腺等异位库中产生脂毒性。肥胖患者需要一种全面的病理生理学和并发症评估的诊断方法。因此,必须保证全面的诊断和管理,以确保适当的健康状况和生活质量。本综述总结了与肥胖相关的不同并发症,同时,我们旨在建立一个新的框架,在精准医学时代加强以患者为中心的肥胖管理方法。
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引用次数: 3
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 Medicine 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
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 Medicine 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
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Reviews in Endocrine & Metabolic Disorders
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