Cornejo-Pareja Isabel, Clemente-Postigo Mercedes, Tinahones Francisco J
Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain.
Front Endocrinol (Lausanne). 2019 Sep 19;10:626. doi: 10.3389/fendo.2019.00626. eCollection 2019.
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
根据世界卫生组织的说法，肥胖是21世纪全球最严重的流行病之一。肥胖常与多种合并症相关，威胁并损害个人健康和生活质量。减肥手术（BS）已被证明是一种有效的治疗方法，不仅能实现持续减重，还能带来显著的代谢改善，这种改善不仅仅是体重减轻。减肥手术对代谢特征的有益影响得到了广泛认可，以至于一些作者提议将减肥手术作为代谢手术，甚至对于中度肥胖患者也可以采用。然而，大多数减肥手术会导致吸收不良和/或胃酸减少，从而导致营养缺乏，因此，从长远来看可能会引发更多并发症。事实上，减肥手术不仅会影响代谢稳态，还会对除专门参与代谢功能之外的其他内分泌系统产生显著影响。生长激素轴、促肾上腺皮质激素轴和性腺轴以及骨骼健康也已被证明会受到各种减肥手术的影响。因此，在对减肥手术提出一般性建议之前，需要在大量人群中研究减肥手术在长期对代谢系统以外的其他系统产生的进一步后果和并发症，并考虑每种减肥手术的情况。在这篇综述中，总结了关于这些问题的当前数据，特别关注生长激素轴、促肾上腺皮质激素轴、性腺轴以及术后骨骼健康。
