Farias Gisele, Netto Bárbara Dal Molin, Bettini Solange Cravo, Dâmaso Ana Raimunda, de Freitas Alexandre Coutinho Teixeira
1 Department of Surgery, Universidade Federal do Paraná, UFPR, Curitiba-Pr, Brazil.
2 Universidade Federal de São Paulo, UNIFESP-EPM, São Paulo-SP, Brazil.
Nutr Health. 2017 Sep;23(3):131-146. doi: 10.1177/0260106017719369. Epub 2017 Aug 24.
Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger-satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure.
This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries.
According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.
肥胖是一个严重的公共卫生问题，主要发生在食物摄入量超过能量消耗时。因此，能量平衡取决于饥饿 - 饱腹感机制的调节，这涉及中枢神经系统与来自脂肪组织、胰腺和胃肠道的外周信号的相互联系，在短期食物摄入和长期能量平衡方面产生反应。体内脂肪增加会改变肠道和脂肪组织衍生的激素信号，这会促进食欲调节激素的改变，降低饱腹感并增加饥饿感。随着传统减肥干预措施（饮食治疗、运动、药物和生活方式改变）的失败，减肥手术成为治疗重度肥胖的广泛接受的工具，可实现长期持续减重。减肥手术可能由于胃肠道解剖结构改变导致营养物质限制/吸收不良从而减少能量摄入而导致体重减轻，也可能是由于与手术效果更好相关的其他生理因素。
本综述讨论能量平衡的神经内分泌调节，描述肥胖中能量平衡控制所涉及的主要激素和肽以及所有目前可用的减肥手术。
根据我们综述的结果，减肥手术不仅通过减少卡路里摄入，还通过引发食欲控制、饱腹感和饱足感的变化以及肠道、神经和脂肪组织衍生激素信号的生理变化来促进有效且持续的体重减轻。
