Kunze Kyle N, Hanlon Erin C, Prachand Vivek N, Brady Matthew J
Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago Illinois;
Department of Surgery, Section of General Surgery, University of Chicago, Chicago Illinois; and Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago Illinois.
Am J Physiol Regul Integr Comp Physiol. 2016 Sep 1;311(3):R558-63. doi: 10.1152/ajpregu.00175.2016. Epub 2016 Jul 27.
Thirteen percent of the world's population suffers from obesity and 39% from being overweight, which correlates with an increase in numerous secondary metabolic complications, such as Type 2 diabetes mellitus. Bariatric surgery is the most effective treatment for severe obesity and results in significant weight loss and the amelioration of obesity-related comorbidities through changes in enteroendocrine activity, caloric intake, and alterations in gut microbiota composition. The circadian system has recently been found to be a critical regulatory component in the control of metabolism and, thus, may potentially play an important role in inappropriate weight gain. Indeed, some behaviors and lifestyle factors associated with an increased risk of obesity are also risk factors for misalignment in the circadian clock system and for the metabolic syndrome. It is thus possible that alterations in peripheral circadian clocks in metabolically relevant tissues are a contributor to the current obesity epidemic. As such, it is plausible that postsurgical alterations in central circadian alignment, as well as peripheral gene expression in metabolic tissues may represent another mechanism for the beneficial effects of bariatric surgery. Bariatric surgery may represent an opportunity to identify changes in the circadian expression of clock genes that have been altered by environmental factors, allowing for a better understanding of the mechanism of action of surgery. These studies could also reveal an overlooked target for behavioral intervention to improve metabolic outcomes following bariatric surgery.
全球13%的人口患有肥胖症，39%的人口超重，这与许多继发性代谢并发症的增加相关，如2型糖尿病。减肥手术是治疗重度肥胖最有效的方法，通过改变肠内分泌活动、热量摄入以及肠道微生物群组成，可显著减轻体重并改善肥胖相关的合并症。最近发现，昼夜节律系统是代谢控制中的关键调节成分，因此可能在体重异常增加中发挥重要作用。事实上，一些与肥胖风险增加相关的行为和生活方式因素，也是昼夜节律时钟系统失调和代谢综合征的风险因素。因此，代谢相关组织中外周昼夜节律时钟的改变可能是当前肥胖流行的一个因素。同样，减肥手术后中枢昼夜节律调整的改变以及代谢组织中外周基因表达的改变，可能代表了减肥手术产生有益效果的另一种机制。减肥手术可能是一个契机，可用于识别受环境因素改变的时钟基因昼夜节律表达变化，从而更好地理解手术的作用机制。这些研究还可能揭示一个被忽视的行为干预靶点，以改善减肥手术后的代谢结果。
