Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA.
Curr Opin Endocrinol Diabetes Obes. 2018 Feb;25(1):55-60. doi: 10.1097/MED.0000000000000381.
Although childhood obesity has leveled off in the last decade, 'severe obesity' continues to be on the rise. Various genetic, environmental and hormonal factors contribute to obesity. This article reviews the most current understanding of obesity's multifactorial origin and recent recommendations for its management in childhood and adolescence.
Epigenetics plays a key role in transmitting obesity risk to offspring. Single-nucleotide polymorphisms at genetic loci for adipokines and their receptors are associated with obesity. Gut microbiota is an important regulator of weight status, and Bifidobacterium species improves metabolic status. The incidence of comorbidities including prediabetes and type 2 diabetes has increased. Novel biomarkers such as alpha-hydroxybutyrate and branched-chain amino acids correlate with insulin sensitivity and predict glycemic control in adolescents. Lifestyle modifications and pharmacotherapy can produce small BMI changes. Bariatric surgery induces substantial weight loss and remission of comorbidities.
Alterations in genetics, epigenetics and microbiota influence childhood obesity. Lifestyle modification remains the mainstay of management and pharmacotherapy with Food and Drug Administration approved medications is recommended only for patients resistant to lifestyle changes and for comorbidities. Bariatric surgery produces sustained weight loss and cardiovascular benefits and is an effective option for adolescents with severe obesity.
尽管在过去十年中儿童肥胖率趋于平稳，但“重度肥胖”仍在不断上升。各种遗传、环境和激素因素都促成了肥胖。本文综述了肥胖多因素起源的最新认识，以及近期针对儿童和青少年肥胖的管理建议。
表观遗传学在将肥胖风险传递给后代方面起着关键作用。脂肪因子及其受体的遗传位点的单核苷酸多态性与肥胖有关。肠道微生物群是体重状况的重要调节剂，双歧杆菌可改善代谢状况。包括前驱糖尿病和 2 型糖尿病在内的合并症的发病率有所增加。新型生物标志物，如α-羟基丁酸和支链氨基酸，与胰岛素敏感性相关，并可预测青少年的血糖控制情况。生活方式的改变和药物治疗可以使 BMI 略有变化。减重手术可显著减轻体重并缓解合并症。
遗传学、表观遗传学和微生物群的改变影响儿童肥胖。生活方式的改变仍然是治疗的主要方法，只有对于对生活方式改变有抵抗且存在合并症的患者，才建议使用美国食品和药物管理局批准的药物进行药物治疗。减重手术可持久减轻体重并带来心血管获益，是严重肥胖青少年的有效选择。
