Westerterp-Plantenga Margriet S
NUTRIM, School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Lifesciences, Maastricht University, P O Box 616, 6200 MD Maastricht, Netherlands.
Physiol Behav. 2020 Jul 1;221:112879. doi: 10.1016/j.physbeh.2020.112879. Epub 2020 Mar 19.
Energy balance is a key concept in the etiology and prevalence of obesity and its co-morbidities, as well as in the development of possible treatments. If energy intake exceeds energy expenditure, a positive energy balance develops and the risk for overweight, obesity, and its co-morbidities increases. Energy balance is determined by energy homeostasis, and challenged by sensitivity to food reward, and to modulatory factors such as circadian misalignment, high altitude, environmental temperature, and physical activity. Food reward and circadian misalignment increase the risk for overweight and obesity, while high altitude, changes in environmental temperature, or physical activity modulate energy balance in different directions. Modulations by hypobaric hypoxia, lowering environmental temperature, or increasing physical activity have been hypothesized to contribute to body weight loss and management, yet no clear evidence has been shown. Dietary approach as part of a lifestyle approach for body weight management should imply reduction of energy intake including control of food reward, thereby sustaining satiety and fat free body mass, sustaining energy expenditure. Green tea catechins and capsaicin in red pepper in part meet these requirements by sustaining energy expenditure and increasing fat oxidation, while capsaicin also suppresses hunger and food intake. Protein intake of at least 0,8 g/kg body weight meets these requirements in that it, during decreased energy intake, increases food intake control including control of food reward, and counteracts adaptive thermogenesis. Prevention of overweight and obesity is underscored by dietary restraint, implying control of sensitivity to challenges to energy balance such as food reward and circadian misalignment. Treatment of overweight and obesity may be possible using a medium-high protein diet (0,8-1,2 g/kg), together with increased dietary restraint, while controlling challenges to energy balance.
能量平衡是肥胖及其合并症的病因和流行率以及可能治疗方法发展中的一个关键概念。如果能量摄入超过能量消耗，就会出现正能量平衡，超重、肥胖及其合并症的风险就会增加。能量平衡由能量稳态决定，并受到对食物奖励以及诸如昼夜节律失调、高海拔、环境温度和身体活动等调节因素的挑战。食物奖励和昼夜节律失调会增加超重和肥胖的风险，而高海拔、环境温度变化或身体活动会在不同方向调节能量平衡。有人假设，低压缺氧、降低环境温度或增加身体活动的调节作用有助于体重减轻和管理，但尚未有明确证据。作为体重管理生活方式方法一部分的饮食方法应意味着减少能量摄入，包括控制食物奖励，从而维持饱腹感和无脂肪体重，维持能量消耗。绿茶儿茶素和红辣椒中的辣椒素部分满足这些要求，它们通过维持能量消耗和增加脂肪氧化来实现，同时辣椒素还能抑制饥饿和食物摄入。至少0.8克/千克体重的蛋白质摄入量满足这些要求，因为在能量摄入减少时，它能增强对食物摄入的控制，包括对食物奖励的控制，并抵消适应性产热。饮食节制强调预防超重和肥胖，这意味着要控制对能量平衡挑战（如食物奖励和昼夜节律失调）的敏感性。使用中高蛋白饮食（0.8 - 1.2克/千克），同时增加饮食节制，控制对能量平衡的挑战，可能有助于治疗超重和肥胖。
