Vella Adrian, Camilleri Michael
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Diabetes. 2017 Nov;66(11):2729-2737. doi: 10.2337/dbi17-0021.
Glucose tolerance after meal ingestion in vivo is the result of multiple processes that occur in parallel. Insulin secretion together with reciprocal inhibition of glucagon secretion contributes to glucose tolerance. However, other factors beyond glucose effectiveness and insulin action require consideration. The absorption of ingested nutrients and their subsequent systemic rate of appearance largely depend on the rate of delivery of nutrients to the proximal small intestine. This is determined by the integrated response of the upper gastrointestinal tract to a meal. While gastric emptying is probably the most significant component, other factors need to be considered. This review will examine all processes that could potentially alter the fraction and rate of appearance of ingested nutrients in the peripheral circulation. Several of these processes may be potential therapeutic targets for the prevention and treatment of diabetes. Indeed, there is increased interest in gastrointestinal contributions to nutritional homeostasis, as demonstrated by the advent of antidiabetes therapies that alter gastrointestinal motility, the effect of bariatric surgery on diabetes remission, and the potential of the intestinal microbiome as a modulator of human metabolism. The overall goal of this review is to examine current knowledge of the gastrointestinal contributions to metabolic control.
体内餐后葡萄糖耐量是多个并行过程的结果。胰岛素分泌以及胰高血糖素分泌的相互抑制有助于葡萄糖耐量。然而，除了葡萄糖有效性和胰岛素作用之外，其他因素也需要考虑。摄入营养物质的吸收及其随后的全身出现率在很大程度上取决于营养物质向近端小肠的输送速度。这由上消化道对一餐的综合反应决定。虽然胃排空可能是最重要的组成部分，但其他因素也需要考虑。本综述将研究所有可能改变摄入营养物质在外周循环中的比例和出现率的过程。其中一些过程可能是预防和治疗糖尿病的潜在治疗靶点。事实上，人们对胃肠道对营养稳态的贡献越来越感兴趣，这体现在改变胃肠动力的抗糖尿病疗法的出现、减肥手术对糖尿病缓解的影响以及肠道微生物群作为人类新陈代谢调节剂的潜力上。本综述的总体目标是研究胃肠道对代谢控制贡献的现有知识。
