O'Dea K
Department of Human Nutrition, Deakin University, Geelong, Vic.
Med J Aust. 1991 Aug 19;155(4):258-64. doi: 10.5694/j.1326-5377.1991.tb142236.x.
To examine the published data on the impact of westernisation on obesity, non-insulin dependent diabetes mellitus (NIDDM), and coronary heart disease (CHD) in Australian Aborigines.
Fifty-five articles from Australian and international sources (primarily peer-reviewed journals) are cited.
Twenty-eight reports providing data on the diet, lifestyle, health and "lifestyle diseases" of Australian Aborigines before and after westernisation are included in this review. A further 27 articles on obesity, NIDDM, CHD, insulin resistance, and the impact of diet and exercise were used to help interpret the Aboriginal data.
Information on dietary composition, anthropometry, disease and risk factor prevalence, and relevant biochemical measurements were used for comparative and interpretive purposes.
The traditional hunter-gatherer lifestyle of Australian Aborigines, characterised by high physical activity and a diet of low energy density (low fat, high fibre), promoted the maintenance of a very lean body weight and minimised insulin resistance. In contrast, for most Aborigines a Western lifestyle is characterised by reduced physical activity and an energy-dense diet (high in refined carbohydrate and fat) which promotes obesity and maximises insulin resistance. When they make the transition from their traditional hunter-gatherer lifestyle to a westernised lifestyle, Aborigines develop high prevalence rates for obesity (with an android pattern of fat distribution), non-insulin dependent diabetes, impaired glucose tolerance, hypertriglyceridaemia, hypertension and hyperinsulinaemia. The striking improvements in carbohydrate and lipid metabolism in diabetic and non-diabetic Aborigines after a temporary reversion to a traditional hunter-gatherer lifestyle highlight the potentially reversible nature of the detrimental effects of lifestyle change, particularly in young people who have not yet developed diabetes.
It is suggested that insulin resistance was important to the survival of Aborigines as hunter-gatherers, but is also the underlying metabolic characteristic predisposing them to obesity, NIDDM and CHD after westernisation. Intervention strategies to prevent chronic diseases related to insulin resistance should be directed at lifestyle modification. To be effective such programmes will have to be developed and implemented at the community level.
研究已发表的数据，以探讨西方化对澳大利亚原住民肥胖、非胰岛素依赖型糖尿病（NIDDM）和冠心病（CHD）的影响。
引用了来自澳大利亚和国际来源（主要是同行评审期刊）的55篇文章。
本综述纳入了28份报告，这些报告提供了澳大利亚原住民在西方化前后的饮食、生活方式、健康状况及“生活方式疾病”的数据。另外27篇关于肥胖、NIDDM、CHD、胰岛素抵抗以及饮食与运动影响的文章用于辅助解读原住民数据。
饮食组成、人体测量学、疾病及风险因素患病率以及相关生化测量方面的信息用于比较和解读。
澳大利亚原住民传统的狩猎采集生活方式，其特点是身体活动量大且饮食能量密度低（低脂肪、高纤维），有助于维持极低的体重并使胰岛素抵抗降至最低。相比之下，对大多数原住民而言，西方生活方式的特点是身体活动减少且饮食能量密度高（精制碳水化合物和脂肪含量高），这会导致肥胖并使胰岛素抵抗最大化。当原住民从传统的狩猎采集生活方式转变为西方化生活方式时，他们肥胖（脂肪分布呈男性型）、非胰岛素依赖型糖尿病、糖耐量受损、高甘油三酯血症、高血压和高胰岛素血症的患病率会升高。糖尿病和非糖尿病原住民在暂时恢复到传统狩猎采集生活方式后，碳水化合物和脂质代谢有显著改善，这突出了生活方式改变的有害影响具有潜在可逆性，尤其是在尚未患糖尿病的年轻人中。
有人认为，胰岛素抵抗对作为狩猎采集者的原住民的生存很重要，但也是他们在西方化后易患肥胖、NIDDM和CHD的潜在代谢特征。预防与胰岛素抵抗相关的慢性病的干预策略应针对生活方式的改变。要想有效，此类项目必须在社区层面制定和实施。
