López-Jaramillo Patricio, Silva Sandra Y, Rodríguez-Salamanca Narella, Duràn Alvaro, Mosquera Walter, Castillo Victor
Grupo Vilano, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
Am J Ther. 2008 Jul-Aug;15(4):362-72. doi: 10.1097/MJT.0b013e318164bf9c.
The prevalence of cardiovascular diseases (CVD) and diabetes mellitus type 2 (DM 2) is decreasing in developed countries despite the increase in the percentage of subjects with obesity and other well-recognized cardiovascular risk factors. In contrast, the recent transition of the economic model experienced by developing countries, characterized by the adoption of a Western lifestyle, that we have named "socioeconomic pathology," has led to an increase in the burden of CVD. It has been demonstrated that conventional cardiovascular risk factors in developed and developing countries are the same. Why then does the population of developing countries currently have a higher incidence of CVD than that of developed countries if they share the same risk factors? We have proposed the existence of a higher susceptibility to the development of systemic inflammation at low levels of abdominal obesity in the population of developing countries and the consequent endothelial dysfunction, insulin resistance, DM 2, and CVD. In contrast, an important percentage of obese people living in developed countries have a healthy phenotype and low risk of developing CVD and DM 2. Human epidemiologic studies and experimental dietary interventions in animal models have provided considerable evidence to suggest that nutritional imbalance and metabolic disturbances early in life may later have a persistent effect on an adult's health that may even be transmitted to the next generations. Epigenetic changes dependent on nutrition could be key in this evolutionary health behavior, acting as a buffering system, permitting the adaptation to environmental conditions by silencing or increasing the expression of certain genes.
在发达国家，尽管肥胖及其他公认的心血管危险因素的比例有所上升，但心血管疾病（CVD）和2型糖尿病（DM 2）的患病率却在下降。相比之下，发展中国家近期经历的经济模式转变，其特点是采用西方生活方式，我们将其称为“社会经济病理”，这导致了心血管疾病负担的增加。已经证明，发达国家和发展中国家的传统心血管危险因素是相同的。那么，如果发展中国家的人群与发达国家有相同的危险因素，为什么前者目前心血管疾病的发病率却高于后者呢？我们提出，发展中国家人群在腹部肥胖程度较低时，对全身性炎症发展的易感性较高，进而导致内皮功能障碍、胰岛素抵抗、2型糖尿病和心血管疾病。相比之下，生活在发达国家的很大一部分肥胖人群具有健康的表型，患心血管疾病和2型糖尿病的风险较低。人类流行病学研究和动物模型中的实验性饮食干预提供了大量证据，表明生命早期的营养失衡和代谢紊乱可能会对成年人的健康产生持续影响，甚至可能传递给下一代。依赖营养的表观遗传变化可能是这种进化健康行为的关键，它作为一种缓冲系统，通过沉默或增加某些基因的表达来适应环境条件。
