Centre de recherche sur les soins et les services de première ligne-Université Laval, Québec, QC, Canada.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada.
Proc Nutr Soc. 2020 Feb;79(1):4-10. doi: 10.1017/S0029665119001010. Epub 2019 Jul 18.
Although the first description of a syndrome defined by the co-existence of atherogenic and diabetogenic metabolic abnormalities is debated in the literature, it was Gerald Reaven who proposed, in his landmark 1988 Banting award lecture, that a significant proportion of individuals (with diabetes or not) were characterised by insulin resistance causing prejudice to cardiovascular health. However, Reaven was influenced by seminal observations made more than 50 years earlier by Himsworth who proposed that there were two forms of diabetes (insulin resistant v. insulin sensitive). Reaven went further in proposing the theory that insulin resistance was the most prevalent cause of CVD associated with metabolic abnormalities that he named syndrome X. Because there was a syndrome X documented in cardiology, the term evolved to insulin resistance syndrome. As Reaven could also find insulin-resistant individuals in non-obese subjects, he did not include obesity as a feature of syndrome X. Imaging studies then revealed that excess adipose tissue in the abdominal cavity, a condition described as visceral obesity, was the form of overweight/obesity associated with insulin resistance and its related abnormalities. As obesity risk assessment and management remain largely based on body weight (BMI) and weight loss, it is proposed that our clinical approaches and public health messages should be revisited. First, patients should be educated about the importance of monitoring their waistline as a crude index of abdominal adiposity. Secondly, public health approaches focussing on 'lifestyle vital signs' including achieving healthy waistlines rather than healthy body weights should be developed.
尽管文献中对同时存在动脉粥样硬化和糖尿病代谢异常的综合征的首次描述存在争议，但正是杰拉尔德·雷文（Gerald Reaven）在他 1988 年的班廷奖演讲中提出，相当一部分（无论是否患有糖尿病）个体存在胰岛素抵抗，从而损害心血管健康。然而，雷文受到了 50 多年前希姆斯沃思（Himsworth）的开创性观察结果的影响，希姆斯沃思提出存在两种形式的糖尿病（胰岛素抵抗型和胰岛素敏感型）。雷文更进一步提出，胰岛素抵抗是与代谢异常相关的 CVD 的最常见原因，他将这种理论命名为综合征 X。由于心脏病学中有一个综合征 X 的记录，这个术语演变成了胰岛素抵抗综合征。由于雷文也能在非肥胖个体中发现胰岛素抵抗的个体，他并没有将肥胖作为综合征 X 的特征。影像学研究随后表明，腹腔内过多的脂肪组织，即所谓的内脏肥胖，是与胰岛素抵抗及其相关异常相关的超重/肥胖形式。由于肥胖风险评估和管理在很大程度上仍基于体重（BMI）和体重减轻，因此有人提出，我们的临床方法和公共卫生信息应该重新审视。首先，应该教育患者监测腰围的重要性，因为腰围是腹部肥胖的粗略指标。其次，应该制定以“生活方式生命体征”为重点的公共卫生方法，包括实现健康的腰围，而不是健康的体重。
