Lutz Thomas A, Bueter Marco
Institute of Veterinary Physiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland; Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Institute of Laboratory Animal Science, University of Zurich, Zurich, Switzerland; and
Center of Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
Am J Physiol Regul Integr Comp Physiol. 2014 Dec 1;307(11):R1275-91. doi: 10.1152/ajpregu.00185.2014. Epub 2014 Sep 24.
Obesity and its related comorbidities can be detrimental for the affected individual and challenge public health systems worldwide. Currently, the only available treatment options leading to clinically significant and maintained body weight loss and reduction in obesity-related morbidity and mortality are based on surgical interventions. This review will focus on two main clinical effects of Roux-en-Y gastric bypass (RYGB), namely body weight loss and change in eating behavior. Animal experiments designed to understand the underlying physiological mechanisms of these post-gastric bypass effects will be discussed. Where appropriate, reference will also be made to vertical sleeve gastrectomy. While caloric malabsorption and mechanical restriction seem not to be major factors in this respect, alterations in gut hormone levels are invariably found after RYGB. However, their causal role in RYGB effects on eating and body weight has recently been challenged. Other potential factors contributing to the RYGB effects include increased bile acid concentrations and an altered composition of gut microbiota. RYGB is further associated with remarkable changes in preference for different dietary components, such as a decrease in the preference for high fat or sugar. It needs to be noted, however, that in many cases, the question about the necessity of these alterations for the success of bariatric surgery procedures remains unanswered.
肥胖及其相关合并症会对患者个体造成损害，并给全球公共卫生系统带来挑战。目前，唯一能实现临床上显著且持续的体重减轻以及降低肥胖相关发病率和死亡率的可用治疗方案是基于手术干预。本综述将聚焦于Roux-en-Y胃旁路术（RYGB）的两个主要临床效果，即体重减轻和饮食行为改变。将讨论旨在了解这些胃旁路术后效果潜在生理机制的动物实验。在适当情况下，也会提及垂直袖状胃切除术。虽然在这方面热量吸收不良和机械性限制似乎并非主要因素，但RYGB术后肠道激素水平总会发生改变。然而，它们在RYGB对饮食和体重影响中的因果作用最近受到了质疑。导致RYGB效果的其他潜在因素包括胆汁酸浓度升高和肠道微生物群组成改变。RYGB还与对不同饮食成分的偏好发生显著变化有关，例如对高脂肪或高糖食物的偏好降低。然而，需要注意的是，在许多情况下，关于这些改变对减肥手术成功的必要性问题仍未得到解答。
