Richelsen B
Arhus Amtssygehus, medicinsk-endokrinologisk afdeling III.
Ugeskr Laeger. 1991 Mar 25;153(13):908-13.
This review concentrates on recent prospective studies concerning evaluation of the health risk of obesity with special reference to the impact of the distribution of the adipose tissue. Analysis of the data indicates that adipose tissue localized to the abdominal region (especially intraabdominal fat) is associated with an enhanced risk profile including elevated levels of triglycerides and insulin, low levels of high density lipoprotein-cholesterol and elevated blood pressure. Abdominal obesity, determined by the waist/hip ratio, was associated with cardiovascular disease, premature death and non-insulin demanding diabetes mellitus. On the other hand, the total fat mass (measured as body mass index) was positively associated only with non-insulin demanding diabetes mellitus. The androgen/estrogen activity seems to be an important factor for determining the topographical localization of the adipose tissue. The great amount of free fatty acids which may be released from the abdominal fat tissue seemed to be of great pathogenetic importance for the metabolic consequences of abdominal obesity. In conclusion, obesity and the abdominal localization of adipose tissue seem to be two separate entities with different pathogenesis and clinical consequences. The abdominal obesity is the type which is predominantly associated with enhanced health risks. These associations may result in an altered strategy of treatment of the obese population.
本综述着重关注近期有关肥胖健康风险评估的前瞻性研究，特别提及脂肪组织分布的影响。数据分析表明，腹部区域（尤其是腹内脂肪）的脂肪组织与风险增加相关，包括甘油三酯和胰岛素水平升高、高密度脂蛋白胆固醇水平降低以及血压升高。通过腰臀比确定的腹型肥胖与心血管疾病、过早死亡和非胰岛素依赖型糖尿病相关。另一方面，总脂肪量（以体重指数衡量）仅与非胰岛素依赖型糖尿病呈正相关。雄激素/雌激素活性似乎是决定脂肪组织局部定位的一个重要因素。腹部脂肪组织可能释放的大量游离脂肪酸似乎对腹型肥胖的代谢后果具有重要的致病意义。总之，肥胖和脂肪组织的腹部定位似乎是两个具有不同发病机制和临床后果的独立实体。腹型肥胖是主要与健康风险增加相关的类型。这些关联可能导致肥胖人群治疗策略的改变。
