Sims E A
Endocrinology, Diabetes, and Metabolism Unit, Department of Medicine, College of Medicine, University of Vermont, Burlington VT, USA.
Metabolism. 2001 Dec;50(12):1499-504. doi: 10.1053/meta.2001.27213.
The aim of this article was to review the evidence for a metabolically normal subset of the obese and its implications for clinical and research work. The methods included literature review and correspondence with authors. Since 1947, when Vague described a relation between distribution of body fat and the risk factors for cardiovascular disease, much evidence has suggested that early onset of the obesity, hyperplasia of normal adipocytes, and normal quantities of visceral abdominal fat may be associated with a favorable metabolic response in obese subjects. Analyses in 1973 by Keyes and later by Reuben Andres in 1980 suggested that obesity for some was not a risk factor and might even be an asset. Recently, in the study by Bonora et al of the relation between insulin resistance and the 4 main disorders of the metabolic syndrome in the Bruneck epidemiologic study, a subgroup of obese individuals with a normal metabolic response was evident. In a current study by Brochu et al of an obese metabolically normal subgroup of postmenopausal women, visceral abdominal fat estimated by computed tomography (CT) scan and age of onset were significant variables. The obese, metabolically normal subgroup (OBMN) must be taken into consideration in both clinical and research work. Persons with OBMN and their parents may be wrongly blamed because of the obesity. Attempts at weight loss may be counterproductive. The criteria for selection of obese research subjects may favor inclusion of an OBMN subset, which may invalidate statistical analysis. Findings suggesting the OBMN subset include family members with uncomplicated obesity, early onset of the obesity, fasting plasma insulin within normal range, and normal distribution of the excess fat. Hormonal, genetic studies, and prospective studies will help to clarify the significance and underlying mechanisms of this subset.
本文旨在综述肥胖人群中代谢正常亚组的相关证据及其对临床和研究工作的影响。研究方法包括文献综述以及与作者的通信。自1947年Vague描述身体脂肪分布与心血管疾病危险因素之间的关系以来，大量证据表明肥胖的早发、正常脂肪细胞的增生以及正常量的腹部内脏脂肪可能与肥胖受试者良好的代谢反应相关。1973年Keyes以及后来1980年Reuben Andres的分析表明，对某些人来说肥胖并非危险因素，甚至可能是一种优势。最近，在布伦内克流行病学研究中，Bonora等人对胰岛素抵抗与代谢综合征4种主要病症之间关系的研究发现，有一个代谢反应正常的肥胖个体亚组很明显。在Brochu等人目前对绝经后女性肥胖且代谢正常亚组的研究中，通过计算机断层扫描（CT）测量的腹部内脏脂肪以及发病年龄是显著变量。在临床和研究工作中都必须考虑肥胖且代谢正常的亚组（OBMN）。患有OBMN的人和他们的父母可能会因为肥胖而被错误指责。减肥尝试可能会适得其反。肥胖研究对象的选择标准可能有利于纳入OBMN亚组，这可能会使统计分析无效。提示存在OBMN亚组的发现包括肥胖情况不复杂的家庭成员、肥胖早发、空腹血浆胰岛素在正常范围内以及多余脂肪分布正常。激素、遗传学研究以及前瞻性研究将有助于阐明该亚组的意义和潜在机制。
