Martos-Moreno Gabriel Á, Barrios Vicente, Muñoz-Calvo María T, Pozo Jesús, Chowen Julie A, Argente Jesús
Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain.
Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
Adv Nutr. 2014 May 14;5(3):299S-305S. doi: 10.3945/an.113.004853. Print 2014 May.
Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even more common in pediatric endocrinology. As might be predicted, the prevalence of obesity-associated comorbidities is also increasing in children and adolescents. It is widely accepted that this increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the current lifestyle in Western countries. However, there is increasing evidence indicating that an individual's genetic background is important in determining obesity risk. The physiologic mechanisms controlling appetite and energy expenditure are being revealed in part because of the identification of new causes of human monogenic, syndromic, and endocrine-related obesity. Thus, it is no longer appropriate to talk about obesity, but rather about "obesities" or "different diseases causing obesity," because their pathophysiologic bases differ. Moreover, these obesities require different diagnostic and management approaches. The pediatrician must be aware of this issue and focus the clinical history and physical examination toward specific clinical signs and symptoms to better exploit the available diagnostic and therapeutic resources when facing a child with obesity. Genetic, genomic, and metabolomic studies are often necessary to obtain a more appropriate diagnosis. Cognitive behavioral therapy is fundamental in obese children. The identification of potential targets will hopefully result in new pharmacologic approaches for translational and personalized medicine for obesity in the near future.
肥胖症是目前西方国家最普遍的儿童慢性疾病。它是普通儿科最常见的就诊原因之一，在儿科内分泌科更为常见。可以预见，肥胖相关合并症在儿童和青少年中的患病率也在上升。人们普遍认为，肥胖症的增加是由于能量摄入与消耗失衡所致，正能量平衡的增加与西方国家目前的生活方式密切相关。然而，越来越多的证据表明，个体的遗传背景在决定肥胖风险方面很重要。由于发现了人类单基因、综合征性和内分泌相关肥胖的新病因，控制食欲和能量消耗的生理机制正在逐步被揭示。因此，现在谈论肥胖症已不再合适，而应谈论“多种肥胖症”或“导致肥胖的不同疾病”，因为它们的病理生理基础不同。此外，这些肥胖症需要不同的诊断和管理方法。儿科医生必须意识到这个问题，并将临床病史和体格检查聚焦于特定的临床体征和症状，以便在面对肥胖儿童时更好地利用现有的诊断和治疗资源。通常需要进行基因、基因组和代谢组学研究才能做出更准确的诊断。认知行为疗法对肥胖儿童至关重要。对潜在靶点的识别有望在不久的将来为肥胖症的转化医学和个性化医疗带来新的药物治疗方法。
