Department of Emergency and Organ Transplants, Unit of Endocrinology, University of Bari Medical School, Bari, Italy.
Hospital of Bisceglie, ASL BAT, Italy.
Ann Hepatol. 2017 Nov;16(Suppl. 1: s3-105.):s68-s82. doi: 10.5604/01.3001.0010.5499.
Obesity is rapidly increasing and has reached epidemic features worldwide. It´s linked to insulin resistance, systemic low-grade inflammation and common pathogenic pathways with a number of comorbidities (including cancer), leading to high mortality rates. Besides change of lifestyles (diet and physical exercise) and pharmacological therapy, bariatric surgery is able to rapidly improve several metabolic and morphologic features associated with excessive fat storage, and currently represents an in vivo model to study the pathogenic mechanisms underlying obesity and obesity-related complications. Studies on obese subjects undergoing bariatric surgery find that the effects of surgery are not simply secondary to gastric mechanical restriction and malabsorption which induce body weight loss. In fact, some surgical procedures positively modify key pathways involving the intestine, bile acids, receptor signaling, gut microbiota, hormones and thermogenesis, leading to systemic metabolic changes. Furthermore, bariatric surgery represents a suitable model to evaluate the gene-environment interaction and some epigenetic mechanisms linking obesity and insulin resistance to metabolic diseases.
肥胖症在全球范围内迅速蔓延，已呈现流行趋势。它与胰岛素抵抗、全身低度炎症以及多种合并症（包括癌症）的共同发病机制有关，导致高死亡率。除了生活方式的改变（饮食和体育锻炼）和药物治疗外，减重手术还能够迅速改善与过度脂肪储存相关的多种代谢和形态特征，目前是研究肥胖症及其相关并发症发病机制的体内模型。对接受减重手术的肥胖症患者的研究发现，手术的效果不仅仅是继发于胃机械限制和吸收不良导致的体重减轻。事实上，一些手术程序积极地改变了涉及肠道、胆汁酸、受体信号、肠道微生物群、激素和生热的关键途径，导致全身代谢变化。此外，减重手术是评估肥胖症和胰岛素抵抗与代谢性疾病相关的基因-环境相互作用和一些表观遗传机制的合适模型。
