Kopp Wolfgang
Diagnostikzentrum Graz, Graz, 8043, Austria.
Diabetes Metab Syndr Obes. 2020 Nov 27;13:4631-4642. doi: 10.2147/DMSO.S280146. eCollection 2020.
Obesity has reached epidemic proportions and is one of the greatest challenges for public health in the twenty-first century. The macronutrient composition of diets, in particular the amount and ratio of carbohydrates, fat and protein, have received considerable attention in recent decades due to its potential relevance to the development of obesity and weight loss. The effects of various macronutrients on body weight regulation are still under debate. High-carbohydrate diets, and particularly high-fat diets, have been blamed for the increase in the prevalence of obesity. This paper shows that neither fat nor carbohydrates are fattening per se. Mixed diets with substantial amounts of fat and high-glycemic carbohydrates, like current WDs, are required to promote weight gain and obesity. High-glycemic carbohydrates are the active partner (the "driver"), which promotes fat storage through its insulinogenic effect, while fat is the passive partner (the "passenger") on the way to obesity. Elevated insulin levels (postprandial, but more importantly due to hypersecretion and hyperinsulinemia) promote fat storage and play a key role in obesogenesis and the obesity epidemic. Furthermore, mixed diets high in high-glycemic carbohydrates and fat promote fetal programming, with long-term adverse impacts on the offspring, including insulin hypersecretion, (childhood) obesity and metabolic diseases. Maternal obesity and high weight gain during pregnancy have also been linked to deleterious effects on fetal programming. As the global obesity epidemic increasingly affects women of reproductive age, a significant percentage of fetuses will experience fetal programming with a tendency towards obesity - a self-reinforcing process that further fuels the epidemic. A change in lifestyle and diet composition is needed to prevent or limit the development of obesity and related diseases.
肥胖已达到流行程度,是21世纪公共卫生面临的最大挑战之一。近几十年来,饮食中的宏量营养素组成,特别是碳水化合物、脂肪和蛋白质的含量及比例,因其与肥胖发展和体重减轻的潜在相关性而备受关注。各种宏量营养素对体重调节的影响仍存在争议。高碳水化合物饮食,尤其是高脂肪饮食,被认为是肥胖患病率上升的原因。本文表明,脂肪和碳水化合物本身都不会导致肥胖。需要像当前西方饮食那样含有大量脂肪和高血糖碳水化合物的混合饮食来促进体重增加和肥胖。高血糖碳水化合物是活跃的一方(“驱动者”),它通过其促胰岛素作用促进脂肪储存,而脂肪则是肥胖过程中的被动一方(“乘客”)。胰岛素水平升高(餐后,但更重要的是由于分泌过多和高胰岛素血症)会促进脂肪储存,并在肥胖发生和肥胖流行中起关键作用。此外,富含高血糖碳水化合物和脂肪的混合饮食会促进胎儿编程,对后代产生长期不良影响,包括胰岛素分泌过多(儿童期)肥胖和代谢疾病。孕期母亲肥胖和体重过度增加也与对胎儿编程的有害影响有关。随着全球肥胖流行日益影响育龄妇女,相当比例的胎儿将经历倾向于肥胖的胎儿编程——这是一个自我强化的过程,进一步加剧了肥胖流行。需要改变生活方式和饮食组成来预防或限制肥胖及相关疾病的发展。